Photo by Sandra Seitamaa on Unsplash.

The realities of aging alone are very different from the most of the stories we read.

So many stories are written about “how I experience getting older.” So many invitations to accept aging and enjoy what we have.

We know that physiology matters. Differences in health, mobility, and cognition shape how people age.

But people also differ in how they react to those changes.

And when you are aging solo, defining yourself as a single person, your experiences and expectations will be very different from those of married people.

Too often, writers generalize not only about getting older but about how people should feel about it.

For some people, aging is an occasion for self-deprecating humor. “I forgot where I left my car keys again.”

For someone else, the same experience may feel devastating. Their reaction is closer to “I’d rather be dead.”

Stories about aging can be more annoying than helpful because they assume everyone experiences aging the same way.

They don’t.

First, people differ in the degree to which they face age-related challenges.

Some people can barely walk. Others have serious vision problems. Some face major illnesses such as cancer, heart disease, or liver disease that require surgery and constant monitoring.

But the social context of aging also matters.

Single people have often become accustomed to freedom. Freedom from explaining where they are going or when they will be home. Freedom from negotiating daily routines with another person.

Married people may experience aging differently. When a spouse dies, they must suddenly cope with loneliness and the loss of shared roles.

Second, people differ in how much something bothers them.

What is a minor inconvenience to one person can feel unbearable to another.

A friend once said to me, “I hate having televisions in waiting rooms. I never watch them.”

I asked, “Do you ever say anything?”

“No,” he said. “It’s not that bad.”

For him, it was an annoyance.

For me, it feels like an assault.

You can even see these differences within families.

In one online discussion, someone described their mother announcing at age fifty-eight that she wanted no more medical treatment. “I just want to go,” she said.

Meanwhile, their ninety-year-old grandfather wanted every possible intervention.

“No matter what it takes,” he said, “I want to live to one hundred.”

Same family. Completely different attitudes toward aging and survival.

For people who have lived alone for decades, another issue becomes critical: control over their environment.

About thirty percent of households are now single.

Someone who has lived alone for ten, twenty, thirty, or fifty years will react very differently to the idea of living with a caretaker or entering a monitored facility.

In Never Say Die, Susan Jacoby describes a single man who was forced to accept a caretaker. He stole the caretaker’s car keys, drove to a bridge, and jumped.

Jacoby’s point is that he should not have been forced into a situation that felt intolerable to him.

For some people, living with a caretaker might be an inconvenience.

For someone who has built a life around solitude and independence, it can feel like a nightmare.

Hospitals and institutions are largely blind to this issue.

I have spoken with many single people who are not afraid of dying alone. Yet experts constantly warn about it.

“What if you die alone with your cats?”

Many single people respond, “That would be wonderful.”

Solitude changes how you experience everyday things.

Noise is one example.

Television noise feels overwhelming to me. Living in silence feels healing and restorative.

But many medical staff find this baffling. The idea that someone might want to read quietly instead of listening to a blaring television simply doesn’t register.

And they have no training in dealing with people who prefer quiet.

That is not the same as introversion. Many people who enjoy solitude also enjoy social interaction.

I certainly do.

Holidays are another example.

People constantly ask, “What will you do for Thanksgiving or Christmas?”

Many singles look forward to those days. They enjoy reading, watching films, or spending time outdoors.

Other people cannot tolerate the idea of being alone on a holiday.

I once had a friend who believed strongly that Thanksgiving had to be spent with family.

Her relatives lived near a suburban train station but refused to pick her up.

Every year she rented a car to reach their house.

It was expensive. She could barely afford it.

If it were me, I would have stayed home, bought myself a wonderful meal, and gone to a play or a movie.

But she didn’t want alternatives. She believed Thanksgiving meant family, no matter the cost.

Finally, lifestyle preferences make some forms of aging easier and others harder.

I have friends who love cruises. They have taken them for years.

Cruising works well as people age. You can travel comfortably into your seventies, eighties, and nineties.

But many people prefer independent travel.

When I travel, I book my own flights and hotels. I stay in one place for a week or two. I walk all over the city. I eat small meals in cafés.

