Why is it that, when asked, people largely express the desire not to live much longer than the present human life span? Usually they want to do a little better than their peers, but no more than that. I have suggested that this is a matter of conformity and discounting of future value – that the value of expressing a conforming opinion now, or holding a conforming belief, wins out over the future value of more years of good health and life.
Another popular hypothesis is that most people believe that longer lives will be accompanied by more suffering, more dysfunction and disease, and thus they have no great appetite for it. This has sometimes been called the Tithonus error, after the mythic figure granted eternal life without eternal health. It is an erroneous belief because there is no practical way to achieve this outcome through progress in medical technology. One cannot keep a damaged machine running without addressing the damage, and one cannot keep an aged human alive without addressing aging. The only way to improve matters is to repair the underlying cell and tissue damage that causes aging, and thus improve function as well as life span.
The patient advocacy community has long tried to make it clear that effective therapies capable of extending human life span would also extend healthy life span, indeed must also extend healthy life span, rather than produce a longer and worse decline. To be effective, a therapy must slow or reverse the damage that causes aging, and that will inevitably produce a better state of health in later life in addition to a longer life. Advocates clearly still have a long way to go in delivering that message to the world at large, however.
How long older individuals prefer to live given hypothetical adverse changes in health and living conditions has been insufficiently studied. The current study addressed how long individuals want to live and under a set of adverse hypothetical life scenarios. The sample was a population of adults aged 60 years and above in Norway from the NORSE study. The results suggest a relatively high preferred life expectancy (PLE) compared to findings from other investigations, although comparisons across culture and context are inherently problematic.
The desire to live is considered a basic driving force, but high life expectancy may also be related to individual unfinished business aims, and tasks one would like to finish before dying. Older age translated into higher PLE, particularly among the very old respondents. In our study, there was a tendency for longer PLE among men compared to women, but the difference was not significant. Thus, we did not replicate findings from other studies reporting that women prefer somewhat shorter lives.
Adverse health and living conditions prevalent at older ages may reduce preference to live longer. This study investigated the relationship between six hypothetic situations and PLE: dementia, spousal death, becoming a burden, poverty, loneliness, or chronic pain. The finding that dementia had the strongest negative effect on PLE concurs with prior studies suggesting a widespread fear of dementia. Chronic pain was also strongly associated with lower PLE in this study. For many people, chronic pain has been found to reduce quality of life and limit opportunities for social activities. It is also noteworthy that the third-highest ranked reason for lower PLE in this study was the belief that one represents a burden. Perceiving oneself to be a burden can relate to other outcomes in terms of self-view, including a loss of dignity at older ages.
Slightly above half of the respondents stated that poverty would decrease how long they would like to live. Poverty increases the risk of lower quality of life, autonomy, and wellbeing at older ages and relates to a greater disease burden. Severe poverty is rare in Norway. Older age groups have experienced rapid decreases in poverty levels over the last decades. Nevertheless, the fear of poverty in old age can still be widespread among older individuals, many of whom have grown up in a context where poverty was more prevalent.