Too Young to Die, Too Old to Worry

THIS weekend, the singer and songwriter Leonard Cohen is celebrating his 80th birthday — with a cigarette. Last year he announced that he would resume smoking when he turned 80. “It’s the right age to recommence,” he explained.

At any age, taking up smoking is not sensible. Both the smoker and those who breathe his secondhand smoke can suffer not only long-term but acute health problems, including infections and asthma. And yet, Mr. Cohen’s plan presents a provocative question: When should we set aside a life lived for the future and, instead, embrace the pleasures of the present?

At the start of the 20th century, only one-half of 1 percent of the United States population was over the age of 80. Industrialized nations were preoccupied with infectious diseases such as tuberculosis and polio. Many of the common diseases of aging, such as osteoporosis, were not even thought of as diseases.

Today, 3.6 percent of the population is over 80, and life is heavily prescribed not only with the behaviors we should avoid, but the medications we ought to take. More than half of adults age 65 and older are taking five or more prescription medications, over-the-counter medications or dietary supplements, many of them designed not to treat acute suffering, but instead, to reduce the chances of future suffering. Stroke, heart attacks, heart failure, kidney failure, hip fracture — the list is long, and with the United States Department of Health and Human Services’ plan to prevent Alzheimer’s disease by 2025, it grows ever more ambitious.

Aging in the 21st century is all about risk and its reduction. Insurers reward customers for regular attendance at a gym or punish them if they smoke. Physicians are warned by pharmaceutical companies that even after they have prescribed drugs to reduce their patients’ risk of heart disease, a “residual risk” remains — more drugs are often prescribed. One fitness product tagline captures the zeitgeist: “Your health account is your wealth account! Long live living long!”

But when is it time to stop saving and spend some of our principal?

http://www.nytimes.com/2014/09/21/opinion/sunday/too-young-to-die-too-old-to-worry.html?hp&action=click&pgtype=Homepage&module=c-column-top-span-region&region=c-column-top-span-region&WT.nav=c-column-top-span-region