Dear Dr. Roach: I realize most of the letters you print are from senior citizens, like me. I am 72 and have health issues — high blood pressure, elevated cholesterol and arthritis, and I realize I will not live forever. One of my friends woke me up when she said she “has to die of something.” The thought of death does not petrify me. When I’ve been in senior health facilities, I’ve seen many people whose quality of life is so limited that I think I would choose a peaceful death over some of those situations.
Sometimes I get the impression that some of us think that if we get just the right physician’s care and medications, life can go on and on. I also realize that Americans spend many of their health dollars in the final year of their lives, and that seems wasteful and unnecessary. So I’d like you to relate what current life expectancies are and what factors most affect life expectancy.
J.G.
Thank you for this honest and thought-provoking letter. As a primary-care doctor for 20 years, I have thought a lot about the issues you bring up. I also have spent a lot of time examining mathematical models of life expectancy.
Let me start with your point that Americans spend many of their health dollars in the last year of life. (In Canada, where you have universal health care, it’s still true that about a quarter of the health-care dollars you will use in your lifetime will go in the last year of life.) In fact, 27 per cent of spending is during the final year of life. Unfortunately, it is not always clear as it is happening that the last year of life is upon us, or even that the illness one is facing is destined to be the final one.
So, it makes sense to treat illness appropriately, no matter what the age. I don’t see people regretting medical care when the outcome is uncertain; people regret too much medical care when a terminal result is certain.
That often takes time. You have been wise enough to look at what the future might hold, and now is the time, if you haven’t already, to write out your wishes in the form of a living will and to designate — and, especially, discuss with your durable power of attorney for health care — what your wishes are in case you are no longer able to make those wishes known. That way, once it becomes clear, your family and doctors will know what you want.
Your second question is about life expectancy. These numbers are available readily from the Social Security Administration website, and you can find that a 72-year-old woman has, on average, a life expectancy of about 15 years. On the other hand, if you make it to 87, you still have a life expectancy of about six more years.
However, nobody lives forever. Even for a person with the healthiest lifestyle, who has avoided chronic diseases and has good genetics, that person at 72 has a life expectancy of 20 to perhaps 30 years.
You can make a huge difference by keeping your blood pressure under control, exercising regularly and eating well. The jury remains out, but I suspect personality traits, including resilience, and strong social connections also predict long life.
Dear Dr. Roach: In three weeks I’ll be 80. I am in good health. I have one minor problem: I find it difficult to stand up after sitting on our couch. The seat isn’t as far off the floor as our chair seats are. I think I have weak thigh muscles. I used to do squats in high school. Should I resume them now?
M.G.
Let me give you a modified squat that will be easier on your knees. Put two pillows on a steady chair, one whose seat is higher than the couch’s. Stand in front of the chair with arms crossed over each other on your chest.
Lean a little forward and then lower yourself onto the pillows. Do as many repetitions as you can do comfortably. Try to increase the number of reps as the weeks go by.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
