As has happened with many other things that have caught my attention, the more I explore the information about aging well, the more unexpected and expansive the dimensions of the subject become. An article in The Atlantic magazine, What Happens When We All Live to 100[i], brought to the fore a whole new reason for living well as long as possible. Where I had thought of it primarily in terms of our individual well-being, with some thought given as well to minimizing the inconvenience for our families, writer Gregg Easterbrook makes the case for taking care of ourselves to be an important social responsibility. As he points out, “Since 1840, life expectancy at birth has risen about three months with each passing year.” That’s a pretty amazing statistic. It’s not hard to see that, if that trend continues, it may well be that before long, people will commonly live to be a hundred years old. Easterbrook points out that if an increasing age span “…simply leads to more years in which pensioners are disabled and demand expensive services, health-care costs may balloon as never before, while other social needs go unmet.” The happier prospect that he considers, however, is that with medical advances and wiser personal choices to increase not only the span of life but also the span of health, most of us will be “…living longer in good vigor, and also working longer, keeping pension and health-care subsidies under control.”
This line of thought brought to mind an aspect of my training as a firefighter with Volunteer Company 8A in Pa`auilo, Hawai`i. A number of Hawai`i Fire Department trainers have reviewed for our Company the fundamental priorities in the task of fighting fires. Number one: the preservation of life. And every trainer has emphasized that this applies, first and foremost, to the firefighter’s responsibility to keep him or herself alive and safe. This is not simply a matter of self-preservation: it is an essential component of maximizing the effective deployment of the resources assigned to an emergency. A firefighter who gets into trouble is not only unable to contribute to the stabilization of the incident (the second priority), but diverts personnel and focus away from the original emergency by adding another complication to it.
Similarly, as we enter into dependent circumstances in the course of aging, we have the effect of altering the activities of family, friends and agencies who serve as caretakers. Their efforts to provide the support and care of aging dependents occupies some portion of their time and energy, complicating the resolution of their other, also important, concerns. Though increasingly depending on others is nearly inevitable as the end of life approaches, it seems like a great idea to delay its occurrence and minimize its duration. Given that many aspects of “normal” aging are affected by our choices – for better or worse – we need to think carefully about what we can do to live well as long as possible – such as our activity levels, our nutritional choices, our engagement with others, and how to infuse our lives with meaning and purpose.
I’ve been talking with the staff at the North Hawaii Education and Research Center about the value of getting out the word about aging well; their non-credit course coordinator, Ramona Herlihy, spoke of her interest in the subject and mentioned a book relevant to it, The Conversation.[ii] After reading it I also found it valuable and worth a strong recommendation. The “conversation” referred to in the title is, ideally, a series of considerations and discussions about what one prefers to do and have in place as the end of life approaches. Dr. Volandes uses examples from his clinical experience to illustrate the importance of having thought seriously about and communicating to those who will be with us at the time, our preferences for end-of-life treatment among what he terms Life Prolonging Care (“…a full code, full-court press, where the main goal of medical care was to prolong life with any medical intervention available regardless of whether the success rate was slim or the intervention caused great suffering.”), Limited Medical Care (which does not “…include overly invasive treatments (no CPR and breathing machines) nor was it entirely focused on comfort-oriented measures. The goal was maintaining basic functions like walking, talking, eating, seeing, hearing and thinking”) and Comfort Care (“…making sure a patient was not in pain and the priority was to remain outside of the hospital, ideally at home, with appropriate hospice care”).
Dr. Volandes has put great effort into presenting these options on videos with all possible unbiased clarity so that individuals considering them can understand them and choose the approach they prefer without being nudged one way or the other. This kind of preparation is of great help to all as they seek to be responsible, helpful and supportive at the end of a life in which they play a part. There’s a lot more to the book and I encourage you to find out – among other things – which choice, statistically, tends most to extend life.
My conversations with the North Hawaii Education and Research Center have led to a collaboration to present a series of four 90 minute Saturday morning classes beginning on October 17.
If you have comments, or questions for me to address, use the comment section of this blog.
Copyright Hugh R. Montgomery, PhD, 2015
[ii] Angelo E. Volandes, M.D. The Conversation: A Revolutionary Plan for End-of-Life Care. Bloomsbury, 2015.