Marks Daily Apple
Serving up health and fitness insights (daily, of course) with a side of irreverence.
30 Mar

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.

You want comments? We got comments:

Imagine you’re George Clooney. Take a moment to admire your grooming and wit. Okay, now imagine someone walks up to you and asks, “What’s your name?” You say, “I’m George Clooney.” Or maybe you say, “I’m the Clooninator!” You don’t say “I’m George of George Clooney Sells Movies Blog” and you certainly don’t say, “I’m Clooney Weight Loss Plan”. So while spam is technically meat, it ain’t anywhere near Primal. Please nickname yourself something your friends would call you.

  1. I couldn’t agree more. I would rather going out swiftly or with a bang than long and drawn out. My great grandfather was bedridden for about 10 years before he died. I too want to be like your neighbor, enjoying life up unto the last minute.

    Conner P. wrote on March 30th, 2011
    • Another thoughtful post from Mark. My wife and I love cruising the world, however, the average cruise passenger is far from inspirational. I’m 66 and in pretty good shape, sprinting, running and doing pullups and pushupa as well as my gym rings. It amazes me that the terrible, immobile, obese shape most Americans have degenerated to his accepted as normal.

      We all get old and somewhat disfunctional but decrepitation is the new norm.

      fit65 wrote on March 30th, 2011
    • 10 years? This makes me feel so unbelievably blessed that I discovered the primal lifestyle at such a young age of just 22 years old.

      Living a vibrant life is what its all about. One must try their absolute best to cherish every moment as one never knows when it will end. Live primally and your chances of making it to 100 increase.

      Whats certain is that the quality of life is grand.

      Primal Toad wrote on March 30th, 2011
    • “Let it be known in history that we chose to die on our feet, rather than live on our knees”

      Jason wrote on February 14th, 2014
  2. Its better to burn out than to fade away.

    Graham wrote on March 30th, 2011
    • Exactly my thoughts :) Gotta love Neil Young!

      Alhaddadin wrote on August 16th, 2011
  3. Great post. Motivation to increase the amount of time I’m healthy (as opposed to just increase my lifespan) is my main reason for living Primally.

    I wonder, though, about the effect of improved diagnosis in those results. I haven’t read the article, but I wonder if the authors address this (btw, the link to the press release is missing the “h” at the beginning of “http”).

    Erin wrote on March 30th, 2011
    • It’s pretty hard to miss being sick and miserable even if you don’t have an official diagnosis.

      Dana wrote on March 30th, 2011
      • Unfortunately it seems like a lot of doctors seem to brush off decreased performance, mobility, etc. as “Well you’re old, it’s to be expected.” as opposed to seeing it as something to aggressively address with exercise and better nutrition…

        Jenny wrote on March 31st, 2011
        • As a GP I can tell you that I would dearly love it if my patients were willing to tackle their issues with “exercise and better nutrition” but THEY DON’T LISTEN and if they listen, they still don’t comply. They want a pill. They don’t want to put forth the effort. I understand it’s hard work to stay in shape- I dedicate a fair amount of time and yes, money to it- but it’s absolutely worth it in my book. But try telling that to the average patient. They just don’t want any of it. Don’t blame the doctors!

          Emily wrote on March 31st, 2011
        • True, Emily — it’s definitely a two-way street. I’ve heard plenty of doctors complain about people who come in and just want a pill without further instructions, even in matters of life and death.

          I tend to forget about that when I’m here since pretty much anybody hanging around here is taking charge of their own health, but still. You’re right.

          Jenny wrote on April 1st, 2011
      • I agree with you. My husband has felt sick for at least the past 5 years. Sure, he has heart disease, congestive heart failure, and type 2 diabetes, but so much of his “sick” feeling cannot be contributed to any one cause. It’s frustrating!

        Christine Mattice wrote on April 15th, 2012
  4. Agreed.

    Many see middle age as a time of aging (when various ailments begin to manifest) as natural and inevitable, how often do you hear ‘it’s my age’ (and often from people only in their 40s).

    The biggest thing Primal has to get over is ‘it doesn’t have to be that way’. It isn’t natural, it’s pathological and mostly completely avoidable.

    Kelda wrote on March 30th, 2011
    • I know what you mean. I hear friends, only in their early 30’s, blame their age for forgetfulness or health problems. It makes me feel quite strange when I am standing their listening to them talking this way (I am in my 40’s). These people often forget that I am actually older than they are 😛

      Kitty wrote on March 30th, 2011
      • good point Kitty! we need to be careful what we say to ourselves about our selves – I am bad at this!

