Editor's Note
The New 80
My first memory of old age was of my maternal great grandmother. On weekends, my mother would pile the family into our car and drive the 2½ hours to bustling Sheridan, Illinois, population 300, where my great grandmother Gransden lived with her bachelor son in the white frame house that had been her home for 60 years.
At 80, she was already a marvel for the 1950s, having long ago eclipsed the longevity records set by others in her family. For the next decade, I remember innumerable emergency trips to Sheridan because she had had another stroke, only to see her survive with hardly a trace. After about the third such trip, my father sardonically proclaimed that she would outlive us all. She didn’t, but when she died at the age of 93, it was cancer, not the repeated strokes, that took her.
While in her 80s, Grandma Gransden moved slowly, and so did her daughter when she reached the same age. My grandmother Schloerb confined her activities at our lake cabin to kitchen duties and watching the waterfront activity. Eighty-year-olds are different these days. Many lead active, vigorous lives, living independently, traveling extensively, and working in their communities. And there are more of them as well as their elders, the 90- and 100-year-olds.
The explosion of the “oldest old,” those 85 and older, in recent years has challenged the economics and the science of medicine. In a few years, the bumper crop of baby boomers will begin their trek to the elder ranks, and the calculus of Medicare and Social Security dollars has economists and politicians scrambling to make the numbers add up. Not only are physicians seeing more of the commonplace problems of the aged such as hearing loss (p. 48), falls (p. 11), and sleep disturbances (p. 45), but we are uncovering new problems such as gambling addiction in the elderly (p. 14) and dealing with others that become dicier when they happen in the very old. I had a 92-year-old patient whose angina responded only to IV nitroglycerin and whose coronary arteries were not treatable by angioplasty. Our choice was to turn off the nitroglycerin and let her heart muscle infarct or send her to bypass surgery. We did the unthinkable surgery, and she survived.
Whether the elongation of lifespan is good or bad is debatable. The 85-year-old widower with a new 82-year-old girlfriend would say it’s good. But clearly more nonagenarians and centenarians mean more tough medical choices. Even if future medical science solves some of the conundrums of aging, as more and more of the elderly reach old, old age, the expensive medical problems of the last days of life will still happen. In 1980, Stanford gerontologist James Fries, M.D., introduced the concept of compression of morbidity, shortening the time, and hopefully the cost, of end-of-life illnesses. At its ideal, compression of morbidity would have everyone staying active until a ripe old age and then dying suddenly. Part of the discipline of geriatrics is figuring out how to help the elderly navigate their final years with the least morbidity possible.
My other memory of old age in my family is of my parents. For his entire life, my father resisted the trappings of the elderly, insisting that his grandchildren call him “Dick” rather than grandpa, downing Adele Davis concoctions with their promise of retarding age, and waterskiing into his 60s. He and my mother maintained a hectic social and travel schedule into their 80s and, though they experienced some morbidity (hip replacements and a coronary bypass), they lived independently until their death in a plane crash at the ages of 84 and 83. Theirs was an unusual tale for Grandma Gransden’s era; but in the 21st century, stories such as theirs will likely be the rule rather than the exception.
Charles R. Meyer, M.D., editor in chief
Dr. Meyer can be reached at
cmeyer1@fairview.org