Here’s the executive summary: Most disease and health spending is age-related. As we age we get infirmities ranging from dementia to cancer to vascular disease. Nothing can prevent aging. Period. For millennia mankind has been been on a futile search to prevent aging.
Search for the Elusive Elixir of Life
For 3500 or more years mankind has been searching for the mythological Elixir of Life, the fountain of youth, the philosophers stone, pool of nectar, etc, that will defeat aging and extend life, if not achieve immortality.
According to Wiki, “The elixir of life, also known as the elixir of immortality and sometimes equated with the philosopher’s stone, is a mythical potion that, when drunk from a certain cup at a certain time, supposedly grants the drinker eternal life and/or eternal youth.”
All around the globe from 400 BCE alchemists, from India to China to Europe, were seeking the elixir of life. Many thought gold was an essential ingredient of such an elixir.
The Fountain of Youth, also known as the water of life, was part of the search for the elixir of life. That search was in full throttle during the crusades, and was carried to the New World by Spanish explorers, the most famous of whom was Ponce De Leon in the 1500’s. Even the Mayans had legends about waters of eternal youth.
The search for the elixir of life didn’t end there.
In the 19th century in the US many believed that bathing in special springs had healing powers. During that era people flocked to Eureka Springs, Hot Springs, Healing Springs, and many many more. So called healing spas are still very popular today.
“Snake oil” salesmen were peddling various cure-alls and panaceas into the 20th century. A search on the internet will reveal a large number of “promising” balms and salves, some of which actually worked for minor scrapes and burns.
If you’re over 60 or so you may recall Carters Little Liver Pills. It was advertised to treat biliousness and other ailments. The FTC made them drop the word liver from the name. Carters Little Pills are still sold but as a laxative.
If you watched the Lawrence Welk show, you saw ads for Serutan, which is “natures” spelled backwards. It’s a “vegetable hydrogel”.
Today the search for an elixir of life, by various names, is still in high gear and salesmen for that notion are abundant today.
People today are still pursuing the same version of living longer and healthier lives by pursuing a mix of vitamins, supplements, wellness, incentives, education, exams, tests, etc., that will push the time of their death out a few years.
But, alas, the human body and its organs simply wear out over time. No insurance plan, wellness plan, patient education program, or prevention combination, can defeat the inevitable. As we age our bodies just wear out. For example, the reason brain aneurysms and strokes occur in the elderly is that blood vessels get thinner and more fragile with age. The same applies to other vascular diseases. Joint diseases are common as we age. Why? Joints just wear out over time. Dementia is usually related to aging. The list goes on and on.
According to NIH data all cancer rates begin to skyrocket at about age 65. That is partially the effect of age-related diminishing immune systems. Our immune systems wear out as we age.
Companies are paying huge dollars to elixir of life promoters today when all the facts show it just doesn’t work as advertised. Such companies’ intentions are good, even noble, but doomed to fail. Lesson: whatever you want and seek, someone will find away to sell it to you.
We are all going to have a mortal illness someday unless we die sooner from something else like an auto accident. My grandfather died at age 99. Every organ in his body was failing. His kidneys were failing, as was his vascular system, his brain, and his liver, etc. Why? He simply outlived his body. I’ve known a number of good people who in the end died a miserable terrible death after years in nursing homes. I wouldn’t wish that on my worst enemy.
Another factor driving up costs in the US has been the creation of the emergency phone number system of dialing 911 and having a life-saving trained team show up at your door in few minutes. The dial 911 system saves live no doubt, but there have been unintended health cost consequences too. If one survives a heart attack the average cost is about $250k. Because of the 911 phone system some 80 year olds are surviving three heart attacks in 9 months just to die from the fourth one, adding $750k to their last 12 months. Now they are even putting ventricular assist devices to keep people like that alive for one more day at a cost of $900k.
I’m not making a comment on the morality of deferring and elderly person’s death for 9 months at a cost of $750k to $2M. But we need to have an adult conversation in American about how we are going to pay for all this. By any measurement Medicare and Social Security are both totally unsustainable unless huge changes are made that will impact everyone. Beware of proposed changes that promote intergenerational rivalries.
This chart shows death rates by age (source WIKI). When people hit about age 50 the death and sickness rates begin to skyrocket.
This chart shows leading causes of death (source WIKI). See the strong correlation to aging and heart disease. People are simply outliving their hearts and blood vessels. In 1900 people rarely died of heart disease because they didn’t live long enough to develop chronic conditions. Most of the chronic diseases we worry about are simply a consequence of aging. They are irreversible. Like the Hydra of Greek mythology, if you defeat one chronic condition, three others will pop up in its place.
The third chart shows health spending by age (source Incidental Economist), again correlating disease to aging. That will always be that way until someone comes up with a way to prevent aging or finds an “elixir of life”. That chart also illustrates the massive wasteful spending on end-of-life care in the US compared to peer countries.
