Crimmins found that between 1998 and 2006, the loss of functional mobility in the elderly increased. In 1998, about 28 percent of American men 80 and older had a functional limitation; by 2006, that figure was nearly 42 percent. And for women the result was even worse: more than half of women 80 and older had a functional limitation. Crimmins’s conclusion: There was an “increase in the life expectancy with disease and a decrease in the years without disease. The same is true for functioning loss, an increase in expected years unable to function.”
Read the whole thing. I mean it. This is an excellent and important article. Pointer from Tyler Cowen.
The more optimistic view of aging is represented by Gregg Easterbrook.
In your comments, please spare me the snark about Emanuel, Obamacare, and death panels. Speak to the point of what happens to quality of life after age 75. We know many examples of people for whom it was good. But on average is Emanuel correct, and is he correct that we have seen in recent decades, if anything, a deterioration in the quality of life among the very old?
Rather than hope I die at 75 because so many people have lower functional mobility, I strive to have higher functional mobility at 75 and train accordingly.
Or, are people with generally poorer health getting such good health care that they make it to 80, decreasing the health of that over-80 group?
It looks as though the effect kicks in with those who make it to 20.
c.f. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3060013/
That was precisely my thought.
A 75-year-old is a WWII baby. My father and father-in-law are both 75 +/- a bit and are polar opposites in their health right now. My father worked factory jobs his whole life. He is decrepit and represents this exact “loss of functional mobility” right now. My father-in-law has been an engineer his entire life, and has never had to do heavy manual labor. He is still going strong, working on contract for the same employer where he retired ten years ago. Last Christmas he shocked me by hopping on my son’s Razor scooter and zooming down his driveway like a kid. My father hasn’t been able to do anything like that in 15-20 years.
I realize these are anecdotes but I think any data on 75-year-olds is suspect in predicting the immediate future because we’re dealing with depression-era, WWII-era, pre-boomer data still. There’s still a large fraction of retirees that did heavy labor their whole lives, and that will be reflected in their health and mobility.
20-30 years from now the percentage of 75-year-olds who experienced that kind of physical damage in their careers is going to be much lower. That does not even consider the changes in air quality, food quality, marriage quality, etc., etc., that really took hold with the boomers.
Possible, but notice that Brock (below) would take the opposite side of this trade — I think he thinks that the white collar desk bound will be in bad shape.
The article provoked outrage based on the “fortune cookie” version of its contents. To say that he will voluntarily forego medical treatment after 75 is a personal choice, which the author is free to make. He can argue, as he does here, that others should do so. But it is naive to take at face value his claim that he is not advocating this as government policy. When he says this: “And I am not advocating 75 as the official statistic of a complete, good life in order to save resources, ration health care, or address public-policy issues arising from the increases in life expectancy” — I don’t believe him. There is no reason for a person of his stature, his role in creating the current government health care regime, to make these arguments in public other than “prepping the battlefield” for defining 75 as the point where the taxpayer considers you “dead” and you are on your own. The need for cost savings is obvious, and this is an obvious way to do it. If the cost of care is primarily a public responsibility then taxpayers are going to tell others that death is their civic duty. In the UK and the Netherlands an informal euthanasia program is in place already. That seems to be the inevitable orientation when you have government as the provider or guarantor of health care. Left unanswered by the author is whether the life quality of older people is inevitably going to decline to the extent it does now after 75. There are outliers, very hale people in their 90s, and they are in fact a tiny minority. But can the average level of health and fitness for the elderly be raised? Could significant health improvement in this phase of life be the new breakthroughs which Peter Theil is saying we should be aiming for? Are there “zero to one” opportunities in this area? That would change the author’s analysis if the answer is yes. (I hope the foregoing is not perceived as snark.)
Regarding Peter Thiel…I think Mr. Emanuel knows how he would respond to Peter Thiel’s interview question?
I liked Emanuel’s article quite a bit, but then I have had the misfortune of recently watching aged relatives’ health start to decline precipitously, so maybe my view is tainted.
I do seriously question that data point, however. It describes men and women “over 80”, but as far as I can tell, doesn’t tell us what the mean age for that group was in 1998 vs 2006.
This doesn’t surprise me – it’s a cohort effect. Over time there’s more retirees who worked desk jobs, and lived their adult lives during the age of rising obesity. Functional health will continue to get worse over time as today’s obese and diabetic Boomers become elderly.
The only solution, in my mind, is to find a real cure for obesity and metabolic syndrome, and then practice it in a preventative manner among the elderly.
