The reason I was in Basel (see last blog) was to speak at the annual meeting of the Swiss Medical Association (SGIM). The title I was given by Verena Briner, the Association’s president, was “Does longer life mean better life and better life mean longer life?”. Of course this was an impossible question, so it was necessary to break it down into a number of constituent parts. The first question related to what is happening with longevity. Life expectancy has increased enormously in developed countries in the past century, even though retirement age has hardly changed. What can we expect in the future?
Essentially, there are two views. One is that there is no reason why life expectancy should not continue to increase. The other was that we are now, at least in the countries where people are now living longer, reaching a biological limit. I was able to draw, in particular, on an excellent review of the evidence by Jean-Marie Robine, who is one of the leading European experts in this field. In essence, it seems that the maximum age at death is not likely to increase dramatically in the future, with the oldest people dying at about 110. However, many of those people who, in the past, died much younger, are now living to quite old ages, so that overall life expectancy is increasing.
But if people are living longer, will they be sicker? Almost 30 years ago, Jim Fries, at Stanford, proposed the concept of “compression of morbidity”, whereby the factors that allowed populations to age, such as reductions in risk factors such as smoking throughout life, would mean that those surviving to old age would be healthier than in the past. There is now considerable evidence that this is happening. However, older people are accumulating more chronic disorders, such as diabetes, Parkinsons Disease, and arthritis. Fortunately, the availability of modern pharmaceuticals is allowing them to remain active and engaged with society.
But does this mean that they will cost society more for their health care. Apparently not. What does cost money is not being old but being close to death. Indeed, paradoxically, the cost of dying is often less at older ages because health professionals intervene less intensively.
So the challenge is how to age successfully. This is an issue that is being examined by my colleague Yvonne Doyle. Using imaginative analysis of British surveys, she is showing how important it is not only to minimise exposure to risk factors but also to remain engaged with society and, in particular, to retain self-confidence. Essentially, you need to believe in yourself as you get older. The crucial thing is that you should not write yourself off when you retire.
Clearly, this was a more optimistic message than many of the audience were used to and it was nice to have such a positive reception when I finished. However, I then received a tribute that has, in my experience, quite unique when, at the dinner afterwards, one of the speakers read a poem about my talk that he had written in the intervening few hours. I am extremely grateful to Dr Max Stäubli both for writing it and for his permission to reproduce it below. I haven’t attempted to translate if from the original German as it would ruin the rhyme. However, if readers want to pass it through Google Translate, I won’t stand in their way, but of course I certainly won’t guarantee whether it still means anything when it comes out the other end!
Heisst länger leben besser leben,
den Standard immer höher heben?
Dazu muss man statistisch denken,
das heisst, den Blick erst rückwärts lenken:
die letzten 170 Lenze
stieg an die mittlere Lebensgrenze
aufs Doppelte, kam `s nicht zur Panne
verfrüht schon in der Lebensspanne.
Doch gilt die Regel wiederum
nicht für das Altersmaximum,
denn dieses in der gleichen Zeit
wuchs nur um eine Kleinigkeit.
Daraus folgt klar die Konklusion,
Wunschdenken nur und Illusion
ist `s wenn man glauben will, es werde
der Mensch stets älter auf der Erde.
Auch hier ist `s besser, Mass zu halten,
den Alltag sinnvoll zu gestalten,
Verpflichtung weiterhin zu wagen,
dem Raucherlaster zu entsagen
und immer kreativ zu bleiben,
vernünftig einen Sport zu treiben,
so wird auch kürzer jene Zeit
Die Alten alten so gesünder
im Kreise der Urenkelkinder.
In Japan sind die Mehrfachkranken
viel seltener, was sie verdanken
der Soja- oder Tofuspeise,
das heisst, der Grundernährungsweise.
Und immer öfter lassen Leiden
beim Älterwerden sich vermeiden,
sowie entsprechende Beschwerden,
die Wohlbefindlichkeit gefährden.
Ist über 90, wer verstirbt,
Herr *Couchepin `s [Swiss minister of health affairs] Budget nicht verdirbt,
denn in dem Falle klar ergibt sich,
man macht nicht alles, was mit 70,
man noch zu investieren neigt,
wenn sich die gleiche Krankheit zeigt.
Ist auf der Pyramidenspitze
man angelangt, braucht es die Stütze
durch unsere Lieben zwecks Bewegung,
für Botengänge und Verpflegung,
dass letztere nicht nur einerlei,
jedoch gemischt bekömmlich sei.
Wer insgesamt sich so bemüht,
auch noch mit 95 blüht,
trägt bei zum Sozialprodukt,
indem man seine Papers druckt.
Und das gelingt, wenn nimmermüd`
man bleibt auch ein Vereinsmitglied,
pro Jahr sich einmal SGIM-versammelt,
damit der Estrich nicht vergammelt.
Max Stäubli, Basel, 2007