People in born in the US today can expect to die along a bell curve centering on age 80. If we all do everything we can possibly do to be healthier for all of our lives there will be slightly fewer deaths around ages 78 or 79. (A great source of information on This topic is Nortin Hadler’s The Last Well Person: How to Stay Well Despite the Health-Care System available on Amazon.)
In any case if you are able to add a year to your life it will be added to the end of your life. For most people that will mean another year in a nursing home, in assisted living, or as an invalid at home. (For a Washington Post article on just how nasty nursing homes can be click here. Again, I would not wish that on my worst enemy.) People sometimes tell me about someone who was more or less healthy and independent at age 90. For every person like that there are a hundred in nursing homes or dementia units.
Most people retiring today don’t have enough in savings to support themselves for more than a few years, let alone enough to pay for assisted living and/or nursing homes when they are elderly and frail. Medicaid nursing home budgets are likewise unsustainable. Don’t count on that. For many people living a year or two longer will simply mean being a burden to your children for another year or two, both financially and emotionally.
What about your children’s lives? Do you really want them to have to look after you well into their 60’s. At that age they should be concentrating on their own welfare.
As people age into their 80’s and 90’s, many become demanding in an irrational way. Some people age 55 and up are relieved when their elderly parents pass away, but often with feelings of guilt. Most people have witnessed this in their own families.
Someday researchers may discover a way to delay the effects of aging. Personally I believe such is the province of science fiction. If that ever happens, God help us. That would be very destructive to mankind.
Imagine our world populated by a billion or more centenarians. Imagine a nation with an average age of 65. Imagine yourself at age 90 with a 120 year old parent or two. Who will look after whom? Will 70 year old children or their 45 year old children be able to look after and support such parents, grandparents, and great grandparents? The news from Asia is that many young people are no longer willing to support their centenarian parents or grandparents today, let alone great-grandparents.
What should we all do then? Simple. Spend less time wringing your hands over which illness will get you in the end, rather make the most of the time you have. Worry will never add a day to your life.
The Romans had a blessing: May you live well and die suddenly.
This post is thought-provoking, esp for me as a geriatrician.
Recently I was looking over a journal article about using citalopram for agitation in dementia patients. There is a precaution: at higher doses it can cause long QT syndrome! Which might cause sudden cardiac arrest!
So many people have told me they’d like a sudden stop, as John’s mother experienced. (Although I think most prefer for it to happen while in bed.) I found myself wondering if dementia patients or their families would object to a higher risk of fatal cardiac arrhythmia.
I don’t think we should be casual about drugs or treatments that increase the risk of mortality. But we rarely discuss what kind of death people would prefer. Unless people are on hospice, we don’t generally decide to stop trying to prevent a certain type of death.
Thank you for your wise comment.
Of the resource advantaged countries, the US and Japan stand out for ill-preparedness for 21st century demographics. The vast majority of the population of the resource-advantaged world can now expect to enjoy an 80th birthday largely intact and can also expect to die of something (“all-cause mortality”) not long after. In Japan, this represents a unique cohort effect; it is only the post-World War 2 birth cohort for whom such a prediction pertains. Japan is caught with overwhelming cultural and financial demands without an infrastructure in place. The US has no such excuse. We’ve been incrementally responding, ignoring and profiting from the plight of successively longer-living birth cohorts throughout the 20th century. The result is a highly inefficient, in every sense, patchwork that is another reproach to the social construction of health in our nation. Occasionally, one finds a “NORC”, a naturally occurring retirement community that integrates the challenges of the elderly, the aged, and even the frail into the continuity of the life of the community. NORCs are much easier to find in Europe, and even in West Sumatra, than in the US. In America, we have a tendency to sideline, even warehouse our elderly till we are they and wont to complain. We have more than a tendency, we make the warehousing another profit center, from the meanest of LTC facilities to the exclusivity of the gated retirement communities. I discuss this as one of the themes in Rethinking Aging http://uncpress.unc.edu/books/T-9195.html but we need to discuss it openly and widely. We all need to learn that “healthcare” requires innovative input from city planners and benefit managers as much as from geriatricians and social workers. Otherwise, our grandchildren will be echoing our plaints. As for waiting for molecular biologists to tie up our fraying telomeres, don’t hold your breath.
Thanks for your comment, Nortin. Much of what I’ve learned about this topic came from your books all of which I highly recommend, esp. Rethinking Aging.
Nortin, you are picturing a vision. Draw it out for us in more detail. Are you saying that you like the NORC idea? How would this get funded? Even if families and friends work for free, and live in a communal arrangement, it still costs a lot for supplies. We just finished the death watches in several family members. It costs about 4-13k per month to take care of people at home or in board and care facilities. There is no way to do this more efficiently or cheaper. If you give people morphine because of pain or to ease their struggle for breathing, you depress their respiratory center and they begin to not clear airways. These obstruct, and distal pneumonia always occurs and death in a few days. So hospice and nursing homes kill people sooner than best-care natural-demise finish lines would dictate. I really think folks are doing their best with this puzzle-mess-dilemma and that there simply is no good solution. I guess I am cynical because we just saw a healthy non-demented WWII-vet-family-friend die too soon at 96 because hospice gave him morphine (inspired because we think everyone was running out of money.) Anyway, dying will be optional in a few dozens of years. Our science is getting too close to great answers.
