Monday, September 16, 2019

Preparing for Death The Final Frontier

One in five Americans still die using emergency services, with more than 14% of these deaths occurring among patients 85 years and older. Although death is our only exit strategy in life, few of us are preparing for it. Ask any person how they want to die and they will have a definitive response, “quick and painless.” Yet despite this authoritative choice, we remain shy when planning to achieve such an exit--which is why many of us will end up in an emergency room to die.

A classic study conducted in Oregon—which has a state law for physician assisted suicide—found that twice the number of terminally ill hospice patients choose to speed their deaths by refusing food and drink rather than by physician assisted suicide. Their nurses reported that these patients, who typically died within two weeks, died more serenely than those who chose other methods.

Planning for death might involve a number of formal decisions, such as advance directives, living wills, powers of attorney, and Do Not Resuscitate orders, and hospice. However these options remain underutilized. An analysis of a random sample of all U.S. deaths in 1986 found that about 10% of decedents had living wills. In addition, when they were completed, it is not uncommon to find that the attending clinical staff ignored them.

In addition, although hospice is an increasingly-accepted choice, often considered to be the "gold standard" of optimal end-of-life care, less than half of eligible patients utilize these services, and when they do, most start hospice too late. Hospice care is not just for the dying patient, but also for the family. Caregivers of the dying are twice as likely to have depressive symptoms as the dying themselves. This is why the hospice setting is more likely to be at home than at a hospital, and involves the family.

Communication is especially important. One of the ways to initiate an end of life discussion is to start with “Five Wishes.” This document meets the legal requirements for an advance directive in California and in 41 other states. Answers to the following questions will start the discussion of how you can die with dignity:
The Person I Want to Make Care Decisions for Me When I Can't;
The Kind of Medical Treatment I Want or Don't Want;
How Comfortable I Want to Be;
How I Want People to Treat Me;
What I Want My Loved Ones to Know.

Dying quickly and painlessly means that we are willing to discuss these final details with those around us. This level of dignity implores us to communicate about our eventual death and to design a course of action that reflects our wishes and desires. This is a difficult and uncomfortable topic. But no one said that aging is easy.

Mario Garrett PhD is a professor of gerontology at San Diego State University can be reached
© Mario Garrett 2010

Sunday, August 26, 2018


Dance as journey of discovery - The San Diego Union-Tribune
Jan 7, 2012 - Directed by SDSU professor Mario Garrett, the festival's purpose is to offer positive images of aging. All films are free of charge and screen at ...

Jing debunked - The San Diego Union-Tribune
Mario Garrett. Sometimes we joke about how other civilizations or other ages looked upon old age. Since we have “medicalized” aging and death, we have ...

Older adults are the backbone of volunteerism - The San Diego Union ...
Mario Garrett. Volunteerism has long been one of America's traditions. Since Benjamin Franklin's founding of Philadelphia's first volunteer firefighter company in ...

Life span is a moving target - The San Diego Union-Tribune
Life span is a moving target. Mario Garrett. Not all immortal beings are the creation of Hollywood. In the same league as Peter Pan, Dracula and the Highlander, ...

Feeling of well-being among older adults is on the decline - The San ...
Mario Garrett. The state of well-being among older adults does not seem to be improving. A recent AARP report compared sex and well-being in 1999, 2004, ...

[PDF]Increase in aging population means challenges to transportation system
Sep 6, 2011 - By Mario Garrett ... Copyright 2011 The San Diego Union-Tribune LLC. ... Mario Garrett, Ph.D., is a professor of gerontology at San Diego State

Hemlock Society of San Diego -- articles related to End of Life Issue
Letter to the San Diego Union-Tribune about "Suicide Kits" -- by Faye Girsh ... the Living - by Dr. Mario Garrett in the San Diego Union Tribune -- July 12, 2011

Word of Mouth: Good News And Bad
"New Insights in Aging" by Mario Garrett This is a book, taken from a series of 500 ... from September, 2010 to November, 2011, in the San Diego Union Tribune.

