Clinical Geriatrics

We continue to see an increase in the average life expectancy in the United States, and we are proud of this accomplishment. Obviously we are doing something “right.” The average lifespan is defined as that age to which a baby born today can expect to live, based on actuarial data that estimate when 50% of those born in a given year can expect to live beyond. Data from 2003 recently issued by the Centers for Disease Control and Prevention listed 77.6 years as the average lifespan for a baby born that year, a rise of 0.3 years over that recorded just one year prior. This represents a 1.7% decline in the overall death rate. Baby girls born in 2003 can now expect to live to age 80.1 years on average, whereas baby boys can look forward to living to 74.8 years, a difference between the sexes that has continued to narrow in recent decades. We have seen significant declines in mortality from cancer, stroke, and heart disease—the three leading causes of death. A decline in mortality from HIV, alcohol abuse, drugs, and violent crimes also are believed to contribute to this increase in expected lifespan.

Although we might gloat on this apparent success with more people living into their 80s and beyond than ever before, let us not forget the discrepancies that still exist between races even within our borders. Black men in the United States live approximately 6 years less than white men, and black women live close to 4.5 years less than white women, on average. Native Americans and Eskimos have even shorter lifespans, on average. This is a complex issue, with genetic predisposition to certain diseases playing at least some role; access to health care, social issues, and environment have also been implicated as possible modifiable factors contributing to reduced life expectancy.

When one looks beyond our own borders, however, the data are even more troubling. In 2000, the last year I was able to obtain international data for comparison, the United States had an average life expectancy of 77.1 years. That same year, Finland boasted 77.4 years, Sweden 79.6 years, Japan 80.7 years, and San Marino 81.1 years. In contrast, Cambodia had an average life expectancy of only 56.5 years, Afghanistan 45.9 years, Angola 38.3 years, and Malawi 37.6 years.

We have come a long way since the early 1900s when the average U.S. lifespan was also less than 50 years of age. Computer models tell us that even if we cure all heart disease and cancer, the average lifespan will not rise much more than 8 additional years beyond what it is currently. The goal, in my opinion, seems to be to continue to find ways to improve the “quality of life” for all for as long as possible, and not merely to prolong life for the sake of some statistic. We still have a lot to do if we are to continue to improve functional capacity and quality indicators for our growing number of elderly persons. There are still many chronic diseases that need to be conquered; fortunately, new treatment modalities continue to surface that give promise of a healthier old age for all. These are truly exciting times. Unfortunately, there is no simple solution to assure that all individuals on this planet have the same chance of living to a ripe old age, as we have become increasingly accustomed to in our country. We clearly have a long way to go to help others reach our same level of success!

Send comments to Dr. Gambert at medwards@hmpcommunications.com.