Wednesday, September 17, 2014

Death's fashion moment

It's not just us palliative care folks who think a lot about aging and death these days. "Bucket list" is a thing that everyone knows about, movies like "The Fault in Our Stars" are popular and lots of famous people are dying. I've been thinking that our society has had several decades with less than an average amount of death and is now headed for some time with more.

Something ocean's waves something something life something very deep.  
The way I see it, the folks coming of age around the time of WWII, who have been called "the greatest generation" popularly, have ended up with a very happy intersection of events: growing old with improvement in health care and growing up without serious environmental degradation. We have figured out a lot of key things about heart failure, strokes and cancer in the past 20-30 years so anyone lucky enough to make it to the 1990's has had the benefit of catheter driven cardiology, a daily aspirin, less toxic and more effective cancer therapies, beta blockers and statins. In the 1990's, people coming of age at the end of WWII were around 65, just the perfect age to get the advantages of those advances. These advances caused folks who otherwise might have died to survive their heart attack or their early breast cancer that would not have been survivable a generation before. Thus they were more likely to live past 65 and into their next decades. Postponing of death cannot go on indefintely, however. None of us lives forever and the human body eventually wears out. Folks born in the 1920s and 1930 are in their mid-80's now and are getting to the point where even the best science runs out of rabbits in the hat. Essentially, I think there are a lot of people in their 80's who are still alive who probably would not have lived to their 80's if they had lived their lives out twenty years earlier, but they are getting to the point where there are no more tricks to keep them going. Thus there is an uptick in deaths among the "greatest generation" set.

I think there is also starting to be an increase in deaths among the boomer set as well. The oldest boomers are in their late 60's and are approaching the age when people start dying. It seems that perhaps because of a combination of increased smoking rates and environmental degradation, the boomers are going to be dying a little younger than their parents, thus leading to an uptick in death rate among the boomer set.

These two trends colliding has lead, it seems to me, to an increase in the rate of dying. I don't think it's our imagination; we're busier. I think our society will be thinking more about death for the next twenty years because we will all be experiencing a lot more death than we have for the previous twenty years. Hospice is such good work; it's always a good time to be in it, but it might be a particularly good time to be in it. I think we will also notice a huge uptick in the amount of popular culture that will be devoted to thinking about death and dying.

May we all live long and prosper.