A Growing Army : Life Past 85: Often Sweet but Painful

At 91, Del Delamater needs a wheelchair to get around, but he has no trouble finding someone to push it. His bubbly wife, Octa, who lives with him at Los Angeles’ Hollenbeck retirement home, does it cheerfully. She’s 102.

“I married a young man so he’d look after me when I got old, but it got turned around,” she explains. The wheelchair helps her, too: Without it to lean on, she gets dizzy from standing.

The Delamaters are extraordinary members of an extraordinary group. They are the oldest of the old, a growing army of men and women who are living longer than any generation in history. With public health measures and medical science almost doubling life expectancy in the last 100 years, those 85 and older have become the fastest-growing segment of the U.S. population.

And beyond their mere age, the Delamaters are part of a phenomenon never before faced on such a scale. They are among the millions of the “frail elderly,” whose lives remain potentially rich in joy and meaning but who require at least some help in coping with the physical and mental demands of day-to-day living. Spared the catastrophic illnesses that mangle and terminate many lives, the frail elderly suffer instead from a host of chronic, debilitating ailments that reflect the unplanned consequences of medical progress.

“We succeed in letting people survive to old age,” said Steven Zarit, director of USC’s Andrus Older Adult Center. “But then we don’t know what to do with them.”

Challenge to Families

The frail elderly represent an unmet, largely unrecognized challenge to families, to government officials and to society as a whole. Although most of the nearly 30 million Americans who are 65 and older remain healthy enough to live their lives independently, a recent federal survey suggests that 6.5 million of them need help performing tasks as simple but critical as balancing a checkbook and using a bathtub. In the view of dozens of experts interviewed for this series, no government or private programs exist on the scale needed to meet their special needs.

As a result, the ever-increasing legions of the frail elderly pose painful questions about the nation’s values and priorities. In the words of philosopher Laurence McCullough of Georgetown University’s Kennedy Institute of Ethics: “What are our obligations to the elderly--and what are the limits on them?”

Medical science is largely responsible for the predicament. “Our tools permit me to regularly crack problems that led to fatal illness when I entered practice 21 years ago,” said Dr. Alan Nelson, a Salt Lake City surgeon. “My grandfather died with a deformed heart valve that we’d simply fix now.”

But medical science has not found the answers to the litany of chronic ailments--arthritis, Alzheimer’s disease, cataracts, deafness, diabetes, osteoporosis--that can make the frail elderly wonder if their longevity is worthwhile.

“Things are getting better,” said James E. Birren, dean of gerontology at USC. “But because they’re getting better, they’re getting worse.”

The hundred-year-olds at the Hollenbeck retirement home illustrate the problem. An exceptionally hardy lot, they find much to enjoy in life but nonetheless suffer from the complex, chronic infirmities that often accompany advanced age.

Exercises Daily

Octa Delamater, who turned 102 earlier this month, is hard of hearing but energetic enough to exercise daily. Until recently she showed off by lying on her back and reaching over her head with her feet. “I was having a little trouble with my back and thought maybe that was causing it,” she says, “so I quit when I turned 101.” She recently began wearing glasses to correct far-sightedness and gave up her hobby of painting landscapes because she had trouble drawing straight lines.

Octa, who married Del when she was 60 and looks ahead to their 42nd anniversary, puts her arm around a visitor and says with a smile: “There’s so many lovely things about life if you look for them.”

Similarly, there is 102-year-old Mabel Starr, who sits alone in her room peering through a magnifying glass at large-print Reader’s Digests. Slow-moving because of painful arthritis in her legs, she jokes that her “underpinnings” are failing. Her bridge partners have died, she laments, “so it’s left me here to play solitaire.”

And there is Leland Coffelt, an even 100, a once-hefty former steelworker who roams the halls in his wheelchair. He has inoperable cataracts in both eyes and shouts when he talks because he can barely hear. But he is undaunted. “The first 100 years is the hardest,” he thunders, breaking into a smile. “And I’ve already passed that.”

