On Old Age and Death VIII – Readers and Writers Book Club

On Old Age and Death VIII

“The human machine shall be more perfect the better that it defends itself against the penetration of influences from the external environment; when the organism ages and grows weaker, it becomes more sensitive to the external influences of cold, heat, humidity, as well as to all climatic influences in general.”
Claude Bernard, Introduction à L’étude de la Médecine Expérimentale. Dover Publications; Mineola, New York, USA, 1865.

“Our bodies are made of extraordinarily unstable material…  It is therefore to be expected on the one hand that the body is affected by its hostile environment and slowly degrades, much like man-made objects, while on the other hand it is thei efficacy of maintenance and repair processes which determines how long it takes for this eventual degradation to occur.”
-Walter Brandford Cannon PhD, The Wisdom of the Body: Classics of Medicine Library, January 1, 1989

In the interest of brevity, this will be a prescriptive communication, with the caveat that every suggestion is backed by good science. 
In Conclusion: How to Live Happily During Old Age. You are definitely not alone in the pursuit.
1. Start a new hobby or activity, especially something creative or a new language.
The Bengali Indian poet, short-story writer, novelist, dramatist, artist, sage, and philosopher Sir Rabindranath Tagore [1861-1941), often credited with a major role in the cross-fertilization of East and West, won the Nobel Prize in literature in 1919. Nearing the end of his life, he lamented his lack of productive activity.

“The song I came to sing remains unsung for I have spent my time in stringing and unstringing my instrument.”

