Other Redefinitions

Dare to Be 100
by Walter M. Bortz II, M.D.

(Page 3 of 3)

Not only does the comprehension of the true time of a lifetime, the when, lead to a deconstruction and reconstruction of the health and medical care system, but it leads inevitably to scrutiny of other basic institutions of our society.

Many of our oldest institutions are out of date. They were formulated centuries ago when our ancestors died in their 40s, 50s, and 60s, yet we have made little effort to correct them. Now it is clear that we must, if we are to survive with any sense in the system, presuming we have the smarts to do it.

The educational system, the work career, and the basic family organization are fundamental social constructions that must be reexamined in the light of our new knowledge about the human lifespan. There is invariably a substantial lag phase between the occurrence of any major novel event — such as a new technology or catastrophe or demographic shift — and the impact on the persons involved. The arrival of tens of millions of baby boomers into newly extended lifetimes predictably will cause substantial political, economic, and personal unrest — until the new realities are recognized, analyzed, and reacted to.

The arrival of the baby boomers at the third stage of their lives represents a disruptive occasion. This huge age cohort has already been held accountable for many changes in the educational system in America. It has been claimed that when this group attained school age, in 1951, the schools changed from being educational institutions to child care centers, simply because there weren't enough teachers and school monies available to accommodate the glut of new students. Similarly, their arrival into the housing market resulted in the boom in real estate prices in the 70s.

This gang exits their work phase to what? What are the opportunity structures out there to meet them? There appears to be a large gap between the potential of 100-plus years and the tasks that the new design offers. Lacking opportunity, the tens of millions of newly old will find a roleless role to play, a process that has been termed "social death."

Sociologists John and Mathilda Reilly explain that the rigid age-defined sequence of education, work, and leisure was developed when life expectancy was only 45 years of age, and it was developed largely as a male model. But what seems needed now is an age-integrated approach, in which education, work, and leisure are distributed over the lifespan — a model that more closely approximates a female life strategy. Each life phase should include elements of each function.

Of course, we need the smarts to carry this off, including field experiments, to see how each function fits into each life phase.

Lifelong Learning

Knowledge is said to double every seven to ten years. What if you stop learning around 20 years of age, and live another eighty years thereafter, with no further educational pursuit? This scenario clearly makes no sense. Our present system of grade school, junior high, high school, college, and the rest was instituted back in Elizabethan times when life expectancy was about 35. It probably made sense then to matriculate until the early twenties and then go to work, hope for a decade or so of work, and then die. But what about now, as we reach to 1007 Is it right to read your last book at age 22 and then live eight more decades without any formal effort to rev up your brain?

Gerhard Casper, president of Stanford University, is known for his enthusiasm for shortening the college curriculum from four years to three as a cost-cutting measure. I propose an alternative scheme: instead of shortening the study course to three years, expand it to eighty. As a freshman is admitted at age 18, he or she is enrolled in a program that has study courses every so often and culminates in graduation around age 98. Others have suggested taking every tenth year off from work for an educational boost. The sabbatical model makes a lot of sense from many perspectives.

What does a lifelong learning curriculum look like? Clearly, no single formula is appropriate for all. Emphasis on maintaining and extending cultural tradition, enrichment of historical perspectives, and libraries would perpetuate the social role that elders have played in society since the earliest times. Many formats will be necessary to encompass the needs of those persons with mobility or other frailty concerns. No one is ever too old to learn. The Elderhostel movement is booming. Its 1994 catalog listed more than 10,000 programs.

The necessity of reorganizing our educational institutions in the face of a lifetime of 100 years cuts directly to the heart of the issue as to whether the last fifty years of life is spent as a liability or as a resource. As the huge cohort of baby boomers turning 50 confronts what is left for them in life, how educated they continue to be is a critical and society-shaping issue. If they remain content to coast on knowledge gained in their first two decades, their role as social burdens will be assured. However, if somehow there can be a consensus built that education is a continuing responsibility, then the scene is set for the omega generations to claim their appropriate role as vital, contributing, abundant segments of the larger community. While an educated elder is a precious resource, a disconnected, disinterested, disused elder is a liability. The newly identified life expectancy demands a redesigned educational format so that lifelong learning is facilitated and rewarded.

