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Asking the Right Question: Do You Want to Live Longer, if Good Health is Guaranteed?


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Posted 12 December 2017 - 12:53 AM


Historically, the public at large has shown themselves to be quite disinterested in living longer. Over the years I've been aware of the longevity science movement, it has always been a challenge to expand the community towards greater acceptance, support, and funding. As an example of attitudes we observe, you might look at the Pew survey of attitudes to life extension from a few years back, in which the people surveyed generally agreed that they wanted to live a few years longer than their peers - in the same sort of way as a house should be just a little bit larger than those of the neighbors, to make the point, but not so much so as to be gauche. Humanity is ever petty in the details when conducting any of its grand madnesses; we can see that in even a cursory glance across a lengthy history of what is, by modern standards, a series of sweeping, cruel insanities. Yet we will be judged just as harshly by those yet to come.

Are we asking the right questions? It has long been thought in our community, though gathering supporting evidence for this hypothesis is ever a difficult proposition, that people are on the whole unenthused by the prospect of longevity because they instinctively feel that a longer life would mean becoming ever more decrepit and sick. They think that superlongevity would mean a collapse into an exaggerated caricature of a wizened elder, unable to do anything other than suffer ever more bitterly. This hypothesis for the public rejection of longevity science for so many years was outlined more than a decade ago, and brought up again at the time of the aforementioned Pew study.

Yet "older for longer" is not the outcome that rejuvenation therapies will achieve. It was never the plan, and no researcher has ever claimed to be working towards that end. Functional, working rejuvenation biotechnologies based on periodic repair of the cell and tissue damage that causes aging will instead postpone aging in the young, and restore health and youthful ability to the old. They will turn back age-related disease. The future is not being older for longer, but rather being younger for longer. This has proven to be a very difficult message to deliver; it has been repeated over and again, and never seems to stick.

Yet in the past few years, a few small surveys have shown that if you ask the right questions in the right context, then ordinary, everyday people will say that they want greater longevity. The right question is whether or not one would want to live longer if health is guaranteed for those additional years. Focus on the health, and people inch towards wanting more time. We have yet to collectively figure out how this should translate into our advocacy for rejuvenation research - it isn't quite as straightforward as one would hope. After all, the message we have delivered for years is exactly that we want to extend health as well as overall life span, and that in fact the only practical way to achieve longevity is to provide greater and longer-lasting health.

People say they want to live longer - if in good health

Longevity is a such a pervasive goal in public health policy and even popular media, but individually most people only want to live long lives if they will be healthy, according to a new study. "People in three cultures from around the world are reluctant to specify their desired longevity. To me this is interesting because longevity is such a valued public health objective, but at the individual level, longer lives are a goal 'only if' I remain healthy."

The results of these interviews reinforce previous findings from this research group that revealed many older adults - in various cultures - think of life as not a smooth continuum of time but segmented into different states. The researchers refer to four "ages" or stages of life, including the third age, which is an active retirement where people leave traditional work and family roles, followed by the fourth age. "People seem to view one part of the future as wanted and another as not wanted, typically the 'fourth age' which is basically the period when one might experience a disability or a potential health decline."

For this study, the researchers interviewed 30 people in each country, and they recruited the sample with sex and age quotas to reflect a range of experience with retirement. About one-third of respondents did not express aspirations for a longer life. "Some felt their lives had already reached a stage of completion, and others as a form of fate acceptance." A larger number of respondents did mention they wanted to extend their lives. Yet less than half of that group noted a specific amount of time they desired to live. The strongest opinion among that group was the desire to live longer only if they maintained their current or what they deemed to be acceptable levels of health.

Is longevity a value for older adults?

The human desire to prolong life and postpone death has a long history. In modern times, population longevity, as measured by the statistical estimate of life expectancy, is taken as a measure of nations' progress and development. The promotion of longer lives, principally through reduced mortality at younger ages, is a prominent goal of public health policy and research. Academic units concerned with gerontology have been adding the term longevity to their titles - a center for longevity, a longevity institute. Presumably, this skirts the negative connotation of aging and aligns the organization with a desirable end. Longevity can be an organizational mission in a way that aging cannot.

At the same time, longevity is not without shadows because modern medical care can maintain lives that are felt to be too long. At the population level, rising numbers of long-lived persons can pose societal challenges. Sheer longevity is also qualified by the age from which it is projected, for the hope of a long, full life is one thing at age 10 or age 20, but another in the seventh, eighth, and further decades of life. This latter stretch is the concern of our paper.

Longevity counts time from some point forward but it is also an individual perception about time left before the ultimate deadline of death. Deadlines are motivators and none more so than death. The question about future time left and one's goals can be reshuffled to ask another question: whether time left is itself a goal. Do older people value longevity for themselves? That is the focus of our analysis, based on conversational interviews with older adults in three cultures. The study of "desired longevity" (vs. expected longevity) has been quite limited, which is particularly puzzling given such theoretical interest in the end of life and gerontology's tacit assumption that most people want to live a long life. On the one hand, the modern promise of increasing health and vitality predicts an embrace of longevity. On the other hand, worries about late-life frailty and illness may make people hesitate to welcome extended lives.

Survey techniques have been used to ask adults about desired longevity, this in order to examine the distribution of replies (always contingent on respondents' ages) as well as associated factors that may explain the replies. One feature of these findings is a curious amount of non-response (refused to answer, don't know) to questions about desired longevity. Distributions of numerical answers about desired longevity also display another pattern: the "age heaping" of replies at five-year intervals, such as 80, 85, 90, etc. Taken together, approximate-age replies along with nontrivial amounts of response refusal suggest that older adults' longevity goals may not be sufficiently measurable by survey techniques.

In this study, we asked people in an open-ended way about their desire for longer life: Would you like to have more time? What age would you like to become? This was something more specific than asking about a preference for survival without reference to any length of time; about one's plans for the future; or whether people see the future as open or limited, as in studies of future time perspective. Our attempt was to discover whether there were preferred temporal spans with which older adults framed their futures and plans.

The two-question series about extra years and desired age ("How old would you like to become?") was designed to generate talk about extended life. Free to answer the questions in their own way, participants could say any number of things about longer life during the interviews. Amid these responses, our analysis capitalized on a pattern that was strongly apparent. When it came to desired longevity, most people did in fact want to live longer, but few supplied a numerical answer that was not also conditional on the maintenance of continued good health. The majority preference was for longer life but "only if."

The health stipulation was cited by three-quarters of the 57 cases who desired longer lives. This stance was a prominent pattern, and in the replies to our questions there were certain similarities: the conditional expressions (if, as long as, it depends), the anecdotes about others in poor health, and the reference to medical discourse about quality of life. The bundling of longevity desires with a health stipulation was common to all three research sites. Such similarities suggest to us that longevity expectations, while personal expressions, are also generated from social discourse of a kind that exists in the three cultures and that yields shared styles of talk about extended life. We posed questions to individuals and each replied in his or her own way, yet there was a consistent, cultural convention favoring health-qualified longevity.


View the full article at FightAging




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