Coffelt appears to be the frailest of the three, but he has fared vastly better than his father, who died of measles at 36. Maybe that is why he is able to describe how he feels with a joke, one that contains more than a little philosophy: “I’m bigger and stronger than I was when I started.”

In his wry fashion, Coffelt put his finger on the heart of the matter. The frail elderly treasure life, but, like babies and children, are more vulnerable and dependent than the great mass of people in between.

Starts With Isolation

“Their isolation may bring on depression, the depression may bring on malnutrition, the malnutrition may bring on certain illnesses and, before you know it, you have a patient in a psychiatric hospital,” said Eva Skinner, a retired nurse from Los Angeles who has specialized in the aging.

For the most part, this is the plight not of all the elderly but of the very old. People in their 80s and beyond are far more likely to be poor, alone and unwell than the younger “Winnebago set”--the healthy, active retirees who follow the sun in motor homes or hike the local golf course.

The 85-plus age group--now about 2.7 million strong--is growing so fast, according to the Census Bureau, that by the year 2000 about 5.2 million Americans will be 85 or older. And by the middle of the next century, when the surviving members of the post-World War II baby boom generation reach old-old age, the 85-plus group will be triple that size.

As many in this age bracket have already discovered, American medicine is geared to the short-term task of curing temporary sickness--keeping people alive. For many older people, this goal becomes increasingly irrelevant.

The National Institute on Aging, for example, is spending only $43 million this year for research on Alzheimer’s disease, which attacks the mind and leads to physical helplessness and death. Dr. Robert Butler, chairman of the geriatrics department at Mt. Sinai Medical Center in New York, called that “a drop in the bucket given the $10 billion-plus that is being spent just in nursing home care, let alone other care for people that are suffering from this devastating disease.”

Sometimes Cruel Costs

When it comes to Alzheimer’s and other such debilitating diseases, much of the cost falls outside the bounds of conventional medical care--with sometimes cruel, even catastrophic results.

Medicare, the national health program for those over 65, does not pay for custodial care in nursing homes or for such common expenses as prescription drugs, eyeglasses and hearing aids. Similarly, private health insurance concentrates on hospitals and doctors. Insurance companies routinely place limits on the extent of coverage of the non-medical services that enhance a person’s ability to live at home--services such as visits from an aide to help with baths or housekeeping chores. California and some other states provide limited benefits for home attendants for the frail, but people above welfare levels generally do not qualify.

Nursing homes are jammed with 1.3 million elderly people, and many more would like to get in. Facilities often prefer to admit the affluent, who typically pay 30% more than the government Medicaid rate for the needy. And availability of beds is limited. Most states, including California, have restricted the industry’s growth as a way to prevent uncontrolled demand on Medicaid budgets.

As a result, patients in some areas have to be placed 25 miles away from home, where they are isolated from elderly friends and relatives, according to Margit L. Craig, a patient’s advocate with Jewish Family Service of Los Angeles.

Outside of nursing homes, another 5 million elderly manage to get by only with the help of friends, relatives and neighbors, according to the newest federal estimates. By age 85, one-third of the population depends on others for at least one basic household activity. And, according to a 1982 federal survey, about 10% of the elderly who had trouble with basic tasks reported that they did not get all the support they needed, either from families or public services.

“We think that a lot of people are placed at home who should be receiving nursing home care,” said Elma Holder, executive director of the National Citizens Coalition for Nursing Home Reform.

‘All Help Each Other’

Jose Isabel Lopez is among the fortunate. Lopez, 83, suffered a paralyzing stroke seven years ago, but he has been able to rely on his 60-year-old wife, Severina, to take virtually complete care of him in their Reseda home.

“We all help each other,” said Maritza Lopez, 20, a dental assistant and one of Lopez’s four children who live under the same roof, along with a son-in-law and two grandchildren. “My mom helps my dad. I take care of the kids sometimes.”

