Boomers aging “longer and better” ? Not so fast, not so good, and tell me your zip code

One of the key issues in approaching any data regarding average life expectancy (ALE) in the United States and the interpretation of that one number – the magic number we hear about – and hope that “it” keeps” increasing is being cautious and specific about exactly WHO benefits from the gains, and WHY, and WHERE.  Furthermore, when the gains in ALE takes place over a period of time – what is the gain?  Look at the figure below – it shows the life expectancy for U.S. residents at age 65, by sex and race, from 1999 through 2006.

And? Well, take a closer look. The data show gradual increases in the number of years from 2000 to 2006 for whites, blacks, men, and women, with the increases ranging from 0.7 years for white women to 1.1 years for black women; life expectancy at age 65 years increased by 0.9 year for the overall U.S. population. The gain over six years was “upward” but I am always amazed by the number of people who assume we are adding (or increasing) 5-10 years to ALE per decade – but that is not the case. I can almost sense the heavy disappointment in many aging baby boomers: “Wait, let me get this straight – ALE at 65 increased by o.9 ? Whooopeeddedo – big frickin deal. That’s it? In six years? – Yeah, but if that is the case, then by the time I hit 75, then….oh, I see…..”

Upward in gains – yes. But like a rocket and overnight express change in ALE ? – No.

QuickStats: Life Expectancy at Age 65 Years, by Sex and Race — United States, 2000–2006*

And then there is other dimension of living longer – Is is any better? Again, it depends. But do not think that the boomers are leading some sort of humongus transformation in quality of life issues into the aging years. Instead of some big paradigm shift in health and functioning, maybe it is more realistic to say there is an incremental and progressive (slow and sure) transition, but again nothing to put up on your Facebook page and shout to the world. 

+ HEALTH STATUS

Health and Functioning Among Baby Boomers Approaching 60 

The Journals of Gerontology Series B: Psychological Sciences and Social Sciences 2009 64B(3):369-377; doi:10.1093/geronb/gbn040

Linda G. Martin¹, Vicki A. Freedman², Robert F. Schoeni³ andPatricia M. Andreski³

Objective: To investigate whether the health and functioning of the Baby Boom generation are better or worse than those of previous cohorts in middle age.

Methods: Trend analysis of vital statistics and self-reports from the National Health Interview Survey for the 40–59 population. Specific outcomes (years of data): mortality (1982–2004); poor or fair health (1982–2006); nine conditions (1997–2006); physical functional limitations (1997–2006); and needing help with personal care, routine needs, or either (1997–2006).

Results: In 2005, the mortality rate of 59-year-olds, the leading edge of the Baby Boom, was 31% lower than that of 59-year-olds in 1982 (8.3 vs. 12.1 per 1,000). There was a similar proportional decline in poor/fair health, but the decline reversed in the last decade. From 1997 to 2006, the prevalence of reports of four conditions increased significantly, but this trend may reflect improvements in diagnosis and treatment. Functional limitations and need for help with routine needs were stable, but the need for help with personal care, while quite low, increase

Discussion: Trends varied by indicator, period, and age. It is surprising that, given the socioeconomic, medical, and public health advantages of Baby Boomers throughout their lives, they are not doing considerably better on all counts.

And finally, I hate to say  this, but I will: Tell me WHERE you live (your zip code, area code, etc. etc) and then I will tell you some more about how ALE will vary and how geography is (may- quite possibly be) destiny.

+ WHERE (Geography)

Although the average life span in the US continues to rise, gaps in life expectancy have changed little from 1982 to 2001. There is a wide gulf — as much as 33 years — between those who enjoy the best health and those who are most likely to suffer from illnesses, according to a new study published in PLoS Medicine. Researchers at Harvard University’s Initiative for Global Health and its School of Public Health divided the US into eight “Americas” based on factors including race, location, population density, income and homicide rates:

Asians, 10.4 million popuulation, $21,566 average income, life expectancy 84.9 years;
Northland low-income rural whites, 3.6 million population, $17,758 average income, life expectancy 79 years;
Middle Americans, 214 million population, $24,640 average income, life expectancy 77.9 years;
Low-income whites in Appalachia and Mississippi, 16.6 million population, $16,390 average income, life expectancy 75 years;
Western Native American, 1 million, $10,029 average income, life expectancy 72.7 years;
Black middle America, 23.4 million population, $15,412 average income, life expectancy 72.9 years;
Southern, rural, low-income black, 5.8 million population, $10,463 average income, life expectancy 71.2 years; and
High-risk urban black, 7.5 million population, $14,800 average income, life expectancy 71.1 years.

The primary cause of the disparities between racial and geographic groups is early death from chronic disease and injuries, an analysis of data from the Census Bureau and the National Center for Health Statistics showed.

Asian-American women living in Bergen County, NJ, enjoy the greatest life expectancy in the US, at 91 years. American Indians in South Dakota have the worst, at 58 years.

The differences were attributed to a combination of injuries and such preventable risk factors as smoking, alcohol, obesity, high blood pressure, elevated cholesterol, diet and physical inactivity — particularly among people from 15 years to 59 years of age. They were not due to income, insurance, infant mortality, AIDS or violence, said the study’s lead investigator, Christopher J.L. Murray, director of the Harvard Initiative for Global Health.