I have a “vision” that borrows from the notion of a NORC, which are rare in the US but not so rare elsewhere. I am a student of the here and the elsewhere. As is true of our entire health care system, reform and tweaking will get us nowhere. We need novel thinking and alternative approaches. Let me put on my geriatrician hat (I was certified by that Board, too, and have long contributed to that literature.) You can’t simply fund new NORCs, they must grow out of a common need with communitarian ethic. Furthermore, they must find a find footing in the community where there already is a patchwork of agencies and programs that are largely failing or we wouldn’t be having this conversation. And if that wasn’t daunting enough, they must define a common good as a moral high ground and not as a regulatory gantlet (the only industry more regulated than LTC facilities is the nuclear industry) or as another incursion into the “free market” (https://thehealthcareblog.com/blog/2016/01/30/there-is-nothing-free-about-the-health-care-market/ ).
As is true for any dialectic to gain traction, there need be open discussion. All must appreciate where are society is heading: What’s worth preserving and what needs replacing? Do we want to spend our sunsets in regulated institutional warehouses marking time that is punctuated with futile visits to acute care facilities? Do we really want to remove ourselves from the communities we nurtured and enter into homogeneous artifacts hiding behind gates?
That’s when we hear of the communities that are providing group living experiences at all stages of the march toward frailty. We need to learn how to train individuals who are capable of facilitating the interactions between within these residences and between these residents and the broader community in which they remain participants. All of us who are able, from the young to the able old, can find the time to offer caring once doing so becomes part of the quality of life for all. This doesn’t require much money, a fraction of the lucre expended in the operation of our reproachful political system.
So much for vision.
Thanks for your thoughtful reply, Nortin. I would love to see one of these. I really believe we don’t need to be so lugubrious about this end of life stuff. We are in a strange and primitive era of healthcare which is going to pass. Mankind does well on technical problems and aging and death are just chemistry…we’ve only had a hundred years or so to be working on this. How short a time this is!
Get a recent text on molecular biology and you will see many clues re prolonging life. “Molecular Biology of the Cell” by Alberts is good. Our cells are just machines and some already show immortality that we don’t appreciate. E.g. germ cells that are used in procreation have shown continuous life for several hundred thousand years, since the dawn of first man. Cancer cells can be grown in tissue culture forever. Read about telomerase and about NADH and caloric restriction. Death is a technical problem. You are going to be quite correct for a few more decades and then people will chuckle over this post by c.e. 2100. I wish there was a futures market that would take this bet.
My mom was a food writer. This is how she died.
One day she got on a bus and went into Manhattan to see a highly respected cardiologist. The cardiologist, a family friend who has looked after our family for twenty years, gave her a clean bill of health and sent her home.
My mom got back on the bus. Rode back to her house. She made herself dinner and drank half a glass of wine. And then fell dead as a stone in her kitchen of a heart attack.
The cardiologist called me a few days later, sounding worried.
He cheered up noticeably when I told him I wasn’t going to be suing anybody.
My mom was 83 years old and in declining health. She faced an uncertain future.
Her husband had died a decade earlier after a terrible illness that dragged out for years. When I think of all of the scenarios that could have played out, I am profoundly grateful.
My mom lived well. She died suddenly, in a place she loved, surrounded by her cookbooks.
Could I have found an attorney willing to take the case?
An up and comer who would have argued convincingly that an incompetent cardiologist had deprived my mom of another six months – or a year, or five years – of life by missing a symptom or a some tale sign. I think could have. Could my cardiologist’s attorney have shown conclusively that he did not miss something? I don’t think so.
Did I consider it?
Not for a second.
Good for you John. I hope to die like your mother, just after I enjoy a good meal with a good glass of wine. What better way to go?
Excellent post. I finished up 15 years of next-of-kin/caregiver duty in 2011 (starting in 1996, my now-late daughter, then both parents, who spent their final years in extended expensive LTC). Now I turn 70 next week, and just had my own unhappy turn in the barrel last year (lengthy RadOnco prostate cancer tx). My doc says “you’ve got another 20 years.” Given what I witnessed with my parents, I have to wonder what the latter 10 of the 20 will hold for me. And whether I will want to bother.
Bobby, I’ve had the exact same thoughts having seen three grandparents suffer miserably after years in nursing homes. They should put a sign over the door of such places that reads “abandon hope all ye who enter here.”
The modern welfare state has robbed old people of their savings through inflation, and has provided them with unlimited resources to prolong their lives, a gift that is unsustainable for everyone. This is worse than a Faustian bargain!
Good point Michel. I agree.
“The modern welfare state has robbed old people of their savings through inflation…”
And zero interest rates to subsidize a dishonest stock market.
If only I could run out of air and money at the same time.
“… Ponce De Leon in the 1500’s.”
Yeah, that didn’t turn out so well. A poison arrow to the leg took him out.
Like the executive summary of death
For the busy executive who missed the memo …