5 ms·

I have an idea that's been floating around in my head for a while, and I don't know how I feel about it. So I'll float it here with a note that I am not strenuo

I have an idea that's been floating around in my head for a while, and I don't know how I feel about it. So I'll float it here with a note that I am not strenuously advocating for the position I'm about to express, and instead wish to have it discussed. I have the feeling that our modern medical obsession with keeping the body alive for so long is leading to negative outcomes. The rate of Alzheimer's diagnoses increases dramatically after about age 70[1]. In the US, we began to see the average life expectancy increase past 70 in the 1950s, and is now approaching 80[2]. As a result, I think the current crop of people who are alive are among the first to see the effects of truly advanced age. Prior to the 1950s, longer life was always seen as a good thing: you had more time to enjoy relative good health. Since few people lived into their 70s and beyond, we didn't see the "bad things" coming. Now that people are living into their 70s and beyond, we start to see the horrible effects of advanced age. So the question, which again I don't put forward with much conviction: is continuing to put forward the preservation of life worth it given the extreme decline in quality of life that we see past the age of 70? The gut answer is "obviously yes," but I think we are the first people to have to truly grapple with this question, as we watch our elders mentally fall to pieces while their bodies chug along. Is that gut answer just the result of centuries of trying to get past year 70? Now that we're past it, should we re-evaluate? I have a very close relative in his late 60s going through Alzheimer's right now. Would it truly be worse if he had passed away a couple years ago? I don't know. [1] https://en.wikipedia.org/wiki/Alzheimer's#Epidemiology https://en.wikipedia.org/wiki/Alzheimer's#Epidemiology [2] https://www.macrotrends.net/countries/USA/united-states/life-expectancy https://www.macrotrends.net/countries/USA/united-states/life...

