Quality of life, not quantity

A life worth living

There is a case to be made that we care far too much about life expectancy. A lot of modern medicine, both with regards to research and to practice, is geared towards increasing our overall life expectancy. Life expectancy is even used as one of the primary indicators for the overall health of a population. But perhaps we’re going about this the wrong way.

Since the 1960, the average global life expectancy has increased by about 15 years. While life expectancy growth has slowed somewhat in developed countries in recent years, the worldwide trend is expected to keep increasing our average life expectancy with another 10 years by 2100. We are getting older all the time, and recent studies showed that we might end up living up to a 150 years. It seems like there’s no end in sight for our increasing lifespan, at least for the foreseeable future.

That’s great right? When we look at the media, they often depict the elderly as vigorous, full of life, and not having lost a step since they were 30. Some of these people certainly exist. In fact, Joe Biden recently became president of the U.S. at 78 years old. But how often are we confronted with people who aren’t as well off in old age? The frail, the mentally incapacitated, those in nursing homes with little outside contact… For most people, getting old is certainly no picnic. At old age, many people have little left to look forward to.

“We rarely spend time and effort on making sure that these additional years are actually fulfilling years that are worth living. Why? Because that’s not nearly as profitable.”

A curious thing happens when you search Google for “looking forward to old age“. You get dozens of hits with titles such as “why you should look forward to old age”, “why I genuinely look forward to aging“, “good reasons to stop dreading old age“, and similar titles. While the overall tone is written optimistic, there is no mistaking what our overall underlying perspectives on old age are: the majority of people do not look forward to getting older, and could do with some good suggestions to make the prospect more palatable.

The numbers go up, but it’s all downhill

There is a good reason why most people are apprehensive at best about old age. While it’s unclear how long our bodies are ‘meant’ to last, it’s clear that we are pushing at the edges. It’s no coincidence that many of our bodily functions and mental faculties start deteriorating at around the same age. In most cases, we experience some minor decline starting in our 30s, but the onset of more serious decline starts setting in around out 60s, and in our 80s most of our systems kick the bucket.

Hearing becomes significantly worse in our 60s. While muscle loss begins around our 30s, the rate at which we lose our muscles increases dramatically after our 60s. The prevalence of visual impairment massively spikes starting around the age of 60. In our 60s, incidences of dementia and Alzheimer’s start emerging. This then increases at an exponential rate, and by the time we reach 80, between a third to half of people have developed some kind of dementia. Heart failure starts to get relatively common when we reach our 60s, and the median overall age for heart failure is in our mid-70s. And the list goes on and on. The trend is always the same. By age 60 we’ve passed the warranty date, and by age 80 we’re better off asking which parts are still working as intended.

On top of that, we spend a larger portion of our healthy lives working. Since the turn of the millennium, the average age of retirement for OECD countries has started creeping up more and more. During that same time period, average life expectancy also increased, but at a slower pace than the retirement age. In other words, the number of years we work is increasing faster than the number of years we live, meaning we spend less time in retirement when we’re done working (although part of the reason is because we need more and more years of education). The consequence is that, as we retire at an older age, both our minds and our bodies will have degraded further, lowering the overall quality of life we have left during retirement.

Work to live or live to work

In addition to the physiological side, the financial side of old age is also often grim. Most governments provide child support, in recognition that a) children cannot be expected to provide for themselves, and b) raising children is expensive. Why do we not apply the same reasoning to retirees? Sure, most countries do have some type of pension system in place, but it is generally a pittance and below even minimum wage. Even when we disregard how difficult it can be to make do with a minimum wage in many countries, pensioner payouts as they currently stand aren’t even enough to survive on.

“Upon reaching retirement age, many end up in poverty.”

It’s therefore no surprise that upon reaching retirement age, many end up in poverty. Across OECD countries, 13% of pensioners live in relative poverty, defined as an income less than 50% of median earnings (for comparison, in most countries this puts them at or below the minimum wage income level). In extreme cases, poverty amongst the elderly can be as high as 37.6% (Estonia), 39% (Latvia) or even 43.4% (South Korea)!

And the problem of elderly poverty is likely to get worse. A large predictor of poverty in old age is whether people own their homes by that time or not. Having a fully owned and paid of home is a large relief from the financial pressure of paying the rent, and homeownership has become an increasingly common pre-requisite for the elderly just to get by. But with housing prices continuing to increase at a dramatic pace, the prospect of home ownership is slowly getting out of reach for a large part of the population. As a result, the number of elderly who live in relative poverty is only going to increase over time.

