To Our Readers

Thank you for visiting. We will not be adding new content, but we are leaving up Over 65 as an archive of personal essays and policy commentaries examining the challenges facing our aging society.



Because of a combination of a sabbatical for one of us and a series of other commitments, Over 65 will take a hiatus from publication until May, 2015. We appreciate the interest and engagement of our writers and readers, and look forward to resuming publication in the spring. In the meanwhile, we want to wish all an excellent holiday season and a happy and healthy 2015.

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Palliative Care – Not Just for the Dying

I used to think that palliative care was just for people who were dying. Then I found out—about a dozen years ago—that palliative care had expanded its original focus on end-stage cancer patients to include people with serious illness throughout the course of their disease (or diseases). Palliative care, I realized, is far more than hospice, a program that in the U.S. is effectively restricted to patients expected to die within 6 months.

With this shift in perspective, I decided to move from an emphasis on the geriatric population, principally the frailest and sickest of the elderly, to a concentration on patients in the last stage of life, regardless of age, and regardless of how long that stage might be expected to last. Continue reading…


The Grand Alliance

Grandparents and grandchildren have a natural alliance. Both have inevitable conflicts and competition with the generation between them, but the relationship between grandparents and grandchildren is insulated from parent-child tensions. The same sort of alliance potentially holds true to some extent with generations, such as over 65ers and those under 35.

Some recent examples in my life illustrated such alliances. Continue reading…


Life Can Turn On a Dime

[Introduction from Jim Sabin: This anonymous post was published recently on the Age with Spirit blog. Via Al Martin, the editor of the blog and author of a number of posts for Over 65, I’ve received permission from the anonymous author to republish it. I wanted to do so because it discusses the psychological transition to “being old” in an especially dramatic manner. A number of Over 65 posts have discussed this transition, in the contexts of a birthday, diminished vitality, hearing loss, and whether one is working.]

Two months ago, I turned 68 while in the ICU. I was propelled there, almost literally, by being hurled over the handlebars of my bicycle while speeding downhill on a familiar back road. The accident left me with a major concussion and 14 fractures (including five ribs, my right clavicle and right forearm), only two of which required surgery. Continue reading…


Re-Designing Medicare

Under the headline “Greedy Geezers,” the cover of the March 28, 1988 issue of the New Republic shows a phalanx of angry over 65ers surging forward, toting golf clubs and fishing rods. The accompanying article by Henry Fairlie, 64 at the time, excoriated over 65ers as being out for themselves and ready to bankrupt the country by their demands for more Medicare and Social Security benefits. But an important recent report – Re-Designing Medicare – from the Center for Healthcare Decisions, puts the lie to the “Greedy Geezer” accusation, at least as it applies to the Californians who participated in the study.NewRepublic Cover-1988mar28 Continue reading…


Retirement, 20 years from now

A national organization recently asked me to write a brief piece on the future of retirement.  Here’s how I responded.

I know what retirement will–or at least should–look like 20 years from now. I’m just not sure how we will get from here to there. Unfortunately, my best guess is that we will have to experience a crisis before we land in the right place.

Why a crisis? Well, consider our current situation. We face a sharp mismatch between retirement needs and retirement resources. We need more money than ever before because we are living longer and continuing to retire relatively early (average retirement age for men is 64, for women 62), which means that we have to support ourselves for two decades on average and considerably longer for many. This extension in the retirement span has occurred as health-care costs have risen substantially and show signs of further increase. At the same time, real interest rates are at historical lows, so to produce a given stream of income we have to boost wealth accumulations.

While we need more retirement income, we are now getting less from Social Security and employer pensions. Continue reading…

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Sex after Sixty-Five  

“No personal confession or revelation impends here, but these feelings in old folks are widely treated like a raunchy secret.” (From Roger Angell’s “This Old Man: Life in the Nineties.”)

In contrast to my usual posts on this site, there will be no personal revelations by me here either, other than to say that sex after sixty-five should not be a raunchy secret.

There it is. I’ve said the word!

Although I may have missed it, I don’t think that the word “sex” has been mentioned in any of the posts or comments for “Over 65”. Most surely, that doesn’t mean that there is an assumption of little sex over the age of sixty-five, does it? Continue reading…


Caring for Nursing Home Patients under Medicare

What drove me crazy about practicing medicine in a nursing home wasn’t the patients, although with their many medical problems often including cognitive impairment they were a challenge; and it wasn’t the families, though with their anxiety and attentiveness and sometimes their guilt they were an even greater challenge. What drove me crazy about nursing home medicine was Medicare billing.

