To Infinity and Beyond

When I was a medical student, it was uncommon to see a patient beyond the age of 80. Even patients beyond the age of 70, mostly showed severe signs of aging, and had relatively limited life expectancies. This situation in regards to expected lifespan, had a very significant effect on medical decisions. If a patient was diagnosed with a condition that was slow acting, the physician could easily advise an older patient to do nothing, based on the principle that the patient would pass away of natural causes before the condition had a chance to hurt them.

A classic example of such a condition was prostate cancer. I trained in Urology and therefore saw a great number of older patients with this disease. In many patients, prostate cancer is very slowly progressive. So for the patient who had a heart condition and was diabetic and continued to smoke, we would often explain that surgery or radiation or hormonal treatments might all be more disruptive than simply watching the prostate to see how it progressed. And, for many such patients the best thing to do was nothing

Since the beginning of the last century, we have seen a tremendous positive change in longevity. The most striking thing is that mothers delivering newborns were once considered extremely high risk patients. Today, when heaven forbid, a mother or baby die during childbirth or soon after, it may very well be front-page news (because it is so rare in the developed world). The advent of vaccinations, antibiotics, advanced intensive care, advanced computer technology, and even basic hygiene are all contributors to a fundamental change in the health of the world’s population. For example, whereas a heart attack was once a fait accompli and all that was left to do was to give medications to minimize the progressive damage, today we can use angiography to identify where the blockages are and clear the path for healthy blood to reach the heart muscle. This prevents many heart attacks or the progressive damage from heart disease so that heart patients do not die at younger ages and continue to live on for a great deal of time.

Today, it is by no means unusual to see 80+-year-old patients having very active lives  with minimal to sometimes no disease burden. So when an 85-year-old patient now presents with early signs of prostate cancer, you cannot by any means assume that the patient will die of natural causes before the prostate cancer significantly spreads. Each patient must be carefully evaluated and a specific decision must be made.

It should be realized that advances are happening every day in the field of human longevity. I suspect that within the next few decades, there will be a dramatic increase in human lifespan due to advanced technologies that allow us to manipulate the aging process at the cellular level. Of course, further vaccinations and better diagnostics to identify disease earlier on will all contribute to prolonging natural lifespan. But it likely will be the discovery of the microscopic timer that decides how long our cells will function, that will be the first step to potentially endless cell life and thus endless life.

Is there a cost to living longer? I think most people know of the present day arguments about dramatically delaying retirement. The retirement age of 65 was chosen based on the expectation that most people would only live into their early 70s. Based on this calculation, most people had enough in terms of savings and retirement plans to live comfortably for the last years of their lives. More so, more people left behind significant assets that financially helped the next generations. Today, people may often live 20 to 30 years beyond the age of 65. But for many, these additional years are not necessarily healthy ones. Older individuals may need advanced and extensive medical care. They may also need in-house help to maintain their independence. Both of these factors could easily exhaust any assets that the older individual has.

So living longer has psychological, medical and economic repercussions. For the older individual who is in perfect health except for a horrible disease like Alzheimer’s, the emotional toll on the person and their family can be tremendous. The stress amongst caregivers for older patients can manifest as or promote disease in the caregivers. As such, the caregivers may need more support and medical care. And this in turn will have an effect on their children.

The obvious solution is to cure diseases like Alzheimer’s and Parkinson’s and other degenerative diseases that destroy the quality of life of older individuals. And we will succeed  in doing this. But clearly it is taking time.

There are simple things that we can all do that appear to reduce the risk of these diseases, while promoting a much more active and productive life even late into people’s 80s and 90s. Daily exercise is almost magical in that it improves quality of life and can reduce the risk and/or effects of many diseases. A circle of friends that is emotionally supportive of an individual, can dramatically improve mood and reduce the risk of depression. A proper diet and exercises to strengthen the core muscles and the upper body can reduce the risk of frailty. Frailty is a medical condition in which a person suffers from weakness of their muscles and difficulties maintaining posture and limited aerobic capacity. Frail people may have perfectly healthy hearts and lungs but cannot leave the house due to poor balance or a nonspecific difficulty in walking down and up stairs. A frail person may not be able to carry bags from the local grocery or get in and out of the bath by themselves. Clearly, frailty can dramatically reduce a person’s quality of life and require constant assistance. Therefore, eating properly and exercising are essential for older individuals.

Our hope is that we will find solutions for the myriad conditions that hurt older individuals, before we succeed in dramatically extending life span. But whatever may come, there is no question that technology will continue to develop and to create new options for people, of all ages, who are in need.

Thanks for listening.

About the Author
Dr. Nahum Kovalski received his bachelor's of science in computer science and his medical degree in Canada. He came to Israel in 1991 and married his wife of 22 years in 1992. He has 3 amazing children and has lived in Jerusalem since making Aliyah. Dr. Kovalski was with TEREM Emergency Medical Services for 21 years until June of 2014, and is now a private consultant on medicine and technology.
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