We are the Tsunami..

Seniors lining up for food aid vouchers in Hong Kong. Lam Yik Fei for The New York Times

Today’s New York Times carries yet another article about the huge wave of elderly in need of more services than their countries can provide. This particular article focuses on Asia, particularly Japan, where almost a third of the population is over 65. The US is not far behind, with 17% of our population already over 65, and an expected 21% of us over 65 by 2040. As an elder closer to 80 than 65 years old, I care greatly about the impact of these numbers on me, my agemate friends and our children.  I am worried about

  • The difficulties in hiring caregivers for my age group. As I near 85, it is increasingly likely that I will need a caregiver; in 2018, the percentage of older adults age 85 and older who needed help with personal care was 21%, a number that will increase with each birthday. My effort to hire a caregiver for my mother just 15 years ago resulted in cash payments to a non-certified community of women with varying levels of skill and experience.  My husband and I were adamant that we wouldn’t do that to our children and thus we live in a senior community, where the task of hiring caregivers is part of what we pay for.

  •  Social Security and Medicare funding is simply inadequate, and the burden is too heavy for future generations – my children and grandchildren—to carry.  These entitlement programs are critical to my economic independence, and yet those who are funding the program are simultaneously being robbed of the financial ability to adequately prepare for their own retirement.  Entitlement programs are already politically divisive; that will continue. I recall that FDR’s social safety net, Social Security, was most popular among those with aging parents, who knew that taking care of grandma for many years wasn’t a good idea for them. In 1940, elderly parents had the good grace to die at age 60 for men and 65 for women. The actuarial tables used by Social Security anticipate that I have another 11.6 years ahead of me and many of those years could require extensive care.

  • The lack of caregivers and the expectation that elders will age without burdening their children creates an unhealthy isolation for many of us.  A recent CDC report states that about one-forth of the over-65 cohort is socially isolated, and that number is highest among the most elderly. The report goes on to cite the health impact of isolation:
    • 29% increased risk of heart disease  
    • 32% increased risk of stroke.
    • Higher rates of depression, anxiety, and suicide.
    • Among heart failure patients, a nearly 4 times increased risk of death, 68% increased risk of hospitalization, and 57% increased risk of emergency department visits.

What to do? Hope for technological answers to caregiving (robots and more AI are coming very soon). Vote for candidates who acknowledge that the solutions aren’t easy, but who are willing to address the issue. Encourage medical providers to consider the negative impact of expensive late-life care.  Address immigration meaningfully, to offset the decline in the population of workers and taxpayers.. Examine housing constraints against multi-family units, to permit aged seniors to share housing.  More?

 Our government keeps copious statistics about aging, and issues regular reports citing the details of these numbers. Here are some of those reports should you wish to deep-dive into the statistics:

The dangers of New Year’s Diets for the Elderly

My joy in celebrating a New Year is often dampened by the absolute onslaught of advertisements and resolutions featuring diet products claiming to extend your life, improve your social life, etc.  The amount of science behind those claims is debatable at best, and perhaps even dangerous for us old folk.  The trillion dollar diet industry has everything to gain by getting us to buy their products, and money is a welcome excuse to ignore the science. Here’s the truth, with a couple of scientific articles tossed in:

  1. Folks, we are all going to die, but BMI is not a good predictor of lifespan in the elderly. In fact, a BMI of 31.7 is categorized as morbidly obese but in the over 70-cohort is the BMI least associated with mortality.  Furthermore, “a broad range of BMIs are well tolerated by older adults.” Read the article for yourself. A second article goes a bit further to say that “Low BMI and weight loss are risk factors for mortality in the elderly and smoking habits did not significantly modify that relationship. The BMI ranges with lowest risks for 15 y mortality are relatively higher in elderly.” A 2017 Chinese study reiterates “Among older persons aged 65 and above, the overweight-or-obese category of BMI was not associated with excess all-cause mortality.”
  2. Weight loss is common in the elderly, as we get shorter and our systems become increasingly less efficient and less responsive to various feedback loops associated with aging.  It’s not a bad thing to enter old age with a little extra weight, in preparation for illness or normal aged weight loss. Read the article about normal weight loss in the elderly here,
  3. Finally, excess weight may actually be preventative in bone mineral density (BMD) loss.  Body composition (lean mass, fat mass, and soft tissue mass) in older men is positively associated with BMD at all sites of the body (arms, legs, and trunk).

Thanks for allowing me to vent, though I could go on talking about the serious risks of yo-yo dieting to cardiac health, the probability that weight loss won’t endure in most, and the reduction in injury for overweight elders who fall (as we all will).

End of Life is Like A Fine Sunset

To answer the questions asked in the previous post about when and how we disengage from frenzied life, I gathered some very wise responses from thoughtful friends.  I particularly liked these two:

  • Bernard Berenson writes that ‘ the end of life should be like a fine sunset’. I’m not sure that’s what our community fosters, but yet it is what I seek and try to make reality. Our community wants us to keep going and giving and doing. Doing what we always did and more so.That is how many residents see their lives and what administration rewards and recognizes.  

Actually most of us are not at the end of our lives yet. These are our last years, yes. But aware of that as I am, I want to make the best of these last years and to me that doesn’t mean doing what I used to do. It means trying and being and doing something new and, more so, being what I always have been but never took or had the time to realize.

  • Balance in our frenetic world requires paying attention to those signals of feeling rushed, pushed, holding our breath, feeling our shoulders up near our ears.  My mantra has been you have time or there is enough time.  The Dalai Lama long ago cautioned us not to be misled in thinking we have to keep pace with our technical devices.  At another time he advised that There is more to life than increasing its speed. 

Aren’t I lucky to have such amazing, thoughtful friends?