Compression of Morbidity: Vitality to the End

“Live long and prosper.” -Spock

“Live long and drop dead.” –Grok

Got your attention? (Thought so.) Sisson’s gone morbid, you say. Not exactly. Death is on the docket for today but more so the time leading up to death – (for some) a period of morbidity during which we experience major illness and impairment. We live, of course, with the prospect of our own mortality and how it will befall us, but we’re also emotional witnesses to that of our loved ones. I’ve lost many family and friends at this point in my life. Although I believe most had a good life, not many had what any of us would consider a “good death.”

I’d venture to say that most of us have known someone, perhaps even someone very close, who lived their last years with serious disease and debilitation. Perhaps they were in and out of the hospital, caught in continual throes of pain, rendered increasingly immobile and confined by physical weakness, stressed by the financial burden of their ongoing care, juggling medications and treatments whose side effects were almost as unbearable as the conditions they were meant to treat. Those final years may have offered the invaluable chance to be emotionally and cognitively present, to appreciate and reciprocate the love of family and friends, to bring individual and interpersonal business to a peaceful, meaningful closure. Maybe not. Either way, we can’t help but wish our loved ones could have lived out those years with less suffering, less hardship.

On the other hand, we’ve known people who, up until the day they died, lived active, independent lives wholly on their own terms. Old age obliged perhaps a slower rhythm but little constraint. There was a spirited, graceful older lady I knew growing up. Up until her last day, she lived (not far from us) in the house she’d raised her children in – staircases and all. She entertained her dozens of grandchildren and great-grandchildren there. She mowed her own yard. She biked around town every day. She kept one of the most beautiful gardens I’d ever seen and tended dozens of ferns (some thirty years old or more) in her sunny Victorian home. One spring morning while she was dusting a curio, she died of a massive, sudden heart attack. There’d never been evidence of heart disease or any other medical condition. She’d been fit as a fiddle, as they say, until the day when she literally dropped dead in front of that cabinet, duster still in hand. She was 89.

To be sure, it’s a shock when people die that way, but after the reality sinks in, there’s also a sense of gratitude, relief, even fortune that they had the life they wanted – up to the very last moment. Whatever the extent of our own grief, we take comfort in their quick passing. Given the choice, I sincerely hope to follow my old neighbor’s example.

We’d all like to live to a ripe old age. What a trip it must be to turn 100. However, I’d gladly give up those extra years, even decades, if it meant they were to be spent bedridden and miserable. Truth be told, I live the way I live not because I’m shooting for longevity. If I’m lucky enough to enjoy a long life, so be it. Rather, I live my life according to certain principles in order to push illness and markers of aging further and further down the road. Coined by James F. Fries, M.D., there’s a phrase for this: compression of morbidity. It’s the shortening of the period between the “first appearance of aging manifestations and chronic disease symptoms” and the end of life (PDF). In my book, that’s what it’s all about.

While statistics show that we’re generally living longer – some 78 years and 2 months according to the latest figures, the flip side is that other research shows we’re living fewer years disease free and more years with chronic and often debilitating disease. We congratulate ourselves in the developed world on our mortality-related statistics (e.g. life expectancy), but our morbidity picture is increasingly abysmal. As Eileen Crimmins, AARP Chair in Gerontology at the University of Southern California and co-author of the study examining morbidity and life span, observes, “There is substantial evidence that we have done little to date to eliminate or delay disease while we have prevented death from diseases. …At the same time, there have been substantial increases in the incidences of certain chronic diseases, specifically, diabetes.” In a short ten year span, we’ve lost on average a full year of healthy life (slightly more for women) – life without one or more of the major diseases that constitute the most common causes of death in the U.S.: cancer, diabetes, and cardiovascular disease. (I wonder what the picture would look like if you added other common chronic and debilitating conditions like Parkinson’s and Alzheimer’s.)

As this study showed, we also spend less of our life fully mobile. Just ten years ago, the average 20-year-old man would experience 3.8 years of his life with impaired functional mobility – “the ability to walk up ten steps, walk a quarter of a mile, stand or sit for 2 hours, and stand, bend or kneel without using special equipment.” Today that number is 5.8 years. Women fare even worse. Ten years ago, that number was 7.3 years and has since risen to 9.8 years. That’s almost ten years of one’s life without basic mobility. Yes, there’s much more to life than the ability to walk up stairs, but I can’t call this an ideal. We’re not talking about a freak accident here that couldn’t have been helped. This trend represents broad and gradual systemic decline – the kind of impairment that is almost always preventable by effective and consistent lifestyle intervention.

Call me callous (or not), but I think we’re shockingly blasé about the constraints people are routinely living with at the end of their lives. We’re physical beings, of course. I understand that bodies don’t last forever. Nonetheless, the fact that we’re losing so much ground in only a decade’s time should constitute a five-alarm fire.

For those who suffer in their final days or years, I’m grateful for the interventions of modern palliative medicine. Yet, it’s an uneasy contract. Do we accept the limitations, pain, and suffering of chronic disease more as a society when we have a “fix” to treat it? No one I know who’s dealt with a long decline has many good things to say about the treatments that spared them the worst of their suffering. They’re grateful, but they still traverse a long, hard road. These measures are better than the immediate alternative to be sure, but the commonality of their circumstances still begs a bigger question, I think.

For my part, I’m not going gently down that path of decrepitude. There’s no sense of surrender here. I’m not master of the universe, but I do have quite a bit to say about my own fate. I live every day of my Primal life as an affirmation of wholehearted, all-out living. Thriving, as it were. I’ll make my peace with my life and loved ones each day rather than wait until some compromised 13th hour. I’ll embrace every particle of discipline and self-respect to live a life that I know will support my well-being and independence today and in my later years. Let me live with the primal spirit of my ancestor kin and meet death (when it comes) with a vigor and vitality that confound the statistics and conventional resignation of our time. That, in my mind, would be the best resolution for a Primal life – and a good death.

Thoughts? Responses? Let me know what you think, and thanks for reading today, everyone.

TAGS:  Aging, Grok

About the Author

Mark Sisson is the founder of Mark’s Daily Apple, godfather to the Primal food and lifestyle movement, and the New York Times bestselling author of The Keto Reset Diet. His latest book is Keto for Life, where he discusses how he combines the keto diet with a Primal lifestyle for optimal health and longevity. Mark is the author of numerous other books as well, including The Primal Blueprint, which was credited with turbocharging the growth of the primal/paleo movement back in 2009. After spending three decades researching and educating folks on why food is the key component to achieving and maintaining optimal wellness, Mark launched Primal Kitchen, a real-food company that creates Primal/paleo, keto, and Whole30-friendly kitchen staples.

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