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LIFE EXPECTANCY–LIVING TO ONE HUNDRED?!
Do you want to live to be one hundred? Really? Most people surveyed today think eighty or thereabouts would be good, but increasing numbers are thinking a healthy one hundred would be nice. And you? It might be time to recalculate your age and to think about what medical science can fix. In America, more and more people are buying longevity insurance, annuities that start paying out monthly at age eighty-five!
If you have ever been to a school reunion after many years or some organized gathering of longtime friends or relatives, like I have, you will no doubt have said to yourself, So-and-so looks really good, and So-and-so looks…well…People the same age often do not appear to be the same age, and it is always flattering when people think we are younger than we are. There comes a time in life when genetics and environment take their toll; some people age well and slowly, some not so well.
There is mental age, which is an attitude, and it is something we can work on improving effectively. Then there is physical appearance, which we have a reasonable amount of control over in looking our age or a bit less, from choosing our clothes to how our hair looks to controlling our weight, to using cosmetics and perhaps cosmetic surgery. Disposable income helps here.
But then there is the state of our insides, our true physical age. Some of our parts simply wear out and show their age. Up till now in this book, I have focused mostly on preventive measures and anti-aging practices that will help to keep our machines working well, our appearances looking good, and our souls feeling well for as long as practical. We have now entered the post-genome period, and over the next half century there will be a “restorative” focus on what science and technology can do to help us live well longer. Bring on the regenerative organs and replacement parts.
LIFE EXPECTANCY AND LIFE EXPECTANCY
How do you measure up at your class reunions? How do you measure up physically? How long will you live?
Would you like to know today the age at which you will pass on? If you did, what would you do differently, or perhaps what would you have liked to have done differently?
We know more today about life expectancy than we have ever known. What about yours? At some point in life, when we begin to seriously contemplate retirement, we unofficially shift our focus from our chronological age in years to a life expectancy, the number of years till we die. It is a sobering moment.
Two of the most common worries people growing old today have is Who will take care of me?, and Will I have enough money to support myself till I die? In the developed world and in the new era of globalization where children often live and work far from their parents, the old practice of children becoming their parents’ parents is diminishing and is often simply not possible. This is true in the United States, in France, in China…in most places. It is a worry for many. Plus, for parents who have been their parents’ parents at some point, they don’t want to burden their own children, and they want to enjoy the lifestyle they prefer for their final years. I have heard people say, “I want to die of a heart attack at age ninety in the beauty parlor.” Or “I want to die on the day that I have spent my last penny.”
Nowadays, with people’s increasing longevity, many nations have set up social security networks for health and retirement, but their cost and sufficiency are a daily worry of individuals and nations.
In the United States, the safety-net government-provided retirement system, Social Security, was established in 1935, and the first monthly payments began in 1940. It provided that at age sixty-five, when you retired from work, you would receive (including a spouse) a reasonable monthly sum to live modestly for the rest of your years. At that time, though, the average life expectancy for Americans at birth was less than sixty-five. Today it is about age seventy-nine overall and eighty-two for women in America…and the system is slowly going broke. Life expectancy in France is 81.5 years for men and women, but for women only today at birth it is 85.3 years. However, there is more to life expectancy (which I will get to in a moment), and for those who reached retirement age in America in 1940, they enjoyed the benefit for thirteen years or so.
I have a friend, Pamela, age sixty, who told me last week that she had always expected to retire at age sixty-five, which was and is a standard, unquestioned number and target in America, implanted at birth it seems. But she read a mention in a publication about the probability of her living to ninety, and she realized, “I don’t want to be retired that long, and I cannot afford to be retired that long.” She reset her retirement clock to seventy.
Average life expectancy is a frequently used but also misleading and surprisingly misunderstood number. Not only is it a composite number averaging a lot of people from different backgrounds and conditions, it averages men and women (and women live longer), and, most significantly, it is a count from birth. Once one survives infant mortality factors, the average age expectancy goes up. In effect, for each year you are alive, the average life expectancy in your country or group goes up, with you included.
Also, note the word average. Today, as mentioned above, if a girl is born in France, she is, on average, expected to live to the age of eighty-five. But that means that she has a 50 percent chance of living beyond eighty-five. If you reach sixty-five, the percentage chance for your living beyond eighty-five is much, much higher than at birth or at age twenty-one. Throw in some individualized factors such as health, education, genetics, and race (whites have the highest life expectancy), and you can anticipate an even longer life expectancy.