I have no interest in being herded onto buses or sitting through huge group dinners.

As I get older, it is becoming harder to travel that way.

Eventually I may not be able to do it at all.

That will be difficult for me because travel has been central to my life. I have even held jobs that required one hundred percent travel.

Cruises, however, hold no appeal for me.

They involve single supplements, crowded dining rooms, and constant small talk with strangers traveling in pairs.

I tried a cruise once. I did meet a woman who had asked to be assigned a random roommate.

She loved the arrangement.

I would have been miserable.

Having never lived with someone by choice, sharing a room on a cruise or in a hospital would feel like a prison.

So I cringe when I read articles about the importance of “acceptance.”

Could I accept group travel?

Probably not.

My friend who hates being alone on holidays will struggle more than I will with solitude.

People who cannot tolerate their own company often cling to relatives who treat them badly. They are seen as needy, and over time they may lose friends.

Ironically, they may end up more alone.

Those of us who enjoy solitude will do well until the day we need help.

That is when our preferences may collide with reality.

Personally, I have told my doctors that I do not care about living to one hundred. I would rather die before entering a nursing home.

Fortunately, they respect that.

People who enjoy groups and togetherness may thrive in retirement communities and on cruises.

But I will never be one of them.

In the end, aging well depends partly on luck and health.

But it also depends on something else.

The quirks and preferences we were given by the universe.

And those quirks shape the kind of aging we can accept.

The post Why Solo Agers Can’t Relate to Most Advice About Aging appeared first on .

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In her book Never Say Die, Susan Jacoby tells a story that still unsettles me. A man who had lived independently all his life was forced to accept a caretaker. One day he stole the caretaker’s car keys, drove to a bridge, and jumped.

Most people would call this a tragic suicide. Jacoby saw something different. He wasn’t depressed. He simply couldn’t accept the loss of independence. He didn’t want a caretaker. For him, the choice was simple: live without dignity, or die on his own terms.

A recent NPR/Kaiser Health video shared a similar story. An outdoorsman and adventurer, after his wife’s death, was placed in long-term care by his daughter. At 89, confined indoors with limited control over his life, he jumped from a fourth-floor window.

His daughter spoke only of her grief. No one asked what his life felt like to him.

What We’re Missing

We’re drawing the wrong conclusions from these stories. Yes, suicide statistics show that about 18% of older adults take their lives compared to 12% of the general population. But statistics blur the reality: many older adults are not “depressed” in the clinical sense. They are facing permanent losses of freedom, identity, and meaning.

A 17-year-old who contemplates suicide after a breakup or school stress may find those struggles fade with time. But for an 80-year-old who cannot live alone or make choices anymore, the trajectory points only one way. Therapy may not restore what they’ve lost. Antidepressants deliver side effects and questionable value.

When we say, “They should adapt,” we aren’t making a mental-health observation—we’re making a moral judgment.

The Wrong Frame:  Prevention

The NPR video estimated that one-third of long-term care residents think about suicide. The discussion focused on institutional responsibility and survivor pain—not the residents’ wishes.

What if, instead of forcing people into violent, lonely, painful deaths—jumps from bridges and windows—we offered a dignified “final exit”? Imagine a legal, supported process where someone over 75 or 80 could plan a goodbye ceremony, say farewells, and leave life peacefully. Families would grieve, yes, but without guilt, shock, or unanswered questions.

A Contrast: Sandy Bem

The New York Times once told the story of Sandy Bem, a psychologist diagnosed with early dementia. At 69, she chose to end her life before the disease erased her autonomy. She found medication, said goodbye to family, and died peacefully. She left documentation so her family knew her decision was hers alone.

But Sandy’s story also shows the cruel limits of current laws. She had to act while she was still fully rational, giving up weeks or months of potential life. If assisted dying had been legal, she could have chosen the timing without fear of losing control.

The Questions We Don’t Ask

While researching aging, I found countless studies about suicide prevention—reductions in numbers, checklists of depressive symptoms, interventions to “save lives.” What I didn’t find were outcomes that mattered to older people themselves.

Nobody asked: What makes life worth living for you? Nobody asked: What would make continued existence intolerable?

