TAKE 99 STEPS TO 100
A bestselling expert on aging and geriatric care offers a prescription for achieving longevity and preserving the quality of life. In DARE to Be 100, Walter M. Bortz II, M.D., explains how and why we should all strive to be centenarians with his unique and practical program. Supported by his lifelong research, this program is broken down into the categories of
* Diet (Take a Coffee Break; Beware of Free Radicals)
* Attitude (Be Necessary; Maintain the Creative Spark)
* Renewal (Recharge Yourself; Keep Working)
* Exercise (Keep Your Oxygen Tanks Full; Be Sexy, Be Fit)
The 99 steps in this book offer an effective plan for living long, healthy, and just as important fulfilled lives.
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About the Author
Walter M. Bortz II, MD, the author of We Live Too Short and Die Too Long and more than 100 scientific articles, is a member of the teaching faculty at Stanford University Medical School and a practicing physician at the Palo Alto Medical Foundation. Past president of the American Geriatric Society, former cochair of the AMA-ANA Task Force on Aging, and participant in one marathon yearly, he also serves on the editorial board of Runner's World magazine.
Read an Excerpt
You've got to have guts to grow old
To claim life you've got to be bold
But you have to be smart
As well as have heart
If you want your whole tale to be told.
Guts and Smarts
In 1995 the first of 75 million baby boomers turned fifty. We know this much. What we don't know is, beginning in 2045, how many of them will turn 100. Two principal credentials will have to be presented if most are to make it guts and smarts. Smarts is the accumulation and use of the cascade of new knowledge that provides the when, what, and how to aim for 100. The when, what, and how involve sorting out and disentangling prior ignorance and misinformation, which has until now prevented full extension of the lifespan. The when is the critical appreciation of the dimension of time in everything you do and are. The what is the simple assigning of life forces to the proper category, knowing what is changeable and what isn't. And the how is the understanding of the way the parts fit together. Our current era is the first in which sufficient knowledge has been accumulated to provide sound answers to these basic questions concerning human life. Having smarts affects each part of your life the biological, psychological, and social. It affects you individually and collectively as a member of the larger community. It is one of the two basic ingredients of living to be 100.
But smarts by themselves aren't enough. Smarts are necessary but insufficient. In order to squeeze all the good out of your life, you also need guts. Guts means having the valor of purpose necessary to pursue the why. The capacity to search steadily for a significance in life represents the highest nobility. The why is finding a meaning for all of the expanded living and also the energy and involvement necessary to make it happen. Nietzsche is quoted in Viktor Frankl's Man's Search for Being: "A person who knows the 'why' of life can put up with almost and 'how.'" For the flame of life to burn brightly for all your days, a steady supply of active participation is essential. If apathy, discontent, and boredom are given room to thrive, your chances of seeing 100 are slim to none. If, however, you muster the guts, nourished by a sense of meaning, then a long vivid life beckons. You need to ensure that each minute of your life is crowded with active participation. It is simply the way nature works, and you need the guts to reach for your natural capacity.
John Gardner suggests that we amend our constitution to read "Life, liberty and the pursuit of meaning." It is the pursuit of meaning that gives life its substance. Without this search we humans are pretty much mindless voyagers on a lonely planet. Yet if we can strive for purpose, then life has a direction. This striving takes guts.
Such heroism does not connote an occasional dash into a burning building or pursuit of other episodic risk of personal safety, but instead reflects a steady, quiet slog across the peaks and valleys of everyday life. Guts and smarts. Courage and intelligence. These are the secrets of the fountain of age, the elixir of a long, bountiful life, the dream of the ancients. Guts and smarts are not mythical, mushy-brained ingredients. They are securely documented, tested, and integrated. They fit precisely into a coherent whole. There is now a sufficient fund of data and experience to allow baby boomers and, of course, younger generations to plan their 100th birthday party with calm assurance, prepare the guest list, and muster enough respiratory reserve to blow out all those candles.