When I saw patients in the nursing home, I was hemmed in by the fact that Medicare had a very clear idea of what constituted an appointment with a nursing home patient. Continue reading…


Why I Hope Not to Die at 75

I feel uniquely qualified to comment on Zeke Emanuel’s much-discussed article “Why I Hope to Die at 75.” I’m smack in the middle of the year he hopes will be his last. In addition, many years ago I wrote a book about health care organizational ethics with him (and Steven Pearson). I loved working with Zeke and admire the creative work he’s done on medical ethics and health policy.

Zeke says, correctly, that with limited exceptions, as we pass beyond 75 we typically lose physical and mental capacities, with the result, in his view, that “by 75, creativity, originality, and productivity are pretty much gone for the vast, vast majority of us, resulting in diminished productivity.” Although Zeke recognizes that we “accommodate [to] our physical and mental limitations” by diminishing our expectations and “restrict[ing] activities and projects, to ensure we can fulfill them,” at 57, he is horrified by the vision of diminution.

In Zeke’s view, to be remembered “framed not by our vivacity but by our frailty is the ultimate tragedy.” If a patient said this to me, I’d respond, “We can understand that losing vivacity and becoming frail is sad, but how can we understand why being remembered that way is ‘the ultimate tragedy’ for you?” Over the years, with patients who didn’t want to live beyond a particular age, we virtually always found highly personal fears underlying their picture of what the age meant.

We 75ers know from experience that Zeke has the facts right. I’ve experienced most of the changes he attributes to the age. But as is the case even for people who experience vastly more severe challenges than diminished aerobic capacity and declining productivity, most of us ferret out opportunities to contribute to the world and derive satisfaction. Many posts on Over 65 speak to this effort.

Zeke’s facts may be right, but what about the values he espouses? If Zeke were 17 his article would read as the exuberant outpourings of a brilliant adolescent. But he’s not 17 – he’s one of the leading bioethicists and policy experts in the world. As a result, rather than being understood for what he’s doing – presenting an unflattering view of himself in order to provoke thought in others, the Twitterati see him as telling others what values they should adopt. Even more foolishly, some claim that his highly idiosyncratic perspective, which I believe he will ultimately come to see as misguided, proves the truth of the “death panel” lie.

Many readers of Over 65 will agree with Zeke’s critique of American culture as too focused on the duration of life and too inattentive to the purposes of our lives. He calls this cultural type the “American Immortal.” But very few are likely to emulate his prediction that even if he is in excellent health at 75 he will decline all medical interventions except for relief of pain. No flu shots. No antibiotics for pneumonia.

If that view holds for the next 18 years, which I doubt will happen, I hope that when Zeke declines a flu shot or an antibiotic for a treatable infection his physician will be guided by “Four Models of the physician-patient relationship,” an article Zeke wrote in 1992 with his then-wife Linda. Here’s how they described the “deliberative model”:

“The aim of the physician-patient interaction [under the deliberative model] is to help the patient determine and choose the best health-related values that can be realized in the clinical situation . . . The physician’s objectives include suggesting why certain health-related values are more worthy and should be aspired to . . .” (emphasis added)

The values Zeke anticipates applying are not “the best health-related values” for a healthy 75 year old. It is not “worthy” to invite healthy life to end sooner than need be out of fear that we will be remembered as a frail elder, not as a vigorous youngster. That would be neurosis, not wisdom.

I mentioned above that I had the privilege of working on a project and writing a book with Zeke. I understood him to be a warm-hearted person and a gifted teacher who evinced respect and affection for a wide range of humanity quite independently of whether they were “creative” and “productive.” I believe the article he is being roundly attacked for is actually a gift. Zeke wants us to think seriously about what we value in life. By presenting views that many have found repugnant, and that I see as understandable but wrong, he’s achieving his purpose of provoking thought and discussion.

Zeke gives himself an out in the final paragraph of his long (5,000 words) article: “I retain the right to change my mind and offer a vigorous and reasoned defense of living as long as possible.” (I trust by that he means “as long as possible” in a state in which he can appreciate life and respond to others in a meaningful way.) I’m prepared to bet that when Zeke turns 75 he will no longer regard youthful vigor and stunning productivity as the only values worth living for. If I’m alive, I’ll look forward to his contributions to Over 65 when he hits that birthday in 18 years!

Jim Sabin, M.D., 75, is an organizer of Over 65, a professor of population medicine and psychiatry at Harvard Medical School, and a Fellow of the Hastings Center.