Atul Gawande, in Being Mortal, encourages families of terminally ill patients to ask: “What do you need to give your life meaning?” For some, it’s chocolate ice cream and football. For others, it’s playing with grandchildren. But what happens when those sources of meaning are gone forever?

Cancer patients, heart patients, or patients on dialysis can decline treatment and let nature take its course. People with dementia, macular degeneration, or permanent institutionalization have no such option. They’re told to adapt, medicate, or endure.

Rethinking What It Means to “Save” a Life

We spend enormous resources on counting suicides and preventing them at all costs. But prevention often serves survivors more than the people we “save.” For the elderly, survival can mean years of suffering without autonomy or joy.

Maybe the better question is not how to save every life, but how to honor the lives—and the choices—of those who feel their time has come.

The post When Statistics Ignore Humanity: The Case for Assisted Dying appeared first on .

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“I don’t enjoy doing some of the things I used to,” I said to a friend recently.
“That’s a sign of depression,” she replied. “When you stop getting joy from things you once loved, it’s a sign.”

I was irritated. I hadn’t asked for a diagnosis. I’d just been sharing something real in response to her question.

But her reaction made me realize how widespread this misunderstanding is. Confronting change—especially the kind that comes with aging—is not the same as being depressed. It’s called reality.

The truth is, many of the things I used to enjoy aren’t accessible in the same way anymore. And when I do try to enjoy them, they’re often spiked with new complexities or shadowed by the way others respond to me.

Same Activities, Different Experience

Take exercise, for instance. I’ve always loved going to the studio. Years ago, when I received a (thankfully) false diagnosis and thought I might die, one of my first thoughts was how much I would miss my classes.

These days, I’ve been diagnosed with arthritis. (Yes, it happens even if you’re fit). I’m still going to class, still showing up, still fit—but getting up and down is harder. I modify everything in yoga. And though most people treat me like just another participant, every so often someone jumps in with an unnecessary offer of help—like managing the one small step at the entrance.

I’m still going. But the vibe is different now. I’ve thought about hiring a trainer just so I can move at my own pace without modifying every move. For now, I keep going, and people who haven’t seen me in a while say, “Wow, you look amazing.” It feels good. It’s still worth it. But it’s not the same.

Joy Meets Friction

I used to love going up to my building’s roof deck. During quarantine, it kept me sane. But it takes two steep flights of stairs to get there. These days, sometimes that climb stops me.

And walking. Walking! My favorite low-effort, high-reward activity. But now it comes with the fear of falling. I’ve had falls since I was six. I can trip over my own feet. But now the aches last longer. The recovery takes more time. I still walk. But it’s not as carefree or joyful.

Even non-physical activities feel different. I used to take art classes for self-growth or to add creativity to my day job. Now, many activities feel like placeholders…something to fill time rather than build a future.

Then There’s the Way I’m Treated

Over the years, I’ve noticed the subtle (and not-so-subtle) shifts in how people interact with me. Like the networking event where a very young man asked, “Are you retired?” As if I’d show up just to hang out?

Or the improv class where someone said, “It’s so nice that you come and hang out with the kids.” Kids? Some of them had white hair.

There’s the woman who called out “Go ahead, sweetheart” while I waited for her bike to cross a side street on the way to barre class. When I told her I wasn’t her sweetheart, she gave me a sarcastic “Oh my,” implying I was the problem.

A man at a bus stop once asked, “Do you need help?” When I asked why, he had no answer.

While I waited for a Lyft, a woman saw me checking my phone and asked if I was lost.

Another offered to help me cross a street. I asked why she thought I needed help.
“Because you’re old,” she said. “My mom is old. She needs help. So I figured you do too.”

Let’s be clear: I sometimes do ask for help. For example, I’m terrified of fast escalators, and once in Budapest, I asked a stranger to help me. I ask Amtrak staff if  I can use the elevator when I travel. But if I’m just standing on a corner, waiting for a car or bus? No, I’m not lost. I’m not helpless. I’m just…standing.

These microaggressions accumulate. They change the texture of the experience. They make walking to exercise class feel like something to endure, not enjoy. I’ve even started taking a quieter street with less foot traffic to avoid the unsolicited “help.”