But making 100 is not a sure thing. It will not happen effortlessly. It is your job, not someone else's, to see that it happens. As things stand now, the government would hate it, industry would scream, and almost no families would know how to deal with such widespread longevity if we did achieve it. There must be an awful lot of shifting around of old attitudes and social organizations for the boomers and beyond to fit in comfortably as centenarians.
Life inevitably brings losses. The longer you live, the more there will be. The losses themselves are not the principal threat, however. A lack of resilience is. How you confront and adapt to losses is a major ingredient in daring to be 100. There are many pitfalls along the way, disincentives, wrong information, stereotypes, prejudices, and asynchronies. There are many excuses for not wanting to be 100, but they are wrong-headed. The reason all of us should want to live a century are much stronger than the reasons not to. To wish for less than your full potential is dispiriting. We are born for one purpose, and that is to live. When you are ready to die, you must be able to say "Yes, I have lived." Don't spend so much time worrying about whether there is life after death. Worry instead about the life before death.
SMARTS THE WHEN
The first element of developing the smarts necessary for a long life is the new appreciation of the time dimension of your life. How far is it from womb to tomb? An 83-year-old friend of mine told me how he had been more or less looking idly out the window each day for the undertaker to pull up. Then "Eureka!" he miraculously recognized that "it wasn't time yet." But until this moment he had lacked the clarity of information to know what stage of life he was living, or put another way, what time it was in his life.
In all likelihood, until now, all of your estimates of your lifetime have been wrong. How do you know what time it is in your life? Usually you set your life clock by your parents' and grandparents' experience. If they died young or old, you more or less projected that prophecy onto your own life. My maternal grandparents died in their 50s and 60s of cancer and diabetes, which was pretty much what was expected of them in the 1920s. My paternal grandparents, however, lived into their early 70s, and I recall my parents and all of their friends feeling that Dad's folks were extremely old, outliving their allotted times. They were in overtime.
I am sure that my parents set their life clocks according to my paternal grandparents, making midnight for them around 70 years of age. Dad died at 74, just about on cue. But my mother lived to 95, the last survivor of twelve children, and a widow for twenty-two years. She was confused and awkward about her age, despite the fact that she was healthy until she died. She had lived way past her midnight. On birthdays and Christmases in our house, she was upset that my kids her grandkids did not turn cartwheels when they found her check for five dollars in her card. Despite my continued efforts to encourage her to play a role in our family, she was uncomfortable and out of synch. She often told us to "act your age," but the problem was that she didn't know how to act her age.
Mother lived to 95, not because she paid any heed to the advice of her physician husband and son. She took perverse pride in disregarding everything we ever said to her. She was at least thirty pounds overweight her whole post-me life. Mother lived to 95 because she was designed to live this long and longer. We all are.
When my mother was a little girl, the average life expectancy was only 45 years of age. No wonder she felt awfully old near her end. But there is now a virtual consensus that the maximum human lifespan is around 120 years, or one million hours. This does not mean, of course, that all of us will live that long. But at least two people have Shigecko Isumi was recorded by the Guiness Book of World Records as the oldest documented life 120 years, 237 days (but on February 21, 1996, Jean Calment of Arles, France, turned 121). By merely asserting that some of us can live this long creates a noble vision. It is like being President of the United States. Our Constitution asserts that any one of us can be, but very few will. However, the very possibility stretches our imaginations and encourages a sense of participation.
Virtually all biological processes conform to a bell-shaped curve, which is to say that no feature of nature operates in such a way that allows that everyone is the same height or weight, or that all leaves fall off a tree or a shrub on the same day, and so on. In just such a way, natural life expectancy should conform to a bell-shaped curve, the extreme end of which is 120 years. If 120 is the far edge of the curve, where is the center? The answer is 100, meaning that 100 years of age is the median. Ken Manton of Duke University is the leading age demographer in our country. In a recent article in the International Journal of Forecasting, he calculated that if the current health habits of the past few years continue, in the year 2080 the average life expectancy in America will be 100 for men and 103 for women. Using data supplied by the Census Bureau, Paul Siegel and Cynthia Taeuber predicted that "If the average rates of decrease in death rates continue to prevail in the coming years, in 2050 the average life expectancy will be 100." If this is the case, there will be 19 million centenarians.
