Open Writing

Among my friends and acquaintances who are in their seventies, probably the three greatest concerns are the possibility of having to deal with Alzheimer’s Disease, long-term care when they are no longer able to care for themselves, and outliving their financial resources. Of the three, longevity is an eventuality that healthy people are faced with routinely for the first time in mankind’s history.

The cliché one hears more and more now is that today’s seventy year olds are yesterday’s sixty year olds. Whereas living to be ninety or more was at one time remarkable, centenarians now are almost commonplace. In my wife’s family alone, one woman lived to be over one hundred, and the other just months short of a century. In both cases their children cared for them at an age when they themselves would have been receiving care in the past.

In the year 1900, a white person in America had a life expectancy of 47.6 years. In 2005, that figure was 78.3, according to the US Department of health and Human Services, and is even higher in the UK. The explanation for this trend is better pre and postnatal care, better nutrition and health care, and a less physically demanding lifestyle. Improved conditions in the work place also contribute to a longer life for many people.

Though living longer may seem attractive superficially, the reality is generally less desirable. While much knowledge has been gained about what it takes to prolong life, little progress has been made into methods for sustaining physical and mental viability through those extended, final years.

Tissues lose elasticity, muscles atrophy even in active people, and the brain loses some of its facility in varying degrees depending on the individual. Even with drug therapy, bones become brittle, and the immobilization that often results from a fracture can lead to pulmonary infections such as pneumonia that result in death.

Of all late life problems, Alzheimer’s Disease has to be the most feared, and can even occur in middle age. Not only does it affect the sufferer, but also the entire family, especially those who are responsible for daily care of the patient. Ironically, many Alzheimer’s patients live long lives, exhausting and outliving their caregivers.

Nursing homes are available when the families of the afflicted are no longer able to care for them, but the best they can offer is containment, since there is, as yet, no cure. Only three drugs—tacrine (Cognex), donepezil hydrochloride (Aricept), and rivastigmine (Exelon) have been approved by the US Federal Drug Administration for its treatment. Tacrine has been shown to be effective for improving memory skills, but only in patients with mild-to-moderate Alzheimer’s, and even then only in less than half of those who take it.

Though there are many programs to research a cure through drug therapies, the great hope is pinned on stem cell research and genetic engineering, but a successful outcome is probably years away. If ever there was a case for assisted suicide, surely Alzheimer patients are deserving candidates.

People of my generation entered the work force in the 1950’s. Many sought employment with major corporations and had the hope and intention of remaining with the same company until they retired. The main attraction was the benefits, including contributory or non-contributory pension programs. Some companies also offered profit sharing or stock options.

The provision of such benefits was designed to enhance employee retention, predicated on consistent, future business growth, and it was very successful in that regard. But in subsequent years, when western economies faltered, companies saw retention as a liability in times when they wished to reduce their work force. Benefit programs were gradually eroded, albeit while continuing to provide for those employees who had been in the program prior to the changes. At the same time, employees no longer clung to the expectation of staying with the same employer for all of their working life.

Many of my contemporaries were complacent, believing that they had escaped the worst of the benefit erosion, and thought that their lifestyles were secure until they died. If they had a concern, it was merely that increases in the cost of living might require a little belt tightening over time. I don’t think any of us conceived in our wildest dreams that increased longevity, or disastrous events such as the recent collapse of world economies, would impact our security to the extent they have.

Changes in the way we, as a society, deal with the concerns of the aged are undoubtedly necessary as the elderly population burgeons over the next decades. Governments are already facing huge deficits in their budgets for pensions and health care. There’s money a-plenty available; only the priorities need to be changed. Is it too ridiculous to suggest that it’s time to curb our enthusiasm for preemptive wars and trips to Mars, and redeploy the funds to make late life less fearsome?

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