It's not that I am afraid to die. I just don't want to be there when it happens.

— Woody Allen



A recent issue of The Economist contained some startling information on the aging population.

The average 65-year-old in the rich or developed world (as opposed to the third world) can expect to live another 20 years, half of them free from disability. However, from the age of 80, again in the developed world, 1 person in 5 will be afflicted with some form of dementia, 1 in 4 will suffer from vision loss and 4 in 5 will develop hearing problems. Of those who make it to 90, the majority will have at least one health problem that counts as a disability; many will have multiple ones.

In America today, a 70-year-old man has a 2 percent chance of dying within a year; in 1940 this milestone was passed at age 56. In 1950, just 5 percent of the world's population was over 65; in 2015 the share was 8 percent, but by 2050 it is expected to rise to 16 percent.

Of note is that in Britain there were just 24 centenarians in 1917; today there are nearly 15,000. (A centenarian is 100 years of age or older.) It is estimated that half of all children born in the developed world during this century will live to at least 100.

One new study finds no evidence that the proposed maximum lifespan of around 115 years has stopped increasing. To the contrary, the study demonstrates that any such maximum has yet to be identified. But no matter what aging does to us, we all have to die, and death is a topic most of us wish to avoid talking about. Because It is inevitable, the more we learn about dying the less painful it might be.



‘How We Die’

One of the best books on the subject of dying, “How We Die,” by Sherwin B. Nuland, demythologized the process by helping rid us of the fear of the unknown. According to Nuland, everyone wants to know the details of dying, though few are willing to say so. Moreover, modern dying frequently takes place in a hospital where it can be hidden, cleansed of its organic blight and finally packaged for modern burial.

Dying begins at birth, of course, but biological processes that throughout life have been making replacement parts for dying structures within each cell can no longer do their job. After a lifetime of regenerating spare parts, the nerve and muscle cells’ capacity for regeneration gradually shuts down. The rapidity of circulation diminishes. Cardiac cells cease to live and the heart loses strength.

As this happens, each heartbeat pushes out less blood than it did a year earlier. As the pump ages, its inner lining and valves thicken. Not only the heart itself but the blood vessels are affected by the passing years. Before long every organ is getting less nourishment that it needs.

The normal kidney loses some 20 percent of its weight and develops scarring. Thickening of the tiny blood vessels inside the kidney decreases blood flow and the kidney loses its ability to remove excess sodium or to retain it in the body when needed.

The bladder is also affected. As it ages the bladder loses its distensibility and can no longer hold as much urine as before. Old people need to urinate more frequently.

Like muscles of the heart, brain cells are unable to reproduce. For every decade after 50, the brain loses 2 percent of its weight. Even the immune system is not immune to aging.

In essence, aging results from an accumulation of unrepaired cellular and molecular damage and the limitations in cell maintenance and repair functions — in particular, those of DNA and proteins. The maintenance of DNA integrity is a challenge to every cell, for damage leads to the absence of key proteins and to the synthesis of proteins in the wrong cells at the wrong time. Such damage accumulates throughout life from the earliest time when body cells and tissues begin to form. The same is true for mitochondria (the energy factor in cells).

Symptoms Of Dying

It is comforting to know that symptoms related to dying such as the death rattle (caused by saliva collecting in the throat), air hunger and agitation are generally not uncomfortable to the dying person. All are well-treated by medications and with hospice — it is rare to die in pain.

The great 16th century essayist Michel de Montaigne was once on the verge of dying after an accident and found himself gasping for air, and attempting to pound on his chest to breathe. Fortunately he recovered. He later reflected that despite the trauma, he began to grow languid while feeling like he was being carried aloft on a magic carpet. From this he found that learning to die is not necessary. He noted, "If you don't know how to die, don't worry; nature will tell you what to do on the spot, fully and adequately. She will do the job perfectly for you; don't bother your head about it."

Max Sherman is a medical writer and pharmacist retired from the medical device industry. He has taught college courses on regulatory and compliance issues at Ivy Tech, Grace College and Butler University. Sherman has an unquenchable thirst for knowledge on all levels. Eclectic Science, the title of his column, will touch on famed doctors and scientists, human senses, aging, various diseases, and little-known facts about many species, including their contributions to scientific research. He can be reached by email at [email protected].