These sturdy predictions by leading experts should be heartening for my oldest grandchild, Kellen's, buddies. There years ago I gave a very important public address to his first grade class. Before I started, I passed out papers and asked these bright kids to answer a few basic questions. First I asked how long they would like to live. All but five answered at least 100. One said "forever." The lowest number was 87. Then I asked how long they thought they were going to live. Two answered less than 80, six answered 80 to 90, four answered 90 to 100, the other ten answered 100 plus, one 125, another 254.
A year or so ago, the Alliance for Aging Research conducted a man-on-the-street survey and asked essentially the same questions. Two thirds of the people, this time adults, also said they wished they could be 100 if and this is the important if they could stay healthy.
Given this data, we now know how to set our watches and clocks and calendars. Midnight on the 31st of December comes at 120 years of age. For a 30-year-old that means he or she is only at three o'clock, or in March of the year. A 60-year-old is at six o'clock, or in June. Not until older ages does winter set in. Knowing how to "time" lifetimes is surely one of the most powerful tools we can use to live a fulfilled life. It is a key component of smarts. The when of life.
The physicists teach us that there are really only three basic components of the universe: matter, energy, and time. We mortals can have some input into the first two of these, matter and energy, but time is beyond our control. No one has yet found out how to alter time. This is clear. What isn't clear is our ability to know which aspects of our lives are controlled by the effects of time, over which we have no influence, and which are due to the interaction of energy and matter, which we can actively confront. The distinction between these two aspects is one of the great benefits of being able to comprehend the true time boundaries of our lives.
Until now, we have understood only two times of life, youth and adulthood. Youth and adulthood were and are extremely well studied and understood. There are innumerable texts describing in abundant detail what being a child and an adult are all about. Being a child means growth, learning, developing, maturing. Adulthood means childbearing and-rearing, the time of work. What comes next? The answer for most people, until relatively recently, is that they die. But when you realize that there are as many people alive over 65 years of age in the world today as in all previous history put together, you get the idea that the opportunity to grow old to live into a new third age of life has only rarely existed before. Now it is common and becoming more so, as 15 percent of women and 4 percent of men now live into their nineties. The most rapidly growing segment of the American population is the centenarians, not because of any great medical breakthroughs, but simply because they, like my mother, are fulfilling their natural biological heritage.
Having the smarts to understand the true time dimension of life can be powerfully shaping. With this knowledge, you can redesign your life. Such a positive act helps offset what psychologist Martin Seligman calls "the helpless-hopeless" syndrome. Numerous examples exist that indicate that for many people death seems to occur on cue. Voodoo death and the pointing of the bone are vivid evidences of negative predictions. There are, as well, positive examples in which people die at lower than predicted rates in periods immediately before important holidays or celebratory events. For example, elderly Chinese die at lower than expected rates in the period preceding the Moon Festival and higher rates immediately thereafter.
With a foreshortened lifespan expectation, how can you logically plan the last of your new life? How can you see and know the whole when only the first part has been studied? How can you understand a novel, a mystery, a movie, a ball-game if you leave part of the way through? Now that we see the last part, we can understand the whole.
As children we presume that most of our life will be spent going to school. As young adults we presume that most of our life will be spent with children in the house. As working people we presume that most of our life will be spent working. All wrong. Life is made up of these segments, but the huge post-working segment is unaccounted for. Is it possible that this last segment is the longest of all? What is the job description of this new-found lifetime? It is a gift of found time.