Based on some reliable data, and assumptions and interpolations I’ve made, I believe it is safe to say that if you are reading this book, you have a 1 in 10 chance of living to ninety-five years of age or beyond!
Who wants to live till ninety-five if the last five years are spent in pain not pleasure, or, as we fear today, if we won’t even remember who we are for the last five years?
Insurance companies, annuity and pension funds, and government social security plans all play the game of averages, including regarding our health needs. The half who don’t make it to the average age help pay for the half who do.
If you want to age with attitude, many averages, especially the average life expectancy at birth, are not sufficiently helpful. The two expectancies you should be interested in are (1) your own current life expectancy, sometimes restated as your “remaining life expectancy,” and (2) your remaining years of healthful life expectancy.
The European Commission has become interested in healthy life years (HLY), which is a complementary form of life expectancy related to quality of life and years without chronic diseases. For all of us now, I believe the most helpful published statistics are the estimates of average life expectancy at age sixty-five (or, if available, at your current age) versus the broader life expectancy at birth.
So, for example, in the United States the average life expectancy at birth for women is 81.1 years, but if you are now sixty-five, it is 85.4 for you. That means half of those age sixty-five will reach eighty-five, and half will live longer than that.
WHAT ABOUT ME?
Average statistics are useful for benchmarking and planning, especially when dealing with populations of significant size. But most are interested in a population of one: Myself. Moi.
One sort of rule-of-thumb life-expectancy calculator is the speed and agility of your walking at age seventy-five. If you walk like someone half your age or thereabout…add ten years. You can expect to live to at least eighty-five.
There are increasing numbers of personalized life-expectancy calculators available on the Web at no or modest cost. Just go to a search engine and find a few, and you are in for an interesting exercise. Take ten minutes of answering simple questions about yourself—your sex, age, height, and weight; your marital status and your network of friends; your lifestyle as it relates to stress and to healthy habits, or rather unhealthy habits, such as smoking and eating poorly, or healthy and frequent mental and physical activity and exercise; your medical condition, from blood pressure and cholesterol level to history of disease and chronic conditions to your family’s medical history—then press return et voilà: your estimated life expectancy appears.
I tried it. I think I must have lied about all the chocolate I eat…underestimating un petit peu. The number that came up was 104 years. Yikes!
I don’t believe it, but I am normal weight, I eat exceptionally healthy, my blood pressure and cholesterol are more than good, I walk and do yoga every day, my family has no history of heart attacks or cancer, and my mother lived to age ninety-six. As I said, yikes. Even if I shave ten years off the estimate for “cheating by giving upbeat answers on the test,” or for being on the low side of average, or for the test not being all that it should be, and perhaps having a wide margin of error…still, still…living healthy for a long time is certainly the goal and guides the decisions I make now.
Thankfully, science and technology are already helping a lot. We should be able to live healthier and function better and happier longer than those who have come before us.
BIONICALLY YOURS
Do you not know someone who has had his or her knee or knees replaced? Replacement parts are in, and essentially only a generation old and improving daily. Jane Fonda, the famed, attractive actress and best-selling health-and-exercise-book pundit born in 1937, has an artificial knee, hip, and some vertebrae.
I haven’t had to replace many parts yet—just a couple of tooth implants that work well, thank you very much—but if transplants and implants improve one’s quality of life and let the inner self shine through, so much the better for living today. Maybe eighty-five or ninety can be met head-on and be the new seventy-five? (Hey, a positive mind-set alone is supposedly good for adding ten years.)
The French have very good doctors and advanced medicine (as well as the health-care costs and cuts many nations face today), and while not so inclined as Americans to invasive actions, certainly the French are aware of options, and in our anti-aging plans to live longer and healthy, we need to recognize their place. So, while I am no physician, let me do a quick run-through of what we have to consider in our aging-with-attitude approach to life. Here is how science and technology provide prescriptive, not preventive medicine; let us count some of the ways…but only the ways that approximate normal function and support healthy life years (not science fiction).
Eyes: The eyes are the first to go, right? Yes, at around forty, many people’s arms suddenly seem too short or letters too small. Glasses have been around for centuries, but none so effective as today’s computer-generated laser-cut lenses, with such added bells and whistles as light-sensitive self-tinting and antiglare coatings. Contact lenses have been around since the late 1800s and have been continually improved. With the advent of approved soft lenses that did not have to be removed at night in the 1980s, they gained increased popularity. Corrective laser surgery as an option became widely available in the 1990s, as did improved cataract surgery by laser. The associated implanting of artificial intraocular lenses has been popular since the 1960s. While a bionic eye exists in various forms, there’s nothing that is implantable and functions like a normal eye. That will take time. What is closest on the horizon, perhaps available to you and me within ten years, is stem-cell (master cells that can be made to turn into other types of cells) regeneration of retinal ganglion cells that can repair blindness from glaucoma and related conditions.