sradman 6y ago
> is continuing to put forward the preservation of life worth it given the extreme decline in quality of life that we see past the age of 70? The breakthrough here is in a diagnostic test for Alzheimer's. You are making a generalization based on the assumption that this information will ultimately extend life rather than improve the quality of life. For jurisdictions that allow medical assistance with dying, this information can plausibly result in the opposite effect.
tcbawo 6y ago
Not only do we attempt to extend life by any means irregardless of quality of life, we are encouraged by high costs of education, real estate, child-rearing to toil away the best/healthiest years of our lives. It's definitely a good opportunity to rethink our priorities.
- finnh 6y ago
  I dunno, my twenties were pretty fun. Yes I worked, but fortunately I didn't "toil". What's the proposal here? That we retire for ages 25-50, and then (re)enter the workforce to pay society back?
adrianN 6y ago
Increases in lifespan correlate fairly strongly with increases in healthspan. I think we should invest a lot more into something like SENS to further improve our healthspan. I also think that we should make medically assisted suicide easier.
ux 6y ago
The key word here is "good health". If you start shifting from "living as long as possible" to "living with the most dignity up until the end", you end up questioning euthanasia, but also how people live post work-life: typically, how people are going to live decently through their last stage post 60s, can they enter a stage where they are relieved from the stress, pain, etc. You can't just say "well let them die earlier" if you don't provide some form of hope of relief for their last years. Today I'd argue that the growing lifespan is used as an argument to make people work longer, which means in worse physical conditions. The "Work until your death" motto (the curse of people living in poverty) is not great for a healthy and attractive society. Questioning it ends up in a heated political/societal/philosophical discussion pretty quickly. And we're definitely not heading in the healthy direction: not because we don't want to shift the medical institution, but because we need a more profound society change. From a purely economical PoV, it's great that people die before around the beginning retirement, from a societal PoV it's a disaster.
- adrianN 6y ago
  People are asked to work longer because pension systems were set up when people used to die less than ten years after retirement and now a lot fewer young people have to pay for retirees living 15+ years. The only way to avoid this is to drastically reform pension systems.
echelon 6y ago
Humans should live 500 years. Death is a disease. Aging is a disease. We're not close to fixing this, and barring some tectonic shift in our capabilities, probably won't see substantial change within our lifetimes. But to take the stance that death and aging are acceptable seems so medieval to me.
- benjohnson 6y ago
  Counterpoint: I wouldn't want to be a victim of slavery, torture, or boredom forever.
  - rowanG077 6y ago
    I wouldn't want to be the victim of them at all. Whether it's duration is 30 years or 10000 years. Besides suïcide is almost always an option if you feel your life is unbearable.
cowmoo728 6y ago
Why is it that some people survive to 90+ without significant mental deterioration? My grandfather is 94 and reads the news, does crosswords and sudoku, and plays poker and bridge, at a level comparable to when he was 60. His knees have deteriorated so he stopped jogging 20 years ago, but he still walks and swims. It's worth pursuing longevity science if we can help more people age this way.
steve76 6y ago
"is continuing to put forward the preservation of life worth it given the extreme decline in quality of life that we see past the age of 70?" Yes! - Age is nowhere near as bad as trauma. - When it's really your time to go, you go pretty quick. - Fight the disease not the patient. Knowledge is the real scarcity. - Not your decision to make. People want to do it on their own, and you will have to stop them. - It would be evil to send your grandparents to the friar so you have the money to spend on video games and Hollywood, yet alone illegal drugs and strip clubs.
graeme 6y ago
> As a result, I think the current crop of people who are alive are among the first to see the effects of truly advanced age. You’re mistaking average for median life expectancy. People lived to older ages in the past. But lots of babies died, so the average life expectancy was way down. Add a lot of zeros to a number series and it gets pretty low. Ancient comedy even had a stock character, sexex iratus: angry old man. Certainly there are many more very old people now, but it wasn’t something totally unknown. The aging of people has also coincided with a decline in our physical health and diets. Strength is declining year on year: we have grip strength measures for college age students since the 1980s and it is a steady decline. Diets are worse, people are much fatter and with more health problems such as type 2 diabetes. One of the theories of alzheimers is that it is a form of diabetes. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769828/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769828/ Certainly it is correlated with type 2 diabetes, and with obesity in mid life. (Not in late life, but this may be because sudden weight loss is a precursor of alzheimers https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6205180/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6205180/) Have a look at this chart. Japan has one of the oldest populations in the world, and yet its alzheimers death rate is less than 6x that of the usa: https://www.worldlifeexpectancy.com/cause-of-death/alzheimers-dementia/by-country/ https://www.worldlifeexpectancy.com/cause-of-death/alzheimer... There is more to this than just age. Our lifestyles increasingly leave us hobbled by ailments at young ages, and the medical system patches it up and lets us live through them longer. But this expresses in much more old age morbidity than would otherwise be biologically necessary.
- JamesBarney 6y ago
  > One of the theories of alzheimers is that it is a form of diabetes. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769828/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769828/ Overall, we observed little evidence of causal associations between glycaemia and cognition, structural brain and dementia phenotypes.
  - graeme 6y ago
    What are you quoting from? I searched the text and glycaemia is not present. The paper is concluding Alzheimers is a type of diabetes.
bryanlarsen 6y ago
It's a valid concern, and to answer your concern researchers often use Quality Adjusted Life Years (QALY) when measuring the effectiveness of treatment. I wish I had more time to pull up references for you, but I believe that the answer to your question is "yes" -- extending people's life through intervention usually gives people more years of quality life and usually has little effect on the number of years of poor quality life.
adaisadais 6y ago
I think the life expansion is merely a byproduct of other things that have ultimately led to a higher prevalence of Alzheimer’s and other amyloid plaque based diseases. We have a few factors that have greatly attributed to this increase in life and increase in mental illnesses: decrease in tobacco (specifically smoking) use, increase in processed food eating, increase in life sustaining medicines, decrease in overall activity. Tobacco: on one hand we know that smoking raises chances of having a shorter life span as it really accelerates cellular inflammation and deterioration. (1) On the other the stimulant aspect of nicotine helps the brain continue to stay active and helps resist atrophy. Personally, I notice more and more people I interact with on antidepressants. My parents and grandparents generations probably suffered the same levels of depression (more or less) but moderated this with smoking. Processed Foods: Modern processed foods started to flood grocery stores after the Second World War and became the staples of the American diet. Natural fats were replaced with unnatural and chemical based preservatives were put in many goods to increase shelf life. We know empirically that these foods also (like smoking tobacco) increase all cause mortality. Alzheimer’s prevention advice typically advocates for a diet removing such items. (2) Better Medicine & Decrease in Activity: these two factors may need no introduction but we know that the older we get the less stem cells we have and the worse our cellular health is overall. Moderate Exercise helps slow the death of such cells. (3) Again, this is circumstantial, but all of the people I personally know with Alzheimer’s and other amyloid plaque based diseases did not lead active lifestyles and I would define their lifestyles as quite sedentary. (1) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4098701/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4098701/ (2) https://en.wikipedia.org/wiki/Alzheimer's#Epidemiology https://en.wikipedia.org/wiki/Alzheimer's#Epidemiology (3) https://www.google.com/amp/s/time.com/4776345/exercise-aging-telomeres/%3famp=true https://www.google.com/amp/s/time.com/4776345/exercise-aging...