When Assumptions Define You

In The Other Americans by Laila Lalami, the protagonist is a composer who attends a prestigious music conference—only to be mistaken for cafeteria staff, a trespasser, and a critic, simply because of her skin color. The joy of her performance event is overshadowed by constant microaggressions. She wants to run away.

In 2014, Jacqueline Woodson wrote in The New York Times about winning the National Book Award—only to have the MC introduce her with a watermelon joke. As she said:

“In a few short words, the audience and I were asked to take a step back from everything I’ve ever written… lest I forget, where I came from.”It’s the same with ageism: a stereotype overwrites your identity, eclipsing your accomplishments, your presence, your personhood.

We’ve become more attuned to how damaging it is to reduce someone to their race. But many still don’t recognize how degrading it can be to reduce someone to their age.

I work on books. I stay active. I engage. But I also navigate a world that sees someone who looks like me and assumes frailty and forgetfulness. My actual mental and physical accomplishments disappear.  Their thoughtless remarks change the nature of my experience.

So yes, some things don’t feel the same anymore. But not because I’m depressed.

It’s because the world sees me differently—and insists I play along.

The post It’s not the same — and that’s not depression. appeared first on .

Image by Annette Shuman on Unsplash,

The NY Times published an opinion piece: The Perverse Economics of Assisted Suicide by Louise Perry. July 22. Here’s a version of how I answered it in a letter to the Times. We need to make our voices heard.

It is not clear why the NY Times published this article by an unqualified, insensitive journalist about the economics of medically assisted suicide in countries with national health care.

First medical aid in dying is not assisted suicide.

In many cases there are no current medical alternatives available for the physical or mental illness. Often existing medical alternatives come with horrific side effects and even worse pain.

Often medical aid is not available due to the patient’s finances; in the US we are at the mercy of merciless insurance companies, who are happy to kill their paying customers to save a few dollars. They certainly don’t mind adding to their pain.

Second, families increasingly cannot provide qualified care to their sick or elderly relatives. People live longer with more serious chronic disease. More and more people are single (up to one-third of the population in some cases).

Third, nursing homes and other care facilities increasingly resemble concentration camps with no hope of reform. Nursing homes have always had a staffing problem. With new immigration laws, the situation can only get worse. Many people in nursing homes actively want to die and would choose that option if they could.

It IS true that assisted dying can save money. Millions of dollars are spent on unwanted care that accomplishes nothing.

But so what? People die from easy access to guns, accidental police shootings,  loosened safety measures, and DUIs, in numbers far greater than they ever will be for medically assisted dying.

Finally, let’s remember that in WWII spies were given cyanide pills so they wouldn’t end up dying a horrible death in POW camps. Most medical and nursing home options feel like those camps.

If you oppose assisted dying, you need to present realistic alternatives for the elderly and for others in incurable chronic pain, mental or physical. We need to make assisted dying more widely available, not less.

https://amzn.to/45dVS7f

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I’m listening to a podcast on planning your life.

“Where do you expect to see yourself in five years?”

Um, I hope I’m alive. After a certain age that’s the first thing you think. Is it sevety? seventy-five? eighty? Maybe even younger if you’ve got a medical condition.

As I wrote in my book, the closest definition to old age is not being able to look ahead ten years.

When you’re forty, you anticipate you can pretty much do the same things in your fifties. When you’re fifty, more than likely you can keep going, if you keep fit and do the right things.

At sixty, it gets dicier. Let’s say you are 68. Most people over 75 experience a major shift. And after 80, it’s a crap shoot. I personally dpn’t believe you can move the needle very much after age 80, give or take a few years.

I’m not sure you gain very much from a healthy diet or medical prevention pills. You do make visible gains from exercise, if you do the right ones often enough, but they don’t stave off major health crises. Lots of fit people get cancer or heart attacks or die young.  I’ve seen the studies: they tend to lump everybody over 65 together as “old.

So how do you make any plans? How can you live a meaningful life when you don’t know how long you’ll be able to keep doing the same things? And maybe you know the odds stacked against you living another three, five or ten years.

