October 29, 2010 | 2:27 pm
Posted by Albert Fuchs, M.D.
“I hope I die before I get old”
Composed in 1965 by Pete Townshend, currently 65 years old
The good news is that people are living longer all the time. This trend has been happening as long as records have been kept and shows no sign of stopping. Better hygiene and sanitation, safer living environments, and antibiotics have nearly eradicated death in childhood and early adulthood. As progress continues battling heart disease and cancer, longevity should continue to increase.
The bad news is that we’re unprepared for this. We live as if life is short, and then are unprepared for the decades of life still before us. Just as failing to plan financially for our later years may make us dependent on others, failing to manage our health may mean spending our last decades disabled. A terrific article in the New York Times this week (see the link below) reviews very simple common-sense suggestions that all of us can use to minimize the likelihood of disability later in life.
The first theme of the article is physiologic reserve. Young people have much more lung function, cardiac function, brain cells and muscle mass than they use in a typical day. The difference between how much you have and how much you need is the reserve. But all of these functions slowly decline with age. The article stresses that the simple habits that we develop now will have a major impact when we age.
For example, someone who does moderate cardiovascular exercise a few times a week in her 40s and 50s will enter her 70s with much more cardiovascular reserve than someone who is sedentary. Even though she’ll notice that her walking (or biking or swimming) gets a little slower every year, she’ll still be maintaining a huge difference between what she can do (walk 3 miles) and the minimum required to be independent (walk safely in the home). That is, she’ll maintain a large reserve. Her sedentary neighbor who only does his activities of daily living won’t notice a decline in function until he’s too weak to walk from the living room to the bedroom. At that point, regaining the lost strength through physical therapy will be much more difficult.
There’s also an important diagnostic difference between the two people. The active woman will notice symptoms warning of heart disease or lung disease much sooner than the sedentary neighbor, since she’s putting her cardiovascular system through a mini stress test every time she takes a walk. If, on the other hand, all you do is sit, you’ll only notice your lungs getting worse when they’re not absorbing enough oxygen to sit.
So now is the time for all us middle-aged folks to build the muscle mass reserve and cardiovascular reserve that we will “spend” in our 70s and 80s. That doesn’t have to mean running marathons. But it does mean a commitment to at least walking several times a week. Obviously, if you can do more, all the better.
The second point of the article is safety. Older people frequently become disabled as the result of preventable accidents. The article lists common danger spots in the home that can be modified to prevent falls and injuries. A home safety evaluation from a geriatric case manager is another way to make sure that your home is safe for your level of physical functioning.
The challenge of mortality isn’t that we all die; it’s that we don’t know when. Ultimately we are only in control of what we do with the years we get.
I’ll leave you with some philosophy. The Roman philosopher Seneca mused about the brevity of life about two millennia ago (link below). Give it a read when you’re feeling contemplative, after you’ve exercised.
(Thanks to Rachel G. for pointing me to the NY Times article.)
New York Times article: What to Do Now to Feel Better at 100
Lucius Annaeus Seneca: On the Shortness of Life
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