"Whenever I go into a restaurant, I order both a chicken and an egg to see which comes first"

Monday, April 8, 2013

Why We Age, Dealing With It, And Demographics

There were a number of interesting programs on aging on the BBC World Service last night.  One dealt with the evolutionary explanations for aging and death; another with the  impact of aging populations on national economies; and the third on coping with aging.

Most of us take aging for granted, albeit unhappily.  Despite all the commercial hype to the contrary, ‘The Golden Years’ is a misnomer of epic proportions.  Although many of us will live longer, most of us will suffer from some form of doddering – creaky joints, increasingly forgetful and flaky minds, deteriorating muscles and synapses that either give off a weak spark or don’t fire at all.  Our immune systems, so good in the past at warding off illness, aren’t up to the challenges of the many cancers, pneumonias, viral and bacterial infections that will eventually do us in. 

Spacious and luxurious retirement villages with their 18-hole golf courses, palm trees, and sunny patios are portrayed as he perfect home-after-family living.  Older couples are served by attentive, smiling, respectful staff, and every day will be an adventure of activity and new-found romance.

Retirement - csp1644677

Of course the reality is far from that rosy picture. Most Americans will not be able to afford such accommodations and care and will likely find themselves in bare-bones convalescent homes, alter kocker care on the cheap – surly Jamaican attendants, indifferent night nurses who snore through emergency buzzers, and patronizing physical therapists who get sick and tired handling parchment flesh, looking into dim eyes, and holding withered claw-hands.

How did we get here so fast? Why do we age, and now that we are old, how can we stare a short future of disability and dependence with equanimity if not optimism? An older woman, a British psychologist who has helped the aging deal with this issue was none too optimistic about her own prospects.  “Loss”, she told the BBC interviewer, “is the hardest to face”, especially the loss of a life-long partner. No younger person, anxious to jettison difficult lovers and move on, can imagine the inconsolable grief of losing a husband or wife.  Even if the marriage was not a good one, the psychologist went on, the hole left in the surviving spouse’s life is immeasurable.  Loss of independence, she went on, is perhaps the most depressing aspect of aging.  In America especially, where Youth is king, older parents are often seen as a burden.  While idealists talk of the importance of intergenerational mixing, few young couples want to be saddled with drooling, incontinent parents.

In the same BBC broadcast, a Japanese psychologist spoke of the problem in Japan, a country admired for its respect for if not reverence for the old.  While this may be partially true, she said, most older people fear becoming dependent on their children.  This is shameful, they feel, and many of them commit suicide.  The suicide rate among older Japanese is among the highest in the world.  There are even cases of murder-suicides where children, unable to bear the burden, but feeling dishonor in these sentiments kill their elderly parents and then take their own lives.  Japan also has the highest percentage of older people in its population than any other country and the age-dependency profile is significantly skewed.  Demographic pressures are converging with social and cultural traditions to produce an untenable situation.

The British psychologist went on to describe other kinds of loss in old age.  The loss of beauty, she said, is not a trivial thing.  For years we have valued ourselves to a large degree on our appeal to others, and when we realize that all such appeal has long gone, and we realize we will never again blossom and bloom, the loss is painful.  The loss of intimacy, she said, was equally painful.  Older people retreat increasingly within themselves.  For all that is said about companionship and supportive love, we all must face death absolutely alone.  Once the period of sexual intimacy has passed, she said, most older couples lose the desire or the habit of physical touching.  A hug can be a rare thing, she said. Finally, there is the loss of a future.  For the aged, there is no future, or very little of one; and since most people only realize they are old when they look in the mirror, and the recollections of an earlier, vigorous youth are vivid and real, the reality of loss is acute.

I know many older people who are bound and determined to cheat death, and rather than roll over and give in to flaccid muscles and the sluggish flow of blood through the veins, hit the gym with a vengeance.  They stretch, bend, and pump iron with people decades younger, peering over at the weight lifted by the 50ish guy on the next machine.  These elder warriors cut out all fat from their diet, eat seven portions of fruits and vegetables at every meal, run dehumidifiers, dust and vacuum mites and spores regularly, and have Purell dispensers throughout the house.

It is these people, however, for whom the knell of aging tolls the loudest.  When, because of some genetic mutation, some imperfection in their DNA which had been long hidden, they get hit with a rampaging cancer, or have a paralytic stroke which leaves them with a permanent sneer and a dangling twig of an arm, they are disconsolate.  After all the abstemiousness, hard work, and deprivation from life’s pleasures, look what it got them. 

Despite the millions of mass market self-help books on aging and dying, all of us will have to come up with our own, personalized and very individual approach to the end of our days.

So why do we age at all? What is behind this inexorable process of decay and dying?