In the end, we’re just counting down the years to our eventual demise. And we invest significant financial resources in ensuring that our demise is as far down the road as possible. But we rarely spend time and effort on making sure that these additional years are actually fulfilling years that are worth living. Why? Because that’s not nearly as profitable.

The cost of living

Unfortunately there are strong financial incentives in this push towards older age. As we get older and our bodies start to break down, our medical expenses start to increase almost exponentially. We start needing more check-ups, more treatments. Pills become part of our daily diets. Trips to the hospital or GP become recurring appointments in our calendars. Getting old is expensive.

One of the largest beneficiaries from increasing our lifespans is the pharmaceutical sector. The elderly are far and away the best customers that the healthcare system has. And since health is a necessity that takes priority over almost everything else, the elderly have little choice but to be paying customers. And the older we get, the more we spend and the better of a customer we are. The Netherlands provides an exemplary case of how our spending on pharmaceuticals increases exponentially with age.

“Pharmaceutical companies spend more on marketing than on research.”

Pharmaceutical corporations can charge outrageous prices for their offerings, knowing they have a captive audience that doesn’t have any real alternatives. And they do everything in their power to ensure that we make sure that we want to live as long as possible, and purchase their products to make this possible. In fact, convincing us of that we need them is so important to pharmaceutical companies that they spend more on marketing then on research! The result? Profits in the pharmaceutical industry far outweigh those in most other sectors.

These companies have clear incentives to keep us alive as long as possible. And if being kept alive depends on continuous treatment and a steady stream of pharmaceutical supplements, so much the better. Regardless of whether it’s the government or private wealth that pays for it, artificially extending our lives is a massive financial drain into the pockets of big pharma.

Happily ever after?

We spend all this money and effort on chasing longer lives that are not inherently ‘better’, especially not when quality of life significantly deteriorates with age. What good is a longer life when you’re bound to a wheelchair, blind, can barely hear, and are in constant pain? When we are senile or suffer from dementia, and are no longer capable of making informed decisions about our own life, is life really still worth living?

People generally don’t want to die. At the same time, it’s a fact of life as unavoidable as taxes. When death is inevitable anyway, the question we need to ask ourselves is: Do we really want to postpone death as long as we possibly can, and cling to whatever diminished life we may still have left in us? Or should we accept the inevitable, take control over our own deaths, and set our own terms for going out the way we want to?

On a cultural level, we are entirely too negative about the concept of death, especially when it comes to death due to old age. Of course, by all means mourn those who have passed before it was their time (whenever that might be). But for those who died due to old age? Celebrate their life instead. The Mexican holiday Día de los Muertos, or day of the dead, provides an excellent example of choosing to focus on celebrating the lives of those who have passed, instead of mourning their departure.

Our aversion to death is also reflected in the stance most countries have towards euthanasia: in most countries, passive euthanasia (withholding life support) is considered legal, but active euthanasia (physician-assisted voluntary death) is not. How is this not incredibly cruel towards those with crippling ailments or a low quality of life overall, especially when they are terminally ill anyway? The medical system is based on the principle of “do no harm”. But is leaving someone alive to suffer a burdensome life really the lesser harm here?

“If we don’t own the rights to our own lives, then who does?”

By all means consider if patients can be treated for their ailments first, but otherwise withholding them the right to die is nothing but inhumane. One of the most important things to the human spirit is their dignity. Yet we are seemingly determined to deny people their dignity in death. If we don’t own the rights to our own lives, then who does?

We need to seriously re-evaluate why we are seemingly so intent on keeping people alive as long as possible. Everything and everyone that lives is designed to end. But in our insatiable efforts to thwart nature and bend it to our will, we forgot to examine the price we pay for it. Spock from Star Trek famously said: “Live long and prosper“. But it seems that the longer we live, the less we actually prosper.


Ron Maas
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2 thoughts on “Quality of life, not quantity”

  1. Nice article but a little grim as I am in my sixties now. However I intend to keep the profits of the pharmaceuticals as low as possible

    Reply
    • If you’re in your sixties you should still have plently of gas left in the tank! While our bodies do start to go downhill at this point, it’s generally a very gradual decline, so it should be a while yet before you’d need to start worrying. And I think that by recognizing what the future eventually has in store for us, it also becomes easier to come to terms with it.

      If your plan to keep the profits of pharmaceuticals low is by staying healthy for as long as possible then I sincerely hope you succeed!

      Reply

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