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

hourglass“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’ve seen both sides in my family. Most immediatly, my mother spent 30 years declining due to obesity caused T2 diabetes; years she did not enjoy life, nor have the energy to do much with here children and grandchildren. The costs were great physically, mentally, financially. My Grok-like dad, 90 now, has rarely had a sick day, remains active, and enjoys life fully. He volunteers at a nursing home where most of the people are younger than he by ten or more years. When he dies, it will have cost the insurance he carries, almost nothing. It may seem callous to reduce this to $$, but we all pay for the diet and obesity related
    health problems. But the saddest part is that life is only half lived when illness dominates.

    Digby wrote on March 31st, 2011
    • Sorry for the duplication, my computer wigged out and I thought it didn’t post.

      Digby wrote on March 31st, 2011
  2. As a primal Crossfitter I am hoping to be the tough old gramma who is still around to do Wod’s with my grandkids!
    I lost my dad when I was 17 and I am determined to be around for a very long time for my kids and show them that life is meant to be LIVED!
    love the comments by everyone, Grok on!

    TonyaL wrote on March 31st, 2011
  3. I”m in my late 20’s been diagnosed with renal failure 4 years ago. Yes 4 years ago it was a death sentence, but after 1 year on dialysis and a lot of muscle loss, I started researching food and exercise. I’m not 100% primal more the 80-20 rule. And it works for me. I’ve also started Kettlebell this year and saw my strength go up. I sometimes forget I have renal failure since I”m healthier then before renal failure where I ran, and ate “healthy”.
    It frustrates me when dialysis patients a few years old or younger then me, come to treatment and complain why me. I haven’t asked why me in over 3 years. And I don’t take all the normal drugs that renal patients have. I have normal blood pressure and I feel great. I try to talk to patients about exercise as a start, but it falls on deaf ears.
    I know something related to renal failure will be my end, but I’m enjoying the ride. And people have lived high quality lives for 30+ years on dialysis.
    If you do get some disease learn to manage it and you can still live a high quality life, it will only bring you down if you let it and don’t educate yourself.

    Bonnie wrote on March 31st, 2011
  4. My grandmother died at 93 a few weeks ago–she experienced that slow, long decline into morbidity and immobility that you describe. She lost all of her faculties one by one, starting with her physical vitality, then her immune system, and finally her mind. She was in and out of the hospital constantly for 2 years, and by the end she had had so many small strokes and serious infections that we’re not sure she remembered who her son (my dad) was, and was unable to speak. We are quite sure, however, that she was miserable and in pain. That was pretty obvious.

    She wasn’t Grandma anymore for a long time. She was a shrunken wisp of her formal self. I can say that it was a relief when she finally died. There was a picture of her at her funeral that was taken when I was younger (she was perhaps 75, 80 at the most), and I cried my eyes out when I looked at it, because I was so sad and angry that the memories I have of her from the last several years weren’t really her. That old woman with lively eyes and a sarcastic smile, who used to bake Christmas cookies with me every year, who lived through the Depression and saved everything to the point of obsession, who took care of me when I was small and walked herself to church 6 days a week, every week of her adult life, died a long time ago. Her body just didn’t know when to stop breathing.

    I sincerely hope I have the wherewithal to end my own life if I am ever in a situation similar, before I am too weakened to do it. But the best thing to hope for is that death comes swiftly and unexpectedly for me, and I never have to go through the kind of death my grandmother didn’t deserve.

    Uncephalized wrote on March 31st, 2011
  5. I’m with Carly on this one. Aged 26 I experienced an injury to my spinal cord. I’ve had my backside cleaned by others, remained immobile for many months (unable to move from the neck down), and in 24/7 excruciating pain. Should I have come home with my shield or on it?

    I’m 47 now and still in 24/7 pain, unable to walk unassisted and all the other health implications that come with spinal cord injury. Sometimes when I read MDA I do so with a shield of armour to protect me from the oh so macho approach to living.