Lack of sensitivity to this time dimension of life leads naturally to an assertion of immediate self-gratification the newborn baby has no patience. If there is no sense of tomorrow, we naturally want it all today. If life is going to last 40, 60, or 80 years, we need to get it all done in that span.
What if it were possible to know exactly how long we were going to live? What if our birth certificate had an expiration date stamped on it? The lifestyle of the inner city toughs is predicated on having no life calendar. Each day has no future. Logic is irrelevant all because of lack of identification and appreciation of a sense of lifetime. If gang members knew with confidence that they could and would live to be 100, their mad pursuit of consumption and immediate gratification and glory would erode. Length of life has consistently been shown to relate to intelligence in general. And length of life should logically be expected to relate very highly to intelligence about how long a person might live!
The point is, we can play an active role in determining our lifespan, as long as we understand that it is mutable and not fixed. Having established reliably our true lifetime potential is one of the most precious intellectual gifts our species will ever receive. But of equal or even greater importance is the nature of the new longer life, the what and the how.
SMARTS THE WHAT
Marie Garibaldi is the chief justice of the New Jersey Supreme Court. In 1987 she wrote an opinion in the matter of Kathleen Farrell. The case involved the issue of whether life support efforts could or should be withdrawn from Farrell, a 37-year-old competent, terminally ill patient suffering from ALS, commonly known as Lou Gehrig's disease. Her life was being artifically sustained in the intensive care unit by means of major medical technology. Justice Garibaldi wrote, "Matters of fate have become matters of choice." In this simple sentence she captured the essence of the illuminating moment in mankind's history. Until recently, death was random and virtually immutable. Fate ruled, and what happened was not ours to anticipate or challenge. Even twenty years ago, Kathleen Farrell would not, could not, have lived. Of course, recent knowledge and technology have changed that.
The shift of human destiny from fate to choice is enabled by one thing, and that is knowledge. For the first time we have enough smarts to propose a coherent whole view of what life can look like. We know how long it can be (the when) and, significantly, the nature and course of those conditions that threater, its quality as well as extent. We don't enter the future; we create it.
Along the same lines, almost everything in the medical textbooks about aging is wrong, inadvertently confusing one disease or condition with one another, and often returning to the presumption that aging by itself is the villain. The hackneyed joke concerns the old fellow with the sore leg visiting the doctor's office. The doctor, after a cursory exam, attributes the sore leg to aging. The patient's challenge "But, Doc, the other leg is just as old and it's fine" is haunting. Sure, aging and the passage of time play a role, but not nearly to the extent that have been presumed until now. This is great news. For conditions of old people not to be due to the passage of time gives hope that counterstrategies can be derived to prevent or reverse at least a major part of them. As we develop a conceptual framework of what aging truly is, we become newly able to reformulate the whole of the conditions that affect our lives.
FATE VS. CHOICE
Fate > Choice
Conditions as diverse as tuberculosis, hardening of the arteries, and Alzheimer's disease have in the past fatefully been conceded by practitioners to be due to aging. The error in this miscategorization is now clear, but as recently as forty-five years ago, stiff and clogged arteries were thought by all to be a reflection of "God's will." It is now evident that this fatalism was wrong. The facts that young people have some arteriosclerosis, that some old people don't, and that it is reversible proves that the condition is not due to aging. What this tells us is that it is susceptible to control.
By putting the correct label of disease on arteriosclerosis, fate is replaced by the choices of prevention or treatment. Medicine, like politics, is based on the art of the possible. If an illness is acknowledged to be due to something that is either obscure or beyond one's control, then little effort is likely to be expended. But what if the illness is not inscrutable, and a curing moment is lost because of the application of the wrong tag?
The correct diagnosis has been the cornerstone of the practice of medicine. When the cause of a condition is accurately known, the precision of treatment is made possible. Medicine has labored long and hard to make diagnosis and the rational categorization of disease a science. In my grandparents' day, thousands of people died of "acute indigestion." Thousands die today of "myocardial infarction," the same condition, but under the correct explanation.
