Most Elderly Don't WANT to Live to 100

[Dean Pomerleau]

All,

 

I was quite surprised to see in this study [1] posted by Al (thanks Al!) that among a population of nearly 1500 elderly people (age 75-96), two thirds said they didn't want to live to see 100. And these folks were apparently not institutionalized, but instead were "community dwelling" and recruited randomly by mail from the Helsinki's population registry. So they should have been a pretty good sample of older folks, if anything skewed towards being healthier than average rather than decrepit since they were able to respond to the survey. 

 

The two factors that correlated most strongly with desiring to make centenarian status were being male and being in good subjectively-reported health - so most of us have that goin' for us. For those who said no to the question of living to 100, their reasons were a litany of complaints about life and old age - pretty depressing actually:

 

Among those not wishing to live to be 100, by far the largest

proportion gave anticipatory explanations, seeming to believe

that disease or poor functioning would be inevitable in a

long life (n = 226): ‘Too many diseases!’ ‘Probably I would be

too frail’ (Table 3).

 

Emerging attitudes were mainly pessimistic. Many of the

participants seemed to experience that life is meaningless (n

= 111), ‘Not worth living’, or they conveyed indifference

(n = 82) or even bitterness (n = 72): ‘Pointless suffering’;

‘Society is so cruel’. In addition, these old people were concerned

about being a burden to others (n = 96): ‘It is a strain

on yourself and your loved ones’. Some people expressed

more positive attitudes, such as integrity (n = 16) or belief (n

= 10): ‘I have led a rich life’; ‘I’m grateful every day’.

 

In addition to rational reasons or attitudes, fear of the

future was the third theme. Fear of loss of autonomy was

striking (n = 98): ‘I’m afraid of frailty and helplessness’. Also

loneliness (n = 23) and pain (n = 17) fed fear of the future.

 

It shows how important it is to maintain one's health and especially a positive attitude. Obviously it's not so easy for the vast majority of people, at least in Finland - which is ironic, because Finland is perennially recognized as one of the happiest countries on Earth (#5 of 157), and it appears Finland has a darn good safety net for the elderly.  I'm frightened to know what a survey of oldsters from the US (ranked #13) would reveal...

 

--Dean

 

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[1] Do you want to live to be 100? Answers from older people.

Karppinen H, Laakkonen ML, Strandberg TE, Huohvanainen EA, Pitkala KH.

Age Ageing. 2016 Apr 13. pii: afw059. [Epub ahead of print]

PMID: 27076523

http://sci-hub.io/10.1093/ageing/afw059

 

Abstract

 

BACKGROUND:

 

little is known about the oldest-olds' views on ageing.

 

OBJECTIVE:

 

to investigate older people's desire and the reasons they give for wanting

to live to 100.

 

DESIGN:

 

a postal questionnaire, analysed both quantitatively and qualitatively.

 

SETTING:

 

population based in Helsinki, Finland.

 

SUBJECTS:

 

a random sample (response rate 64%;N= 1,405) of community-dwelling older

people (aged 75-96).

 

METHODS:

 

a structured self-completed questionnaire with an open-ended question on the

reasons why/why not participants wished/did not wish to live to 100.

 

RESULTS:

 

one-third (32.9%) of home-dwelling older people wanted to live to be 100.

Those who did were older, more often male and self-rated their health better

than those who did not. Often the desire for long life was conditional:

'Yes, if I stay healthy'. Among the reasons is that many were curious to see

what would happen. Many stated that they loved life, they had twinkle in

their eye or significant life roles. Those who did not want to live

extremely long lives gave various rationales: they would become disabled,

life would be meaningless, they were reluctant to become a burden to others

or they feared loss of autonomy or suffering pain or loneliness. Some people

also shared the view that they should not intervene in destiny or they felt

that they had accomplished what they wanted in life.

 

CONCLUSIONS:

 

one-third of the oldest-old participants wanted to live to 100. Identifying

what motivated them to desire long life could be a resource in their care

plans.

 

KEYWORDS:

 

centenarian; older people; oldest-old; qualitative; will-to-live

[Michael R]

Do note that nearly all of the reasons are explicitly tied to present or anticipated effects of degenerative aging, and the remainder are arguably implicitly in the same category. It's not that they "don't want to live to 100," it's that they don't want to go on being or become frail, sick, and dependent. Even those who say their lack of desire to live on relates to life being "meaningless" or "Not worth living" are presumably judging that in whole or in part as a result of the loss of friends, social role, career, and independence that comes with degenerative aging and a society built around it.

 

While less than rigorous in design, the results of a web-collected, demographically-targeted survey of desire to live a long life finds similar lack of interest when the question is asked without qualifiers, but "that stipulating good health changes responses to favor longer lives by an order of magnitude:"

 

 

We surveyed 1000 individuals (through “Ask Your Target Market,” http://aytm.com/) about how long they wished to live (to age 85, 120, 150, or indefinitely), under 3 scenarios: (1) sustained mental and physical youthfulness, (2) mental youthfulness only, (3) physical youthfulness only. While responses to the two partial youthfulness conditions recapitulated the results of previous surveys ..., i.e., most responders (65.3%) wished to live to age 85 only—under scenario (1) the pattern of responses was completely different. When guaranteed mental and physical health, 797 of 1000 people wanted to live to 120 or longer, and 53.1% of the 797 [ie, 42.3% of the entire survey population] desired unlimited life spans. Furthermore, 70.1% of the people who responded 85 to scenario (2) or (3) changed their answer to 120 or longer in scenario (1). Full survey response data are publicly available from: http://healthextension.co/wp-content/uploads/2015/11/AYTM-Results.csv.