2. Sign up for volunteer opportunities each week.
3. Explore the outdoors.
4. Adopt a dog to boost your mental and physical health.
5. Spend time with people you love each day; talk, debate, educate, and be educated.
6. Continue working if you enjoy it. Find new and different, more interesting work.
7. Practice gratitude regularly.
8. Learn and practice new skills, including languages.
9. Practice smiling, laughing, and joking, more. Adopt a confident manner in so doing. 
10. Brainstorm new ideas, methods, interests with friends, even those who can disagree agreeably.
11. Seek opportunities for public speaking, formal debate, or extemporaneous debate. Stretch your brain and courage.
12. Consider meditation and/or yoga. Every now and again take time to smell the daisies or just contemplate your navel.
13. Determine what is within your control and focus on that. Leave the bad past in the past, and the unpredictable future to the future for disposition.
14. Adopt positive thinking strategies: especially transform negative self talk to positive; seek different perspectives instead of stalling on things as being too complicated, too new, too big, too different; call and text family and friends instead of brooding that they fail to communicate with you; adopt a more fearless attitude of “I can give this a shot.”
One important factor that is often overlooked is the importance of your attitude toward growing older. Your feelings about aging can actually shape how you age. A study in The Journals of Gerontology: Series B found that older adults did worse on tests that measured things like memory and gait after they were exposed to words that reinforced negative stereotypes about aging. And in a study in the Journal of Personality and Social Psychology, participating seniors with the most negative attitudes about aging died an average of 7.5 years before the participants with the most positive attitudes.
In other words, although some of the aging process is ultimately out of your control, making healthy lifestyle changes and keeping a positive attitude can go a long way toward helping you enjoy and extend your senior years.
15. Watch news in moderation and seek differing views. Try not to brood over events as if they were constant and unchanging. Do not bog down in negative or victim ideologies.
16. Use social media as long as you enjoy doing it. Avoid making it into work or a contest.
17. Eat a healthy diet. Learn to cook fresh healthy things for yourself or try fresh fruits and vegetables raw. Avoid prepackaged and preprepared foods as much as possible. The best diet is the Mediterranean Diet consisting of fresh fruits, vegetables, fish, and limited fatty meats. Decrease caloric intake, including intermittent fasting and regular exercise stimulate metabolism, slow breakdown processes, and increase the frequency and speed of reparative process, i.e. diminish decay, and increase the processes of living.
18. Consult with your medical and dental caregivers and take all prescribed medications and treatments. Be careful to avoid worry over cost and letting that result in neglect and adverse consequences. Do not be penny wise and pound foolish about your health.
19. Study and learn about your health care issues to permit better understanding and ability to communicate with health care professionals. That is crucial in this computer age and high medical specialization. Keep good track of your own issues and speak up.
20. Avoid expensive, ineffectual, trendy, OTC supplements, including vitamin preparations over and above daily nutritional requirements, however popular they may be. Very frequently, you will be offered miracle cures to make money for someone, panaceas the doctors do not know about or shun, or a “natural” product that obviates the need for eating healthy food [beet products are current favorites].
21. Exercise regularly and frequently. Be reasonable about pain producing exercises. Swim-ming and walking are especially good for the elderly.
22. Avoid falls. Avoid falls. Avoid falls. Do not climb ladders. Prevention beats cure every time.
23. Avoid alcohol, tobacco, illegal and nonprescribed drugs including Benadryl as sedatives.
24. Do not borrow or use other people’s drugs, even supplements. They may not be what they purport to be, and they may not be for you. 
25. Sleep 7-9 hours every night. Regularly sleeping less than that is both unhealthy with adverse long term effects and may be symptomatic of health problems such as sleep apnea, nasal obstruction, excessive daytime napping, clinical anxiety, or poor sleep hygiene. No TV just before bedtime. Bed is a place for sleep and sex, not reading, telephone games, etc. Sleep in a cool, dark, quiet, room. Keep lighted clocks faced away to avoid obsessing about time or inability to get to sleep. Avoid a full stomach at bedtime.
26. Keep your family emotionally close; make amends as necessary to avoid guilt and obsessing. It is helpful for good sleep practice as well. Remember Abd Ar Rahman III.
27. Learn about and from your past. Start early to learn about health and medical care in general and keep good records of your personal health issues, treatments, and outcomes. It is crucial for self-defense in your complicated and not overly caring world.
28. Take control of your future. By knowing what to expect when it comes to the aging process, you can take the right steps to maximize your well-being. With aging, it is important to act on the things you can control. Growing older involves many changes. But knowledge and a positive attitude can ensure that you are ready to meet the challenges, deal effectively with stress, and extend your health span. We can do many things to improve our odds of experiencing good health during our senior years. Although you cannot change the genes you are born with, you can make choices that affect how your genes react to the aging process.
At the present time, there is a physiological limit to life. But it is a paradox. While there is a physiological limit, there is no absolute maximum age, which no human can ever cross. In biology, the concept of life span determines the age a species can reach under optimal circumstances. For humans, this life span stands at about 97 years. So, 97 should–in principle–be the limit to human life expectancy. But there is a twist that may give us hope for more. 100 years ago, survival probability of Italian males to live another year came down to almost zero at around age 89; but, according to the theory of life span, even 100 years ago it should have come down to almost zero only at age 97, as it is today.
It is a paradox wherein improving health services and overall economic development do not influence this physiological limit. Better health systems make people survive infections and other sickness, it is true. However, the healthier we are as young people, the faster we will age when we are old. That is a fact that begs further inquiry. The 80-year-old today–although much healthier than an 80-year-old 100 years ago–experiences a much higher rate of bodily decay in the last years of life in the current era. Sometime between the age of 90 and 95, the human species around the world reaches its limit of life, no matter how healthy we were while young. Overall improvements in health systems make us all much healthier as young people; but the compensation effect of mortality ensures that the healthier we are, the faster we will age towards the end. Somehow, nature has equipped our species with an intrinsic rate of bodily decay that will allow only a few of us to live beyond 97. It is built into our DNA, and therefore into our evolution.
29. There are changes in the $16 billion US funeral industry including: new types of urns, personalized obituaries, eco-friendly caskets, drive-thru funeral viewing, living wakes, space burials, green burials, and memorials in an underwater reef vault.
30. A positive change in the conversation about aging and dying has been gradually growing. Some interesting purposeful changes are: The Conversation Project, Death over Dinner Project, and Death Cafes. With death being the last taboo, de-stigmatizing death and having a “good death” are the goals. One of the most unique ideas to get people to talk about death was created by The United Kingdom’s Academy of Medical Sciences. In May, 2019, the academy created a free installation called “The Departure Lounge” in the Lewiston Shopping Center in South London. It was modeled on an airport departure lounge with the installation encouraging people to talk about death, dying, and what it means to have a good death. It was staffed by a diverse mix of researchers, doctors, and hospice workers, with experience of death and dying.
A wall with the sign in large letters, “Departures”, portrayed the big questions that people often feel too afraid or too uncomfortable to ask such as “I could not discuss dying with him because he would get angry and change the subject” and “I never felt I could talk to mom about what she wanted”. Behind each box was information, advice, and audio clips, from experts sharing their knowledge and experiences of death. The idea behind all this was for people to “leave their baggage” behind as they talked about their fears about death.
Another account of how conversations and attitudes about death are illustrated by Becky Hsu, an assistant professor at Georgetown University. She spoke about the Chinese concept of a “good death” as a guest lecturer in Georgetown’s new Aging & Health master’s program. She had spent time in China with a woman who had already bought the outfit she wants to wear for her death: pants, shirt, shoes, earrings, and purse. The woman has an embroidered pillow picked out for her head to rest on. She had a portrait taken that will be displayed at her funeral. All these things are neatly wrapped in a cardboard box that she proudly shows off to friends and family. Ms. Hsu described the woman as being a happy one.
31. If you believe in some kind of afterlife or rebirth, then this existential question may not trouble you so much. But if you believe that consciousness and memory end at the point of death, then the question may be productive of anxiety. It can be difficult to see a point in life when everything that makes us who we are right now ends at the point of death, and one of the missions of hospice is to ease such concerns.
Such people when approaching death often express questions such as:
•What really happens to our subjective experiences, feelings, beliefs, and memories after we die?
•How do you make your one relatively short existence matter in the larger scheme of things? 
•Is there a point to life when your lifespan is so finite?