sradman 6y ago

> is continuing to put forward the preservation of life worth it given the extreme decline in quality of life that we see past the age of 70? The breakthrough here is in a diagnostic test for Alzheimer's. You are making a generalization based on the assumption that this information will ultimately extend life rather than improve the quality of life. For jurisdictions that allow medical assistance with dying, this information can plausibly result in the opposite effect.

tcbawo 6y ago

Not only do we attempt to extend life by any means irregardless of quality of life, we are encouraged by high costs of education, real estate, child-rearing to toil away the best/healthiest years of our lives. It's definitely a good opportunity to rethink our priorities.

finnh 6y ago
I dunno, my twenties were pretty fun. Yes I worked, but fortunately I didn't "toil". What's the proposal here? That we retire for ages 25-50, and then (re)enter the workforce to pay society back?

adrianN 6y ago

Increases in lifespan correlate fairly strongly with increases in healthspan. I think we should invest a lot more into something like SENS to further improve our healthspan. I also think that we should make medically assisted suicide easier.

ux 6y ago

The key word here is "good health". If you start shifting from "living as long as possible" to "living with the most dignity up until the end", you end up questioning euthanasia, but also how people live post work-life: typically, how people are going to live decently through their last stage post 60s, can they enter a stage where they are relieved from the stress, pain, etc. You can't just say "well let them die earlier" if you don't provide some form of hope of relief for their last years. Today I'd argue that the growing lifespan is used as an argument to make people work longer, which means in worse physical conditions. The "Work until your death" motto (the curse of people living in poverty) is not great for a healthy and attractive society. Questioning it ends up in a heated political/societal/philosophical discussion pretty quickly. And we're definitely not heading in the healthy direction: not because we don't want to shift the medical institution, but because we need a more profound society change. From a purely economical PoV, it's great that people die before around the beginning retirement, from a societal PoV it's a disaster.

adrianN 6y ago
People are asked to work longer because pension systems were set up when people used to die less than ten years after retirement and now a lot fewer young people have to pay for retirees living 15+ years. The only way to avoid this is to drastically reform pension systems.

echelon 6y ago

Humans should live 500 years. Death is a disease. Aging is a disease. We're not close to fixing this, and barring some tectonic shift in our capabilities, probably won't see substantial change within our lifetimes. But to take the stance that death and aging are acceptable seems so medieval to me.

benjohnson 6y ago
Counterpoint: I wouldn't want to be a victim of slavery, torture, or boredom forever.
- rowanG077 6y ago
  I wouldn't want to be the victim of them at all. Whether it's duration is 30 years or 10000 years. Besides suïcide is almost always an option if you feel your life is unbearable.

cowmoo728 6y ago

Why is it that some people survive to 90+ without significant mental deterioration? My grandfather is 94 and reads the news, does crosswords and sudoku, and plays poker and bridge, at a level comparable to when he was 60. His knees have deteriorated so he stopped jogging 20 years ago, but he still walks and swims. It's worth pursuing longevity science if we can help more people age this way.

steve76 6y ago

"is continuing to put forward the preservation of life worth it given the extreme decline in quality of life that we see past the age of 70?" Yes! - Age is nowhere near as bad as trauma. - When it's really your time to go, you go pretty quick. - Fight the disease not the patient. Knowledge is the real scarcity. - Not your decision to make. People want to do it on their own, and you will have to stop them. - It would be evil to send your grandparents to the friar so you have the money to spend on video games and Hollywood, yet alone illegal drugs and strip clubs.

