Reviewed by James Morris
The Wilson Quarterly
In separate books, Ted C. Fishman and Susan Jacoby both cry crisis, but in different registers of alarm. Their common theme is the disruptive effects, on nations and individuals, of the coming worldwide increase in the ranks of the aged. Fishman tends toward dispassion; Jacoby, toward exasperation. He's a better guide to the scale of the changes; she's more adept at making them painful and personal. Both sound wake-up calls that go on till afternoon, long after they've made their points. But their troubling message needs to be heard. Take it in perhaps with a glass of aged scotch.
Fishman is a cool-headed observer, whether as journalist, demographer, or sociologist, and has done a prodigious amount of research. He piles on the facts and figures, from the biological to the economic, the transnational to the domestic, and leaves the worst of their possible consequences to our extrapolating imaginations. Five of his 10 chapters have a geographic focus, on aging populations in two American cities -- upscale Sarasota, Florida, and downscale Rockford, Illinois -- and in the nations of Spain, Japan, and China. (Several chapter titles even manage to put a smiley face on the dour demographics: "Senor Moment: Spain's Discovery of Age," "Japan, Land of the Missing Son.") Each geographic chapter is headed by attention-grabbing demographic data specific to the region. Thus, there will be 66 million Americans over the age of 65 in 2025. There were 167 million Chinese over the age of 60 in 2009, and the estimate is for 438 million in 2050; indeed, China in 2025 "will be home to one-fifth of the world's population, but home to one-fourth of all people over 65."By 2050, Spain is projected to have a higher proportion of people over 65 -- 37 percent -- than any other country in the world.
How will nations so configured, with declining birthrates, sustain their economic status and prevent crippling fissures in their societies? Where will they find the resources, psychic and financial, to attend to the new numbers of the aged, and on what haphazard landscape of homes, hospitals, hospices, asylums?
Fishman's geographic chapters are interlaced with others reflecting on various aspects of aging. There is, for example, a universal sequence to how we age physically, and Fishman summarizes it deftly, decade by decade, in a dozen pages that may leave you gone fetal on the floor. Our bodies destroy themselves daily at the molecular level ("We begin to die while still in the womb") in their progress from the pulled muscles of age 30 to the slack, papery skin and dementia of 80. But the inevitable deterioration doesn't necessarily hasten death. Thanks, if that's the word, to stubborn genes or the holding-pattern powers of medicine, the ancient mad may one day number countless millions around the world.
Buried deep in Fishman's book is an inspired subhead, a backhanded (backsided?) homage to the columnist Thomas L. Friedman: "The World Is Flatulent." The page is a nice example of how the macro-minded Fishman can also narrow his range, here to foresee a future of better bathrooms for the aged: "Toilets will sport stylish handrails, lift and drop on command, and even spray water in places that older people have a hard time reaching. And because the physical effects of age befoul the air, the toilet deodorizes its bowl, its user, and the room." Well, that's something.
Little about the gassy world to come leaves Susan Jacoby composed. She derides the myths we're fed about aging in favor of what to her is the evident reality. She skewers Americans' fashionable tendency to deny age and postpone death with a lifestyle cocktail of scientific advances, chemical procedures, Pilates, vegetables, and no desserts but their just deserts. She dismisses the psychobabble that calls old age "a time of placid contemplation"or tells the aged they're not getting older, just wiser and happier and freer. She's a secularist and an atheist, and she counters arguments that push the nobility of suffering and oppose what she calls "rational" suicide.
Jacoby makes an essential distinction between the "young old" and the "old old." It's the young old (among whom, at 65, she counts herself) who write books about the privileges of old age and the new opportunities for finding fulfillment by embracing every claptrap mantra and junk promise that society pitches. The higher wisdom of the moment routinely makes a distinction between chronological age and "real" age. Real age is now what you and your lifestyle will it to be. Real age sends those fond-hope and fat-chance birthday assurances that 70 is the new 50. Yet for every paragliding 80-year-old there are legions of immobile others, pressed to submission by disease or the stony weight of madness.
Chances are the young old won't be cheerleaders for longevity when they cross the line to join the old old, the shuttered, stumbling, ailing, diapered, defecating, delusional, and adrift old. And it's the likely growing number of the latter that alarms Jacoby. Madness is much on her mind: "The most important thing Americans need to know about dementia is how many of the old -- nearly half of those over 85 -- are affected. The prevalence of Alzheimer's doubles in every five-year period over age 65. These statistics cannot be cited often enough." Science is apparently not close to a cure for dementia, even as scientific, medical, and public health advances keep us alive the extra years that put us at increasing risk for the condition. America is not prepared -- and not preparing -- to cope with a great population of devastated minds.
"The two overwhelming problems of real old age in the United States today," Jacoby writes, "are health, which generally worsens over time, and the tendency of all but the richest Americans to grow poorer as they grow older." The most crippling side effect of prolonged illness is often impoverishment, and that reality will not abate as years are added to lives. Science may one day cure diseases that today are intractable, she acknowledges, but faith in a future redeemed by science must not keep us from doing what the old need now, such as expanding Medicare to help cover "the open-ended care of those who may live for years with Alzheimer's."
Jacoby wears her New Yorker's passion on every page and her liberal politics on almost as many. She wants "a new intergenerational contract that covers social welfare needs for Americans of all generations," and she would "tax all income, including that of people over 65, at a level necessary to maintain the kind of social safety net that exists in every other developed country -- which would include comprehensive health insurance for the young as well as benefits for the old." Amid the current fierce divisions over health care in this country, her proposals are below the level of the quixotic.
A doomed agenda, then -- unless, Jacoby suggests, America's aging, privileged boomer generation can be persuaded to come to the rescue and use its shortened breath to demand it. To the confluence of developments explored in her book -- the medical advances that delay death but may not soon cure the ailments that ravage the extra years, the bankrupting costs to individuals of coping with extended life that is no more than half-life -- add one that might have a disproportionate effect. As the charmed boomers come up against the limits of the immortality they had assumed for themselves, they may decide to conclude their lifelong litany of demands with an insistence that old age and death, if they do have to occur, treat their cohort with due deference and at minimal expense.
In the end, at the end, living and dying both earn their cliches. The dice are rolled, the wheel is spun, and some of us are lucky, and some not. It alters nothing to rail against the roster of reasons why, whether a divine plan, planetary alignment, or bum genes. Does age at least bring wisdom? (Another myth, Jacoby says.) The evidence is mixed. When Verdi was almost 80, he wrote Falstaff and set his librettist's final lines -- life is a farce and makes fools of us all; laugh last and you laugh best -- to music that itself whirls and laughs. When Sophocles was near 90, he wrote Oedipus at Colonus, and his chorus sang that anyone who wants a long life is a fool; not to be born is best, but next best is to die as soon as possible. Amen to them both.
James Morris is an editor at large of The Wilson Quarterly and a senior scholar at the Woodrow Wilson Center.
Books mentioned in this post