The present author will not even attempt to answer such fraught philosophical, religious, ideological, or spiritual, questions; but rather, I will offer the answers given by a research group pertaining to answering the question, “What is the point of life?”

1. The Dalai Lama argues that the ultimate point of life is to be happy, and most people agree.
2. To Make Other People Happy—to foster a personality of empathy and of caring and compassion for other people which provides fulfillment and meaning in your own life. Sociopaths are seldom happy people.
3. To experience the fullness of who you are.
Life rarely goes according to plan, and everyone is destined to experience pain and disappointment at some point. However, it is important to know that this does not mean that life is over, nor does it define the remainder of one’s life. The more of life you experience, the more self-aware and self-actualized you become. Leaning into all the experiences of life–both good and bad–is part of your journey.
4. To Be Useful, to create something that either you or other people can use.
“[The purpose of life is] to be useful, to be honorable, to be compassionate, to have it make some difference that you have lived and lived well.”
-Ralph Waldo Emerson
5. To Love and be loved, to live with positive energy for those around you, especially for family and friends, or even for strangers. 
6. To become the greatest version of yourself.
The point of life might be to expand your consciousness and uncover your true potential, to learn how to look beyond impressions and perceived boundaries, and to look at boundaries as opportunities?
The concept was epitomized by Hannibal, the great king and general of Carthage, who set out to cross the Alps in winter to execute a surprise attack on his enemies, the Romans. The going was extraordinarily difficult. War elephants and men were dying from the cold and from falling off cliffs.
Finally, his generals came to him and asked, “How can you keep going when the exertions and perils are so great?”
Hannibal’s timeless reply was, [Latin] “Aut inveniam viam aut faciam.” [rendered into Latin from Punic by Seneca and later into English: “I shall find a way or make one.” 
7. To discover your inner and outer worlds
Learn about the world and visit as many countries and peoples as possible. Ever seek endless knowledge through reading, studying, and learning new skills. Stretch beyond your comfort zone and perceived limitations. Dare to do things that inspire and motivate you to evolve and progress spiritually. 
8. To live mindfully
The present moment is all you have in life. Therefore, the point of life may be to live mindfully every day and appreciate each moment as it comes your way. Live in the present but be mindful of both the past and the future.
Meditation allows you to engage more intimately in all aspects of life and find peace and happiness that frees you from mental suffering. The present author found that meditation or self-hypnosis is effective even in children to relieve pain, anxiety, and suffering.
9. To Leave a legacy of a gift of property, and passing along your accumulated knowledge and wealth of wisdom and insight. 
It is the gift of your core values, beliefs, and significant life experiences that can inspire those who come after you. Future generations can learn the joys and sacrifices that molded the family from previous generations. It is even a type of emotional heirloom. It is part of your work as an elderly person and not to be shirked or minimized.
10. To become the lead role in your personal story.
You are no longer a victim of circumstances but rather a creative life force to be dealt with. No matter what happens life, good or bad, you are empowered to make your own choices and decisions. You can pass this on to your descendants.
11. To Achieve Self-Actualization
Self-actualization is the process of evolving into more of who you are innately rather than trying to become someone you hope you are but fear you are not. It is the process of living authentically, being altogether truthful. 