Plastic Surgery Replaces the Movie 'Cocoon' as Seniors' Preferred ...
San Diego State University gerontology professor Mario Garrett writes more surprising facts in the San Diego Union Tribune: Americans 55 and older had 3.3 ...

[PDF]Happy Holidays - Peisch Custom Software
Apr 25, 2011 - The San Diego Union-Tribune, March 13, 2011. ―Florist proves irresistible in La Jolla ... to emotion and, perhaps, longevity‖. By Mario Garrett.

[PDF]Behavioral Health Services Beyond the Talk: A Resource Toolkit to ...
State becoming equal parts Hispanic and white. San Diego Union Tribune. Retrieved from .... Angelica Garcia. B5. Diversity in Dementia. Mario Garrett, PhD.
Join us for the next public lecture as we welcome Mario Garrett, PhD, professor of ... The San Diego Union-Tribune · ETC: Spy Camp, Brain Fitness, Songwriters' ...


Sunday, January 7, 2018, 16:10 by Mario Garrett ... Mario Garrett was born in Malta and is currently a professor of gerontology at San Diego State University in ...
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Aug 19, 2018 - We can always stay alive even when dead, until pneumonia or some other bacteria, fungi, virus or parasite gets us. Mario Garrett was born in ...
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Sunday, December 17, 2017, 10:21 by Mario Garrett ... Mario Garrett was born in Malta and is currently a professor of gerontology at San Diego State University ...

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Sunday, May 28, 2017, 10:58 by Mario Garrett ... Mario Garrett was born in Malta and is currently a professor of gerontology at San Diego State University in ... › BC Disease News

... see how stress can cause dementia, but not all dementia is caused by stress.' [iMario Garrett 'Does stress cause dementia' (January 2018 Times of Malta) ...

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Mario Garrett was born in Malta and is currently a professor of gerontology at San Diego State .... Malta to execute EU-Japan partnership - Times of Malta

Click Here to Read: Fear of death and purpose of living by Mario Garrett on the Times of Malta website on December 17, 2017. Graham Crumb. Public Domain ...

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Thursday, May 24, 2018

Cartographer of the Mind

The exploration of the physical world would not have been possible without the skills of the map makers. There has not been any great discovery without a map that might have formed the basis for the exploration. In 2013, Jerry Brotton published A History of the World in 12 Maps, which described why specific maps were important in making history.  Maps not only represent it, but they also determine our world. In 2017 following her GPS, a 23-year-old woman  drove her Toyota Yaris straight into a lake in Ontario, Canada. Following in the path of Columbus who followed a similarly flawed map made around 1491 by Henricus Martellus, a German cartographers which had Japan straight ahead to the east of Spain. It was also third smaller, but compensated by using Arabian miles (1830 meters) rather than about 1,480 meters for Italian miles and which led Columbus to expect the voyage to Asia to be much shorter. He came across America by using a flawed map. Maps are the spring board to exploration, and in todays information overload, gaining a reference map will help knowing where you are going.

Today we need maps to navigate the information morass. We used refer to this as the information highway, but there are no rules, no lanes, no order, different speed, erratic direction, unseen drivers, no drivers and ope for sale. This is the Memorial Day sale of information, every imaginable interest pushing across their ideas. Fake news, fake science, conspiracy theories, and the awareness of relative truth together with the scientific and the spiritual.

Sunday, May 20, 2018

Slowing Down Aging

Do ugly older people die younger?

In 2012 Ian Deary and his colleagues with the University of Edinburgh, tested whether older adults who looked less attractive died before their more attractive peers. The authors asked people to rate the photographs of 292 older adults aged 83 years of age. They rated the photographs on how old healthy, attractive intelligent and happy they looked. They also looked at how symmetrical the faces are (the left side of the face is proportionally similar to the right). Then the authors followed the people in the photographs over a 7-year period to see which ones died first. They were trying to see if we can predict who dies first. What they found is that the main predictor was how old they were judged to be. After accounting for how old they looked, this was followed by how healthy they were rated from the photographs. Looking more attractive did not have any advantage after accounting for how old they looked. It seems, looking older rather than looking less attractive predicted an early death. But the two are related—looking attractive is also related to looking younger. Age determines how we judge people as attractive.