Much confusion streams from the lack of a lifetime perspective. Illnesses are still viewed as static episodic events. This snapshot approach is driven, too, by the "quick fix" urgency of high medical costs. The acute moment of the illness obscures the evidence of earlier excess spending. In other words, only when the check bounces does an overdraw and sick notice arrive. Additionally, too much faith in the power of technology to cure has seduced us into unsound health practices.
Aging, too, has lacked a conceptual framework. By and large it has been neglected as a legitimate target for scientific study, or worse, it has been slotted as a traditional disease like scarlet fever, thereby susceptible to a curative approach. Where does aging come in? Does it deserve a subheading under all other headings, is it a disease, a process, a behavior, a symptom? What exactly is aging? Most texts don't even try to define it. Many describe symptoms that are commonly found in old persons, but almost none make an effort to provide a conceptual framework into which aging fits.
This is one of the intellectual gifts given to medicine by new research with old people. Conditions can be placed in the right slots.
This new formulation proposes that all human ailments fall into four separate and distinct types. Not only do these types have different causations, but their causations also lead to specific approaches, and even further to specific and appropriate public policy responses. These four types are (I) blueprint error, (II) lightning, (III) dissonance, and (IV) time. In more technical language, they are conditions of genetic defect, extrinsic agency, intrinsic agency, and aging.
If I, and you, have heard it once, we have heard it a thousand times. "If you want to live to a ripe old age, be sure to choose old grandparents." Cute, but wrong. Heredity has little to do with how long you live. Many scientific studies, including those which study longevity records of twins, conclude that inheritance has only 15 to 20 percent to do with how long you will live. In other words, "It's not the cards you're dealt that matter most, it's how you play your hand."
Certainly there are conditions due to a bad blueprint. These are known as the genetic diseases, such as sickle-cell anemia and cystic fibrosis, which clearly are the result of mismatched or defective genes and chromosomes. Fortunately, most bad seeds are expelled in utero, yet some do survive. Most mismatches that make it to the world are problems of early life, encountered largely by pediatricians. Once you make it to midlife, the medical conditions are basically not those due to defective design, but to conditions over which you can exercise a high degree of personal control.
The reason this is so important to emphasize is that until now people have, fatalistically, more or less programmed their health as an issue presided over largely by one's grandparents, and if a problem arose, the doctor would rush right in to restore order. It's not that simple.
Until the present era, nearly all deaths were caused by lightning conditions meaning conditions in which the person afflicted had little or no role to play in their occurrence. Such conditions are infections, malignancies, injuries, poisonings, and war. At the start of this century, eight of the top killers were lightning conditions pneumonia, meningitis, tuberculosis, and so on. Virtually the entire current medical establishment has been dedicated to addressing lightning conditions, antibiotics and surgery being the two principal areas developed to offset them, exemplified by removal of a tumor or the administration of penicillin for a strep throat. Most medical technology and efforts of the pharmaceutical industry are directed to curative approaches to these events.
Importantly, lightning conditions often lend themselves to a curative effort. Time usually has played no role in the event, and the afflicted person can, by a direct and specifically targeted therapy, be restored to the original state of health. Much great good has occurred as a result of our new understanding and treatment of lightning conditions. Unfortunately, however, new villains have rushed upon the stage, and it is these conditions, which are due to dissonance, that now crowd doctors' offices and hospitals.
Unlike lightning conditions, in which the individual has little or no personal role to play in the ailment, dissonance conditions are the direct result of the inappropriate relationship of the person with his or her environment. Further, their onset is insidious, they take years to develop, and once encountered do not lend themselves easily to cure. This is not to say that heroic amounts of energy and money aren't spent in the effort, but like Humpty Dumpty, once the cracks are made, cure is impossible. Heart attacks, strokes, arthritis, emphysema, and cirrhosis are common examples of medical conditions due to dissonance, or imbalance.
