A friend recently quoted a saying from Albert Schweitzer that was especially meaningful to him as he approached his 70th birthday:
The meaning of maturity which we should develop in ourselves is that we should strive always to become simpler, kinder, more honest, more truthful, more peace-loving, more gentle and more compassionate.
This advice captured my aspirations for the over 65 phase of life eloquently. To me it seems obviously true. But the skeptic in me asks – “Why should these be our goals?” Didn’t Dylan Thomas urge us not to “go gentle into that good night“? Continue reading…
It’s that time of year again, when the Alzheimer’s Association releases its annual report: Alzheimer’s Disease Facts and Figures. The 2014 edition doesn’t tell us much that’s new—which amounts to a good deal of bad news.
An article on “caregiver burden” in the March 12 issue of JAMA (Journal of the American Medical Association) opens by describing a painful, nearly fatal, situation:
Mrs. D, at 84 years of age, was the primary caregiver for her functionally impaired 86-year-old husband and shot herself 3 times in a suicide attempt. Mrs. D’s family did not perceive the severity of the caregiver burden as a family picnic was planned for the day of her attempted suicide. Mrs. D did not leave a note and later stated she fully intended to kill herself. While recovering in the hospital, she expressed relief at not having caregiver responsibilities. Two months later, her husband died, which Mrs. D described as a release for her.
What stands out for me as a psychiatrist is that despite the depth of depression that led to Mrs. D’s potentially lethal suicide attempt, when she no longer felt trapped in the caregiver role, suicidality and depression lifted without psychotherapy or medication. Changing the situation provided the “cure.” Continue reading…
Lots of proposals have been put forth for a new and better retirement system, but they don’t answer the question of how we get from here to there. (For examples of proposals, see the SAFE plan or the Guaranteed Retirement Accounts proposal.) We have a fairly extensive – albeit far from perfect – 401(k) system that people have just begun to understand. In my view, it makes more sense to transform 401(k) plans into our ideal rather than to superimpose a new system on top of what we already have. But figuring out just what steps to take is hard. I am beginning to think that the single most important step is to shift the responsibility for sponsoring and administering retirement plans from employers to independent entities. Continue reading…
I keep thinking about this notion that 70 is the “real” Social Security retirement age. It is the age at which people get maximum monthly benefits, and if they work beyond this age they see their lifetime benefits decline. But is 70 the right age?
“Right” can mean a number of things. One issue is how 70 in 2014 compares with 65 in 1940 in view of the increase in life expectancy. Another is how to rationalize it given the large dispersion in life-expectancy gains between high- and low- income groups.
People are certainly living longer in 2014 than they did in 1940. The increase for those age 65 has been about seven years for both men and women. How should these additional years of life expectancy be spent? Continue reading…
Did you ever wonder about the veracity of the eulogies given at funerals? Was this really the same person you thought you once knew?
I know, I know. Eulogies are meant to convey the best of the deceased person, to leave us with happy memories. Eulogies are a way of honoring the person. Most people deserve to be honored in some way, do they not?
Now, maybe this is just the psychiatrist in me, but there may be some drawbacks, side effects if you will, in this practice, too. Continue reading…
Today’s New York Times has an excellent article on income and longevity that compares Fairfax County, Virginia, to McDowell County, West Virginia. In Fairfax, median household income is $107,000. In McDowell it’s about one-fifth of that. In Fairfax, the average life expectancy for men is 82. For women it’s 85. In McDowell, the comparable life expectancies are 64 and 73.
On average, men in McDowell County don’t survive into the age cohort the Over 65 blog is about!
In 1975 Samuel Preston used data from the 1900s, 1930s and 1960s to show that the relationship between greater wealth and longer life is a worldwide phenomenon, a finding named for him as the “Preston Curve.” The correlation is well-established. The causative factors are less clear, and most likely include health behaviors such as smoking, community factors such as access to affordable nutritious foods, poverty-related factors such as chronic stress, and more.
Liberals focus on income inequity as the core problem. Conservatives focus on individual responsibility for health-related behaviors as the core problem. In all likelihood, each “side” is allied with a portion of the truth. But whatever the causative mechanisms, in the U.S. the correlation between income inequality and divergent life expectancy is getting stronger. The current effort to raise the minimum wage is a small step in the right direction.
Jim Sabin, M.D., 74, is an organizer of Over 65, a clinical professor of population medicine and psychiatry at Harvard Medical School, and a Fellow of the Hastings Center.
The death last week of Dr. Sherwin Nuland, author of the prize-winning 1994 book, How We Die, reminded me of a line in that book “about our society’s denial of the naturalness, even the necessity of death.” Death in an ICU, he wrote, was the “purest form” of that denial, but more broadly he wrote, “Nowadays, the style is to hide death from view.” I suspect that death has become more open since then, in great part because of his book. It is still not an easy topic for most people.
Like many other skills we take for granted, our upright posture and balance are amazing unappreciated functions. Imagine balancing a five or six foot top-heavy object on a one foot base and you get a sense of how precarious it is for us to stay upright, no less add movement, twists and turns, leaning and bending. The epitome of balance complexity for me is a basketball player with a six and one-half to seven foot frame leaping and twisting and still managing to come down upright on the ground. This is all managed by a series of functions that each instantly take in data about one’s position in space, coordinate inputs with each other and make fine adjustments in the time of an eye blink. Watching a young child learn to walk demonstrates how much time and practice it takes to master this skill. They spend years learning to master walking and running, constantly trying, falling and learning to interpret the inputs to their nervous system.
There are at least five functions that are associated with our ability to maintain balance: Continue reading…
A little over a year ago I went off salary at The Hastings Center, keeping a few duties but losing the formal status that gave me health insurance through private carriers. I promptly signed up for Medicare coverage and simultaneously for the AARP medigap program. Since I write on health care and aging I was naturally curious to compare Medicare coverage with the earlier private coverage, and to see if medigap was as good as advertised. I have been pleased on both counts and have felt even more economically secure than I had earlier. But I haven’t really put them to the test, deciding simply to avoid all serious illnesses, long-stays in ICUs, and rare forms of metastasizing brain cancer for which there is a $200,000 painful treatment good for three-to-four extra days of life.
What I could not avoid was paying $15 a year charge for a subscription, with accompanying membership, to AARP The Magazine, required as part of the medigap plan. Continue reading…