But even those with family support cannot always cope with what advancing age has in store for them. In Seattle, 65-year-old Betty Gann suffers from mentally debilitating Alzheimer’s disease, and her husband, Newton, a Boeing executive, finds his carefully laid retirement plans crumbling around him.

“There swept into our lives this catastrophic illness with costs so great that it was obvious our little retirement nest egg would be wiped out in no time at all,” said Gann, 61. “Surely, aging was intended to be something better than that.”

At least Betty Gann has a husband to help her. Harry Millner, 98, lives alone in a Los Angeles retirement home; his wife is dead and his son lives in San Jose. A gray-haired elf at 5 feet, 2 inches and 95 pounds, he has a sharp mind and, despite a stroke, walks several blocks each day with a two-pronged cane.

But in his room, the former optometrist teeters unsteadily on his feet. The thick red carpet, he says, throws off his balance. In the last few months, Millner says, he has fallen four times, cutting himself once. “I feel weak,” Millner said. “But when I sit down for a minute or two, it goes away.”

U.S. Trails in Resources

The United States trails much of the industrialized world, notably Canada and some European nations, in the resources it devotes to its frail elderly. Birte Codel, a Danish woman who is married to an American and now lives in Washington, told the House Select Committee on Aging that she keeps her Danish citizenship “as a security blanket” for old age.

“If and when I become old and frail or in need of long-term care, I would much prefer to be in a Danish nursing home,” she said. “To me, they are much more homelike and less institutional than American nursing homes. I prefer the peace of mind knowing that I could not possibly be a financial burden to my family.”

Only in the 20th Century have such concerns become pervasive. “It is the first period in human history when any child can expect to attain old age,” said Butler, a former director of the National Institute on Aging.

More than 2,000 years ago, Hippocrates, the Greek pioneer of medicine, declared that old age started at 56 and was characterized by shortness of breath and stiffness of joints. The aged, he said, suffered from diseases that “generally never leave them.”

Life expectancy increased from 18 during the Bronze Age to about 22 for a Roman citizen in the time of Jesus and to 30 in Italy during the Renaissance, according to Rita Aero’s “Book of Longevity.”

Even in the United States in 1900, a baby could expect to live only 46 years. About 21% of the population succumbed to pneumonia, diarrhea or tuberculosis--all now routinely controlled with antibiotics and other treatments--before age 10.

Dramatically Longer Life

By contrast, today’s leading causes of death--heart disease, cancer and stroke--are more likely to strike those who have reached advanced age. And substantial progress has been made in combatting all three.

For babies born in the United States today, life expectancy is an unprecedented 71.1 years for a boy and 78.3 years for a girl. And that is only part of the story. For those who survive through middle age, the expected length of life is dramatically longer. A man who reaches 65 today can look forward to living until he is 79.5. A woman figures to make it to 83.7.

Despite such strides, longevity apparently has its limits. Scientists believe a maximum age of about 110 appears to have remained constant for many thousands of years.

But that leaves ample room for continuing increases in the life expectancy of the average American. What is not on the horizon is that old age will become any easier.

“It is very hard to imagine breakthroughs that will reduce the amount of disabilities greatly,” said Bruce Vladeck of the United Hospital Fund in New York, an expert on long-term care problems. “The next breakthroughs will deal with cancer and heart disease. They will increase the number of Alzheimer’s disease patients and severely arthritic patients.”

Already the United States has a growing number of individuals who have surpassed their most extravagant dreams of longevity. However society responds to their concerns, it is clear that the old--like the young--vary enormously in their needs and outlooks.

Mabel Starr, who traces her lineage to Colonial New England, says she is bored. Her friends are dead, and she refuses to watch television because she dislikes the chase scenes and the violence. “It just means you’ve lived beyond your interests,” the former pharmacist says. “. . . I’m out of my time.”

Harry Millner, the former optometrist, complains of boredom as well. Many of his neighbors are not mentally alert, and he cannot find enough people to talk with. But he acknowledges, almost sheepishly: “I don’t want to die.”