        Cecilia wrote on March 30th, 2011
      • LOL..that made me laugh.
        But it’s happened to me, too. Having a conversation with younger people and I get to hear about their health problems…it’s ironic.

        We live in a housing area and I see tons of people (young ones) huffing and puffing in their professional work-out clothing down the side walk with their arm weights and walk-man.
        And here I come in my 40’s sprinting down the street with my dog:)

        Suvetar wrote on March 31st, 2011
      • I know what you mean, Kittly. And the more they think about their forgetfulness or health problems (and blame it on their age) the more they’ll start experiencing those problems. This is a classic case of mind over matter!

        Christine Mattice wrote on April 15th, 2012
    • my experience? it starts in people’s 30s these days.

      it is common for my 31 yr old girlfriends to say ‘oh, well, you know, it’s aging!” or, if i pull a muscle or some such (rare, but still) “that’s because you’re aging! can’t do what you used to!”

      it’s so sad.

      Zoebird wrote on March 30th, 2011
      • My 25-year-old brother-in-law thinks it’s normal that he has lost significant mobility compared to when he was, say, 14. I tried to explain to him that it wasn’t normal…couldn’t make him listen (although I didn’t try ridiculously hard since it appeared he would have taken it as an insult).

        labbygail wrote on March 31st, 2011
  5. This has been on my mind all week. My grandmother is only 69 years old and takes enough pills everyday to stock a small pharmacy. She can’t get around very well and as a result, battles with depression. About three weeks ago, her doctor changed her depression medicine which ended up making her worse and last week she took a whole bottle of sleeping pills to try and commit suicide. In her “suicide note”, she said she just couldn’t handle being a burden on her family. She ended up living and is now staying with my parents until we can figure out what to do but it brought home the reality to me about living an all around healthy life and steering clear of excessive medical interventions when possible.

    Matthew wrote on March 30th, 2011
    • I know someone in his *early 40s* who takes enough pills to stock a small pharmacy. Some of them are for asthma, but even that responds to changes in his lifestyle. In other words, if he takes better care of himself, he has fewer attacks and needs less medicine.

      Dana wrote on March 30th, 2011
      • Yeah, my ex has the same kind of asthma and he is in his 30’s. He has remarried and is now eating mostly processed food high in carbs and chemicals, and he has gotten worse. He has also aged about 20 years before my eyes.

        Kitty wrote on March 30th, 2011
  6. What a timely post. Not more than 10 minutes ago, I was talking about compression of morbidity with my sweetheart…yeah, I know…why was I talking to her about something like that? But, as she cares for her aging mother in a nursing home, our discussions often turn to how we never want to be in the same situation. We want to be going strong until the moment we keel over and die.

    We both believe that our lifestyle choices will go a long way in making that happen. While we’re not completely primal yet (we’re close), we do see the benefits of the primal lifestyle and we hope that those primal choices will help us live a long healthy life.

    Steve wrote on March 30th, 2011
  7. Mark, great post today.

    I work in a hospital, and I see the effects of this morbidity on a daily basis. People rarely ever die of just one thing. I see patients here with a host ailments, multiple emergency room trips, life support, and heroic measures being used to save and prolong their life. What a life it is too. They go home, bedridden, on hosts of medications with invasive procedures, doctors appointments, and in home (or nursing home) care a necessity.

    I’d much rather be healthy right up until the day I “die of nothing”.

    Yaish wrote on March 30th, 2011
  8. Very well said. Sometimes people focus so much on “retirement” and don’t even bother living and relishing the moment.

    Gary Deagle wrote on March 30th, 2011
  9. Love this post, and concur! I’ve thought this too as different family members pass, those that go suddenly opposed to those that suffer for what seems like eternity. The ones that suffer leave you with that feeling of despair, their sickness something you can only hope you do not have to endure. A heart attack while tending your favorite plants (doing what you love) definitely is the way I want to leave.

    Jeanna wrote on March 30th, 2011
  10. My grandfather lived to be 95 and he had no health problems except for diabetes which he controlled with 1 pill and with his diet. For whatever reason, he hung himself last November. I think he was tired of living…if that makes sense.

    bjbegoon wrote on March 30th, 2011
    • Some brave Ones are lucky to be able to carry through with that choice! I hope you are able to accept it without pain.