Another part of the problem is the FDA. They are institutionally dead set against anything that smacks of “anti-aging” medicine. They only want to cure “diseases”, and simply getting old is “natural” and not something to be fought. That mind set needs to change if we are going to see any progress in the USA.
The bioethicist philosopher Daniel Callahan (himself now 84 years old) has been writing on a similar theme for many years.
Some of his books:
What Kind of Life?: The Limits of Medical Progress
Setting Limits: Medical Goals in an Aging Society with “A Response to My Critics”
The Troubled Dream of Life: In Search of a Peaceful Death
Medicine and the Market: Equity v. Choice
The Goals of Medicine: The Forgotten Issues in Health Care Reform
Taming the Beloved Beast: How Medical Technology Costs Are Destroying Our Health Care System
I don’t know if he has moderated his views in the last 15 years, but he used to advocate a kind of ‘cash in your chips’ approach to low-bang-for-buck public-expenditures on medical interventions for people past 70 who are probably near the end of their life.
Worth noting is that many people have a high quality of life in situations that they abhorred before they tried it. An example on that is life while paralyzed and on a respirator:
http://lesswrong.com/lw/1ab/dying_outside/
I find that quite a disturbing way to live. However, the article claims that most people who try it say that their quality of life is “high”. It’s a biased article, but this might be a case akin to Bryan Caplan’s comments about raising children: people who actually try it, like it.
As an irresistable comment on health care policy, what public support is appropriate for late-life improvements to mobility? It’s not something that will save a life, and they are going to be some of the most expensive procedures on the market for the next few decades.
FWIW, note that when his quality of life dipped further, Hal Finney had the ventilator pulled and “died”.
http://www.economist.com/news/obituary/21615469-harold-finney-futurist-and-cypherpunk-died-august-28th-aged-58-hal-finney
(“died” as he was frozen and is being stored at Alcor)
The claim by people that that their quality of live is “high” after being paralyzed may be an example of another Caplan bugaboo: social desirability bias. You’re not supposed to say, “My life sucks and I want to die” so you don’t.
The same time period that saw an increase in the fraction of elderly with disabilities also saw an increase in the fraction of children with disabilities. Maybe we’re counting disability differently.
1. First I’ve never seen snark here. 2. 75 is literally crazy, as in it it just suicidal as an individual choice and if it isn’t just some guy’s bizarre view but a policy implication then…
Anyway, it could be, like with autism, you are defined as having the problem when upu get a nominal diagnosis and that is the point your life has gotten better in real terms.
Hi,
I haven’t read anything yet beyond your post. I would be very skeptical of anyone who says there has been a recent trend that people are getting non-functional *earlier* in life.
I don’t know if y’all saw the Ken Burns special on the Roosevelts. Good stuff, as always…even if I disagree with nearly all of Burns’ admiration for both men.
Anyway…Teddy died in 1919 at age 60. Franklin died in 1945 at age 63. The morning Franklin died, he was arguably the most important man in the world…and his blood pressure measurement on the morning he died was 300/190 (!!!!) (!).
It is reasonable to expect that, within the next 2-4 decades, replacement body parts made out of stem cells, and replacement mechanical parts, will get to the point that they are close to or even exceed what the automobile world calls “OEM.” And that’s even discounting the possibility that Ray Kurzweil’s nanobots will be able to do repairs from within. So, need a new heart? A copy comes from your own stem cells? Hearing gone? Cochlear implant, as good or better than new. Pancreas shot, causing diabetes? New artificial pancreas, as good or better than new.
Now I should probably read what Emanuel wrote. 😉
Mark
Great to post right after Mark Bahner!
I posted this at EconLog an hour ago:
After reading the article, it reminded me of The Great Stagnation— very provocative, not well thought out, and blind to what is currently happening in technology.
What do economists and policy makers make of top longevity researchers who have claimed for the past few years that serious health pills will likely be on the market by around 2020?
No one knows exactly what the health pills will do, but they are expected to extend healthspan between 7 and 25 years. So if Emannuel takes the pill in 2020 at age 62, it would be as if he would reach his desired death year of 75 in 2033 with the body and mind of what he would have had at around 65 to 68. But what health pill or rejuvenation therapy will be like at 2033?
Before economists and healthcare policy makers can discuss the elephant in the room, they need to know that there is an elephant in the room.
Of course, there actually has to be an elephant. I am reminded of the late Seth Roberts’ complaint that the Nobel Prize in Medicine and Physiology almost always went for something that the Prize statement said would have great clinical significance. Yet even though the discovery had taken place years ago, the actual improvement in people’s lives was STILL in the future.
He drew a rather cynical conclusion.
The “best” solution would be a cohort effect.