Look around and you see people that look better than others—and by better of course, I mean younger. We naturally assume that looking younger is healthier and more attractive. That dress that takes 10 years off, or a haircut that makes you look younger are all compliments. And we can easily speed up aging by stress for example. We know of people that have gone through a trauma in their life and they “aged” quickly. We have this idea of the process of aging that can speed up or slow down. One of the main stressors in our modern lives is money, and lack of it. We know that rich people live longer, but are they also more attractive? Such a relationship could work from both sides with attractive people getting more preferential treatment and becoming more successful which in turn allows them to make their life better.

Susanne Huber and Martin Fieder 2014 found rich your parents predict facial attractiveness in their children at young adulthood (17-20 years old). Of course, attractiveness is mainly due to the symmetry of the face. In 2001 Deborah Hume and Robert Montgomerie with Queen's University, Canada, examined this symmetry. What they found is that women symmetry was best predicted by how fat they are and by previous health problems. For men, facial attractiveness was best predicted by how rich they are and their how comfortable their environment is. Attractiveness seems to be positively related to the degree to which an individual cope with stress growing up. For women it is mainly their weight and health, for men it is mainly money.

The economics of beauty has been written about extensively. Daniel Hamermesh in 2011 consolidated some of these thoughts in his book Beauty Pays. There is no age limit for vanity. In the US single women aged seventy years and older spend over forty-three minutes a day in grooming. From archeological sites we can see that grooming behavior extends across the world and throughout human history. Of course,  what we think of beautiful differs by country, culture and across time, but there are certain constants and being younger is one of them. There are no older Venuses nor older Davids. Old age is not paraded as examples of beauty. Never was across any culture.

Which is why women are judged more harshly for their looks than men, we also see ageing as being more determinantal to women in how they are treated by others. For people who weren’t born to have attractive features or have been in an accident, Hamermesh mentions that cosmetic surgery has been a solution for many older adults including increasingly for older men. In 2016 the US spent $16.4 billion on cosmetic procedures. This is one and a half times more than the total economic productivity of Malta ($10.95 billion in 2016). Americans spend more on having body parts modified than Malta’s total economy. And one of the main group is those entering into older age, 55 years and older.

In 2016, those over 55 years and older had 4.1 million total cosmetic procedures, an increase of 3-4% in procedures since the previous year. Of these 387,000 were surgical procedures, and 3.7 million were minimally-invasive procedures (injections and friction). For middle aged adults the main surgical procedures were eyelid surgery, facelift, dermabrasion, liposuction and forehead lift. Minimal invasive surgery included in order of popularity; Botox, soft tissue fillers, chemical peel, laser skin resurfacing and microdermabrasion. While most popular procedures among young adults focus on their bodies, older adults are apparently more concerned about more visible features, such as their faces. Older adults know that they are being judged by how old they look and their faces are their calling cards.

For these older adults who have had cosmetic surgery, regardless of how young they look, they will not prolong their time of death. What they are fighting is not death but being judged. In a world that judges attractiveness by how old we look older adults are in greater and increasing numbers resorting to fighting it b attempting to look younger. But it is the judgment that needs to change. Such vanity discrimination draws striking parallels with ageism, racism and sexism. The only way to confront these is not by becoming the “other” but by eliminating the category of other altogether.

© USA Copyrighted 2018 Mario D. Garrett


Dykiert, D., Bates, T. C., Gow, A. J., Penke, L., Starr, J. M., & Deary, I. J. (2012). Predicting mortality from human faces. Psychosomatic medicine, 74(6), 560-566.

Huber, S., & Fieder, M. (2014). Effects of parental socio-economic conditions on facial attractiveness. Evolutionary Psychology, 12(5), 147470491401200514.