    Even with all my neurological health problems I still have a zest for life. Perhaps this is why many hang on with their meds… because life isn’t just for those who are physically fit.

    It’s true; everyone has to decide how much ‘decrepitude’ they’ll tolerate. Sadly, some of us have to face that choice through no fault of their own from a very early age. I’m grateful for big pharma, the medical profession and the paleo/primal way. Hell! I’m thankful I can feed myself.

    Mitsouko wrote on April 1st, 2011
  6. When I turned 40 I started getting what I called “Old-guy-itis” and I realized that I wasn’t necessarily getting old, I was just out of shape. But getting in shape again had to be different than when I was 20 and could just start running every day and call it good. I got really inspired by Cross-fit, and loved that whole functional fitness idea. The main challenge for me was restoring flexibility and elasticity of my joints, ligaments, and building strength for my whole body. I love PBF and appreciate how you have such holistic approach to being alive. Thanks Mark!

    Matt Muller wrote on April 1st, 2011
  7. My grandfather used to say he was going to get shot by a 21 year old jealous husband when he was 95. He was a dynamo till 89. Almost no pills his whole life.

    Bill wrote on April 1st, 2011
  8. Oh, if only my sweet husband had lived long enough to read these posts! We tried so hard to live a “healthy” lifestyle (according to USDA guidelines). How wrong we were. I’ve been Paleo for two months and am feeling great! I am no longer depressed, my joints don’t ache anymore, my acid reflux is gone and I’ve dropped 14 pounds from my 5 foot frame. I’m never hungry since I eat all I want of nutritious, tasty proteins and vegetables. The most difficult part of this lifestyle is not irritating the hell out of your friends who don’t yet understand! “-)

    Sandy M wrote on April 1st, 2011
  9. “Is life so dear, or peace so sweet, as to be purchased at the price of chains and slavery? Forbid it, Almighty God! I know not what course others may take; but as for me, give me liberty or give me death!”

    Gentry wrote on April 1st, 2011
  10. In Japanese sword fighting Kendo you have to be at least 46 before you can attempt to achieve the highest level 8th Dan. See here these fantastic athletes compete
    http://www.youtube.com/watch?v=ylpdy0XEOfw.
    Some are in their 70’s and 80’s

    Or see the 10th dan master Mochida Moriji Hanshi her in action at age 76.
    http://www.youtube.com/watch?v=_XHSZ-sLG3I
    These old guys move so fast. Sometimes a fight lasts 1 second and you have to see it in slow motion to see what happened. Functional fitness and vitality to the end!!

    Mark Young wrote on April 2nd, 2011
  11. Wow, thank you for this. I was just saying last night that I’d rather live a great life to 55 than a disease-ridden one to 85.
    My husband is an emergency physician, and this topic is so important, and yet one many people won’t discuss. I can’t even explain the brutalities that happen to elderly patients in the ED all in the name of “doing everything possible.” Our entire society needs a reality check on this issue.

    Karen P. wrote on April 2nd, 2011
  12. I been a subscriber to the daily apple for only a short time. However, discussion like this have convinced me how different this group is from some of the other “fitness” sites I have seen. I would like to share the following: I am 62 years old. I have been exercising vigourously (weights, running, biking walking) since I was a child. I have never stopped, through college, professional school up to the present. I have seen my contemporaries age before my eyes, with chronic self inflicted illness over the years. My own health and vigor have always been enough motivation for me to continue with this life style. Two years ago my wife and I took custody of our then 5 year old and 18 month old grand sons from their drug addict parents. I now firmly believe that “providence” guided me along this path. I will continue with the primal life because I have a duty to these two little ones to be as healthy and strong as possilbe for as long as I can. I want to teach them about living and dying in the best possible way. We owe this to them and to each other. To all of you keep up the good fight, you may never know who else will benefit from what you do for yourself.

    dave wrote on April 6th, 2011
  13. Thanks Mark,

    That couldn’t be summed up any better, good work. Thaks to you from Australia.

