Janice Lynch Schuster

Disenfranchised as I am from the Roman Catholic Church in which I spent my childhood, I rarely find much about its workings to be instructive. But last month’s news of what is variously termed the abdication, retirement, or resignation of Pope Benedict XVI gives me pause.

Historically, Catholics expect their leaders to die with their boots—or slippers— on, regardless of age or illness. Benedict’s predecessor, John Paul II, did just that, dying of heart failure and related complications a few weeks shy of his 85th birthday. But, the current Pope made a markedly different decision. As Benedict described his decision to leave his post: “Before God, I have come to the certainty that my strengths, due to an advanced age, are no longer suited to an adequate exercise.”

His remarks will be anathema to many Americans who claim that 50 is the new 30, 90 the new 60, or gray the new black. My friend, geriatrician Joanne Lynn, M.D., talks about our lives as the “temporarily immortal,” and the reality that we are all “old folks in training.” As a society, we are inclined to believe that if we only live right—eat right, exercise,  don’t smoke, drink little—good health and nearly perpetual life will be ours. We envision an old age that mirrors those we see on TV or online, rocking a comedy like Betty White, or skydiving, like George H.W. Bush.

Reality will be less kind to us, and, as it turns out, we have not been so good to ourselves. One recent study indicates that Boomers are, in fact, in poorer health than previous generations, and predicts that they will contend with a host of chronic conditions, such as diabetes and heart disease. (1) Other studies point to the growing burden of chronic disease, and the increasing numbers of people who will live for several years with an array of chronic conditions. (2) The bright side, if there is one, is that modern medicine and technology can help us to live with and despite illness. And for the most part, we will be grateful for the things that prolong our lives.

But those lives will, inevitably, end. And, for most of us, they will not end suddenly, or dramatically, in our sleep or in a lover’s arms. In fact, many of us will, like Pope Benedict, dwindle away, beset by illnesses, frailty, and a general lack of reserves. We will live for a few years with several chronic conditions; we will rely on others to provide the most basic kinds of care. Indeed, too many of us are likely to end our lives in an intensive care unit where we will have undergone aggressive, costly, and ultimately ineffective treatments. Others will end in hospice care, but even that, new research suggests, comes only after a course of aggressive treatment.

The real trouble in all of this will lie in our ongoing inability to address burgeoning needs and inadequate resources. When people reach a certain level of frailty and poor health, inevitably they will  need much more than medical care; they need help with getting to appointments, stocking the cupboards, paying the bills, and so much more. For now, much of this work falls to unpaid family caregivers who provide something like $450 billion dollars each year in care for loved ones. The health care system increasingly relies on these caregivers to perform skilled nursing tasks, such as changing wound dressings, monitoring IVs, giving injections, and checking vital signs.

Aging boomers will not have this kind of support available to them. We had fewer children and so have fewer caregivers on whom to rely. And our children, beset by the economic downturn, are increasingly unable to bear the financial consequences of caregiving.

What’s a society to do? We can take several steps, which would include recognizing frailty as a distinct phase of life, one with very particular needs and issues. We need to create comprehensive care plans that address all aspects of a person’s life, that can be accessed anywhere, and that change over time. We need to bridge the gap between medical services and social supports. And we need local authorities that can monitor community needs and target resources.

In the meantime, we need to acknowledge that increasing age presents challenges and opportunities that are foreign to us when we are young and well. As Pope Benedict lives out this phase of his life, we should see our own futures unfolding. We will not be able to turn to the resources of the Catholic Church, or engage in the contemplative life of the monastery, to which the Pope is bound. But figuring out how each of us can make this journey is an essential task for us all.
This post originally appeared on Altarum Health Policy Forum.

References

1)  King, D. E., Matheson, E., Svetlana, C., Anoop, S., &  Broman-Fulks, J. (2013)  The status of Baby Boomers’  health in the United States: : The healthiest generation?  JAMA Internal  Medicine. Advance online publication. doi:10.1001/jamainternmed.2013.2006

2)  Skerrett, P.J. (2012) , December 14). Studies explore global burden of disease and heart disease in the United States. [Web log post].

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