Monday, April 6, 2015

A Rhapsody of Falling Apart

© Charles D. Hayes

Human genetics are a roll of the dice, and nothing highlights life’s unfairness like health issues. Some people sail through life in great health while others never seem to get a break, having one illness after another until they finally succumb. Needless to say, health is a major topic of interest among seniors.

Far too much attention is paid to the economic juggernaut but false promise of products and services offering eternal youth. What we ought to focus on is the reality of our demographics: Because of our aging population, we are facing an economic and human needs train wreck of epic proportions.

Let me say first that I’ve always promised never to let my physical condition become the dominant focus of my conversation. But now at an age some consider elderly, I find that reaching a period in one’s life when one seems at times to be literally falling apart is interesting in itself to observe. At the same time, it is also a wake-up call about America’s long-term health care predicament because millions of people are having similar experiences, many with grave consequences.

The sudden appearance of new ailments cracks open a critical window on reality. The more often the occurrence, the wider the view, and the greater the need to pay attention to the politics of health care.

In 2011, Laura L. Carstensen published A Long Bright Future: Happiness, Health, and Financial Security in an Age of Increased Longevity. More recently, she wrote a piece for Time magazine suggesting the baby pictured on the cover could live to age 142. The evidence is clear that we are living longer, but what we aren’t doing as a society is preparing for it.

The baby-boom generation comprises 78 million individuals, with more than 40 million already over age 65 and four million more adding to that number every year. The elder bulge will continue to expand until 2029. Elsewhere I’ve written extensively about this subject, mostly with positive expectations. We have many dedicated people working tirelessly to meet the economic demographic challenges of aging, but we aren’t even close to making acceptable progress. Time is running out.

If you are introspective and curious as you reach advanced age, you may, like me, become hyperaware of the seasons of life: the cycles of existence, falling leaves, sunsets, magnificent trees, and winter. All seasonal reminders of mortality and similar patterns begin to stand out. Conditions that match your expectations seem to pop up everywhere for perspective, and new incidents of physical pain give rise to serious moments of thoughtfulness.

These experiences bring to mind the Brahodya competition, something that religious scholar Karen Armstrong describes as having occurred among tenth-century Indian priests. In it, a group of priests would compete to describe and capture the essence of reality. The contest winner was the one whose comments could render the others dumbstruck. This brief moment represented the Brahman—something akin to the highest form of consciousness one can achieve.

Dumbstruck silent is a condition similar to what I refer to as a time-out for thoughtfulness, contemplation, and perspective, especially when we consider what the future portends for aging citizens. Geriatric health care is ripe for a Brahodya competition.

As we age, seniors read the obituary section of the newspaper more frequently because more and more people we have known show up there. In so many of these cases, the individuals featured awoke one morning with an ailment and a few months later ceased to live. So it’s not surprising that one’s new aches and pains come with a few moments of dumbstruck wonder, prompting the questions, “Is this it? Is this what will take me out?” It’s an experience worthy of introspection.

Armstrong offers another example of reflective silence when, at the end of a symphony, the last note is played and one is left with a moment of stunning serenity. I find this comparable to watching a great movie and realizing the end has flashed on the screen. Stirring music is playing, the credits are rolling, and you’re still lost in thought with at least a subliminal awareness that everyone’s story comes to an end. These, too, are opportunities to think.

 Inspirational moments often occur when listening to beautiful music. A crescendo of emotion can be so overwhelmingly exquisite that it seems too good to be true, beyond the capacity of music to arouse. Such moments of stunning exhilaration are times to reflect as well.

I’m not suggesting that all of the circumstances giving pause for thoughtfulness are the same, only that they are related, or that they belong to the same category of openness to experience. Dumbstruck moments can be called an aha, a flash, an inspiration, an epiphany, or simply a time-out, but they all yield a similar opportunity to take stock and truly appreciate the reward of still being alive—a reminder to help raise awareness to the problems that beg public attention. We owe this effort to the younger generations, whose lives will be affected by the current tidal wave of aging citizens.