One way is to completely ignore the whole thing. That’s pretty much what I’m doing. I write books that are coming out in a few months. I happen to like writing books so I don’t want to look for a hobby. Still, my last thought may be, “Why did I spend so much time with that project? It’ll never get finished now.”

Another way is to stop doing anything that might be called “work.” Just live for the moment. You don’t try to produce for the long term; you just do daily activities that begin and end with each day. When you make vacation plans, you check the box for “refundable” in case you can’t make it.

Still, you find yourself saying, “My 8-year-old cat will probably outlive me.” Or, “If I buy new clothes now, I won’t have time to wear them out.”

Planning has a very short horizon. A lot of activities are a long game. A blog or a podcast takes forever to see returns.

Deferred gratification takes on a new meaning. How long will you defer that gratification?

So does that career choice question: “If you had six months to live…”

Because maybe you do. You place your bets and live–or die–with the outcome.

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A recent New Yorker article explores the topic: How to Die in Good Health.  

“One day, we’re going to die. What should that mean for how we live today?” That’s what the article’s author says. And that’s a question we don’t ask enough. 

The article focuses on Dr. Peter Attia’s fight to prolong our years of health by specific measures of diet and exercise. It contrasts those efforts with the cynicism of Ezekiel Emanuel, an oncologist, professor, and vice president at the University of Pennsylvania.

Peter Attia has a best-selling book Outlive. Besides the book, he works with private clients who presumably pay him $2500 for consultation. 

This amount is not as extravagant as it might seem. I recently considered visiting an integrative medicine clinic at a local hospital, a major teaching center in Philadelphia. Although the clinic was associated with the hospital, the doctors did not take most insurance.

As a marketer, I felt they were being deceptive when they did not make this statement on their website; I only found out when I filled out a form. Furthermore, they answered my query with a form letter (mostly focusing on their non-insurance policy) and a recommendation for a service I didn’t want. When I followed up with another query, they were silent. 

According to the article, Attia makes his patients take extensive blood tests. He uses diagnostic tools that most doctors avoid. For instance, he tells people their likelihood of getting Alzheimer’s, although there’s no way to prevent it or treat it.  

Ezekiel Emanuel is most famous for his article in Atlantic Magazine, which the editors titled I Want to Die At 75. You can google his name to watch follow-ups, on YouTube.

He doesn’t want to go the route of assisted dying. He plans to decline medical procedures, such as chemotherapy. After 75, he reasons, life changes drastically for most people, and not in a good way. As the article noted, he’s now 66 but he hasn’t changed his mind.

.Most importantly,  Emanuel scoffs at Attia’s premise.  “The idea that you’re going to get another healthy decade of life just by doing the things he says is hocus-pocus,” says Emanuel.  Exercise and diet will improve our lives but it’s hard to show that Attia’s suggested regimens will be better.

 Meanwhile, the article explains, the time you spend training to live longer is time you don’t get back. 

The article mentions Eric Topol, a cardiologist in a teaching center. Topol points out that some of the activities to prolong life might prolong our suffering. “There’s no evidence for living a long life and then falling off a cliff,” paraphrases the author.  

Ultimately, the debate boils down to this: How much can we extend a meaningful life?

Ezekiel Emanuel reminds us that,  “Living a long time is not an end in itself. If it becomes the focus of your life . . . that is one of the worst mistakes you can make.”

Peter Attia says, “I want to know that I gave it my all. We have this one shot. Wouldn’t it be a shame if we didn’t make the most of it?”

The average patient has an additional problem. We don’t know the odds. For instance, doctors encourage a lot of people to take statins. I’ve yet to see an article where statins provide more than 2% or 3% absolute risk reduction in heart attacks and strokes, Doctors usually give us the relative risk numbers: “These drugs reduce heart attacks by 36%.”

It seems to boil down to values. I have a specific section in my book.

I’ve been told that values change as we approach our deathbed. But we need them to start out.

We also don’t know how much we’re influenced by lifestyle and how much by our genes.

We’re told, “Heredity is the gun but lifestyle pulls the trigger.”   Sometimes, though, you see people who eat healthy and exercise but still die of cancer or heart disease. On the other side, I once knew someone who was overweight and chain-smoked; she was the only survivor in her family. Everyone else died of heart disease.

