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Demystifying Medicine One Month at a Time

Age is Just a Number, Right?

In case you missed them, a couple of lay press articles hammered home the idea of our lifespans being finite.

ezekiel_emanuel_0First there was Zeke Emanuel’s provocatively titled “Why I Hope to Die at 75” in the Atlantic.

The title was unnecessarily inflammatory. A lot of people saw that and thought “Health Care Rationing…” and “what a jerk!

One of the core points of his article is well-taken: when we hit a certain age (75? 80? 85?), it no longer makes sense to “look for disease.”

Health care must continue improving and striving to reflect and honor the wishes of patients, but in addition, we should be more rational about whom we screen for disease and how often. It makes no sense to perform colonscopies in octogenarians to “screen” for colon cancer. Even if they have it, the colonoscopy  is unlikely to extend their life or improve its quality.

I think readers are right to quibble with Emanuel’s contention that at 75 creativity takes a nose dive. He was using that opinion, and the statistical evidence of age-related slowdown, in support of his point about the cutoff age for aggressive medical care. I hope sensible debate is not lost because of his tone and the fact that he’s seen as too political. He did work for the administration during President Obama’s first term, after all.

cohen-01-by_david_boswell

Cohen in younger days.

That same week, the New York Times published an opinion piece by Jason Karlawash of Penn, who wrote about musician Leonard Cohen’s decision to resume smoking (something he’d quit) upon turning 80. Titled “Too Young to Die, Too Old to Worry,” Karlawash examined how the 80+ population has grown from a half of one percent of the population to more than 3.5%. Doesn’t seem like a huge percentage, but it is certainly a significant increase and a huge demographic shift.

As Karlawash writes in the key paragraph of his piece

…Mr. Cohen’s plan presents a provocative question: When should we set aside a life lived for the future and, instead, embrace the pleasures of the present?

5 Comments

  1. Interesting juxtaposition of the two similar-sounding themes from the NYT and the Atlantic articles respectively. To me, they reflect different perspectives. The first does have a vague whiff of care-rationing, but the latter seems to suggest that healthy lifestyle improvements we’d all recommend for mid-life people hardly make sense for the elderly.

    My grandmother outlived three husbands and died well into her 90s. She’d survived all those years on a traditional Ukrainian diet based on the holy trinity of Slavic cuisine (butter, bacon and sour cream). She considered dill pickles to be a vegetable course. When she was hospitalized after a bad fall shortly before her death, the hospital dietician tried to “educate” Baba on why she should start eating healthier food.

    Whaaaaaat?

  2. My father-in-law passed away last May at the age of 97.

    One morning he realized that he no longer had to “watch his waist” and called his “minder” (“babysitter” just didn’t seem appropriate) and asked him to pick up a couple dozen Krispy Kream donuts for him to pass out to his neighbors in assisted living.

    When one woman exclaimed
    “Frank, you should know those aren’t good for us!”,
    he replied
    “Helen, have you looked in the mirror lately!?! We can eat anything we want!”

  3. An elderly man asks, When should we set aside a life lived for the future and, instead, embrace the pleasures of the present?

    My observation is that an ever increasing proportion of our population is ’embracing the pleasures of the present’ …instead of saving to educate their children. The trend is to buy them smart phones and an account to keep their apps and song library , up to date. Household debt is increasing past anything rational. I wish the future ‘lots of luck’ but for their children’s good, maybe we should ‘wise up’ . Most in my family rationalize, ‘no need to leave anything to the children’, ‘let them make their own way’, because the only thing they can leave them is debt.

  4. I’m 83. I’m diabetic on the old standards pills only. My geriatirician thinks my AiC is too low! My endocrnologist thinks its o.k. I’ve become a little more lax in my diet as I’ve a;lways had a sweet tooth. I keep actiove but don’t “exercise” per se. I do my own yard and housewaork. So I wonder if I need to follow all the recommendations one constantly reads about to “keep healthy?”

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