Work Matters

As a longer lifespan mandates reexamination of early life and its commitment to learning, so, too, does it force a rethinking of work time. Retirement in the mid-60s was appropriate when first initiated a hundred years ago in Germany. Very few people even lived long enough to reach retirement then. But now, many people spend almost as much of their lives post-retirement as when working. This 65th birthday is sanctified as a major life marker, an event which my Palo Alto Clinic mentor, Dr. Russel Lee, liked to call "statutory senility." The event usually signals a major downshifting of gears from participating to spectating, simply because of a calendar date that has absolutely no biological significance.

In 1900 67 percent of men over 65 worked; in 1950 half did. Now, fewer than one sixth do. From an era derived during Puritan time, in which work was judged to be essential for self-esteem ("don't outlive your work"), we enter a time in which workers see retirement as a right earned after a life of work at the bench. A state of structured dependency is the result.

The new availability of generous social security and employer pension benefits are seductions to an early retirement. Social security payments rose from $5 billion in 1950 to $250 billion in 1990, from 2 to 20 percent of federal spending. This clearly can't go on.

The new abundant leisure time afforded by retirement is dangerous. One fourth of retirees admit to a feeling of obsolescence, completely separate from the notion of money. The Gallup organization asked a number of older volunteers how they got started. "Someone asked," was the common reply. The opportunity for important volunteer work gratifies the need to be valuable. Thirty-six percent of people over 55 do volunteer work, but 40 percent more say they would like to. They need only be enlisted.

New work formats need to evolve. The forty-hour work week with two weeks off in the summer as vacation just won't cut it. More flexible schedules relating to retraining and reeducation, job shifts, expansion of career options, and creation of interchangeable responsibilities are consistent with the redefinition of our work experience. For many, life is defined by work. If this is true, a radical redefinition is in order, in light of our longer and healthier lifespans.

Family Matters

The opportunity to confidently predict and live a hundred years places the family in a different context. The future necessitates that all of us be prepared for remaining vitally involved with the family structure. Of course, this means that there must be roles to play and responsibilities to fulfill. One hundred years of life means at least four generations, and maybe even five. The sandwich generations — and the first generations as well — should profit from the presence and wisdom of the older generations. The elders of the family are, for better or worse, prophets to the younger generations about what their future may hold. Our frenetic domestic mobility has devalued the role of the family elders, but many studies indicate that being near family is one of the most highly desired elements of retired persons. In fact, various research reports validate that people who retain family relationships live longer and are more functional. In other words, social ties double survival.

It is certainly true that the stereotypical family unit has many new and complex variations. New devotions and affiliations arise, and many families are geographically scattered. The resulting erosion of interdependence among kin leads to insecurity and isolation in old age. Notable, too, is the trend toward government, as opposed to family, responsibility for the well-being of older people as usually this surrogate governmental support is both economically insufficient and lacking in emotional sustenance.

Regular communication, the sharing of goods and ideas, maintenance of tradition, and mutuality of support efforts are all components of family life that aid in longevity. The proposition that all of us can and should live to 100 opens up the possibility for family role playing. It endorses the idea that the best way to make the new design fulfilling is within the family framework — all for one, one for all.

Guts and smarts are the ground rules for 100. This chapter has as its central intent the establishment of the horizontal time dimension of the life portrait, the when, and assignment of its ingredients to the proper category — fate versus choice, the what. Loudly proclaimed these days are "right to die" initiatives. But rights derive from responsibility. Yes, we all have the right to die, but only after having lived responsibly. We now know enough that this responsibility is here to stay. The ability to distinguish what is ours to choose and change, and what is ours to accept, has been sacred since St. Francis and before. The when and what of smarts lead naturally to the how, which is the subject of the next chapter.

Copyright © 1996 by Walter M. Bortz II, M.D.

About the Author

Walter M. Bortz II, M.D., the author of We Live Too Short and Die Too Long and more than 100 scientific articles, is a member of the teaching faculty at Stanford University Medical School and a practicing physician at the Palo Alto Medical Foundation. Past president of the American Geriatric Society, former co-chair of the AMA-ANA Task Force on Aging, and participant in one marathon yearly, he also serves on the editorial board of Runner's World magazine.