Dying in Good Health: Can We Have a Healthy Aging Process?

Can making good choices extend our healthy life and shorten the dying process at the end?
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In this Episode:

• 01:46 - Ready for the Holidays?
• 06:47 - Lore Segal, Émigré Life Novelist, Dies at 96 
• 12:25 - Recipe of the Week: Texas Twinkies
• 14:00 - Making the Most of Life in Old Age
• 24:19 - Outro

Is it a requirement to get sick as we get old? Can we reduce the risk and delay the onset of age-related diseases? While aging is inevitable, can we have healthy aging process with a compressed dying so that we have a sudden death in our old age. One day, we’re going to die. What should that mean for how we live today?

Chapters

• 0:00 Intro
• 1:46 Are You Ready for the Holidays?
• 6:47 Lore Segal, Émigré Life Novelist, Dies at 96
• 12:25 Recipe of the Week: Texas Twinkies
• 14:00 Compression of Morbidity: Making the Most of Life in Old Age
• 24:19 Outro

Transcript

Dying-in-Good-Health-Can-We-Have-a-Healthy-Aging-Process

This podcast does not provide medical nor legal advice. Please listen to the complete disclosure at the end of the recording. Hello and welcome to Everyone Dies, the podcast where we talk about serious illness, dying, death, and bereavement.

I'm Marianne Matzo, a nurse practitioner, and I use my experience from working as a nurse for 46 years to help answer your questions about what happens at the end of life. And I'm Charlie Navarette, an actor in New York City, and here to offer an every person viewpoint to our podcast. We are both here because we believe that the more you know, the better prepared you'll be when an end-of-life crisis hits.

So welcome to this week's show. Please relax, get yourself a fruit smoothie, and put your feet up, because it might be your last chance to do so before the holiday season gets into full swing. And thank you for spending the next hour with Charlie and me as we talk about how to achieve the goal of dying as old as possible in as good of health as possible.

Like the BBC, we see our show as offering entertainment, enlightenment, and education, and divide that into three halves to address each of these goals. Our main topic is in the second half, so feel free to fast forward to that chatter-free zone. In the first half, Charlie talks about the author Lori Siegel, who at 96 approached death with the same powers of perception she brought to her fiction and also has our recipe of the week.

In the second half, I'm going to talk about having healthy birthdays every year until we die. And in the third half, Charlie has a cheeky obituary for you. So Charlie, getting ready for the holiday seasons? No.

Said the Grinch. You're a mean one, Mr. Grinch. I don't know.

It's, um, um, they're nice, but I don't, uh, yeah, I don't know. It's just really nothing that's special. Um, I'm past running around and making sure the holidays are all perfect for, for everyone.

And. Did you ever do that? I'm past that. I'm sorry, what? Did you ever do that? Um, when, hmm, personally, no.

But when I was married, there was, I just really, really, really disliked it because the ex would just, everything just had to be, it's just, you gotta do what they say. No, no, no, you can't. No, it just was no, no.

And I remember the first time when I did not go home for, it was Thanksgiving, right? Yeah. It was Thanksgiving. I mean, years ago.

And I just decided I don't feel like being with the family. My family is, you know, long, long before I got married. Um, and I still remember this.

I stayed, I ordered a pizza. Um, I, I watched, uh, a movie on TV. It was so relaxing.

It was. Yeah. Yes.

That. I think there's, there's too much, there's too much pressure with the holidays, especially as the kids grow up and have, you know, their husband's family. And, you know, it's like, well, who's going to go where? Who's going to do what? And I, I don't, I don't do that.

I don't get into that. It's like, if Thursday is when you need to go do something, how about we do Thanksgiving on Friday or. Oh, wonderful philosophy.

I like it. Whatever, you know, it's like, is it about the day or is it about the family enjoying themselves and eating like really good food? So I, I don't, um, my last kind of holdout for that had, had been Christmas. And, um, I've even really kind of given that up.

And we go to like an all-inclusive resort at Christmas and invite the kids. And if they want to come, then we pay for them to come and that's their Christmas present. And if they don't want to come for, or can't come for whatever reason, then we say, okay, if you want us, you know where to find us.

What a wonderful philosophy. We're on a beach, you know, with a mudslide and scuba diving and basking in the sun. And there's, then there's like, there's no, there's none of the pressure of.

Exactly. Whatever. Exactly.