So we’re left wondering how to establish our values with incomplete information. And we have two medical doctors taking exactly opposite views.  I must admit, I’m inclined more towards Ezekiel Emanuel. But I hedge my bets by avoiding sugar, at least most of the time.

The post The Controversy: Can You Truly Die in Good Health? appeared first on .

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Paula Span, the New York Times writer on all things aging, just published a piece on profit vs non-profit hospice. 

“Nearly three-quarters of hospice organizations are now for-profit,” she says. Yet (no surprise here) nonprofit hospices do a better job on several measures, including expelling patients who are taking too long to die.

If you’re not familiar with the term “hospice,” the NIA says:

“Hospice care focuses on the care, comfort, and quality of life of a person with a serious illness who is approaching the end of life.” It’s designed for situations when a serious illness can’t be cured or a patient chooses to forego treatment. A move to hospice puts an end to attempts to cure the underlying illness.

Former President Jimmy Carter chose to enter hospice care rather than receive more treatment for an undisclosed illness. He’s reported to be in good spirits, according to this NBC News report

In contrast, according to the NIA, “palliative care is specialized medical care for people living with a serious illness, such as cancer or heart failure.” It includes symptom relief as well as treatments attempting to cure the underlying illness.

Hospice has become an increasingly popular option for end-of-life care. As Paula Span reports:

“Roughly half of Americans who die each year now turn to hospice. The number of Medicare beneficiaries enrolling in hospice rose to 1.7 million in 2020 from 580,000 in 2001.

The increase in demand has attracted for-profit players.

When compared, the non-profits …

…fulfilled requests for special supplies and equipment much faster
…were less likely to discharge patients before they die (breaking the “implicit contract” to care for their patients through the end of life)
…weren’t involved in fraud cases  (such as billing

More than a third of nonprofits, but only 22 percent of for-profits, were “high performers,” says the article. That’s still a low number: almost two-thirds of the nonprofits were *not* high performers, as were nearly 80% of the for-profits.

The article concludes, “Most family caregivers still give hospice care high approval ratings.” The Times article provides no data to support this claim.

There appears to be a scary parallel with nursing homes,

The CDC reports 15,000 nursing homes in the US, about 70% for-profit, with a total number of licensed beds of 1.7 million (as of 2018).

The CDC reports elsewhere 4,700 hospice care agencies, 1.6 million patients (as of 2018), and 66.4% for-profit.

The parallels are not encouraging. In my book on aging stereotypes, I cite statistics on abuse in nursing homes. It’s hard to believe there’s no abuse in hospice. Moving people back and forth between hospital and hospice would seem to come close.

We need to stop being squeamish about the end-of-life process and look to ways of dying with dignity. That may include, for many people, an option to choose medically-aided dying.

The Times article referred to the need for reform. They’ve published many articles about abuse in nursing homes, even identifying the problem as a crisis and Something’s Got to Give.  There’s no evidence that anything has changed there and it’s likely even less will change in the hospice arena.

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When I wrote my book on aging (click here for a link to buy and trigger warnings), I was aware that many people fear aging. A lot of people avoid hanging out with “older” people as though aging might be contagious.

Some people think fear of aging is related to a fear of death. I don’t think that’s true. Older people aren’t afraid of dying. They’re afraid of living a miserable, painful existence in the months or years before death. 

As I wrote in the book, people are living longer. Aging is gaining recognition with columns in mainstream media like the New York Times, dozens of blogs and special categories on social media

But as I wrote: 

The downside is, many of us live longer and take longer to die. The days are gone when you could keel over on the street on a Monday and be dead and buried a week later.  Our health care system and political infrastructure haven’t kept up.

As a result, many millennials have watched their parents struggle to take care of their own aging parents. They’re smart to be scared. 

So “growing old” isn’t on most people’s list of “10 things to do before I die.” Many of us want to move directly to “die.” 

I think of this when I come across articles on Medium (and elsewhere) insisting that age is nothing to be afraid of. 