Dissonance comes in two varieties: too much and too little. Too much contact between the environment and the individual is known as stress; too little as disuse. Stress is an epidemic condition in which a person suffers a broad array of physical problems as the result of what Stanford physicist William Tiller calls the "high event density of life" constant bombardment by a tremendous assortment of often unpleasant and noxious stimuli. Ulcers, high blood pressure, diabetes, kidney damage, and skeletal and emotional problems result from living in a world that often seems simply to be spinning too fast. Disuse, on the other hand, leads to a long list of problems, including cardiovascular vulnerability and musculoskeletal fragility, as the direct byproduct of insufficient stimulation of our bodies by physical inactivity. What I, and other doctors, see in our offices is usually a result of a mixture of these two kinds of dissonance. Our brains are frizzed by too much energy, while our bodies shrivel because of too little stimulation and exercise.
Sixty years ago, famed Harvard professor Walter Cannon coined the useful term "homeostasis" to indicate the wonderful ability the body exhibits to maintain its equilibrium when buffeted by too many or too few influences. Our homeostatic mechanisms allow us to function in the heat and cold, dark and light, fed and starved, at rest and under heavy workloads. Dissonance conditions occur when these stabilizing devices are tested beyond their ability to compensate.
Finally, we come to aging. We have until recently lacked a good definition of aging, and as a result we have assigned too much mischief to it. It is not an exaggeration to assert that almost everything we have been taught about aging has been wrong. Casually and wrongly, we have catalogued almost everything that happened to an older person as due to the passage of time. The truth is that until recently we haven't lived long enough to die of aging. Virtually everything that has been consigned to aging is due instead to the accumulation of changes due to lightning and dissonance.
This recognition is absolutely critical. Aging, in my definition, is the effect of an energy flow on matter over time. It is inevitable and nonpreventable. The march of time leads to the gradual accumulation in all our selves of debris, trash, the result of the generation by our metabolism of free radicals. But as we will learn in the next chapter, aging proceeds at a more stately pace than has originally been thought.
Four possible survival curves of a hundred coffee mugs in the dishwasher are represented in figure 2 on page 32. They conform to the four categories just described. In scenario A nearly all cups break the first day, because they just weren't made to last in the hubbub of the dishwasher. In scenario B all cups break randomly, one each day by accident. The graph looks like the human survival curve of 1900. In scenario C the cups don't break until after fifty days, when assorted minor nicks and cracks accumulated over the first weeks add up and breakage appears. This curve represents the survival curve symbolic of human lifespans. Finally, in scenario D, all cups break on the last day because they simply wore out. This is what engineers call systems death. The first three scenarios represent death from component failure, one or another isolated breakdown leading to death, while the rest of the organism is still okay. Very few of us have lived long enough to get to scenario D. But we will.
This new formulation of the four types of agencies that affect not just the length of our lives but also their quality is made possible by the identification of the power of time in human affairs. If life is viewed as nothing more than a series of unconnected snapshots, then this reconceptualization is impossible. But when we understand life as a long set of tightly connected and interdependent processes, this new comprehension is made possible.
From this definition it is possible to create effective therapies. Blueprint error and time are fate, agencies beyond easy approach. But both lightning and dissonance are phenomena that lend themselves powerfully to preventive and corrective strategies: choice. This differentiation is made possible by the proper redefinition of aging.
Not only does the comprehension of the true time of a lifetime, the when, lead to a deconstruction and reconstruction of the health and medical care system, but it leads inevitably to scrutiny of other basic institutions of our society.
Many of our oldest institutions are out of date. They were formulated centuries ago when our ancestors died in their 40s, 50s, and 60s, yet we have made little effort to correct them. Now it is clear that we must, if we are to survive with any sense in the system, presuming we have the smarts to do it.