      Ross wrote on March 30th, 2011
      • Not sure I’d call it “brave” (since it would make sticking around to live “cowardly!”) but yes, it is an individual, personal choice. Hopefully it’s what he really wanted, at least.

        Jenny wrote on March 31st, 2011
    • Your story was touching, I am sorry for your loss.

      Lucy wrote on March 30th, 2011
  11. This is a timely post for me since I am watching the slow march toward death of my mother.

    She lives at the top of a steep hill and walked most everywhere up until a few years ago. She was still square dancing and could carry on a conversation while hiking up that hill at age 90. Now at 93 she is so weak she has to be pushed around in a wheelchair and has 24 hr. care. She probably has Alzheimer’s but still knows who I am. She has not been interested in anything and I mean anything for the last year or so. This is totally not like her.

    Probably around the age of 85 she started taking medicine for her heart. If she didn’t take it she would collapse on the floor. This medicine gave her another 5 good active years of life.

    Now here comes the problem. The only thing keeping her alive at this point is the heart medicine. She is not in a mental condition to make the choice of whether or not to take the meds and I don’t believe it is legal for anyone else to make that decision plus being a moral question.

    She always said she hoped she had a good death but this does not seem to be a good one or at least one she would have chosen.

    I think you all can figure out the dilemma in this scenario. Does one reject meds to give one another good 5 years with the chance that the same meds will give you a long drawn out exit? Or do you just go early? And, how can one make that decision anyway? Most of us choose life, no matter how compromised, if we have a choice.

    Sadly, I guess we don’t usually have a choice in how is is all going to end but do have some say in how we live.

    I will always have good memories of how my mom lived. I am sad about this last part and hope it will not leave a lasting impression of her with the family.

    Sharon wrote on March 30th, 2011
    • Oh my gosh. It was hard enough to make that call with a family pet. I can’t even imagine having to make it with a parent. I was with my dad when he died at 78 last Summer. He had given up so long before that it almost felt like a blessing. There’s just really no easy way to part with a parent, is there?

      jen duncan wrote on March 30th, 2011
    • My husband just lost his 93-year-old grandmother 4 days ago. For the past 2 years she has been cared for by my mother-in-law after suffering a broken hip and just generally declining. While still in good health, she just became weaker but remained lucid (with quite the sense of humor) until the last few weeks. However, what a tender, intimate end: her eldest child and granddaughter caring for her as no one else could. We have all learned wonderful lessons about life and death by loving her through her end. I guess my point is that we all have roles to play through our births, lives, and deaths. It’s the relationships that matter most. Your mother may not have the end she wished for, but she does have a loving child to be there for her. That is a gift in itself for both of you. Bless your mother, you, and your family.

      joni wrote on March 30th, 2011
      • Thanks Joni.

        Sharon wrote on March 31st, 2011
  12. This is a great post, Mark. It touches on an issue that’s pretty prominent in my life these days. Thanks for posting about it and writing about it so eloquently and effectively. I agree completely.

    Jillness wrote on March 30th, 2011
  13. My grandmother is 90 years old and while certainly not as spry as she once was, she still gets out meets few friends once in while. Loves having my kids come over even if they are mostly there for her tv ( small town and their grandparents do not have cable/sat lol) she has still more life these past 5 years than my cousin who died this year before her 45 birthday. My cousin had been overweight most of her life, and apparently suffered from a chromic illness which last diagnosis might not have been the correct diagnosis and the alternate was just as terminal. Either way our grandmother had more life in her years than she did in and out of hospitals, clinics etc. Her daughter is likely on her way to similar fate if she does not take care now, always been overweight, plus mental health issues.
    I tease my kids about living past 110 and being so darned onery they be almost desperate to have me keel over lol. My dad side of the family live some long lives and most were very onery as they aged.

    Tamara wrote on March 30th, 2011
  14. This subject is one I am more aware of now than ever before. I’m an orthopedic surgeon and I deal primarily with acute injuries in a hospital-based/ER setting.

    I am NOT going to dwindle away in a nursing home, demented and/or nonambulatory. There is no point to it and it’s a tragic way to end your years on earth. I will pay someone if I have to, to take me somewhere I’ve never been, and ski/big wave surf/motorcycle my way to a quick and adrenaline-infused end.

