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With Modern Medicine, Aging In A Lifetime Appointment Can Get Complicated


The question that Pope Benedict faced is not one that confronts all of us: should we stick with our job till death do us part? Popes, monarchs and federal judges all face that question; so do some people who are self-employed, and different people answer it differently. The pioneer heart surgeon Michael DeBakey famously practiced medicine until the day he died and he died a few months shy of his hundredth birthday.

On the other hand, Queen Beatrix of the Netherlands recently announced that she will abdicate this year at age 75, after 33 years on the throne. Are 21st century 80- and 90-year-olds more fit than their ancestors to remain in positions of authority and responsibility? We're going to talk now with Dr. Leo Cooney, who's a professor of medicine at Yale University, where he established the program in geriatrics. Welcome to the program.

LEO COONEY: Thank you.

SIEGEL: Are we indeed living longer, first of all, as a general impression?

COONEY: Yeah. The striking figure to my mind was that in 1950, the male had a five percent of chance, when he reached 50, of living to be 90. In 2003, that chance was 16 percent. Females' chance went from 9.6 to 28 percent. So if you reach the age of 50, you have a much higher chance of making it to 90 than you did 50 years ago.

SIEGEL: Obviously, people do different kinds of jobs. There are forms of physical labor that they're not as much in control of deciding. I'd like to continue being a miner till I'm 85, for example, might be a lot more difficult than I'd like to continue going to the office during that time.

COONEY: Probably the most important thing to remember is that despite the fact that things are better than they were 20 or 30 years ago, that the average 85-year-old in the United States has a high prevalence of disability and also a significant prevalence of dementia.

SIEGEL: Significant presence of dementia.

COONEY: Yeah, the prevalence of dementia roughly doubles every five years after the age of 70. So, from 70 to 75, it would be 3 percent, 75 to 80, 6 percent, 80 to 85, 12 percent, 85 to 90, 25 percent and 90 plus, 50 percent. So it becomes a very prevalent condition as one ages.

SIEGEL: So it sounds like, based on the numbers that you've just recited, that as a rule, we'd be better off not being led by people who are 85.

COONEY: Well, I think people over 85 should be evaluated. I don't think it should be automatic that people who are 86 can't function at a very high level, but I think that they have a higher prevalence of problems and should at least be assessed at that age.

SIEGEL: Is there any kind of typical self-assessment that you recommend, or is that just not practical?

COONEY: No. I mean, one of the things we often deal with are what are called the activities of daily living and the instrumental activities of daily living. The activities of daily living are the ability to get out of bed by yourself, walk by yourself, dress yourself, bathe yourself, feed yourself and toilet yourself. The instrumental activities of daily living are the more advanced things, such as preparing a meal, driving a car, cleaning a house, shopping, using a telephone.

And those things are relatively easy to evaluate. A self-report is pretty good. People can tell you what they can do and they can't do. As far as their cognition is concerned, we use a very simple test called a mini-cog. We'll give them three words, ask them to repeat the three words. We ask them to draw the face of a clock and put the hands in the proper position and we'll give them a time like 1:45 and then ask for the three words back.

That doesn't take very long, but it's a reasonably good screen of cognitive problems.

SIEGEL: Pope Benedict, in this case, we're not privy to his medical records, but he seems to have made a rather clear-eyed assessment of just what he's capable of. And it's not the demands of his ministry.

COONEY: Yeah, I thought it was a very wise decision. I know nothing about Pope Benedict's health, either cognitive or physical functions, but I think it's a good idea to step away from those kinds of responsibilities when you're 85.

SIEGEL: Well, Dr. Cooney, thank you very much for talking with us today.

COONEY: Thank you.

SIEGEL: Leo Cooney set up the geriatrics program at Yale University. Transcript provided by NPR, Copyright NPR.