I don’t think people fear aging as a physical process or a harbinger of death. It’s not just about the gray hair and wrinkles, which get the most attention in the media. 

As early as age 40 you can experience fears of age discrimination, which is real. Age discrimination keeps you from doing meaningful work and getting paid market rates. You can share equally realistic fears of being abused by the medical profession, where complaints often are dismissed as, “What can you expect?” 

As they age, many people particularly fear becoming helpless and being forced to live in a nursing home, which will resemble a prison in many ways. (Even in assisted living you lose a lot of your freedom.) They fear dying in pain because of restrictions on medically assisted dying. 

Defining someone has “old” or “not old” is a waste of time.

I wrote about this in another article on Medium.

If you resist being defined as “old,” it’s not because you’re in denial. It’s because your age is not related to your interests, capabilities and actions. An 80 year old could be lying helplessly in a bed or barely able to walk across a room. Or she could be Willie Murphy, the octogenarian weight-lifter who single-handedly beat off a burglar who invaded her home. 

Let’s replace “fear of aging’ with “fear of stereotypes” and “fear of being helpless.” 

If I ruled the world, you’d get your cyanide pill on request at age 75 (and you could contract with a mafia hitman to spare your family the guilt and anguish, if that’s a concern). That would do a lot to end “fear of aging.” 

If that’s too extreme for you, read this opinion piece by a distinguished physician who’s a bioethicist at the world-class University of Pennsylvania medical school. I don’t agree with everything he says (I don’t think creativity ends at 75) but I agree that “remaining life expectancy” takes on a different meaning at age 75.

Since that’s unlikely, we need to write to our legislators, reminding them that sometimes there are worse things than growing old. And that’s what people really are afraid of. 

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A “resource guide” on the APA website claims, “Depression and suicide are significant public health issues for older adults. Depression is one of the most common mental disorders experienced by elders, but fortunately is treatable by a variety of means.”

Like many sources, this guide puts “depression and suicide” together. As a result, many “elders” are cruelly forced to live meaningless and painful lives.

While some “elders” may resort to suicide as a result of depression, the truth is that not all depressed people are suicidal, and not all suicide is the result of depression.

In some circumstances, especially among the “elderly,”  suicide can be viewed as a rational response to a condition that removes the person’s opportunity to live a pain-free, meaningful life.  Pain is not always responsive to treatment and side effects of medications can be so horrific as to take away all quality of life.

In 2015 the New York Times Magazine reported the suicide of Sandy Bem, a distinguished research psychologist diagnosed with Alzheimers. While she controlled her mind, she wanted to avoid the miserable life that lay ahead.

In her book Never Say Die, Susan Jacoby describes a man who could no longer live alone, after living in solitude for many years and valuing his privacy; he stole his caregiver’s car keys, drove to a bridge, and jumped. She argues that he should have had easier access to death, not psychiatric treatment.

Australian scientist David Goodall chose to die at age 104. He didn’t have a terminal illness or even a serious illness. But he’d just fallen in his own apartment, lying on the floor for two days till his housekeeper found him. His life was no longer meaningful.

“At my age, and even rather less than my age, one wants to be free to choose the death and when the death is the appropriate time,” he said.

These rational decisions are not the result of depression.

During WWII,  the CIA gave cyanide tablets to spy pilots who were in danger of crashing into POW camps. This may be a fantasy, but in some countries suicide pills were part of spy equipment.

In her wonderful book Prague Winter, Madeleine Albright shares the story of a female spy who swallowed her cyanide pill to avoid arrest and torture by Nazi soldiers. Sure, she had pain. But compared to her son, who was tortured and then killed, she got a cakewalk.

For many innocent elderly people, a nursing home will resemble a POW camp, but with no possibility of rescue and no opportunity to live a good life afterward.

Patrick Henry famously said, “Give me liberty or give me death.” Nobody said he needed to seek validation from a mental health professional.

In my book on aging in sneakers, I argue that everyone should get a cyanide pill when they turn 75, to use as they like.

I also suggest they receive a gift certification to the nearest Mafia hitman, who can make their death look like an accident (“just another shooting in South Philly”) to spare their families from unnecessary guilt. I’m not sure I’m joking.