Bottom line: We have a long way to go in the domain of quality-of-life for aging Americans – and any time you hear or read about the ONE NUMBER – life expectancy in the US is………………..”_____”, you will say, Yes, however, it depends on……

thanks, Scott D. Wright

The Rise of Supercentenarians: Kairos, Not Chronos

The Rise of Supercentenarians: Kairos, Not Chronos

Altogether the interval is small between birth and death…look to the immensity of time behind thee, and to the time which is before thee, another boundless space. In this infinity then what is the difference between him who lives three days and him who lives three generations? 
Marcus Aurelius (175 AD)

By definition, you live with longevity for a very long time.
Aubrey de Grey (2005 AD)

Longevity is not a zero-sum game.
Michael Kinsley (2008 AD)

On November 26, 2008, Edna Scott Parker died in Shelbyville, Indiana.

And on that day many more people had ceased to exist on the same day due to various “causes of death.” And the next day – and the next. We see the daily reminders in the obituaries, in the headlines of newspapers, and across the multitude of web sites. And once again, we are reminded of what Dante (and T.S. Eliot) had alluded to with their chilling lines, “I had not thought death had undone so many.” Death is the great reminder about our fate and as the inevitable outcome of living. But Edna Scott Parker – as one of the many – was also someone special. She was the longest living person…alive…on the planet – as of November 26, 2008. She had lived a remarkable 115 years and 220 days. And now (as of this posting on Dec. 13, 2008) the record (verified) belongs to Maria de Jesus dos Santos (born September 10, 1893).

The rise of the supercentenarians has also run parallel with the increase in interest and in publications of “living longer” and as a result, written works on aging are no longer the exclusive province of scientific journals and massive academic tomes as the sheer number of books found on the shelves of both national chain and local bookstores that address the physical, social, and psychological dimensions of life in the long lane. Whether it is about Blue Zones, or about medical tourism, or retirement “hot spots,” both scientists and lay people alike still appear to be in search of the Holy Grail and the fountain of youth – and hopefully both at the same site.

Where to begin to understand our obsession with living longer? Where did the path begin? And where is the wisdom for our aging experience and for our time regardless if life be measured in three days or three generations? (See the epigram of Marcus Aurelius at the beginning of this article).

We could begin with mythological characters, The Three Fates, who have their respective appointed duties to perform where life is woven by Clotho, measured by Lachesis and Atropos cuts the thread of life. Given our contemporary situation, it appears that Lachesis is in need of having her job description upgraded. Or we could begin with one of the plays of Sophocles, Oedipus at Colonus.Or move forward the writings of Marcus Aurelius in his “Meditations” where one will find an interesting array of insights about the processes of aging embedded in a philosophical stance of Stoicism.  In Meditations is the sense of proportion to life regardless of years alive or time spent and it offers solace to those who question the significance of less or more time in life.

We could also find historical nuggets in Tim Parkin’s book, Old Age in the Roman World: A Cultural and Social History or Moog and Schäfer’s article, “Joannes Stobaios, ‘On Old Age’: An Important Source for the History of Gerontology” which also examines Cicero’s well-known text “On Old Age” (Cato maior de senectute) as well.

Leap frogging ahead in time, there was the curious 1921 publication by Sanford Bennett Dodd, Old Age: Its Cause and Prevention which appears to be a provocative precursor to the Jack LaLanne school for living well into the later years. Dodd, who at the age of fifty, claimed to have physically completely broken down but then “reversed” his aging process through a regimen of exercise and diet, which matched the fabled miracle of Faust by changing an old body into a new one. It relates to another story of reversing aging by Mircea Eliade, Youth Without Youth, ^recently made into a movie by Francis Ford Coppola (see my other blog posting on this topic).

But back to senescence in the other direction. There was G. Stanley Hall’s (1922) Senescence: The Last Half of Life and another book, titled Old Age: The Major Involution: The Physiology and Pathology of the Aging Process (1930).

Or we could consult Carl Jung’s (1933) wonderful chapter, “The Stages of Life” in Modern Man In Search of Soul. Moving forward along the path, we could also seek guidance in Ageing, the Biology of Senescence by Alex Comfort (1964) or the deeper reflections of Simon de Beauvoir, (1972) in her book, The Coming of Age Old Age.

We could then move onward to the book, Aging and Mental Health: Positive Psychosocial Approaches (1973) by Robert N. Butler and Myrna I. Lewis, and marvel at cover of that book where the great Russian novelist Leo Tolsoi is pictured telling stories to his grandchildren. We could explore the textured dimensions of aging captured in The Psychology of Adult Development and Aging (1973) edited by Carl Eisdorfer and M. Powell Lawton and then continue on to rediscover the vade mecum of aging (and Pulitzer Prize winning book) by Robert Butler, Why Survive? Being Old in America (1975).

