How long can we expect to live in full health? One of the most important issues in the second half of life is maintaining good health. As we become older, our body may become burdened by a chronic disease. My mother and father suffered from a number of chronic diseases that, in the end, resulted in the loss of independence and mobility. Through my parents, I witnessed the progressive nature of age-related disease and their relentless trajectory toward frailty and dependence. And I wonder, “Will something like that happen to me?”
One of the more despairing aspects of aging is the increasingly levels of frailty we are required to endure as we become older. Frailty is the condition of being on weak or fragile health. To be frail is to be in a vulnerable state. In gerontology, the increasing fragility of the body caused by aging is known as the “frailty syndrome.”
Frailty can rob us of our independence and mobility. I can recall the day my father went down on one leg unable to get himself back up on his feet. His hip had given out, and although he had not fallen and broken it his hip would no longer function. This event became a traumatic age-related milestone in my parents’ lives; it was a transformative event that forced them to leave home forever.
In the Frailty and Functional Decline section the McMaster University Optimal Aging Portal, frailty is described in practical terms:
Frailty is usually associated with noticeable losses in a person’s physical, mental or social functioning such as; walking speed, weight and muscle loss, fatigue, grip strength, level of physical activity and memory loss.
In the blog article, Frailty in the Eye of the Beholder, they clarify that frailty is not an inevitable outcome of aging nor is it a clearly defined condition:
Frailty represents a form of vulnerability or weakness in the older person. It is different from simply ‘growing old’, since some individuals live to an old age without becoming frail. Furthermore, individuals of the same age can be quite different in terms of how frail they are. Frailty would be the opposite of what many consider successful aging.
While there is still no agreement among experts on a common definition or clinical tool for identifying frailty, the most widely applied definition in research includes five symptoms:
- unintentional weight loss
- weakness: (i.e. reduced muscle strength)
- exhaustion: (i.e. a constant feeling of fatigue)
- slowness: (i.e. slow walking speed)
- low levels of physical activity
An individual with any three or more of these five symptoms is classified as frail.
The accumulated health effects of our lifestyle can also cause deterioration leading frailty. A poor diet, for example, increases the potential for adverse health effects when we are older. The inability to effectively cope with stress, tension, and anxiety may silently accumulate over time only to thrust itself into our life as a chronic illness and, as a result, conjure frailty.
One of the essential elements of successful aging is the avoidance of disease and disability. Although aging does not cause disease or disability, it does increase our potential for acquiring a disease or disability as we become older. Frailty is not inevitable, but it is a very serious matter to attend.
Optimal Health and Life Expectancy
The health-adjusted Life expectancy at birth (HALE) is a measurement developed by the World Health Organization that intersects life expectancy and healthy aging. They define HALE as:
Average number of years that a person can expect to live in “full health” by taking into account years lived in less than full health due to disease and/or injury.
HALE integrates the idea of morbidity into life expectancy statistics. The word “morbid comes from the Latin “morbidus” meaning “sickly.” With reference to HALE, morbidity is referring to the presence of disease. It separates life expectancy into two conditions, years lived in full health and years lived in partial health.
HALE research in 2010 has revealed that:
Gains in healthy life expectancy over the last two decades have been made primarily through reductions in child and adult mortality rather than reductions in years lived with a disability.
In 2010, global HALE at birth was 58.3 years for males and 61.8 for females, compared to 54.4 and 57.8, respectively, in 1990. The difference between life expectancy and HALE was 9.2 years for males and 11.5 years for females.
The final decade of our life is a period of significant health challenges.
DALY: Disability Adjusted Life Year
DALY, or disability-adjusted life year, is a related statistical innovation used by the World Health Organization to calculate the global burden of disease on life expectancy. The two main features of DALY are:
- Years lived with disability (YLD)
- Years of life lost (YLL) due to disability, disease, or early death.
The Harvard School of Public Health points out, however, that although human life expectancy has improved in terms of duration, the same cannot be said of healthy life expectancy:
The results from GBD 2010 highlight the limited progress that has been made in reducing the prevalence of disability, and point to the need for greater attention to non-fatal consequences that limit people’s physical and mental function, including mental health conditions and musculoskeletal disorders.
In one sense, optimal aging means to live as long as possible in a state of good health, coupled with a quick and painless experience of death and dying when our time comes. It is grounded in the principle that aging is not a disease, nor is it a cause of disease.
I sensed that my elderly mother, “lived past her time.” Although her life was saved numerous times through medical intervention, her quality of life deteriorated dramatically in the final two years of her life. Eventually frailty confined her to a bedridden state of existence. Near the end, even moving her body in order to make her comfortable caused intense pain. She lost so much weight that she became a shadow of herself. And eventually dementia stole her personality and identity away.
Exploring frailty is a poignant but necessary. If we wish to live a long life in good health, then our work starts in the here and now. However, human beings have a tendency to become entranced by short-term concerns while the downstream consequences of out actions remain unexamined.
Frailty is a future no one wants. Optimal aging doesn’t begin in the second half of life; it is a lifelong process. However, the best time to make a change is always right now.