My wife's aunt passed away last year from some kind of brain issue (I never did figure out exactly what the problem was -- lack of vocabulary). She was in and out of the hospital for about 3 months and while distressing, I think she very much appreciated being alive in those 3 months. After that she essentially ended up in a kind of semi-coma where she was awake for maybe an hour a day -- and she was in a nursing home. After another 5 months or so she passed away. I don't know if she got much value from those 5 months, but I know her husband definitely was able to use the time to come to grips with the reality of the situation. Again, just an anecdote, but I think it's illustrative of the complexity of the situation.

Anyway, I think most people can look forward to enjoying their old age. Of course it makes a big difference if you look after your body when you are young and it is much easier to do so.

>On the other hand, because I live in rural Japan and am only really friends with the people who live near me, almost all of my friends are over 70 (I'm 50).

I'm in a pretty similar situation ... guess from your profile that it's OK to hook up with you by email ?

That's not what selection bias is -- that's just an accurate reporting of what you see around you. It would be selection bias if you additionally claimed that this must be the case elsewhere too.

Perfect disclaimer on the limitations of his analysis because of the selection bias inherent in the data sample.

It's kind of anecdata, but have you ever noticed how in classical books from a few hundred years ago, it's sort of normal that Mr So & So might be on his third or fourth wife because the others died in childbirth? Just something that caught my attention.

To play devil's advocate, a lot of older people in Asian, Latin, and Middle Eastern societies don't end up in retirement homes.

Yes, they exist, but it's culturally expected for children to take care of their parents in old age (just like the parents took care of the kids when they were young). Sure it doesn't make the quality of your last decades in life much better but I think at least it'd involve less crippling loneliness.

In developped countries the cost (mental, economical, physical) of caring for parents drive away children, and where there was two to three siblings decades ago, in these day and age single childs are plenty.

To me, it's absolutely not "questionable at best": it's a tremendous step for humanity on a path to a fully enjoyable long life.

On a population-wide point of view, the next step is that the first 60/70 years should be dedicated to building a strong body. Sport and nutrition, done intelligently (no mindless cardio, for example), can do wonders for the last 20 years of one's life.

A strong body can be achieved by virtually anybody with time and dedication, minus specific conditions (laziness is not a specific condition). I'm not talking about being lean and jacked, I'm speaking about strong body, with working joints that have been taken care of during the whole life.

Of course there's medical conditions specific to old age that can't be escaped even with a strong body, mainly brain decay. Science needs to continue its quest here. I've read that there's hints that Alzheimer may be linked somehow (in a complex way) to lack of sleep: I can assure you that you sleep well when you lift every two days, years after years. In the end there's no simply no logical reason to neglect our body.

The bulk of old people in nursing have just completely neglected their body for their entire life, and that's the main reason why they can't enjoy the last years. As a civilization, we should now focus on engaging current generations to prepare their body for the end.

You can assure me, but it won’t be true. Source: lifted at least five days a week for years and was deeply insomniac the whole time

So naturally the state of those placed in a nursing home is dire, and when you view the nursing home as a place for the old rather than for what it is it’ll give you the idea that old age isn’t something to strive for.

In reality, however, a nursing home is really a long term hospice and everyone who live there is slowly dying from a range of diseases. Often because they didn’t live healthy lives.

That’s not what old age has to look like though. More and more people are living rich lives even after they turn 90, and while we can talk about the quality of life of those who don’t, the technological advances are also helping people who don’t go to nursing homes.

It’s sepecially helping with mobility, so that people who get sick in a non-lethal way, like getting pains from walking, can stay out of the nursing home longer than they used to.

On the surface, we like to say how we're providing care and have their best interests in mind as they "age well" and as we repay the debt of elders who took care of us so dutifully for years.

But in reality, the main usage is to get rid of very burdensome, cantankerous, and irresponsible leeches who because they left their children with a sense of hatred will not give in to the idea of putting up with their crap ever again, so let them rot all drugged up in a coma where they cannot escape as they watch TV in a urine-soaked room and play bingo every Wednesday night until they die off.

It's more a short-term fix for us though, a pretty typical American form of cutting off the nose to spite the face since national spending is sprialing out of control from dealing with the old and will become a larger economic problem. Ironically, it does force the hand of the young in later years once filial laws come back in full swing enforcement who will end up saying enough is enough and euthanasia legalization legislation will come swooping in to deal with this.