    Jill wrote on March 30th, 2011
  15. Another thought-provoking and uplifting post. Thank you for that. My grandmother lived independently and vibrantly until 86. A couple hours before she died, she was gardening — pulling up a small tree by the roots, to be exact! Then she went inside, made some strong coffee, sat down, put her feet up, and went to sleep. That seems just perfect to me.

    Oak_dweller wrote on March 30th, 2011
    • That sounds just perfect to me too, with the possible exception of a glass of wine instead of coffee. But a good cup of coffee would work too.

      Wow! Pulling a tree out by the roots. Way to go!! Thanks for sharing that with us.

      W.J. Purifoy wrote on October 22nd, 2011
  16. Agree 100%. My husband talk about this all the time. It doesn’t matter how long we live, but the quality of life we live. That is why we GROK on.
    We both have family members that are constantly at the doctors and have limitations because of there health. They both just sit in front of the tv for hours in constant pain. It is sad to see.

    Julia wrote on March 30th, 2011
  17. I’m a medical doctor who just went primal three months ago (I have never looked or felt better). I’ve been reading this site daily and felt compelled to write my first post on this topic. I can’t believe all the crap I learned during medical school about health. Acutally I should rephrase that, I mostly learned about disease, and very little about health and preventative medicine. Death is not the failure of our efforts as doctors, its an inevitable part of life. But in this society where Convential Wisdom rules, both doctors and their patients are trapped chasing chronic illness. I agree with Mark, I would give up decades of a bed-ridden life to enjoy more vitality and health. Luckily, by living primal I won’t have to choose as long as I stay away from “stupid things” (I forget what rule that is..). I do think that most doctors want a good quality of life for their patients, but that’s impossible to acheive if they are dead. So prolonging life becomes their goal, which then many times compromises the quality :( It’s frustrating to say the least, especially because these chronic diseases are years in the making. Not to mention that many doctors themselves are unhealthy! I am just glad I discovered primal now, so I can share it with my friends and family and hopefully help them live healthy “aka disease/pill-free” lives.

    shadia wrote on March 30th, 2011
    • I am not sure where you practice medicine but I commend you on your choice to learn and apply wellness to yourself! NOW the million dollar question: How will you apply this knowledge and experience in your practice?

      Harmony wrote on March 30th, 2011
      • I’m in Michigan, and actually I decided to become a pathologist which means I don’t see patients anymore. As a medical student I didn’t have great boundaries, I took home all their problems and worried about them constantly. Now I get to help by examing their tissues and making diagnoses. I diagnose a lot of cancer on a daily basis, it seems in younger and younger people. I found too that the time I did spend with patients as a medical student wasn’t enough to really counsel on lifestyle. And then they wouldn’t listen anyway, not surprising because convential wisdom doesn’t even work! Back then I was sleep deprived, had gained 20 lbs, and chronically stressed so I wouldn’t have listened to me either. But now that I’m primal, and sooooo grateful for discovering it while I’m still in my 20’s and can prevent chronic disease in myself, I tell everyone about it. Many family members ask me for medical advice, and lately I just refer them to MDA!

        shadia wrote on March 31st, 2011
    • I have a doctor who follows the Primal lifestyle and he helps those of his patients who are willing to listen to him. The others he still has no choice but to continue prescribing medications. But I feel truly lucky to have a doctor who understands health and nutrition and does not panic when I talk to them about eating primally; but actually tells me to eat a nice fatty breakfast of steak and eggs! Harmony’s question is a good one. Will you apply your new found knowledge in your medical practice?

      Kitty wrote on March 30th, 2011
    • one down, a hundred thousand to go…well that was just a guess, how many medical doctors are there in this country anyhow?

      DThalman wrote on March 30th, 2011
      • Try the world. My doctor is in Australia 😀

        Kitty wrote on March 30th, 2011
        • Hi Kitty, nice to meet you. I don’t think the medical profession will ever become obsolete, but since a significant amount of time and healthcare dollars are going towards these mostly preventable diseases, it makes sense to me that if the “demand” decreases, so will the “supply”. Of course there are plenty of conditions that require medical attention and there always will be a need for good competent doctors including pathologists like myself. But I personally would rather see fewer people needing medical attention for lifestyle-related chronic illnesses.

