Old age expected

As a primary-care doctor in Paradise, with one of the North State’s larger populations of retirees, Dr. Larry Miller has adapted to accommodate the needs of his older patients. “As my practice matured with me,” the 70-year-old said, he completed a fellowship in geriatrics through the American Academy of Family Physicians, and he sees different health conditions in today’s seniors than in decades past.

As such, Miller was not particularly surprised by a study on longevity released in mid-December. Researchers compiled data from 188 countries and found life expectancy worldwide increased by approximately six years between 1990 and 2013, up to an average lifespan of 71.5 years. Women improved more than men, adding 6.6 years versus 5.8.

The gains were primarily attributed to advances in health care. In wealthier countries, researchers found, those advances manifest in fewer deaths from cardiovascular disease and cancers; in poorer countries, the impact is evident in decreased fatalities from sicknesses like diarrhea.

The findings—published in the Lancet, a leading medical journal—resonate with Miller, who sees the generalities about longer life spans applying locally. “I live it,” he said. “My whole day is consumed with managing chronic diseases in the elderly, in the old-old—those over 85.”

From his perspective, reining in contracted illnesses (such as influenza) has played just as significant a role as the so-called “lifestyle diseases” (heart attack, stroke and diabetes) exacerbated by poor diet, smoking and low activity.

“Those probably are the two biggies,” Miller said. “There’s a lot of technology and a lot of medication that have made a big difference in addition to diet and healthy living.”

Dr. Roy Bishop, a family medicine physician in Chico, framed the past two decades’ results in the bigger picture.

“Life expectancy has been increasing since the mid-19th century due to public health measures like clean public water supplies and sewers, then treatment of infectious diseases and, more recently, making progress against cardiovascular and pulmonary disease with medications,” he said. “It is not surprising that women live longer than men. The extra X chromosome seems to protect women from some degenerative disease, although fewer men are dying in workplace accidents, violence and wars.”

Dr. David Potter knows first-hand about longevity advances. He’s a longtime Chico oncologist who is transitioning from treating cancer patients at Enloe Medical Center to working in hospice and palliative care. The change would have come sooner had he not suffered a stroke a few months back; he’s since been on medical leave, which he lightly calls his “longest vacation in 33 years.”

Potter credits his wife’s quick recognition of stroke symptoms and the emergency care now available for his return to full functionality.

“In one part of the [Lancet] article they delineate different diseases where there seems to have been improvement,” Potter said, “and I suppose I’m living proof right now of some of the improvements in the treatment of stroke and the decline in deaths from stroke.

“In a number of diseases we’re seeing the effect of people cutting back smoking—whether that’s heart attacks, strokes and some malignancies [of cancer]—where people aren’t dying at the rate they used to, so that makes sense.”

On the cardiovascular front, Miller credits statin drugs that lower cholesterol levels for having a big effect, as well as stents (blood-vessel supports, sometimes infused with medicine) and procedures less invasive than traditional surgeries. He also cites vaccines for flu and pneumonia among other longevity boosters.

Not only are patients living longer, but doctors have begun to diagnose previously uncommon conditions more frequently. For instance, Miller said he used to come across pancreatic cancer once or twice a year; now it’s eight or 10 times. Hepatitis C, linked to liver cancer, is on the rise (by 125 percent, according to the study). Miller also looks carefully for chronic kidney disease.

“Even though we’re saving people from some of these vascular diseases, some of these malignancies are occurring more frequently,” Miller said. “It may be that we’re just living long enough to die from malignancy instead of heart disease.”

The quality of those final years—extra years, if you believe life has been prolonged—became a national discussion point ahead of the Lancet’s longevity report.

In October, Dr. Ezekiel Emanuel wrote an essay in The Atlantic magazine advocating against medical interventions for the aged. The telling title: “Why I Hope to Die at 75.” In raising the concept of “healthy life expectancy,” Emanuel discusses incapacitation and diminished mental function.

So do local physicians.

“Length of life is not all that matters,” Bishop said. “We have the problem that more people are living to be very old, but half of them over 80 have some degree of dementia. We need to look at quality of life.”

Miller and Potter also singled out dementia, which Potter called “the real bugaboo” of old age.

“One of the real dilemmas of this [longevity boon] is: Are people adding good years?” Potter said. “That’s a philosophical question for different people to think about as they get older.

“This is kind of the How the Grinch Who Stole Christmas version of responding to these statistics. Overall, they’re very encouraging as a sign of progress in public health and some dimensions of medicine, but as the average goes up, at least some people will look at old age as not quite the triumph that the statistics might suggest.”