In The Age of Dignity: Preparing for the Elder Boom in a Changing America, published this year, Ai-Jen Poo is launching a movement promoting some very kind, thoughtful, and practical ways to address our aging health care concerns. But, in spite of our best efforts, the reality of aging demographics portends a fast-approaching social catastrophe.

Ai-Jen Poo calls our attention to the economic estimates made by the Alzheimer’s Association that the total health care costs for Alzheimer’s over the next four decades could be $20 trillion. That’s not a train wreck. That’s a nuclear blowout. It can’t happen. It’s out of the question. We either have to cure Alzheimer’s or take drastically different steps in the way we address the care of patients.

In thirty of fifty states, the shortage of nurses is expected to increase for decades. The shortage of doctors in the field of geriatrics is shocking. Medical professionals say we need a doctor-patient ratio of 1 to 300, but by 2030, the current estimate is 1 to 3,800. That’s a derailment.

Medicare is already so inadequately funded that it’s become harder and harder to find physicians who will accept new patients. Eligibility for Medicaid requires proof of abject impoverishment. We don’t even have the political command to address the long-term viability of Social Security. More and more seniors are struggling just to get by, even as the costs of health care escalate.

Families increasingly can’t meet the whole burden of caring for aging relatives, and the cost of institutional care continues to skyrocket. As a workforce, health care givers are underpaid across the board, and the turnover rate is appalling. We have to think and act our way out of these dilemmas. Without a political effort nationwide to meet the demand for services, millions will suffer needlessly.        

One of the things I’ve learned from living, studying, and talking to aging peers is that with a long life comes affection for one’s own life experience. More often than not, the idea of changing places with someone in a younger generation is rejected as undesirable. In and of itself, feeling a sense of ownership of one’s experiential knowledge is worthy of a time-out for introspection.

This might seem like a stretch, but when you acquire new aches and pains that are inevitable with aging, I suggest making the best of them. Consider listening more often to your favorite music and creating an insightful emotional and intellectual rhapsody of the whole experience. Apply some perspective to having been afforded the life of a human being, because when you consider the odds of it ever happening, you are inevitably dumbstruck.

Whenever we feel a new ache or pain, we should be aware that, for every one of us still in good enough health to be thoughtfully reflective, there are literally thousands of others in worse shape. In nursing homes across the country, aging citizens are routinely shot so full of stupor-inducing medication and so dependent on intrusive feeding tubes that, in effect, they live a hydroponic existence—wearing adult diapers, spending their days struggling simply to breathe and swallow, unable to speak or sit up—and they do this for weeks, months, even years.

Nature seems cruel in many instances, where aging and sickly wild herd animals end up in the jaws of predators while still alive. And it was the custom in many tribes of ancient people to abandon their elderly, leaving them to die in the elements without provisions. In comparison to the nursing home scenario described above, however, nature and the traditions of some ancient tribal cultures seem much less diabolical. If you doubt this, visit a few care facilities, especially in low-income areas.

In her book, Carstensen warned about failing to meet the challenges of aging in America. I’ve always shared her observation about taking dire warnings with a grain of salt, but a trainload of salt is inadequate to describe what the future portends if we stay the present course without taking immediate actions equal to the range of problems we face. We aren’t prepared for people living as long as they do now, let alone far past the century mark.

Of course, myriad technological breakthroughs, from remote monitoring to distant diagnostics, can give us hope. They include robotics and innovations in assisted living arrangements to help aging seniors. But these are expensive, and they also leave us open to crisis during power outages and technological failure.

So, you may think it trite or disingenuous of me to speak in terms of a rhapsody of falling apart, considering all I’ve said, but death is an inevitable reality for each and every one of us. It’s long past time that we have grown-up discussions about the realities of aging. Products and services promising endless youth are not the answer, and those who promote them are selling illusion.

Every time we experience a moment of reflection for whatever reason, it’s an opportunity to think seriously about the future, to engage in dialogue with our elected representatives and social media, and to urge people to wake up and speak up.

Aging demographics are on track full speed ahead, and unless we make some serious adjustments, we are bound for an economic disaster that is likely to play out as a political blame game. Millions of seniors will pay a price of needless suffering simply because our political parties refuse to deal with the economic and social realities of aging. It’s already happening, but too few are calling attention to our collective denial.

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