In Rethinking Aging, author Nortin Hadler, M.D., says we have to revise, individually and as a society, how we navigate the difficult waters of old age.
You've found 85 to be the current "ripe old age" we can expect. Is that number likely to go up, or are you pessimistic about what we can expect from biotechnology?
That's the great unknown. The death rate is one per person. And most of our octogenarians would tell you that living that long is not terrific. But this is a celebratory book! We are the first generation in the world that can hit 60 and get to think, "What do I want to do in the next 20 years?" The job of the physician is to help these patients understand the limits of certainty.
You have some startling advice about the increasing number of screening tests available to aging Americans—but point out that screening is far different from diagnostic tests. Is the medical industry being honest with us about the difference?
The institution of medicine in our country is at the very least perverse and probably ethically bankrupt. What we do have as a resource is a wonderful country of well-meaning, well-trained physicians; the problem is, the system of medicine constrains the physician.... You have to know how to ask: is this really a disease, and is the test likely to benefit me? If I can teach Americans to ask that question, we can help medicine emerge on the high ground. You never want to have a screening unless it's accurate, and screening for a disease that's important and that we can do something about.
You mention your exposure to the care of the elderly through your father's medical practice. Has medicine gotten any smarter about caring for the aged? How can it improve?
Medicine was so focused in the 20th century on saving a life from a particular disease. When you think about a generation that will hit 80, it's a different mindset, and it moves it back to compassion, empathy, and community. You don't want to marginalize the elderly. Our biomedical approach to dying needs rethinking, too. Americans believe you are a coward if you don't fight to the bitter end. We need to step back and wonder if there's another way.
How do you think nursing homes will change as the baby boomers age? Will this be a generation that revolts against an isolated end-of-life?
Nursing homes have become very profitable. But it is no longer appropriate for a society that needs to accept and integrate the elderly into the mainstream. There's very inventive programs—natural occurring retirement communities, group homes.... You don't want to remove the advantages of the perspective of the elderly from community life. It's too important.