In the early 20th century medicine improved remarkably. At the start, something like 10% of infants died. Even in the 50s and 60s you had people just dropping dead in middle age and the small town doctor not bothering to find out, or just not knowing why they died. So that cohort (who were in their 80s in the 1990s) would be made up of those with the hardiest constitution, many of whom survived to that age without a lot of medicine. Probably the kind of person who is active and fit until the day they suddenly die.
The people who are 80 now, were born around 1930. By then infant mortality was already substantially lower. They reached middle age in the 70s when there was already plenty of help available and a lot of the earlier killers were manageable. So now it’s not only the hardy and fit people who reach 80, but also those who bring their diabetes and pacemakers with them into old age.
So it’s not people now having a functional limitation, who in previous generations wouldn’t have had one. They are as fit as ever. It’s people who would have been dead at 1 week old, 45 years old or 65 years old, now being functionally limited 80 year olds.
Note that I don’t know whether this is true. It’s only the least alarming explanation in my opinion.
Great hypothesis. I wonder if it could be proven mathematically, via modeling.
interesting possibility, you appropriately state it with caution
Here are two related articles that I really liked:
http://www.saturdayeveningpost.com/2013/03/06/in-the-magazine/health-in-the-magazine/how-doctors-die.html
(It basically says that most (or at least many) doctors choose to die quickly.)
http://slatestarcodex.com/2013/07/17/who-by-very-slow-decay/
It’s a post about death and some of the lies we tell ourselves about it.
Dr. Kling, for an alternate look, consider David Cutler’s paper on morbidity compression in the US:
http://www.nber.org/papers/w19268
“Compression of morbidity would lead to longer life but less rapid medical spending increases than if life extension were accompanied by expanding morbidity. Using nearly 20 years of data from the Medicare Current Beneficiary Survey, we examine how health is changing by time period until death. We show that functional measures of health are improving, and more so the farther away from death the person is surveyed. Disease rates are relatively constant at all times until death. On net, there is strong evidence for compression of morbidity based on measured disability, but less clear evidence based on disease-free survival.”
Well, I’ve read the Emanuel article. I think it’s wrong on many different levels.
Let’s start with possibly the most important level. He says that not only are people living longer, but that the loss of “functional mobility” in people over 80 is increasing…dramatically. He writes:
“Crimmins found that between 1998 and 2006, the loss of functional mobility in the elderly increased. In 1998, about 28 percent of American men 80 and older had a functional limitation; by 2006, that figure was nearly 42 percent.”
I tried to find that study by Eileen Crimmins. I didn’t find that study, but I did find this one, also by Eileen Crimmins:
http://www.eurohex.eu/bibliography/pdf/1280945410/Crimmins_1997_JGB.pdf
This study by Eileen Crimmins does not seem compatible with the results of the other study, as stated by Emanuel. See Table 1 of that study…there is *not* a strong trend towards increasing disability in people 70 years or older from 1982 to 1993.
As I wrote previously, I’d be very skeptical of any claims towards dramatic increases in disability of people 80 or older. The trend that Emanuel claimed Crimmins found is extremely dramatic…from 28% to 42% in only 8 years. So extreme skepticism is warranted.
Unfortunately, since I’m not over 75, I don’t have the time right now to exercise due diligence on fact-checking the claim.
A preachy ‘getting old sucks’ article is excellent and important? Please elaborate.
Most of us already know that getting old sucks. But, when faced with the reduced faculties of getting old, many people seem to want to keep living as long as they can. Emmanuel didn’t seem the least bit interested in understanding why and getting their perspective. He just derides it as an “American Immortal” culture.
I saw nothing more in that article than a good example of personal preference bias.
How Emmanuel, at 57, imagines he will value his life past 75 reminds me of how I couldn’t imagine, at 24, why someone would pay so much for a professional plumber. I had more time than money then.
But, as life got busier and I discovered I had made a few costly plumbing mistakes, my value perception of the professional plumber fees changed and I realized that my young self was a bit naive.
I also learned that my personal preference was mine and it could differ from others. Rather than deriding others for their differing preference, I try to learn more about why they differ because I might learn something. They may have good reasons.
That’s something Emmanuel didn’t seem interested in exploring and I found the reasons he provided for his personal preference unpersuasive.
I think that at some age maybe (80 to 85) it makes sense to stop getting checked for cancer and heart disease because treatment is unlikely to help you live better or longer and start taking steroids which will increase your chance of getting cancer but will increase your vigor.
As to “In your comments, please spare me the snark about Emanuel, Obamacare, and death panels.” No.
When the architect of alleged death panels reveals his own strong preference for dying at 75, and presumably his advice to us, it is relevant.
That is the story here.