I'm there. So you're going to come to the islands with us then? You're going to come to the islands. I'm sorry, what? You're going to come to the islands with us then? Um, no, I'm not even going to Michigan.

Um, no. I'm just going to stay here. And, and the thing I still need to find is.

A soul? Oh no, I stopped looking for that years ago. The, is, is simply a traditional turkey dinner. And while there's a lot of those around the city, everybody needs, just, you know, makes their, their gravy.

So fufu, they put all these crappy ingredients in it. I just want a simple brown gravy or whatever color it is for Thanksgiving. Um, and that's it.

Age? My sister still makes a very good gravy, but, um, I have not been able to find a place where it's, you know, just a simple gravy without a lot of junk in it. Just a simple gravy, Marianne. Am I asking that much? Apparently.

Apparently. Yeah. So on with the show.

Yep. All righty. In our first half, Lori Siegel was an author of autobiographical novels of her life as a young Jewish Vietnamese refugee in England and as an emigre in America.

Even as her eyesight faded, she followed the same routine she kept for her nearly 70-year career. Up early, coffee and toast, occasionally with gooseberry jam, a condiment that reminded her of her time in England, where she fled as a child to escape the Nazi takeover of her native Vienna. Then, onto the notepad or typewriter or laptop.

It was this practice that allowed her to produce an unparalleled run of wise and funny New Yorker short stories. This practice that yielded five groundbreaking novels, the penultimate of which was named the finalist for the Pulitzer Prize. And it was this practice that had driven her to write.

Between previous surgeries, a popular sequence of stories centered on the lives of a group of elderly writers and artists in Manhattan. The Ladies Lunch Series, she called it. In June, in the sort of ominous description that would not have been out of place in her own fiction, a leak opened in the ceiling of Lori Siegel's apartment on the Upper West Side of Manhattan.

For hours, water splashed across the kitchen countertops and onto the tiled floor, collecting in murky puddles and defying all efforts by Siegel and her part-time nursing aide to catch it with buckets or stanch it with spare towels. Only when the building superintendent managed to locate the source of the problem, faulty pipes in the unit above, was a flood finally halted. Siegel and the aide and Siegel's grandson Isaiah were left to mop up the mess.

Two days later, Siegel traveled with her daughter Beatrice to Shelter Island to visit a friend. She was anxious about leaving the apartment, Beatrice recalled. So Isaiah agreed to stay to keep an eye on things, and that seemed to make her feel better.

But as soon as we got there, it was clear that something was wrong. She went from being able to walk to not being able to walk in the space of a day. Siegel didn't want to eat.

She drank reluctantly. Really, all I could do, she told me, was lie on my back on a marvelous stretch of green grass, looking out at a marvelous stretch of water. Beatrice cut short the trip and drove her mother back to Manhattan to the emergency room at Mount Sinai.

I remember sitting in the car and thinking, okay, yes, I know the reality of the situation. She's 96 and not in the greatest of health. Still, I kept fantasizing that the doctors would give her some fluids, give her some nutrition, and send her on her way again.

Her hopes were not entirely misplaced. Siegel had a long history of rebounding from catastrophe. In her 80s, she underwent open-heart surgery to address a misbehaving valve.

In her 90s, she had a pacemaker installed. Her left hip had been replaced. During the pandemic, she was hospitalized with what turned out to be a case of pneumonia.

And a few months earlier, she lost vision in her right eye. Miraculously, none of the incidents seemed to slow her down. She was still able to get out, albeit with a walker.

Her publisher, Dennis Johnson, said, she still had the charm and the wit. She still wrote, too, writing being her way, as she put it, of being understood and understanding myself. I consider it the most amazing thing one can do with one's life, to find out what has happened.

But sitting alongside her in the hospital, Beatrice could tell her mother's resiliency would no longer be sufficient. A battery of tests, the doctors explained, showed that Siegel had suffered a cardiac event while on Shelter Island, probably a minor heart attack. Was there anything to be done? Not at her age, no.

Between the hard stuff and her blindness, difficulty getting around, lack of hunger, and the kitchen flood, which felt like the last straw, I think she'd lost the last of the will she'd been holding on to, Beatrice said. Siegel agreed to start palliative care at her apartment, which had been outfitted with a hospital bed and an oxygen concentrator. In late June, a few weeks after her aborted visit to Shelter Island, she composed a lengthy email to her friends.