Ears: Long gone are the days of the ear trumpet. Hearing aids keep getting smaller and smaller and better and better. That’s good news, of course, because as we all know too well, hearing is sure to go—50 percent of people at age seventy-five have suffered some hearing loss—and the social consequences are not healthy. Many older people who suffer untreated hearing loss end up becoming increasingly isolated since they have too much trouble processing and interacting with the world around them. This can lead to loneliness and even depression. Hearing aids only make a sound louder. If the inner ear is damaged and the sensory cells do not function properly, then a cochlear implant is now often the solution. It is a neural prosthesis that creates “electronic hearing” by bypassing the damaged cells of the cochlea.
Heart: It’s hardly possible anymore not to know someone who has had heart bypass surgery, which saved and prolonged his or her life. Since the 1960s, a growing number of people have had single, double, triple, and quadruple veins and arteries from elsewhere in the body grafted to the coronary arteries to improve circulation to the heart. Stents to reduce blockage and widen arteries are now very common and life extending. Diseased heart valves are also regularly repaired or replaced through surgery, using man-made materials or human or animal tissue. The biggest and rarest life-lengthening operation is, of course, a heart transplant, which has been available since 1967 to people with severe heart disease in imminent risk of dying, euphemistically called end-stage failure. About four thousand heart transplants take place annually worldwide, and on average fifteen years are added to a person’s life with the operation. But it requires finding a healthy and compatible heart, and demand far exceeds supply. That has led to the development of mechanical or artificial hearts, usually as a bridge till a heart is found. Progress has been made since the 1980s, and in the past few years a series of portable heart pumps have been successfully employed, including at least one fully implantable one. A synthetic replacement heart is one of the top prizes of modern medicine, but it currently is beyond reach.
Other Organs: Kidneys are our most frequently transplanted organs today, followed by the liver. Transplantation medicine, unquestionably complex and challenging, continues to expand and evolve. Beyond heart, kidneys, and liver, lungs, intestines, pancreas, and thymus also are successfully transplanted today, as are various tissues such as tendons, veins, bones, and even corneas.
Our skin is both our largest organ and a tissue. Skin from one part of the body has long been grafted successfully to another part, most commonly in burn cases. But the future holds more promise in terms of both organ regeneration and synthetic skin with electrical neural-network sensitivity.
Teeth: Do you floss every day? Twice a day? It is one way to extend your life and to look good, really. Taking care of your teeth, like taking care of your skin, can make a huge difference in how well you look as you age. Flossing helps prevent gum disease, which if chronic can both cause your teeth to fall out and add plaque to your veins and arteries, thus increasing your chances of heart disease and a heart attack. My mother did not floss (Who had heard of it fifty years ago?), and while she taught me to brush my teeth, I cannot attest to what she did in private. But I know that like many people of her generation, her teeth and gums reached a point where the simple recommendation was to get all of the teeth pulled and get dentures. And that is how she lived for at least four decades…full plates of artificial teeth out at night and replaced in the morning. (She never quite accepted it, and it changed her smile!) Mankind has known false teeth for more than twenty-five hundred years. Full dentures have been around for about five hundred years, and porcelain teeth since 1770. Real progress, though, has come about in the last twenty-five years, meaning that for many, full plates of dentures are no longer necessary.
Partial dentures have also been around a long time, some removable, and others permanently fixed, such as crowns and bridges that are anchored to remaining teeth. They are more stable, of course, and technology has improved the look and feel of them.
With modern bonding techniques, teeth can be capped, veneered, and whitened, and these procedures, along with the replacement of missing teeth, all contribute to a better facial appearance and improved self-esteem. Modern techniques aided by computer modeling produce some fantastic results. Of course, false teeth that fill in gaps also contribute to clearer, more natural speech and enable one to chew and eat a variety of foods. So these are important replacement parts, not just to ensure proper function but to boost one’s quality of health and chances for a long life.