    Primal Al in OZ wrote on April 6th, 2011
  14. Mark – in my opinion, your finest post ever. Years of thought went into this one, and it’s evident. Thanks for writing it!

    Alhaddadin wrote on August 16th, 2011
  15. Do Not Go Gentle Into That Good Night by Dylan Thomas

    Do not go gentle into that good night,
    Old age should burn and rave at close of day;
    Rage, rage against the dying of the light.

    Though wise men at their end know dark is right,
    Because their words had forked no lightning they
    Do not go gentle into that good night.

    Good men, the last wave by, crying how bright
    Their frail deeds might have danced in a green bay,
    Rage, rage against the dying of the light.

    Wild men who caught and sang the sun in flight,
    And learn, too late, they grieved it on its way,
    Do not go gentle into that good night.

    Grave men, near death, who see with blinding sight
    Blind eyes could blaze like meteors and be gay,
    Rage, rage against the dying of the light.

    And you, my father, there on that sad height,
    Curse, bless, me now with your fierce tears, I pray.
    Do not go gentle into that good night.
    Rage, rage against the dying of the light.

    Abby wrote on September 17th, 2011
  16. I’m with you, Mark…I would rather live a shorter amount of years (and be healthy) than live to 100 and be infirm and sick for the last 20 years of my life. On a side note, I think that age is all in the mind. Some people are active and healthy until they drop dead because they don’t think that their age should dictate the state of their health!

    Christine Mattice wrote on April 15th, 2012
  17. New concept :
    Period of Mobidity…

    I’m proud to say that my great grandmom died at 102 and she was fortunate enough to have known her great great grand daughter… Born in 1895 She led an active life – agrarian commercially and did sewing, cooking like other women of that time. I always knew her to be crippled and immobile.. She suffered from arthritis and otherwise healthy she used to shuffle around with her walking stick, over the years that declined into pushing wheel chair, then sedentary in her bedroom most of the day… She died peacefully in her bed in 1998.

    Is living long whilst enjoying uncomplicated health a thing of the past?

    Offspring of Eve wrote on July 21st, 2013
  18. Very beautiful and inspiring….I fell in a manhole in 1998 , thanks to sleazy employers with no regard for human life ( they faked the top to look functional) I was left spinning in the wind…..total body nerve damage…. and 4 slams to the back of the head….workman’s comp MD’s ” WOW’ you should be dead!”….prayer, nutrition and self-rehab (hideously painful) and 7 years later I was no crazier than I was before the accident and looked great (except for the horrible scar where my left shin had been crushed)….since this incident and subsequent miraculous recovery….I am determined not to ever be debilitated again…..I already did my time there…..your blog is always inspiring and keeps me on track….I always get questions on how I can look so young for my age…and when I explain the eating, supplements, and exercise they usually say it’s not worth it….soooo many people want magic….when common sense is really so easy when it’s habitual

    dotsyjmaher wrote on July 31st, 2013
  19. Certainly, poor health habits (obesity, lack of activity) combined with effective emergency medical treatment (they’ll get you through that first heart attack!) contribute to the problem of extended senescence. So do falling per capita murder rates and automobile fatality rates (about half of what they were three decades ago). The reduction in the smoking rate is an another odd contributor to this problem: Smoking is correlated with some very specific and very fatal diseases, like lung cancer, that kill people before they become infirmed.

    In mice and monkeys, caloric reduction and improved diets seem to have more effect on health than longevity: While researchers may be disappointed that recent experiments have shown that CR and/or improved diets don’t appear to be a “magic bullet” for primates, it does suggest that maintaining a good diet, and a good body weight, are likely to leave people disease-free longer.

    Also, if projects like Google Calico (Cynthia Kenyon, Ray Kurzweil, etc.) are able to invent that “magic bullet” to slow, stop, or reverse aging, we’ll all be better off if we are in better shape when we begin the new therapy.

    Karl Kelman wrote on October 1st, 2014
  20. Corbeaux wrote on October 10th, 2014

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