Aging requires the acceptance of some inevitable truths about oneself and about life. We are no longer able to imagine an infinite future. Our mortality is assured. Progressively, we will lose our energy, our friends, our cherished activities and the identity we once knew.  If you are like me, you don’t suddenly arrive at this point, it comes upon you in small fragments of experience which often you would just as soon deny.

We want to think of ourselves as we always were, and, in fact, for most of our lives, aging occurs so gradually that we can maintain that illusion, until some physical or emotional event teaches us otherwise. Over the age of 60 or so, aging progressively accelerates so that this year no longer looks like two years ago. Interestingly, in some surveys of elderly people, most of them said that they still thought of themselves as they once were and couldn’t figure out who the person in the mirror was.

To a great extent, it is probably good that we deny our aging.  It keeps us going as physically active, involved, creative people.  Older Individuals are capable of a lot more than the common wisdom would think while they maintain their health.  However, that has to be balanced with some appreciation of reality, or we will do really stupid things or expect of ourselves feats that are no longer possible.  I find it a constant balancing act, testing my limits but not getting beyond what is safe and enjoyable.

I learned this on a recent trip to Vietnam with my wife where some helpful realities became clear once I could accept them. I have Parkinson’s Disease, and, unlike earlier times in my life when I could overcome physical hardship with a little grit, pushing beyond my limits now results in exhaustion, and I crash.  I imagine my brain just running out of Dopamine so that my muscles don’t work any more.  A little over a week into the trip, I undertook a hike on a very hot day that, though interesting, was beyond my capacity.  I completed it but was wiped out.  This was followed by two days of long drives on bad roads with poor overnight accommodations and limited sleep. Normally, meaning pre-Parkinson’s, I would have been tired and cranky, but in this instance, I was exhausted and physically depleted. I felt unsafe in a place where there was essentially no medical care if I needed it.

Needless to say, we got through this situation, but it took me several more days to fully recover during which I went through the motions of the trip but with little enthusiasm.  In retrospect, I realized that I was trying to travel as I used to, as if I didn’t have to take Parkinson’s and age into account.  I wanted to maximize the time of the trip, go everywhere, see everything and experience as much as possible, a good plan, except it didn’t work.  Overall, I look back fondly on a great experience in a fascinating country, but realize that I came close to getting into real trouble.

I enjoy traveling, and I don’t want to give it up, but it is time for me to accept the limits of my health and to recognize the boundaries of what I am capable of doing and plan trips accordingly. Coming to terms with my reality and accepting it will allow me to keep traveling, albeit at a pace that I can enjoyably sustain.

Deciding what is realistic involves some degree of paradox.  Over-protecting myself means depriving me of things that I enjoy doing.  It also means allowing my body to avoid anything that is difficult or slightly painful.  There is actually good evidence that some amount of physical and mental demand helps people to remain healthier and to live longer.  It may actually activate genes that are associated with longevity.  However, demanding more than you can do robs the activity of enjoyment and can set you up for physical injury or worsening of a physical condition. I’m all for doing as much as one can, but at some point all of us who are lucky enough to live to be older have to accept our limits and refocus on the activities that make sense

What does accepting mean?  In part, it means realizing what is true, but it also means accepting oneself.  I don’t like to see myself as weaker or more limited than other people.  When I compare notes with friends, I take a certain amount of competitive pride in what I have accomplished.  Accepting limits feels bad unless I can accept that it doesn’t mean I am a lesser person, and that I am okay doing what is less demanding and more enjoyable for me.  Realizing that I have to give up more adventurous, physically demanding travel made me sad, but it allows me to focus on what I can still enjoy.

Al Martin, M.D., 75, is a former associate professor of medicine at University of California San Francisco Medical Center and Chief Medical Officer of Blue Shield of California. He writes a blog, Age with Spirit.





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