BOOK REVIEW: ‘Never Say Die’

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NEVER SAY DIE: THE MYTH AND MARKETING OF THE NEW OLD AGE
By Susan Jacoby
Pantheon Books, $27.95, 352 pages

Everyone should read Susan Jacoby’s “Never Say Die: The Myth and Marketing of the New Old Age” because it deals with a topic none of us really wants to contemplate: life after the traditional retirement age of 65. We’d like to think that nowadays it’s fine. After all, we’re told that 60 is the new 40 and that 90 will soon become the new 50. Magazine articles tell us that modern oldsters can do pretty much everything that youngsters can do: they run marathons, take up mountain climbing, write first novels.

And for sure we want to believe the cheery pundits who suggest that forethought plus a can-do attitude plus the wonders of modern medicine will enable us to thwart the ills that flesh is heir to. But Ms. Jacoby warns “It is past time for a more critical and skeptical look at old age as it really is in America, especially for the ‘old old’ - those in their ninth and tenth decades of life.” Her book takes that critical look, and what it shows is not a pretty picture.

Admittedly, the canvas has some bright spots. Ms. Jacoby allows that longevity has been increasing. At the beginning of the 20th century, only about 4 percent of Americans were over 65; in 1970, the figure was 10 percent, and as the front-end of the baby boomer generation qualifies for Medicare this year, the figure will be even greater.

“Many Americans over sixty-five - the now anachronistic age of retirement - are healthy productive members of society,” she notes. Many are still employed; others are volunteering for favorite charities or enjoying trips and winters in warm spots. But even among the group gerontologists call the “young old” - people in their 60s and 70s - many suffer from debilitating conditions including obesity, diabetes and heart disease. And life for the “old old” - those in their 80s and beyond is much, much tougher as diseases such as osteoporosis and Alzheimer’s claw at ever larger numbers, and, so far, no cures are in sight.

Of course we would expect that the very old would have more problems. What we don’t face is that we have fallen for the idea that we can avoid those ills indefinitely. We are constantly hearing of aged stars who still work and look wonderful, of nutritional regimes that will supposedly keep us young and creams and potions and surgical procedures that will keep us beautiful. Such messages are everywhere. They create a myth of “successful aging” that we want - desperately - to believe because the alternatives to feeling good, looking good and living independently are very, very scary.

Ms. Jacoby argues that our enthusiastic embrace of the optimistic view of old age is dangerous. It prevents us as individuals, as families and, most significantly, as a society from planning adequately for the reality. Indeed she suggests that the vast majority of Americans cannot individually prepare to meet the direst contingencies of old age. Those healthy active seniors in their 60s and 70s are typically the fortunate middle-class who have had a decent education, lived a healthy lifestyle and enjoyed well-paid employment.

As they survive into their 80s and 90s, the ability to afford the care they need and the life they want will decline. The less affluent fare much worse. Looking ahead, as the generous pension plans once funded by many employers disappear, few people can expect to have enough money to support themselves in retirement homes and nursing facilities. Social Security and Medicare help, but not enough. One solution Ms. Jacoby proposes is that Medicare pay the costs of aides to care for old people in their own homes - an inexpensive proposition compared to the costs of institutional care.

She also argues for a more humane provision of end-of-life treatment, encouraging readers to write their health-care wishes before they become too incapacitated to do so, and arguing against the knee-jerk insistence on putting old people through medical procedures, unlikely to extend life and certainly unable to heighten its enjoyment.

Indeed, implicitly, “Never Say Die” is a critique of the country’s creaky health care system. Paradoxically, American medicine in the 21st century is both very advanced in its ability to treat disease and also very old-fashioned in its delivery system. As much as it is part of the solution to some of the physical problems of aging, it’s also part of the problem.

Ms. Jacoby’s commentary about improving health care is among many suggestions she makes about how old age can be handled. But though her book suggests reforms, it is not a program. Nor is it an academic account of the state of the aged in America - despite being packed with facts ranging from the history of old age in America to the impact of the large boomer population about to become seniors. The book is a plea - or rather, two pleas.

First, that we resist seeing the happy tales of thriving, active, sexy seniors as the whole story and look at the desperate reality of millions of old lives. And second, that we think and work as a society to figure out how we are to take care of everyone in their last decades and to make those years as rewarding and useful and pain-free as they can be. This need for informed and concerted action is the reason why everyone, including the young, should read this book.

Claire Hopley is a writer and editor in Amherst, Mass.

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