Income and Life Expectancy

Today’s New York Times has an excellent article on income and longevity that compares Fairfax County, Virginia, to McDowell County, West Virginia. In Fairfax, median household income is $107,000. In McDowell it’s about one-fifth of that. In Fairfax, the average life expectancy for men is 82. For women it’s 85. In McDowell, the comparable life expectancies are 64 and 73.

On average, men in McDowell County don’t survive into the age cohort the Over 65 blog is about!

In 1975 Samuel Preston used data from the 1900s, 1930s and 1960s to show that the relationship between greater wealth and longer life is a worldwide phenomenon, a finding named for him as the “Preston Curve.” The correlation is well-established. The causative factors are less clear, and most likely include health behaviors such as smoking, community factors such as access to affordable nutritious foods, poverty-related factors such as chronic stress, and more.

Liberals focus on income inequity as the core problem. Conservatives focus on individual responsibility for health-related behaviors as the core problem. In all likelihood, each “side” is allied with a portion of the truth. But whatever the causative mechanisms, in the U.S. the correlation between income inequality and divergent life expectancy is getting stronger. The current effort to raise the minimum wage is a small step in the right direction.

Jim Sabin, M.D., 74, is an organizer of Over 65, a clinical professor of population medicine and psychiatry at Harvard Medical School, and a Fellow of the Hastings Center.



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Remembering Sherwin Nuland

The death last week of Dr. Sherwin Nuland, author of the prize-winning 1994 book, How We Die, reminded me of a line in that book “about our society’s denial of the naturalness, even the necessity of death.” Death in an ICU, he wrote, was the “purest form” of that denial, but more broadly he wrote, “Nowadays, the style is to hide death from view.” I suspect that death has become more open since then, in great part because of his book. It is still not an easy topic for most people.

Continue reading…


Aging and Balance

Like many other skills we take for granted, our upright posture and balance are amazing unappreciated functions.  Imagine balancing a five or six foot top-heavy object on a one foot base and you get a sense of how precarious it is for us to stay upright, no less add movement, twists and turns, leaning and bending.  The epitome of balance complexity for me is a basketball player with a six and one-half to seven foot frame leaping and twisting and still managing to come down upright on the ground.  This is all managed by a series of functions that each instantly take in data about one’s position in space, coordinate inputs with each other and make fine adjustments in the time of an eye blink.  Watching a young child learn to walk demonstrates how much time and practice it takes to master this skill.  They spend years learning to master walking and running, constantly trying, falling and learning to interpret the inputs to their nervous system.

There are at least five functions that are associated with our ability to maintain balance: Continue reading…

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AARP: Shades of Old Age

A little over a year ago I went off salary at The Hastings Center, keeping a few duties but losing the formal status that gave me health insurance through private carriers. I promptly signed up for Medicare coverage and simultaneously for the AARP medigap program. Since I write on health care and aging I was naturally curious to compare Medicare coverage with the earlier private coverage, and to see if medigap was as good as advertised. I have been pleased on both counts and have felt even more economically secure than I had earlier. But I haven’t really put them to the test, deciding simply to avoid all serious illnesses, long-stays in ICUs, and rare forms of metastasizing brain cancer for which there is a $200,000 painful treatment good for three-to-four extra days of life.

What I could not avoid was paying $15 a year charge for a subscription, with accompanying membership, to AARP The Magazine, required as part of the medigap plan. Continue reading…


Keeping Frail Elderly out of the Hospital

When I was a medical resident at Boston City Hospital, a large, public, inner city hospital, I began wondering whether hospitals sometimes caused as many problems as they cured. Over and over, I saw older patients admitted with one disease such as pneumonia or a heart attack, who ended up falling and breaking a bone or getting a blood clot from being confined to bed. So I did a study in which I measured how often older people became confused, stopped eating, developed incontinence, or fell while they were in the hospital. I tried to separate out those cases in which the new symptom could be plausibly related to the admitting diagnosis: for example, someone who was hospitalized with a stomach ulcer would normally stop eating during the initial treatment, and someone with a stroke might well be confused. Then I compared the rates at which people over 70 developed these unexpected complications with the rates at which younger people developed them. Finally, I speculated that each of these problems might trigger a cascade of adverse events: a patient who became incontinent might have a catheter placed in his bladder, which in turn might cause a urinary tract infection; a patient who got confused might be physically restrained and his immobility might lead to a blood clot.  Continue reading…


Aging and Anti-Aging

As the New Year arrived, many people made New Year’s resolutions. Some, I’m sure, resolved not to age, or at least to age as slowly and healthily as possible. I wondered if I should make such a resolution. 

That particular question just came up as I communicated with an old high school classmate for the first time in 50 years. We were casual friends back then. For our 50th year reunion, he posted a picture and profile on our website. He looked good and healthy, but it was his blurb that really got my attention: Continue reading…


Pulling the Plug on DNR

Recently, a friend commented that she was not sure whether or not to agree to a “DNR order” for her 90 year-old mother. Her mother has dementia and lives in a nursing home; she is her mom’s health care proxy. Complicating her decision was the knowledge that her mother had chosen a DNR status when she was cognitively intact, but then reversed her decision at the time of acute illness, believing that “DNR” meant she would not receive vigorous treatment for medical problems such as an infection or congestive heart failure. My friend told me she believed the purpose of a DNR order was to avoid a protracted, painful death and that DNR was synonymous with comfort care. 

The truth is that DNR means “do not perform CPR”—the “R” in DNR refers to resuscitation, which is shorthand for “cardiopulmonary resuscitation.” Continue reading…


Activism by the Elderly

As a group, we over 65ers have substantial non-working time. According to the US Census Bureau, in 2011 16.2% of us participated in the labor force. The participation rate falls off steeply with age. Among 65 – 69 year old men (2010 data), 35.8% were working. For 70 – 74 year olds 20.9% were employed, falling to 8.6% for those over 75. For women, the comparable rates are 26.4%, 13.5% and 3.9%.

What will we do with all that non-working time? The answer to that question has a strong potential bearing on the quality of civil society.

A recent article in the Boston Globe illustrates the impact an Over 65 blogger is having by using his non-working time for activism. Continue reading…


Our Aging World

Most of us over 65 were raised in an era dominated by a concern for excessive population growth. Paul Ehrlich made himself and that issue famous with his 1968 book, The Population Bomb. An organization called Zero Population Growth (ZPG) drew thousands of supporters who believed that not only did the developing countries have a problem but so did the United States. The Ehrlich warnings were dire, even apocalyptic, with projections of deadly food and natural resources shortages. Malthus was not wrong, just too early. As it turned out those disasters did not happen, at least not from population growth as the dominant force. Continue reading…


Aging Well

My mother will turn 88 in a few weeks. According to the definition of successful aging put forward by Rowe and Kahn nearly 16 years ago, she is aging quite well. Her kidneys, lungs, and heart work fine. She is still very active—she teaches a French class once a week at the local senior center, she tutors English to foreigners, she plays scrabble with friends, and she drives daily to visit my father at the nursing home where he lives. My mother does have her share of medical problems: she has painful arthritis affecting her knees and her back and she is very weak, finding it difficult to turn a door knob or to lift a container of milk. Until about a year ago, she walked at least a mile every day, but now she can only take short walks and has to sit down frequently. Her memory isn’t what it once was, though it’s still pretty good. My mother will say that “old age is no picnic” and that “people live too long” today. When her physician told her she was aging gracefully, she told him he was full of it. Her doctor has one perspective on successful aging; she has another one. How are we to put the two views together? Are we using the right definition of “successful aging?”

A new study in The Gerontologist tries to answer this question. Continue reading…

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