“How many of you expect to die?”

That’s geriatrician Joanne Lynn’s copener when she critiques the lame state of end-of-life care in this country, a presentation described on the New York Times’ “New old age” blog. Hands went up a lot faster when she asked listeners if they’d prefer to be old when it happens. 

Lynn then offered three ways to check out: cancer; chronic heart or lung disease; or frailty and dementia. Her graphs depicting the end of life for each condition (the Y axis showing function, the X axis the passage of time), and her description of the toll each takes, took her listeners, and me, by surprise. Most people opt for frailty over cancer, yet as the graphs show, cancer typically involves a mercifully precipitous drop, not the slow, drawn-out decline of frailty.

Extended frailty and dementia is the path that approximately 40% of Americans will follow, generally after age 85. Lynn describes it as “everyone's worst nightmare, an interminable and humiliating series of losses for the patient, and an exhausting and potentially bankrupting ordeal for the family.” (Not everyone's scenario, keep in mind, but everyone's nightmare.) Nor is our healthcare system designed to handle this outcome. But as Dr. Lynn points out, “We made [the care system] up, and we can make it up better.” And there are many ways to slow physical frailty and cognitive decline. 

When I read Lynn’s description of herself as an “old person in training,” I smiled in recognition. That’s what I’ve become.

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