          I tried to reply under your actual comment below but for some reason I couldn’t, so this one is a little misplaced :)

          shadia wrote on April 1st, 2011
      • The medical/pharmaceutical industry is interesting…at this point its because of these diseases that we have jobs! Maybe that’s why there aren’t as many dollars in preventative health. But if having fewer doctors and health corporations is the natural outcome of our society becoming healthier and happier, I will gladly welcome that day with open arms. And then go back to school because being a doctor is the only job I’ve ever had :)

        shadia wrote on March 31st, 2011
        • Hi Shadia, I think that having doctors is still very impotant. I love my doctor because he does embrace the primal lifestyle and because he is a biochemist and can help with any deficiencies that crop up. But we still need doctors to diagnose diseases either way. Even though I have been primal for almost 12 months, and my blood count is great, 4 weeks ago I got this strange and frightening rash all around my eyes. Turns out that I am allergic to something in the air. It was that bad that I still needed the help of a little cortisol ointment to get rid of it.

          Kitty wrote on March 31st, 2011
  18. Don’t get rusty before you’re old and crusty!

    JB wrote on March 30th, 2011
  19. Great post. I know way to many people in their 40s and 50s who take a bevy of meds to “be healthy.” It’s especially sad when they are family members who I know could be helped by some lifestyle changes, but they are convinced that doctor knows best…
    For my part, if I could pick, I’d choose to have my parachute fail when skydiving at 105 years old!

    Katie @ Wellness Mama wrote on March 30th, 2011
  20. -great post. “Quality not Quantity”… so true. Thrive on!

    Jesselyn wrote on March 30th, 2011
  21. you know, above all else you’re just a really good writer. Good stuff!

    PS Althought you could’ve elaborated a bit more on how we as humans aren’t naturally predisposed to being sick/immobilized the last ‘X’ years of our lives. That only happens in modern/westernized societies, if I’m right.

    Tom wrote on March 30th, 2011
  22. Good article, makes me think again about my long time idol Jack Lalane. He was sick with pneumonia for a week, but he lived for 96 years in the most tip top shape. As you discussed, he was primal in many ways, as he often said “If man made it, don’t eat it” and he only ate twice a day, which we call intermittent fasting.

    I’m really curious to see how long, healthy and happy we can truly live using a primal lifestyle from youth. Art Devany and his wife certainly seem to be going strong.

    Jeff wrote on March 30th, 2011
  23. I lost my dad on the 3rd when he decided dyalisis wasn’t for him. His choice was hard for me to accept. He chose to go on his own terms and I respected his wishes. I miss him terribly. He spared us and himself the agony of declining. His Alzheimer’s and kidney failure could have kept him suffering for years. I hope I may leave this world with the same courage and grace he exemplified. Peter Rose

    peter wrote on March 30th, 2011
    • Wow Peter, I’m really sorry to hear that – my condolences.

      I hope the worst of the grief starts to subside soon so you can start focusing on the happy times and good memories.

      J wrote on March 31st, 2011
  24. I’m a Kinesiologist at a wellness center for seniors. Time and time again I see seniors who are immobile, suffering, and still blaming someone or something else for their health problems. One of the biggest obstacles I have is convincing my patients to see that their health is in their hands. It’s frustrating when they don’t see that so much of their health is affected by their diet and activity level.

    Great post Mark. Thanks for the reminder and inspiration!

    Jenn wrote on March 30th, 2011
  25. “On the other hand, we’ve known people who, up until the day they died, lived active, independent lives wholly on their own terms. ”

    That was both of my grandmothers and my half-brother’s grandmother on his dad’s side. All tough old biddies to the end! :)

    MJS wrote on March 30th, 2011
  26. I’ll gladly trade a somewhat shorter lifespan to go out in either a blaze of glory, or a lovely, final walk in the wood.

    The thought of being overly decrepit and dependent is too horrifying.

    Page wrote on March 30th, 2011
  27. A number of years ago, I met a 91-year-old man (at the gym!) who said that after he was finished exercising, he was going to help a friend who, although younger, wasn’t as able as he was. This gentleman said that he often did light housekeeping, ironing and grocery shopping for younger friends. Not only was this man taking responsibility for his own health, but he was helping others, which was probably also a factor in his longevity and upbeat attitude.

    Nicky wrote on March 30th, 2011
  28. My mom-in-law has been causing me to stop in my tracks lately with thoughts of this issue. She has lost more than 4 inches in height and has lost most feeling in her feet & lower legs to peripheral neuropathy. I can’t find a place in my brain to fit what is happening to her.

    I want to drag her outside to walk under the blue skies. I want to make her lift heavy things! I need HER to shout that she’s not going to give in to this!