 In the following year, A Good Age by Alex Comfort (1976).  Then into the 1980s with the edited book by Alan Pifer and Lydia Bronte (1986), Our Aging Society: Paradox and Promise that was a gold mine of collected writings capturing both the benefits and challenges of an increasing life expectancy. Then into the 1990s with a flurry of distinct publications such as Thomas R. Cole’s 1992, The Journey of Life: A Cultural History of Aging in America. Another lighthouse beacon along the way was The New Aging: Politics and Change in America (1992) by Fernando Torres-Gil. Traveling along the chronological grey line again to Betty Friedan’s (1993) The Fountain of Age who offered a revolutionary interpretation of based on her personal aging experiences and with other’s insights from gerontological research to engage in some effective myth busting. And then along the journey again with Leonard Hayflick’s (1994) How and Why We Age who wisely suggested that many ethical dilemmas would have to be addressed before engaging in lofty scientific goals and tampering with the clocks that govern aging. The hourglass as half empty was further advanced with Jean Amery’s (1994) unbearable-heaviness-of-being publication, On Aging: Revolt and Resignation, who summarized it all thusly: “aging is an incurable sickness.”

And the pendulum would swing back to the unending colorful birthday balloons of Gail Sheehy’s (1995) New Passages: Mapping Your Life Across Time. Then there was the force field of integration economics combined with the findings of cognitive psychology and evolutionary biology of Richard Posner’s, Aging and Old Age. The decade closed with a book by Theodore Roszak (1998)“America the Wise: the Longevity Revolution and the True Wealth of Nations” and then later expanded and revised to be published again in 2001 under the title of Longevity Revolution: As Boomers Become Elders.

But wait five minutes and the weather changes to overcast skies with Peter G. Peterson’s (1999) Gray Dawn: How the Coming Age Wave Will Transform America and the World.  But it is springtime again with the optimistic Age Power: How the 21st Century Will Be Ruled by the New Old (1999) by Ken Dychtwald.  And then there is the buzz-kill-but-needed-pragmatics of The Quest for Immortality: Science at the Frontiers of Aging (2001) by S. Jay Olshansky and Bruce Carnes. Then to the various levels of exploration on longevity into the 21^st century such as landmark research of George Vaillant and captured in his book, Aging Well: Surprising Guideposts to a Happier Life and Longevity: The Biology and Demography of Life Span by J. R. Carey. The cognitive and psychological perspectives of Positive Aging (2005) by Robert D. Hill and then Aging: The Paradox of Life by Robin Holliday (2007). Then outward to the macro-level with Challenges of an Aging Society: Ethical Dilemmas, Political Issues edited by Rachel A. Pruchno and Michael A. Smyer (2007).

As we draw near to much needed rest area on our journey, we can learn from a medical doctors sage advice with Sherwin B. Nuland’s (2007) The Art of Aging: A Doctor’s Prescription for Well-being or learn about the never-ending story, Ending Aging:  The Rejuvenation Breakthroughs That Could Reverse Human Aging in Our Lifetime by Aubrey de Grey and Michael Rae (2007) (and see my blog posting on 2008 Aging Book of the Year Awards). We could review the most up-to-date theoretical perspectives on human longevity with The Biology of Human Longevity: Inflammation, Nutrition, and Aging in the Evolution of the Life Spans by Caleb Finch (2007) or take in the complete vista at the overlook, a four-volume set, titled appropriately enough, Ageing, compiled by Susan A. McDaniel. And we can top it all of with Robert Butler’s (2008), The Longevity Revolution (who offers an interesting term of “shortgevity”).

But I wonder if all the attention to longevity has eclipsed the focus on how to live better with the years that we have – or hope for. While the thread of life may keep getting longer for most of us, what do all of the threads mean? Do they all come together to create something significant – or meaningful? I think Michael Kinsley has come close to examining my concern via a recent issue of The New Yorker. There he considered that the extending of life expectancy (“Mine is Longer than Yours”) and the resulting (and looming?) promise of increased longevity is fast becoming the last big sweepstakes (not counting the escaping of death itself) for the largest generation in history. Kinsley quipped that life offers several rounds to go through and there are many who are successful in midlife but were losers in the high school years. But the last chapter of life (the third round) may be bonanza or disaster as well, but yet while some people may win both rounds, or even all three, all of us will cross that “invisible line at some point.”

And if we all get to look forward to a longer life, there are some who worry that we are not seeing the bad news in the “careful what you wish for” side of the coin.  For example, Charles Mann wrote a provocative piece in the The Atlantic, “The Coming Death Shortage”, whose view is that increased longevity is akin to a cruel joke with blowback and negative consequences for subsequent generations, thus the subtitle, “Why the longevity boom will make us sorry to be alive.” The message in Mann’s article helps to keep us honest in our candy-coated dreams in the era of longevity. Between the pendulum swinging from doom and gloom to prosperity and fulfillment with aging baby boomers, I do hope there is also the middle path.

It’s not so much that we should modify the Hippocratic aphorism of “Ars longa, vita brevis” to “Ars longa, vita longa” rather; we should focus less on calibrating the chronos, and try more to cultivate the kairos.

Where is the discussion of the quality of life in the increasing number of years of life?

To be continued…for a long time.

Iconoclastically yours, 

Scott D. Wright