A square shaped curve

A BMJ article on aortic aneurysms jogged my memory of a conference workshop where a well known local researcher described a square shaped age mortality curve that is developing as people live longer and are more likely to be taken by the grim reaper of unavoidable disease. Square shape rather than a regular drop off of say 2% of the population per year of aging as happened in past decades and centuries. One where everyone gets to live to say 90 and then drop off like flies, dying not of conditions like infection, premature CVD and cancers, but being claimed by degenerative diseases especially neurological and complex interactions of multiple co-morbidities and polypharmacy.

Even the way accidents claim lives is changing especially in affluent nations. Improved motor vehicle, industrial and sports safety have greatly reduced individuals' chance of injury and death, even for the adrenalin junkies who persist in trying to leap from high buildings, swim with sharks, kayak down raging torrents and climbing into backyard balloons. In the 50s only Superman indulged in these sorts of activities, except the last. Nowadays every mother's son (and daughter) seems to be into some form of extreme sport and despite this, there has not been a large growth industry in accident fatalities in the first world. Maybe it’s the risk adverse behaviour indoctrinated into modern generations by baby boomer one and two child parental anxiety.

Actually the baby boomers aren't only a problem as parents. They are failing to follow their parents example of growing old gracefully. According to accident insurance data they're still out there falling off their bikes, skis, motorcycles and even taking up new sports when they should be sitting back sipping their tea and eating their scones. Is it the butter in scones, the poison left after you have taken everything good out of the milk. But have you ever made scones with olive oil? * 

This square curve, besides being an oxymoron, now poses family physicians with a need to consider a new realm of social and ethical issues when it comes to interventions in the multiply co-morbid elderly. Is it worthwhile replacing this 80 year old's arthritic knee when he has CHF, prostatic cancer and moderate renal failure? How realistic is the patient's expectations?  How realistic is societies? Does it equate with those of his cultural group? What if he was a fit health 90, no pills, no diseases (other than the ubiquitous NSAID) but with a 50% chance of dying in the next 2 years?   

Fortunately the curve still had a round corner to it, but how long before an Orwellian system develops a polypill with a timed euthanasia component?

Anyway I'm taking up kite surfing when the weather warms up and it’s too hot to have tea and scones. It is safe they tell me.

*Scone: a peculiarly English cake, often served with cream of some type.