I have been wondering how to say what I need to tell you, the email begins. How much to dump on you? She recounted the cardiac incident and the trip to Mount Sinai. I did not understand, she went on, that the decision had been made outside my ken.

But please, she pleaded, please don't worry for me. I am not sad or angry or afraid. Why aren't I? It seems that having had a good 96 years will do very well.

Lori Siegel died at home on October 7, 2024, at the age of 96. There are links in the show notes to Ms. Siegel's obituary and Matthew Scher's profile. That being said, for the rest of the year, and maybe longer if we feel like it, we are going to feature state-themed recipes, starting with Texas Twinkies.

These are not your mama's Twinkies, I'll tell you that. These stuffed peppers are over-the-top rich and indulgent, at once meaty-smoky, creamy-cheesy, garlicky-savory, and crispy-bacon-y. Some recipes call for grilling, but we tried that and chose to bake instead.

That technique works much better. A quick stint under the broiler at the end adds the char you might miss from the grill. This savory dish of cheese-stuffed jalapeno peppers wrapped in served hot is a spicy appetizer or side dish you can serve at your next funeral lunch.

Bon Appetit, y'all! Please go to our webpage for this week's recipe and additional resources for the program. Everyone Dies is offered at no cost, but is not free to produce. Please contribute what you can.

Your tax-deductible gift will go directly to supporting our non-profit journalism, so that we can remain accessible to everyone. You can also donate at www.everyonedies.org. That's every, the number one, dies.org. Or at our website on Patreon, www.patreon.com, and search for Everyone Dies. Marianne? Thanks, Charlie.

Five decades ago, President John F. Kennedy said, it is not enough for a great nation merely to have added new years to life. Our objective must also be to add new life to those years. The question here is, is it necessary to get sick as we get old? Can we reduce the risk and delay the onset of age-related diseases? While aging is inevitable, can we have a healthy aging process with a compressed dying, so that we just drop dead in our old age, and one day we're going to die? What should that mean for how we live today? In 1980, James Freese, a Stanford rheumatologist, predicted in the New England Journal of Medicine that better medicines and behaviors could enable a compression of morbidity, which would delay diseases and debility until the very end of our lives.

In the late 90s, Freese supported his hypothesis by publishing a decades-long study with the University of Pennsylvania graduates who, in their 40s, exercised more, weighed less, and didn't smoke much. These people were half as likely as others to suffer a significant disability in their 70s. They seemed to postpone the onset of disability by more than five years.

Freese himself died of end-stage dementia, which is an age-related disease, in 2021 at the age of 83, and his broader prediction never seemed to come true. If anything, longer lives now appear to include more difficult years. The compression of morbidity may be as illusory as immortality to demographers Eileen Crimmins and Harem Beltran-Sanchez wrote in 2010.

According to the World Health Organization, the average American can expect just one healthy birthday after the age of 65. Let me just say that again. According to the World Health Organization, the average American can expect just one healthy birthday after the age of 65.

Now, doesn't that kind of just blow your mind? So what are we talking about? Healthy life expectancy can be defined as a measure of the average number of years a person would expect to live in good health based on current death rates and the frequency of self-reported good health. So there are two parts which make up the measure of healthy life expectancy. One is the frequency of self-reported good health in the population, saying to people, do you think you're in good health? They don't have to be in good health, but do they perceive themselves to be in good health? And the second are death rates.

Behavioral and socioeconomic risk factors such as physical activity, smoking status, education, and household income are associated with self-reported poor health and have important and complex relationships with each other and physical health status. Deaths from cancer and cardiovascular disease make the largest contribution to years of life lost, so have the biggest impact on life expectancy. Tobacco use is the risk factor making the largest contribution to years of life loss for both sexes, followed by high body mass index or obesity, high cholesterol, and high blood pressure.

Now, hope is not a strategy for a healthy life expectancy. Our podcast series of Preventing Premature Death, of which this is the last episode of the series, talks with you about what you control to not die young. Michael de Monge, the 16th century ethicist, said, in as much as I no longer cling so hard to the good things of life when I begin to lose the use and pleasure of them, I come to view death with much less frightened eyes.

When we are led by nature's hand down a gentle and virtually imperceptible slope, bit by bit, one step at a time, she rolls us into this wretched state and makes us familiar with it. As we grasp that our days are limited, we seem to give up our need for control. We may try to close the gap between what we want and what we have.