The policy, cultural struggle I'm currently having is we won't let the elderly die in peace, with some dignity.

The growing acceptance of hospice and euthanasia, during my life time, has been very encouraging.

But what happens when people are kept alive after they lost their agency?

My immediate family has two people in a nursing home. The sicker of the two is essentially a vegetable and is not permitted to die (feeding tube, other heroic efforts). The some what less sicker is also trying to die, but at least still remembers his own name, can return greetings.

If either of these two men were lucid, they'd be livid to learn they're still here.

There's a guy down the hall who hasn't had any external contact in 11 years. No friends, no family. He's a complete vegetable. It's horrifying.

I've instructed my family that when I'm no longer able to converse, when I need someone to manage my hygiene, to let me die. I do not want to become a long term burden on the living.

I'm so worried about it, I've been researching ways to kill oneself, should the need arise.

Anecdotes based on my experience with mother working as nurse in nursing home, and being American.

Remember the running gag from "The Golden Girls" where Sophia, the oldest member of the cast, was often threatened to be sent back to the retirement home of hell "Shady Pines".

(Another alternative of course popular in some cultures is to let them toil away even at 70 or more, and have them live alone and "independent", with the token visit).

These feelings are universally shared, but only visible to most in times of scarcity and fear. When economies are bubbling along in mania, people tend to lose sight of the eventualities regarding unsustainable societies. It's easy for people to rationalize their actions as charity, benevolence, and empathetic concern when they themselves are rewarded daily for vocalizing the whitewash and justifying what should be by what is now. When the music stops and individuals are left to fend for a chance at a seat, the full intention of previous actions becomes apparent as if malice is not something definable by planned greed and desire but puppetered unknowingly by a more clairvoyant self that protects its fragile present with the blessing of moral amnesia.

I do know for sure nursing homes are definitely used to "remove a burden." Dealing with elders at that stage of life can very taxing, and many people would rather simply avoid it. They may even, as the poster hinted at, dislike their family member. However, even then I don't think they share as strong emotions as the poster.

Whatever the case, I'd welcome research into attitudes towards eldercare. Right now, I feel like we're flying blind. For instance, I wouldn't be surprised whatsoever if GenX'ers (like me) would rather die than be warehoused. But no one I know is thinking that far ahead, having these discussions with their kids. Nor are our parents discussing this with us, now that it's our turn to be the care givers.

--

For instance:

Family Involvement in Residential Long-Term Care: A Synthesis and Critical Review [2008]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2247412/

"... These collective findings have helped debunk the myth that families abandon their relatives in nursing homes or similar settings to die in isolation..."

If you happen to wonder "what went wrong with this guy that caused him to become so jaded?" and contend that "he doesn't speak for all of us, I'm different!" well I will say it is very true that I am sort of an anomaly in current sentiment. Most people do not like how I end up deconstructing the world I perceive and view my analyses as ususally extremist, having getting kicked out (or desperate attempts at 'rehabilitative' disciplinary action) of nearly every organization I've ever been a part of from gatherings of family and friends to Sunday schools and churches, scouting, schools, and companies alike. I realize due to the repeating pattern the problem is most likely seated in myself, but if you're listening you still may like to entertain the idea that the superficial gloss we paint the world in vain attempting to heal our souls could in fact only be concealing a necrotic core. Maybe not out of actual belief in such a situation, but only to check due diligence off the list and set your mind at ease that judgement of our times will be favorably looked upon and your decisions were made with principled reason rather than excuses of being led astray by deception.

Sure.

I reprogrammed myself. I chose to be positive, optimistic. It took years.

Life is a gift, every day a celebration. I rejected the recurring debilitating existential terror. I now find joy wherever I can, however I can, and do good works as able.

Good luck.

That said, euthanasia would be a great option to have for those with chronic ailments.

For example he states that for the average 4.7 years of added life expectancy between 1990-2010, 3.8 years added were healthy.

The leading cause of death in the US in 1980 was heart disease. It is still the leading cause of death today. However, the absolute number of deaths due to heart disease has declined by 17% from 1980 to 2015. This is despite the population growing by 42%. That is pretty amazing.