This post comes from my book, When I Get Old I Plan To Be A Bitch.

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There’s a movement out there to associate growing older with embarking on a spiritual journey. The idea seems to be that as you get older, you become a better person. You’re more open to helping others. You focus on your “soul.”

Sorry, I’m not ready to do this. It’s no accident my book was called, When I Get Old I Plan To Be A Bitch.

Some people find themselves becoming more spiritual over the years. Age isn’t always the reason.

Long-time meditators seem to become more spiritual even when they’re using a secular meditation practice, such as Transcendental Meditation.

Members of traditional religions often complain about the designation “spiritual but not religious,” but it’s a meaningful designation for many.  Certain practices, such as gratitude, have become so common they’re no longer associated with spirituality, let alone religion.

Some authors assume you get holier with age. 

Connie Zweig’s book, The Inner Work of Aging, specifically urges a shift “from role to soul” as people get older:

“The unfolding of advanced stages of human development, which are described in every religious and spiritual tradition as the purpose of late-life…the hunger for [deep work] is universal… the moral voice of the elder.”

Many purported benefits of spirituality seem related to forming a community. An article listing 5 ways for “older adults” to meet people and make friends includes “joining a faith community.”

An article from a senior living blog says it all in the title: Becoming More Spiritual: A Natural Progression for Older Adults.  They say, “Seniors in their 60s or older may have enjoyed the material lifestyle when they were younger, but now seek more meaningful days.”

But what if you don’t want to be holy?

What if you don’t want to donate your time to a cause…you want to work and be paid at market rates? What if you want a coworking space, not a senior center?

There’s no reason to make the “older and holier” connection.

End-of-life awareness doesn’t turn everyone into a believer. Christopher Hitchens, the outspoken atheist, died of esophageal cancer at sixty-two. He rejected the possibility of a deathbed conversion:  “‘Thanks but no thanks’ is the reply to those who want me to convert and recognize a divinity or deity.”

We don’t need more reasons to label older people as “different.”

Let’s face it: holy people rarely become mainstream. They might be honored and praised, but they’re not friends and colleagues. They’re the “other.”

It’s also another way to pressure older people into accepting their lot as second-class people.

Back in the old days, the Catholic church had the tradition of “offer it up.” The idea was that if you experienced pain or suffering, you could join with Jesus or donate your pain to the souls in Purgatory. Today even mass-going Catholics have never heard the phrase but it was common back in pre-conciliar days.

Today that advice, along with all those articles urging older people to “turn inward” or focus on their “souls” seem strangely manipulative. All too frequently, these writers say things like, “As we age we don’t care about money;” or, “We should be willing to retire and do nothing.” Or they say, “We shouldn’t take ourselves too seriously when we’re subject age discrimination.”

Now employers can discriminate: “Old people want to donate their time and leave a legacy. We won’t hire them.”

I have nothing against volunteer work, IF it’s truly voluntary…not a way to compensate older people for the paid work they can’t get because of age discrimination. It’s not a way to conquer loneliness.

Associating “older” with “volunteering” suggests that employers can deny employment guilt-free to older people.

It’s also insulting to the millions of people of all ages who volunteer while holding down full-time paying jobs.

Even worse, we’re seeing writers urging older people to accept dependence and helplessness as a path to spiritual growth.

Being helpless can be horrible. If you want to escape In his book, What Makes Olga Run, Bruce Grierson describes an older woman trapped in her own body. With a mind “sharp as cheddar,” she had no way to lead a meaningful life.

Some people want to keep going, no matter how bad things get. Others want to reach for a cyanide pill to end their suffering on their own terms.

During World War II, spies were given cyanide pills in case they got caught. A POW camp was considered worse than death. Many older people would view a nursing home the same way. Hospice takes away your control and doesn’t always take away the pain.

If you’re in pain, you should be taken seriously by the medical profession, not dismissed with, “What can you expect at your age?” And if you can’t be fixed (or you have to pay a horrible price to be fixed), a lot of people would like to stage a Final Exit.

If you associate spirituality with a holy righteous anger, I’m with you.

But if spirituality means putting up with a lot of BS (and worse), no thank you.

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