    But I don’t know if each step that I encourage her to take is one more off the tally of steps she has left. The conflict between maintaining or increasing strength and furthering the physical damage to her nerves is a decision I can’t make for her.

    This is when we decide whether to go down or go down fighting. Do what you can today and appreciate the rain that falls on your head in the middle of a walk. It’s all beautiful.

    Kathy wrote on March 30th, 2011
  29. it is This Idea that motivates me to pay attention to my health Now. my elderly parents are in that phase of illness and it makes me so sad because I have been trying to influence them to exercise (they eat pretty well) but they are stubborn old norskis.

    Cecilia wrote on March 30th, 2011
  30. Mark:
    What you attempting to do is square the mortality curve.
    Incidentally, Michael Rose suggests this can best be done by eating a Paleo/Primal diet (but *only* after age 40!?!)

    I’d love any comments you have on this!
    More info to be found here:

    Jolly wrote on March 30th, 2011
  31. This post comes into my life at just the right time. I found out today that my gramma is on her last leg so-to-speak. She has been suffering for years (arthritis, low blood count, black outs, lost mobility). As painful as it will be to lose her, it has been MUCH more painful to see her quality of life decline to the point of non-existent.

    While sorting through my grief I decided to take this experience as a lesson to take better care of myself. This article perfectly relates.

    I hope to be old like my gramma’s eldest sister- she’s 91, plays the xylaphone and drums in her church band, drives, spends summers at her cottage, and lives at home. What a life!

    RobyRey wrote on March 30th, 2011
  32. Totally agree mark, as the klingons in star trek said, “die well”

    Luke wrote on March 30th, 2011
  33. If we follow the money trail, nursing homes (and drug companies and doctors and…) have in their best interests to keep their residents alive – at any cost to the quality of their lives. I’d be curious to know the residency rate of nursing homes now as compared with prior decades.

    Jane wrote on March 30th, 2011
  34. Mark, you’ve done it again! This was a very
    poignant post. As a young mother of three,
    trying to regain my health after three years of
    being unwell,I am deeply mindful of how my
    lifestyle and choices now will impact my family’s
    future. I have seen the grueling efforts my mother
    has invested in caring for my 82-year-old
    Grandmother who suffers from Parkinson’s.
    It has been brutal, but she has never complained.
    I want my children to have the freedom to live their own lives rather than having to care for
    a helpless parent. Thank you for reminding
    me to live each day well. I feel fortunate to
    have stumbled upon the Primal Blueprint. It is
    steadily renewing my physical and emotional

    Sabrina wrote on March 30th, 2011
  35. This has been on my mind a lot lately. I have one remaining grandparent, my grandfather is 93 and recently had a health scare that landed him flat on his back in the hospital for several days. Before that he was relatively active, still driving, walking to the bingo games at his senior center and working in his machine shop. Even 4 days stationary in the hospital set back his mobility a TON. It took him a week before he could stand up to shave and several weeks before he could walk freely again. He’s back to maybe 70% of his old self (still can’t drive), but it’s been a hard road. This has made it very, very clear to me that staying active is a key to a healthy and enjoyable old age.

    jj wrote on March 30th, 2011
  36. Great post! I figure at age 45, I’m past what the primal world has expected me to live anyway. My only wish is to get my kids independent, after that, anything else is gravy.

    Nick wrote on March 30th, 2011
  37. My father died at the young age of 75. He was killed in a logging accident! I hope to have such a good death someday.

    woo wrote on March 30th, 2011
  38. This, this my friend is what led me to Primal to begin with. Conventional medicine has utterly utterly failed in the quality of life issues which are ultimately all anyone cares about if you ask them.

    Like you I have seen many of those close to me go and I am convinced that the manner of our death has more to do with what’s going on between the ears than anything else. I damn well am going to leave the healthiest corpse possible be it tomorrow or 40 years from now.

    Peter wrote on March 30th, 2011
  39. Life is not a journey to the grave
    With the intention of
    Arriving safely in a pretty
    And well preserved body,
    But rather to skid in broadside,
    Thoroughly used up,
    Totally worn out,
    And loudly proclaiming,

    Woo hoo !!!! What a ride!

    Chris wrote on March 30th, 2011
  40. Gosh, this is sobering.

    I’ve never come across the term ‘compression of morbidity’ before.

    Recently I sat in a hospital waiting room with other people only slightly older than me. It was utterly depressing. I simply cannot contemplate ending up like that.

    Alison Golden wrote on March 30th, 2011

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