For centuries, beginning with Aristotle, scientists and philosophers have struggled to resolve this enigma. The Roman poet and philosopher Lucretius, for example, argued in his De Rerum Natura (On the Nature of Things) that aging and death are beneficial because they make room for the next generation (Bailey 1947), a view that persisted among biologists well into the 20th century. The famous 19th century German biologist, August Weissmann, for instance, suggested – similar to Lucretius – that selection might favor the evolution of a death mechanism that ensures species survival by making space for more youthful, reproductively prolific individuals (Weissmann 1891). (Daniel Fabian, The Evolution of Aging)

Later scientists disagreed with this premise and postulated other, more robust explanations:

Today, it is clear that aging is not a positively selected, programmed death process, and has not evolved for "the good of the species". Instead, aging is a feature of life that exists because selection is weak and ineffective at maintaining survival, reproduction, and somatic repair at old age…

There are two current hypotheses - the mutation accumulation (MA) and the antagonistic pleiotropy (AP) hypotheses. Under MA, aging evolves because selection cannot efficiently eliminate deleterious mutations that manifest themselves only late in life. Under AP, aging evolves as a maladaptive byproduct of selection for increased fitness early in life, with the beneficial early-life effects being genetically coupled to deleterious late-life effects that cause aging.

Aging clearly shortens lifespan, but lifespan is also shaped by selection for an increased number of lifetime reproductive events. The evolution of lifespan is therefore a balance between selective factors that extend the reproductive period and components of intrinsic mortality that shorten it. Whether there exist truly immortal organisms is controversial, and recent evidence suggests in fact that aging might be an inevitable property of all cellular life (Fabian, op.cit.)

Put another way, in the early days of Man, survival and reproduction took precedence over longevity; and the human organism evolved to produce traits that maximized both. Many of the positive mutations that promoted strength, awareness, physical ability, etc. had genetic ‘side effects’ that never showed up or made a difference because people died so young.  Now that we live longer, we are suffering the consequences of earlier positive genetic evolution.   And since natural selection is weak in old age (we are not out refreshing our gene pool), these negative mutations lead to aging and ultimately death.

We are entering the brave new world of genetic engineering, and it may well be possible that scientists will be able to eliminate pesky side effect genes and let us live on eternally as young people; but for a while at least the old genetic imperatives will still be with us.  In the meantime, these same scientists are working to extend our lives through prosthetics, surgery, and pharmacology, and indeed in most developed countries the average life expectancy still has not plateaued.

Therefore, the problem becomes what to do with all these old people.  The skewed demographic profile of Japan and its poor dependency ratio (insufficient number of young workers to support an expanding retired population) are well-known.  China’s One Child policy is now reaping negative rewards as the number of young people necessary to participate in the workforce are far fewer than those needed. Even countries like India which is at a temporary advantage because of its large bubble of young workers will soon lose the edge. The principle of economic determinism is alive and well – as soon as families gain wealth and the education, health, and social status that go along with it, they start having fewer children.  In fifty years there will be far fewer children of these upwardly mobile Indians, far fewer than their parents.

Countries in Europe and America have had low or even negative fertility rates for decades.  Seventy out of 197 countries in the world, most of them in these regions, have fertility rates below replacement level; and most are struggling to figure out how to increase the labor supply.  Attempts to encourage fertility have been futile, largely because the economic incentives provided by the state are woefully short of the real costs of rearing a child.  Appeals to nationalism, patriotism, civic duty and responsibility are even less effective and silly.  Few people make reproductive choices relative to concerns outside their own families.

Immigration is the most logical solution.  There are plenty of countries with high birth rates (some as high as 7.0 compared to Germany’s 1.4) whose unemployed citizens would love entry to the EU.  Europe is not excited by the prospect, however.  Much of the immigration to Europe has been from predominantly Muslim countries, and politicians and voters alike are wary of social instability and a loss of what they perceive are fundamental cultural values.   Some countries, like Japan, have far fewer women in the workforce than any other country; but the long cultural tradition of male dominance will be hard to reverse.

The United States has also struggled with its fertility rates, but for different reasons.  The fertility rate among poor black and Hispanic populations has always been higher than for whites.  While the birth rate among black populations has been declining, that of the Latino population is still high and above replacement.  Fertility per se is not the issue in America but whose fertility. The dependency ratio is also not an issue per se, for there are more than enough numbers of young people in the country.  Although the US population is aging, the median age (37) is still significantly below that of many European countries (e.g., Germany at 45); but we do not have enough of the right kind of young workers – those well-acculturated and –educated.

Our demographic issues then are how to care for a rapidly increasing number of older people in a climate of austerity and public sector cuts; how to control immigration and to balance the need for cheap labor with US unemployment levels; and how to reduce fertility among poor and disaffected groups.

In summary, many of us are getting older faster than we ever thought; and it is no comfort to know that extended longevity is far in the future.  While it is fascinating to learn how and why we age, we wish that our vaunted private sector would stop hawking Botox and breast enhancement and focus on DNA therapy – get rid of those pesky aging genes and do it fast.  As far as fertility is concerned, I spent a good part of my professional life trying to get Indians to have fewer children.  It is a good thing my blandishments fell on deaf ears because thanks to Indians’ love of large families, they have enough strong arms to work the levers of a vibrant liberal economy.

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