For me, who once ran into an old-school dentist when I had a problem, and he willy-nilly suggested that I get a lot of my adjacent teeth pulled because they were eventually going to have problems and be extracted, I was saved by progress. The advances in dental techniques and technology have helped save my few problem teeth. For the two that could not be saved, two dental implants of the post-and-crown variety have been miracles of modern replacement medicine. That is real progress that enhances a long life. I only wish they were more affordable and available to more people.
Joints: Sports, arthritis, and nature’s long-term wear and tear have resulted in massive numbers of joint-replacement procedures around the world. Hips, knees, ankles, elbows, and shoulders are commonly replaced successfully, relieving pain and increasing mobility. More than a million such replacements take place each year in the United States alone. While the body is often likened to a machine, it seems very much the case here since it is possible to head to the garage for a “tune-up” and a new part. Technology has been providing better and better parts in orthopedic prostheses. Artificial knees and hips last longer and work better.
TONY’S CASE
I have an acquaintance, Tony, who had both knees replaced—one in December and the other the following December. It took about six to eight weeks of postoperative recovery and physical therapy for him to be out and about and singing the praises of the operations. But one thing he found strange was that before he had the first operation, he had to shop for the knee he wanted. The surgeon and the second-opinion physician he consulted literally took out a parts catalog and went over the pros and cons of the various manufacturers’ products. Before he made the final choice, he held the chosen part in his hands. The next year he assumed he would simply have the same artificial knee joint implanted in his other leg, but the parts catalog had new-and-improved models to choose from! Why put in last year’s model that had been superseded—thanks to science and technology—by a better version? Today he is walking around well with two different artificial knees…and is proudly one inch taller.
Stem-Cell Regeneration: No question, a quantum leap in replacement and regenerative medicine has been the use and further potential use of stem cells (again, the master cells that can go into specialized cells) to replace or regenerate human tissues or organs. Someday, probably this century, you will be able to regrow an ear in a laboratory from your own cells. Lab-grown bladders already exist, and many more complex bioartificial organs are in the development pipeline. Even more approachable is the injection of stem cells or progenitor cells into parts of our bodies as seedlings to regenerate aging or failing organs.
If we are going to increase potential life expectancy to, say, 150, it will not only be because we can grow or regenerate more of the body’s worn-out or damaged organs and tissues. (Currently the maximum potential life span is projected to be 125 to 130 years, though no fixed limit has or can be established.) It will also be because of bioengineered gene therapy, helping to make, for example, stronger knees or hearts by scientists altering DNA and creating naturally produced performance enhancements in our bodies through enzymes and proteins or by reengineering cells to provide protection and even immunity from various diseases. Corn today…a fresh brain tomorrow?
Brain: Sorry, no replacement part is available yet. But we now know that some brain cells have been shown to regenerate, something long thought impossible. And we do know that surgeons poking around inside our brains can achieve dramatic effects, such as calming the shaking associated with Parkinson’s disease.
HOW OLD IS “AGED,” OR SHOULD I SAY “ELDERLY”?
So in the way the last generation used to think of sixty-five as being old, today many consider eighty as elderly. Thanks to science and technology, nutrition and exercise and lifestyle and medicines, the next generation may well think of ninety-five or one hundred as elderly…okay, old. France already has seventeen thousand centenaires, two-thirds women, and this one hundred–plus years category is growing fast.
Postadolescence, the two great killers around the world today are cancer and heart disease. And the two greatest drivers of greater longevity today are the improved awareness and treatment of these killers. According to the World Health Organization, 30 percent of cancers could be prevented. And happily, in my lifetime, recovery from breast cancer has improved tremendously, boosting life expectancies for women in most countries. Still, too many people die from breast cancer each year, especially in developing countries. While survival rates are high (over 80 percent) in Western countries, anything less than 100 percent is not acceptable, and we continue to look to science and medicine for more help. However, as early detection is a key to the best outcomes for all cancers, we need to first look to ourselves to avoid becoming a statistic.
Life expectancies will continue to increase over the coming years, with some estimates suggesting one hundred as the projected average life expectancy of Japanese women by 2050. You never know. The prospects of stem-cell regenerative organs, artificial organ implants, and reengineered DNA know no boundaries. Consequently, there are a growing number of people who pay to have their bodies “placed in cryonic suspension” (i.e., frozen), in hopes of being revived in a hundred or two hundred years, or whenever science has cures for what ailed them (including how to thaw their frozen bodies!).
Today, the challenge for most of us remains not living long, but living well. How do we increase our probabilities of enjoying extended, long, and healthy lives? Science and technology are on their way to making one hundred HLY (healthy life years) a reality.