The educational system, the work career, and the basic family organization are fundamental social constructions that must be reexamined in the light of our new knowledge about the human lifespan. There is invariably a substantial lag phase between the occurrence of any major novel event such as a new technology or catastrophe or demographic shift and the impact on the persons involved. The arrival of tens of millions of baby boomers into newly extended lifetimes predictably will cause substantial political, economic, and personal unrest until the new realities are recognized, analyzed, and reacted to.
The arrival of the baby boomers at the third stage of their lives represents a disruptive occasion. This huge age cohort has already been held accountable for many changes in the educational system in America. It has been claimed that when this group attained school age, in 1951, the schools changed from being educational institutions to child care centers, simply because there weren't enough teachers and school monies available to accommodate the glut of new students. Similarly, their arrival into the housing market resulted in the boom in real estate prices in the 70s.
This gang exits their work phase to what? What are the opportunity structures out there to meet them? There appears to be a large gap between the potential of 100-plus years and the tasks that the new design offers. Lacking opportunity, the tens of millions of newly old will find a roleless role to play, a process that has been termed "social death."
Sociologists John and Mathilda Reilly explain that the rigid age-defined sequence of education, work, and leisure was developed when life expectancy was only 45 years of age, and it was developed largely as a male model. But what seems needed now is an age-integrated approach, in which education, work, and leisure are distributed over the lifespan a model that more closely approximates a female life strategy. Each life phase should include elements of each function.
Of course, we need the smarts to carry this off, including field experiments, to see how each function fits into each life phase.
Knowledge is said to double every seven to ten years. What if you stop learning around 20 years of age, and live another eighty years thereafter, with no further educational pursuit? This scenario clearly makes no sense. Our present system of grade school, junior high, high school, college, and the rest was instituted back in Elizabethan times when life expectancy was about 35. It probably made sense then to matriculate until the early twenties and then go to work, hope for a decade or so of work, and then die. But what about now, as we reach to 1007 Is it right to read your last book at age 22 and then live eight more decades without any formal effort to rev up your brain?
Gerhard Casper, president of Stanford University, is known for his enthusiasm for shortening the college curriculum from four years to three as a cost-cutting measure. I propose an alternative scheme: instead of shortening the study course to three years, expand it to eighty. As a freshman is admitted at age 18, he or she is enrolled in a program that has study courses every so often and culminates in graduation around age 98. Others have suggested taking every tenth year off from work for an educational boost. The sabbatical model makes a lot of sense from many perspectives.
What does a lifelong learning curriculum look like? Clearly, no single formula is appropriate for all. Emphasis on maintaining and extending cultural tradition, enrichment of historical perspectives, and libraries would perpetuate the social role that elders have played in society since the earliest times. Many formats will be necessary to encompass the needs of those persons with mobility or other frailty concerns. No one is ever too old to learn. The Elderhostel movement is booming. Its 1994 catalog listed more than 10,000 programs.
The necessity of reorganizing our educational institutions in the face of a lifetime of 100 years cuts directly to the heart of the issue as to whether the last fifty years of life is spent as a liability or as a resource. As the huge cohort of baby boomers turning 50 confronts what is left for them in life, how educated they continue to be is a critical and society-shaping issue. If they remain content to coast on knowledge gained in their first two decades, their role as social burdens will be assured. However, if somehow there can be a consensus built that education is a continuing responsibility, then the scene is set for the omega generations to claim their appropriate role as vital, contributing, abundant segments of the larger community. While an educated elder is a precious resource, a disconnected, disinterested, disused elder is a liability. The newly identified life expectancy demands a redesigned educational format so that lifelong learning is facilitated and rewarded.
As a longer lifespan mandates reexamination of early life and its commitment to learning, so, too, does it force a rethinking of work time. Retirement in the mid-60s was appropriate when first initiated a hundred years ago in Germany. Very few people even lived long enough to reach retirement then. But now, many people spend almost as much of their lives post-retirement as when working. This 65th birthday is sanctified as a major life marker, an event which my Palo Alto Clinic mentor, Dr. Russel Lee, liked to call "statutory senility." The event usually signals a major downshifting of gears from participating to spectating, simply because of a calendar date that has absolutely no biological significance.