I don't have data on exactly what contributed to this decline in heart disease deaths, but I'd bet it is better drugs. The first statin was approved in 1987. ACE / ARB inhibitors were approved in the 1980s and 1990s. Again I don't have data on exactly what caused the decrease in cardiovascular disease deaths but would love to hear if others do. Nutrition and lifestyle (less smoking?) could have played a role as well, but diabetes deaths have increased a lot, so I don't think lifestyles have become too much healthier

The second leading cause of death is cancer. The number of deaths from cancer has roughly tracked population growth.

The third leading cause of death in 1980, stroke, has seen absolute numbers of deaths drop by 18% from 1980 to 2015

Is this a good metric though? It seems to me that (1) once you get cancer, you always have cancer, and (2) if nothing else kills you, cancer does. So maybe a better metric would be, the lifespan of people with cancer?

Unfortunately I don't have data either, but I do have a hypothesis that may or may not end up surviving scrutiny when the relevant data becomes available. If someone can refute these ideas, please contribute.

The ultimate cause: demographics changed.

The recent decades have seen native populations reduce their fertility in the US. This is analogous to ecological succession of pioneering species colonizing barren land building up new soils by quickly flourishing and in turn crowded out in competition as other species take hold in niches opened by the pioneers laying a rich framework however being unsuccessful at sustaining dominance due to the energetic and fitness costs of extreme adaptation in resource poor environments that are unable to be useful traits relative to other species that can quickly capitalize on existing infrastructure when there's no need to divert capacity to build anew when resources become abundant. Today when applied to populations of humans in the US, the same principal goes under names like "white flight" as fleeing urbanization to recreate past conditions that were more favorable in competition strategies, "gentrification" when enclaves of urban areas decay and are then susceptible to recolonization efforts, and "immigration" to relieve bottlenecks in reproduction and the resulting scar of exposed barren land and poor nutrient circulation in the ecosystem that are caused by pioneer individuals stockpiling reserves without reinvesting in reseeding efforts.

Heart disease is typically a progressive terminal stage of diabetes and other metabolic disorders that intertwine risk factors such as poor nutrition, excessive calorie consumption and resulting unhealthy body fat percentages, alcohol abuse, cigarette use, and high stress. Looking closure at the medical literature, I'd actually reconsider the idea that statins produce beneficial health outcomes, but I won't get into that in this comment.

The point here is that in heart disease being the cumulative effects over a lifetime and diabetes as a _leading_ (not trailing) indicator of population risk for heart disease, what you're really seeing is the transition of health since WW2 when war rationing forced the agricultural and food processing industries to change course in providing massive amount of calories at low cost and effective propaganda and marketing to ensure sustained demand when the war was over to not shock the economy back into depression. Heavily processed foods like spam, American cheese, and canned/dried foods are technological means to make food supplies go further with less waste and higher caloric density. Add in things like pushing cigarette consumption heavily after the war and you get the perfect storm that kills off a large percentage of the lower class baby boomer generation early in life by around the 1980s. What's left since then are the middle and upper class baby boomers whose children reproduce in far lower numbers, being replaced with immigrants. Those immigrants come here with very different cultures regarding food consumption, nutrition, and healthcare that for a period of time did decrease the incidence of influence of the cultural epidemic of war-era food technology.

Usually after one generation though, immigrant families transition to the already establish cultural expectations and shift dietary and consumption patterns. Therefore you get the next surge of diabetes as the form of the next incarnation of the cycle. In a few decades you'll see another recurrance in more prevelent heart disease.

My Mum is 86 and my father turns 90 Saturday. I live at my Mum's summerhouse currently and most of the people around are around 80 y.o. There is a bias of course (some died and others ain't comming to their summerhouses) but they are active and taking care of themselves.

I have some re-modelling of the summerhouse done by a neighbor who is 80-ty, he has cancer, had a stroke but is very active, optimistic, friendly and God, he is good with his tools and when starts working he can't be stoped.

The healthcare ain't perfect but it is quite good, the pensions are OK and if you managed to stay active and relatively healthy then you can enjoy your time. That's my impression.

Which ones?

Some people might still think these are good things. I think "questionable at best" is a good summary.