graeme 6y ago

> As a result, I think the current crop of people who are alive are among the first to see the effects of truly advanced age. You’re mistaking average for median life expectancy. People lived to older ages in the past. But lots of babies died, so the average life expectancy was way down. Add a lot of zeros to a number series and it gets pretty low. Ancient comedy even had a stock character, sexex iratus: angry old man. Certainly there are many more very old people now, but it wasn’t something totally unknown. The aging of people has also coincided with a decline in our physical health and diets. Strength is declining year on year: we have grip strength measures for college age students since the 1980s and it is a steady decline. Diets are worse, people are much fatter and with more health problems such as type 2 diabetes. One of the theories of alzheimers is that it is a form of diabetes. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769828/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769828/ Certainly it is correlated with type 2 diabetes, and with obesity in mid life. (Not in late life, but this may be because sudden weight loss is a precursor of alzheimers https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6205180/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6205180/) Have a look at this chart. Japan has one of the oldest populations in the world, and yet its alzheimers death rate is less than 6x that of the usa: https://www.worldlifeexpectancy.com/cause-of-death/alzheimers-dementia/by-country/ https://www.worldlifeexpectancy.com/cause-of-death/alzheimer... There is more to this than just age. Our lifestyles increasingly leave us hobbled by ailments at young ages, and the medical system patches it up and lets us live through them longer. But this expresses in much more old age morbidity than would otherwise be biologically necessary.

JamesBarney 6y ago
> One of the theories of alzheimers is that it is a form of diabetes. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769828/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2769828/ Overall, we observed little evidence of causal associations between glycaemia and cognition, structural brain and dementia phenotypes.
- graeme 6y ago
  What are you quoting from? I searched the text and glycaemia is not present. The paper is concluding Alzheimers is a type of diabetes.

bryanlarsen 6y ago

It's a valid concern, and to answer your concern researchers often use Quality Adjusted Life Years (QALY) when measuring the effectiveness of treatment. I wish I had more time to pull up references for you, but I believe that the answer to your question is "yes" -- extending people's life through intervention usually gives people more years of quality life and usually has little effect on the number of years of poor quality life.

adaisadais 6y ago

I think the life expansion is merely a byproduct of other things that have ultimately led to a higher prevalence of Alzheimer’s and other amyloid plaque based diseases. We have a few factors that have greatly attributed to this increase in life and increase in mental illnesses: decrease in tobacco (specifically smoking) use, increase in processed food eating, increase in life sustaining medicines, decrease in overall activity. Tobacco: on one hand we know that smoking raises chances of having a shorter life span as it really accelerates cellular inflammation and deterioration. (1) On the other the stimulant aspect of nicotine helps the brain continue to stay active and helps resist atrophy. Personally, I notice more and more people I interact with on antidepressants. My parents and grandparents generations probably suffered the same levels of depression (more or less) but moderated this with smoking. Processed Foods: Modern processed foods started to flood grocery stores after the Second World War and became the staples of the American diet. Natural fats were replaced with unnatural and chemical based preservatives were put in many goods to increase shelf life. We know empirically that these foods also (like smoking tobacco) increase all cause mortality. Alzheimer’s prevention advice typically advocates for a diet removing such items. (2) Better Medicine & Decrease in Activity: these two factors may need no introduction but we know that the older we get the less stem cells we have and the worse our cellular health is overall. Moderate Exercise helps slow the death of such cells. (3) Again, this is circumstantial, but all of the people I personally know with Alzheimer’s and other amyloid plaque based diseases did not lead active lifestyles and I would define their lifestyles as quite sedentary. (1) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4098701/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4098701/ (2) https://en.wikipedia.org/wiki/Alzheimer's#Epidemiology https://en.wikipedia.org/wiki/Alzheimer's#Epidemiology (3) https://www.google.com/amp/s/time.com/4776345/exercise-aging-telomeres/%3famp=true https://www.google.com/amp/s/time.com/4776345/exercise-aging...