 

The fraction of people who changed their answer from 85 to 120 or longer was significantly higher among people with some interest in science (445/622 vs. 13/31, p < 0.001, Fisher's exact test), and this was the main predictor of changing the answer to favor longer life. Less significant correlations were found with other surveyed variables such as age, health status, and self-esteem. Similar results were recently reported for Canadians (Dragojlovic, 2013): 59% of 1231 respondents wished to live to 120 (the maximum age included in that survey), and science orientation was the strongest predictor of support for life extension.

We also reproduced our primary finding—that most people wish to live far longer than the average human lifespan so long as they stay healthy—using Google Surveys (McDonald et al., 2012). ... Full survey data and results are publicly available in an interactive browsable format from: https://www.google.com/insights/consumersurveys/view?survey=rkiemlpdkjgfe.

 

And, as usual, I would like longitudinal followup: however early people may claim to want to die, ask them again six and one month before their self-declared preferred expiry date ...

[Dean Pomerleau]

Michael, I agree with you that a lot of the negativity about living to 100 that the elderly people expressed in this survey is likely a result of pessimism about future quality of life.

 

But their pessimism is probably justified. Given they were between 75 and 96 at the time of the survey, there is very little chance of the kind of dramatic and quickly proven intervention that will make a dent in their future (dis)quality of life, other than the daunting task of improving their diet/lifestyle, which can be done as shown by this inspiring oldster¹ who turned his life around at age 87, but which isn't easy or guaranteed to work.

 

however early people may claim to want to die, ask them again six and one month before their self-declared preferred expiry date ...

 

Having been through the dying process of people who were close to me, as well working with people in hospice, I can tell you that the majority of people are OK with their own imminent demise when the time comes. They just don't want it to hurt too much...

 

But you are certainly right that people who are in good health when approaching their self-proclaimed expiry date are extremely likely to change their tune and rescind their declaration that "X years is long enough".

 

--Dean

 

¹ I note with some pride that the "inspiring oldsters" thread is the #1 result  Google returns for a search of that phrase.

  

[Michael R]

We're actually in furious agreement here, Dean ;) .
 

Michael, I agree with you that a lot of the negativity about living to 100 that the elderly people expressed in this survey is likely a result of pessimism about future quality of life.
 
But their pessimism is probably justified. Given they were between 75 and 96 at the time of the survey, there is very little chance of the kind of dramatic and quickly proven intervention that will make a dent in their future (dis)quality of life, other than the daunting task of improving their diet/lifestyle, which can be done as shown by this inspiring oldster¹ who turned his life around at age 87, but which isn't easy or guaranteed to work.

Oh, sure: in terms of the rationality of their internal calculus (and at that age, I'd say it's even true of a late-life radical lifestyle overhaul for most), I must regretfully agree entirely. What annoys the hell out of me, and  what triggered my post, is that when you talk to people about your own desire or the social good to be reaped from the deceleration, delay, arrest, or reversal of degenerative aging and ensuing life extension, they will use a superficial reading of survey data like these to say "you may think you wanna live a long time now, but people who have actually lived a long time get sick and tired [note the language ...] of life and just want to die. So I, and you, and everyone will actually not want to live past 85 [or pick your date, a few years outside of average life expectancy] when we get there." Whereas what's really going on — as the second and even the first study clearly show — is that people don't want to go on in indefinite suffering and ongoing degeneration from aging processes. Put the prospect of maintaining or restoring their health on the table, and even people who have already lived a long life by today's standard actually would embrace a very substantially longer one.
 
The issue, then, is to invest in the development of rejuvenation biotechnologies now so that today's younger seniors (and even more so, today's middle-aged and younger generations) can live the much longer, healthier lives that they will actually want to be able to live when they get there.
 
 

 

however early people may claim to want to die, ask them again six and one month before their self-declared preferred expiry date ...

 
Having been through the dying process of people who were close to me, as well working with people in hospice, I can tell you that the majority of people are OK with their own imminent demise when the time comes. They just don't want it to hurt too much...

... because they're already hurting, and their lives constrained, and their minds failing, and their friends dead of degenerative aging — and they know it can and likely will get a hell of a lot worse. That's perfectly rational. Let's build a future where it's no longer rational for the vast majority of people, because they're not in hospice but on the tennis court, and in the hospital for their latest rejuvenation treatment instead of for their umpteenth increasingly-futile rescue from cardiac arrest.
 

But you are certainly right that people who are in good health when approaching their self-proclaimed expiry date are extremely likely to change their tune and rescind their declaration that "X years is long enough".

'Zackly.