Compressing Our Morbidity

It’s a great concept — that we will reduce our illness and our functional problems to a small period of time before death. We will live healthier lives and not live an old age of long years needing care or living in long-term care institutions. One of the more frightening aspects of older ages is the frailty and disability that we see in some older people. Having a stroke in your 70s and living until you are 85 is not our idea of the ‘golden years’ of retirement.
George Bernard Shaw lived to be 94 and died shortly after a fall that came while pruning an apple tree. It is the type of death we all aspire to – active into our later years and not debilitated.
We were hopeful for a while. It did seem to be that life expectancy increases were being matched by an increase in disease free years. A recent piece in the Journal of Gerontology: Social Sciences by Eileen Crimmins and Hiram Beltran-Sanchez suggests that, unfortunately, research indicates we are not experiencing fewer years free of disease and loss of function. They posit that “compression of morbidity may be as illusory as immortality.”
The good news is that we may be doing better handling the diseases we get than in previous years. We are identifying diseases sooner and thus initiating treatment sooner which is allowing us to live longer despite the presence of serious diseases. Diseases are ‘less lethal and less disabling.’ We have improved the ability of our environment to support our capacity to function. Most of us will take longer life if the diseases we have are manageable and we can function.
The bad news comes from two sides. The first is the increase in obesity at all ages and the potential effect of this on life expectancy and decrease in life functioning. This trend will compress mortality by shortening lives but may increase morbidity. The second source of bad news, at least for our wallets, is that those extra years we are enjoying with disease require more medical intervention than ever and disease care costs money. Witness the predictions about the ‘bankruptcy’ of Medicare and how the year that happens keeps getting closer.
The best action we can take? It’s the same old answer – exercise, eat right, stay connected with people. And maybe keep pruning those apple trees.