Bing Crosby set the standard for dying well. At 74, he dropped dead of a heart attack after doing what he most loved in life -- playing 18 holes of golf -- on a gorgeous course in Spain.
Crosby achieved the geriatric gold standard: Maintain full physical and mental faculties well into your golden years and then go out fast. No gradual decline. No nursing home. No nightmare. The problem is that few of us die like that.
Tonight , "Living Old" presents a brutal, relentless picture of what happens to the rest of us, particularly the burgeoning population of the very old. This is the cohort of Americans over 85, who are, as a percentage, the fastest-growing group in the country. "
Never mind -- this is still a harrowing hour for viewers of any age. Images affect us here in ways that text simply can't. Mimi Navasky and Karen O'Connor, who together wrote, produced, and directed the program, spare us nothing in terms of graphic human decline or thorny ethical issues around life and death .
Medical technology prolongs a high quality of life. Then that same technology keeps us alive long past the time we expected , on into a gray world of subsistence. The footage of the very old in nursing homes, together with the pronouncements of experts about the inabili ty of the American health care system to cope with the present situation, let alone what's coming , are chilling.
"We're on the thresh old of the first-ever mass geriatric society," says Dr. Leon Kass, chair of the President's Council on Bioethics from 2002 to 2005. Adds Dr. David Muller, cofounder of Visiting Doctors, which provides primary care to homebound elderly in New York City, "Nobody's bothered to think about what the repercussions are of trying to keep people alive longer and longer."
For starters, we aren't training enough geriatric physicians. And within the next 30 years, the population 65 and over will double, reaching 20 percent of our population. We simply haven't come to grips with the human dimension of this wave. Only 1 in 20 over 85 are fully mobile. Over half of the very old go to a nursing home, and the vast majority of those who stay past six months never leave.
Take Chester and Rosemary Haak, both in their 90s, who share a room in a nursing home. They arrived three years ago so that he could recover from hospitalization but stayed because of her dementia. Today, he has Parkinson's and she has Alzheimer's, and they're there to stay.
Those elderly who avoid nursing homes have a rare degree of support from their children. According to Kass, someone with three or more daughters or daughters-in-law has a better-than-even chance of not ending up in a nursing home or institution. Absent this kind of help, you're courting trouble. Our medical system is designed to treat acute diseases, not chronic ones.
Some elderly stay active and sharp . Estelle Strongin, 94, was still a practicing stockbroker when she was interviewed. (She has since died.) More are like Rose Chanes, 96, who says, "You've got to be crazy to call it a blessing to live like this. . . . I call it a curse."
Sam Allis can be reached at firstname.lastname@example.org