Dependence, decrepitude and death: how long is too long a life?

Further reaches. Ageing by Shutterstock

In 2100, I will be 117 years old, and my younger sisters will be 112 and 107. According to the Cambridge academic, Peter Laslett, we can now live to such ages, but those of us who do will be experiencing the fourth age, “an era of final dependence, decrepitude and death”. Not quite the dream of “active ageing” and a positive old age.

It used to be the case that most of us would die at the end of the third age, about ten years after retiring, when we had plentifully enjoyed the company of our family, were still in fairly good health, and we successfully had completed the life projects we’d planned. Then, the process of dying and death, as well as the care associated with it, would happen in the space of a matter of months.

Now, increasing life expectancy means that we are living longer than ever before. But we don’t ask enough whether this is actually good news.

Living into the fourth age means that, little by little, our senses will leave us. We may well be doubly incontinent, and our sight, like our senses of hearing and taste, will be profoundly impaired. Physical abilities will be severally compromised and we will probably find ourselves bed bound in a care institution for several years. Our social universe will shrink significantly and few friends and family members, if any, will be left to visit, leading to feelings of social isolation and loneliness. I also imagine young carers playing us ABBA on the stereo because they assume that’s what we listened to in our youth.

According to the Alzheimer’s Society, one in six of us will suffer dementia. Consequently, many of us will experience dying with reduced mental capacity along with all its challenges.

And what if we fall into a coma and our next of kin are forced to ask: “Why are patients in permanent comas routinely kept alive?” This will then inevitably raise ethical questions regarding what treatment to give – or not give – to a patient who is nearing the end of a very long life.

Reducing faculties. Dementia by Shutterstock

Perhaps we will be “lucky” and free of degenerative diseases of the brain. We will then have much more time to think clearly, dwelling on the many emotional hurts that we have done to others or which have been done to us during the course of our lives and which can no longer be put right – something that gerontologist Malcolm Johnson has called “biographical pain”.

Johnson suggests that a third of all deaths are people aged over 85. Two thirds of those over 75 are women – more in the higher age groups – and two thirds of this group of women live alone, are widowed or never married, which makes the female population more vulnerable.

This is also perhaps why many have argued that we must be responsible citizens and take charge of our death and dying, as campaign organisation Dying Matters advocates. And in general we are also being encouraged to make legally-binding advanced decisions in case we become minimally conscious.

It is also advisable, if not necessary, to plan for our funerals. This is due to the profound financial strain it puts on our next of kin and the difficulties associated with sometimes unwieldy systems of financial support for funerals.

In the light of the above I suggest that we go beyond talking about “active ageing” and confront the physical as well as spiritual reality of dying in the fourth age. We need critically to examine what it really means to live so long and whether we really wish to prolong an era of dependence, decrepitude and death.