Healthy aging seems to require a shift in mindset as much as a shift in muscle mass. Don't we want to say that we gave our all to the one life that we know we have? We have this one shot. Wouldn't it be a shame if we don't make the most of it? In the words of Alexander Hamilton in the musical Hamilton, I am not throwing away my shot.

I am not throwing away my shot. Hey, yo, I'm just like my country. I'm young, scrappy, and hungry, and I'm not throwing away my shot.

Make good choices. Don't throw away your shot to die in good health. Charlie, any thoughts or questions? Yeah, actually, you know, my first thought is, um, yeah, always go for top shelf liquor.

It might cost, uh, you know, a couple of bucks more, but you know what? You're worth it. Well, I am. I don't know about anybody else.

Don't overdo it, but, um, yeah, it's, it's, yeah, exactly. I, I just don't, what am I, you know what? I just, I, I don't feel older. Um, my body reminds me that I am.

Um, and I, I don't know. I just don't look at it as I'm getting older. Um, I, I do need to be more, um, not cautious, aware, aware of, um, just walking sometimes, um, lifting something.

But my dad instilled in all of us, bend your knees. And I still remember that. But yeah, it's, yeah, I don't not do something because, oh, I don't know.

I just don't feel like, no, I just got to do it. And that's it. That's it.

Yeah. That's what I have to say. You know, you know, the, the, the, the thing I, I, I've gone or gotten back to is this notion of follow your bliss, where you just do something for the sake of doing it.

You know, there's no goal or peak or anything like that. You just do it for the sake of doing it. Um, I find, I don't know, peace in that, harmony in that.

And I think people should do that more often. I know it's hard. You got to work.

What's the last blissful thing you did? Um, you, um, you know, it's, maybe it's a sandwich family situation where you have to look after not only your elderly parents, but then also your children. And sometimes these kids are in their twenties and thirties. Yeah, it's not easy.

So what's the last blissful thing that you did for yourself? Um, I can't say it on the air. Uh, no, I said, well, I would not say this. Oh, Charlie, it's just you and me.

I won't tell anybody. Oh, shoot. Yes.

Yes. Um, well, actually, actually, you know what? I did it last night. Um, so I was out, um, you know, took a book with me and reading and one of my favorite little dive bars.

And, um, I really not thinking of anything else, but I'm just really enjoying reading. Mm hmm. So that's, so find your bliss.

Yeah. Yeah. I mean, you find it in different ways.

I know with you, with your, in your gardening. Yeah. So it's good.

In our third half from our cheeky obituary department, Jennifer Ann Kelly. Farewell, Jenny Kelly. Born 15 May, 1936.

Our wild and wayward mother died on 28 October, 2024. She refused to say past. We spent most of our lives compensating for our upbringing, said Jenny.

She believed that exposing youth to religion was a form of child abuse. It was impossible to watch the news in her presence due to her vocal outrage at the way the country is run. She held John Howard in particular contempt.

Mom grew great dope, never wanted to leave a party and gave up champagne or gin frequently, but never simultaneously. Her rare attempts at responsible parenting or grandparenting were always touching. She said Sean was a much better driver that Chris.

News on what's next to follow. Bring a shovel. And that's it for this week's episode.

Please stay tuned for the continuing saga of Everyone Dies. And thank you for listening. This is Charlie Navarrette.

And when asked what happens when we die, writer Rose Tremaine said nothing. Death is the anesthetic from which none come round. And I'm Marianne Matzo and we'll see you next week.

Remember, try to make good choices and every day is a gift. This podcast does not provide medical advice. All discussion on this podcast, such as treatments, dosages, outcomes, charts, patient profiles, advice, messages, and any other discussion are for informational purposes only and are not a substitute for professional medical advice or treatment.

Always seek the advice of your primary care practitioner or other qualified health providers with any questions that you may have regarding your health. Never disregard professional medical advice or delay in seeking it because of something you have heard from this podcast. If you think you may have a medical emergency, call your doctor or 911 immediately.

Everyone Dies does not recommend or endorse any specific tests, practitioners, products, procedures, opinions, or other information that may be mentioned in this podcast. Reliance on any information provided in this podcast by persons appearing on this podcast at the invitation of Everyone Dies or by other members is solely at your own risk.