In is incumbent on us all to assist the elderly or others approaching death by contributing to their terminal well-being. Help them to understand and to deal with fear, pain, suffering, guilt, and worry about how their death will impact loved ones they leave behind, to address issues that must be addressed, emotions notwithstanding.  
For people who are afraid to die, especially of dying alone, family members, hospice workers, and religious advisors, need to be notified and to gather around even if dying and death are unpleasant and fearful for them. Help the dying to have a comforting view of the events as they unfold. Do not lie. Do not minimize. Avoid euphemisms.
The truth can be discussed gently and sincerely. A display of compassion and genuine interest is worth more than a pound of gold, and more than a thousand empty platitudes. Take the time to find out what the hospice patient truly fears and what his/her real needs are and help as much as possible, even though both you and the person dying know that the inevitable cannot be avoided. 
Very few people actually feel ready to die. It is perfectly normal to feel angry about life ending–maybe earlier than expected. 
The dying person and/or his or her loved ones may well feel that it is unjust or cruel; and they have a perfect right to be angry; and they may it take out on the caregiver. Do not react to the anger. You can try to channel the anger as a source of energy to help yourself or other dying person to take action where it is needed. You can use it as fuel to solve problems, to become assertive, or to get needs met. Try to re-channel your anger to do meaningful, positive, things instead of just venting a sense of impotent anger, hatred, or need. 
My father died when he was 51—a man who was vital and necessary for his family and the town where he lived. A viewing was held in our house and twice as many people as lived in our town passed by his open casket that day, including three elderly town drunks who had been on the dole for decades. I was furious at the manifest injustice. My uncle–an army psychiatrist and an atheist–took me aside and gave me perspective: “Do not seek for justice or even an understanding about why he died. You will never find it, and you will do yourself harm by searching and by being angry. In the normal course of things, death occurs; and we have little impact on the how or when, and almost none on the why. Learn to accept things as they are with placidity and tranquility.” 
That helped then and in my career where I had to face such situations with some frequency.

“… But at my back I always hear
Time’s wingèd chariot hurrying near;
And yonder all before us lie
Deserts of vast eternity.
Thy beauty shall no more be found,
Nor, in thy marble vault, shall sound
My echoing song…

“Now therefore, while the youthful hue
Sits on thy skin like morning dew,
And while thy willing soul transpires
At every pore with instant fires,
Now let us sport us while we may,
And now, like amorous birds of prey,
Rather at once our time devour
Than languish in his slow-chapt power.
Let us roll all our strength and all
Our sweetness up into one ball,
And tear our pleasures with rough strife
Thorough the iron gates of life:
Thus, though we cannot make our sun
Stand still, yet we will make him run.”
-Andrew Marvell [1621-1678], To His Coy Mistress 


I chose to use a pseudonym for personal reasons. I’m a retired neurosurgeon living in a rural paradise and am at rest from the turbulent life of my profession. I lived in an era when resident trainees worked 120 hours a week–a form of bondage no longer permitted by law. I served as a Navy Seabee general surgeon during the unpleasantness in Viet Nam, and spent the remainder of my ten-year service as a neurosurgeon in a major naval regional medical center. I’ve lived in every section of the country, saw all the inhumanity of man to man, practiced in private settings large and small, the military, academia, and as a medical humanitarian in the Third World.