In 1900 67 percent of men over 65 worked; in 1950 half did. Now, fewer than one sixth do. From an era derived during Puritan time, in which work was judged to be essential for self-esteem ("don't outlive your work"), we enter a time in which workers see retirement as a right earned after a life of work at the bench. A state of structured dependency is the result.
The new availability of generous social security and employer pension benefits are seductions to an early retirement. Social security payments rose from $5 billion in 1950 to $250 billion in 1990, from 2 to 20 percent of federal spending. This clearly can't go on.
The new abundant leisure time afforded by retirement is dangerous. One fourth of retirees admit to a feeling of obsolescence, completely separate from the notion of money. The Gallup organization asked a number of older volunteers how they got started. "Someone asked," was the common reply. The opportunity for important volunteer work gratifies the need to be valuable. Thirty-six percent of people over 55 do volunteer work, but 40 percent more say they would like to. They need only be enlisted.
New work formats need to evolve. The forty-hour work week with two weeks off in the summer as vacation just won't cut it. More flexible schedules relating to retraining and reeducation, job shifts, expansion of career options, and creation of interchangeable responsibilities are consistent with the redefinition of our work experience. For many, life is defined by work. If this is true, a radical redefinition is in order, in light of our longer and healthier lifespans.
The opportunity to confidently predict and live a hundred years places the family in a different context. The future necessitates that all of us be prepared for remaining vitally involved with the family structure. Of course, this means that there must be roles to play and responsibilities to fulfill. One hundred years of life means at least four generations, and maybe even five. The sandwich generations and the first generations as well should profit from the presence and wisdom of the older generations. The elders of the family are, for better or worse, prophets to the younger generations about what their future may hold. Our frenetic domestic mobility has devalued the role of the family elders, but many studies indicate that being near family is one of the most highly desired elements of retired persons. In fact, various research reports validate that people who retain family relationships live longer and are more functional. In other words, social ties double survival.
It is certainly true that the stereotypical family unit has many new and complex variations. New devotions and affiliations arise, and many families are geographically scattered. The resulting erosion of interdependence among kin leads to insecurity and isolation in old age. Notable, too, is the trend toward government, as opposed to family, responsibility for the well-being of older people as usually this surrogate governmental support is both economically insufficient and lacking in emotional sustenance.
Regular communication, the sharing of goods and ideas, maintenance of tradition, and mutuality of support efforts are all components of family life that aid in longevity. The proposition that all of us can and should live to 100 opens up the possibility for family role playing. It endorses the idea that the best way to make the new design fulfilling is within the family framework all for one, one for all.
Guts and smarts are the ground rules for 100. This chapter has as its central intent the establishment of the horizontal time dimension of the life portrait, the when, and assignment of its ingredients to the proper category fate versus choice, the what. Loudly proclaimed these days are "right to die" initiatives. But rights derive from responsibility. Yes, we all have the right to die, but only after having lived responsibly. We now know enough that this responsibility is here to stay. The ability to distinguish what is ours to choose and change, and what is ours to accept, has been sacred since St. Francis and before. The when and what of smarts lead naturally to the how, which is the subject of the next chapter.
Copyright © 1996 by Walter M. Bortz II, M.D.
Table of Contents
Introduction: The Future Isn't What It Used to Be
CHAPTER 1 Guts and Smarts
CHAPTER 2 Our "Just So Story," or How We Got This Way
CHAPTER 3 Life Involvement
CHAPTER 4 The Roots of 100
CHAPTER 5 Gameplan for Life
CHAPTER 6 Ninety-nine Steps to 100
CHAPTER 7 Know Your Age Act Your Age
CHAPTER 8 The Portrait of a Life