Hume, D. K., & Montgomerie, R. (2001). Facial attractiveness signals different aspects of “quality” in women and men. Evolution and human behavior, 22(2), 93-112.

How Films Portray Aging

In our increasingly digital world, we get an enormous amount of information from films. Our imagination has always been fired up by films. A relationship that has endured since the first films.  How older people are portrayed in film is best described through the interpretation of a narrative arc. An arc is the linear development of a story—a beginning, a middle and an end. 

One of the first films describing a simple story about older people is the 1952 Japanese film Ikiru by the acclaimed director Akira Kurosawa—acclaimed for the Seven Samurai, Rashomon, and Ran. Ikiru has a fairly simple narrative arc. An older man who worked in an office all his life, on the cusp of retirement, is informed that he has terminal cancer. The narrative arc focusses on the main character in the film attempting to find meaning and leaving behind a legacy in his life before he dies. This simple story highlights that after one’s entire life spent doing what you are supposed to do—work, maybe family—that at the end what is important is relationships. At the end, he finds some solace among his younger mates, where he finds friendship.

This narrative arc of an older man at the end of life, was further developed by another seminal director, Ingmar Bergman who in 1957 wrote and directed Wild Strawberries. Filmed in black and white, perhaps in homage to Ikiru, the film goes further in search of the meaning of one’s life. Following a fairly similar story of an accomplished professor, Wild Strawberries explores the question of what was it all about? We do not have ambitions for getting old, and once we get there, we remain without a plan. Admired but not loved, the professor starts to explore what the continuation of his story in older age should be. Like Ikiru, relationships seem to be the answer. Such a conclusion is not far-fetched from what we observe at the end of life.

In 2012 Bronnie Ware, an Australian palliative care nurse, wrote The Top Five Regrets of the Dying: A Life Transformed by the Dearly Departing. Our two male protagonists in Ikiru and Wild Strawberries follow these regrets. These misgivings focused on having unfulfilled dreams and unrequited loves. Not having the courage to follow their dreams, where (mostly) men tended to regret working so hard. Stifling feelings in order to settle for a mediocre existence. And not staying in touch with their friends and loved ones. And the final regret is not allowing oneself to be happy. They got stuck in a rut. The agreement between the narrative of these two films and the five regrets of dying people is stunning.

Some films on aging tend to start off with a negative view of aging, and then transforms into a story about friendship and family. That it is not too late to address past regrets.  But what if this transformation did not take place? If the negative view of aging remains without the salvation of a new-found story for older age? This is the story of the two characters in the 2015 Italian film Youth.

Paolo Sorrentino’s film centers on two close friends sharing a vacation at an exclusive Swiss spa. One is a film director who continues producing the same kind of films, surrounded by increasingly younger writers. While the other character is a music composer who has decided to retire. The composer stopped composing—to the chagrin of many—because of his wife’s dementia which he hid from everyone including his daughter. He made changes that address this trauma and his aging. Negative events in life change our story sometimes for the better. We realize what is important. In contrast, the other character, the director, only had one story—to remain doing what he did in the past. He did not have a different story for when he got old, and the quality of his work diminished. At the end, his suicide was the only answer to his failing career since he did not have a plan B, an evolving story for getting old.

We also place people in a story. We create a cage for them. Do a little exercise with me.

Let’s imagine that you have a 100-year-old woman that you are going to interview. What is the single question that you will ask her. Write it down. Then assume that you have a 16year-young girl coming to be interviewed. What single question would you ask? Write it down.

The prediction is that you probably ask the older woman about her past and the younger woman about her future. You have already hemmed them into your view of what their story should be.

To age successfully we must have a story that goes beyond adulthood—to extend into older adulthood. Our story is important because it is how we conduct our life, including into older age. What films teach us is that others can influence our story about getting older.

© USA Copyrighted 2018 Mario D. Garrett

Trailers on Youtube
Wild Strawberries: