Dr Mark Moore

Mark Moore, MD
Tallahassee Anesthesiology, PA

Articles of Interest

65 -- the new scarlett letter

The New Scarlet Letter
Mark Moore, MD Tallahassee Florida

Thirty-five was decrepit for most humans who have ever lived on this good earth.
Today, age alone has no significant meaning anymore. An Adult Functionality Life Score (ALFS) would fill the need for a more sophisticated method to assess and identify adults, instead of their age.

While attending a panel discussion on Health and Aging for the Florida Tax Watch Research Institute, a speaker commented “I do not think ageism discrimination will be eliminated in my time”. She was 30.

In the United States, forty is young. And sixty-five?  Far from old, I propose it is the start of mid-life. I recommend age 90-110 be considered the new “Golden Years”. 

The number “65” has become an identifier itself—a Scarlet Letter where “A” is for Age.  The thrust of this article is to promote a non-discriminatory way to identify adults—not by an arbitrary number of years lived, but with a combination of basic functioning and life ability. This new identifier will have the following characteristics:  a simple, easy to remember scale, the score calculated in less than a minute, and will provide an immediate and useful snapshot of the functionality of any adult. 

Life expectancy is a function of current age.  For 7 million years of human history, life expectancy at birth was 20-30 years. Infant Mortality was high. Half the population died in childhood. If an individual survived, they gained an average of an additional 20-30 years, taking them to age 45 or 50. Mid-life began at age 15 and the elderly were 30. As recently as the year 1900, the world average life expectancy at birth was still only 31. By 1950, this had risen to 48 and by 2010 was 67. In the U.S., this figure is 76 for males and 81 for females.   Maximum lifespan is approximately 120 years.
The 65th year has been an American set point for adults since 1935 when FDR’s Committee on Economic Security designated it as the qualifying year for the Social Security Program. In the 1930’s ironically, the average lifespan at birth was only 58 (men) and 62 (women). There was only 6.7 Million people age 65 or older. If one made it to age 65, your new life expectancy would allow you to collect Social Security for an additional 13 years. These added years over age 65 represented 20 %. When one extrapolates from 90, it gives us “golden retirement years” of age 90-110.

The Adult Functionality Life Score (ALFS) when recorded for each patient contact, would be an ideal method to evaluate adults rather than using their age as a designation. The structure of ALFS is based on the APGAR Score as used to evaluate newborns. There are 5 categories each with a score of 0, 1, or 2, and a total score range from 0 to 10.

The categories are:

  1. Physical ability
  2. Mental ability
  3. Tech ability
  4. Family support
  5. Financial support

A description of each category includes:

1. Physical ability (0-2 possible score)  
               Full physical function or at least 80% —2
               Some physical limitations and/or medical ailments—1
               Severe physical limitations, homebound – 0

2. Mental ability (0-2)
               Full cognitive function or at least 80%—2
               Some cognitive limitations—1
               Severe cognitive limitations—0

3. Tech ability (0-2)
               Full tech use ability –2
               Some tech use ability—1
               Minimal to no tech use—0
               Technologies: Drive a car, Use a computer, smart phone and remotes
               Use a home phone, mobile phone, use home appliances. 
4. Family support (0-2)
                Strong family and/or friends network and support—2
                Some family and friends support—1
                Severely limited, minimal or none —0

5. Financial support (0-2)
                Full financial independence—2
                Some financial support, though limited –1
                Severe financial hardship – 0

Definition of ALF Score totals:  ALF Score of
9-10   excellent adult life functionality, independent.
6-8   moderate to fair functionality, somewhat independent
4-5   poor functionality, mostly dependent
0-3   severely limited, fully-dependent.


The amount of independence of an adult based on their life functionality determines how much help they will need to live on a day-to-day basis, and as their ‘dependency’ increases, so does the potential for associated costs of support, whether from family or from the state or federal level.

With regards to categories included in ALFS, physical and mental ability are basic cornerstones of adult living. Tech ability is needed in today’s world because technology and the proper use of it can keep adults connected to friends, family, and society. Simple technologies such as the ability to drive an automobile can keep adults active and independent. Complex technology like smartphones and computers can offset limitations in other areas. Family support and involvement is an important life factor and is credited with longevity and satisfaction. Adequate financial support is an obvious necessity. What may not be as clear is that full financial independence can allow for hiring of nursing assistants, and more accommodating living arrangements which can enhance an adult’s lifestyle, especially those who may be limited in other categories.

Though not morally or ethically applicable, ALFS can allude to whether an adult is a giver or receiver to the system, that is, are they adding to society by way of activities, tax generation and other such positive input, or withdrawing funds from a system because of need for support.  ALFS aligns with the gradual shift in retirement age from 65 to 69.

The U.S. continues to discriminate based on age—a single point with questionable significance.  To eliminate this abuse in our time, we must reconfigure our evaluations of adults to include useful information such as functionality. Previous attempts to do so have been burdensome and onerous, as some adult tests take an hour to score. While I do not suggest that everyone work until age 90, we must consider that a number is the wrong designation for an adult who may choose to be productive in so many ways, long after they have reached an age that was once called retirement.

ALFS is a simple assessment tool that quickly provides a practical measure of adults. States, counties, cities and health insurance plans can more accurately assess the needs of their patients and citizen, in addition to assisting practitioners in follow the changes that occur during the transition of adults into their final golden years.

Mark Moore, MD is a private-practice anesthesiologist in Tallahassee, Florida.  He serves on the board of Florida Tax Watch Research Institute on the panel for Health and Aging.

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These papers may address virtually any important topic in medicine, public health, research, ethics, health policy, or health law and generally are not linked to a specific article. Viewpoints should be well focused, scholarly, and clearly presented and must have no more than 3 authors. The text should include the full name, academic degrees, and no more than 2 institutional affiliations for each author. Maximum length: up to 1200 words of text—or 1000 words of text with 1 small table or figure—and no more than 7 references. Viewpoints not meeting these guidelines will not be considered.

Hawthorne, Nathaniel, The Scarlett Letter. Boston, MA. Ticknor, Reed and Fields, 1850

Center for Disease Control and Prevention, National Center for Health Statistics, Atlanta, GA

Statistics on 65 year olds and Life Expectancy—U.S. Social Security Administration, Washington, D.C.


Apgar, Virginia (1953) “A Proposal for a New Method of Evaluation of the Newborn Infant” Current Researches in Anesthesia and Analgesia  32 (4) 260-267

  Greenspan, Alan, Report of the National Study on Social Security Reform, Social Security Bulletin, February 1983 Vol.46, No.2. Washington, D.C.

Greenspan, Alan, 1983 Greenspan Commission on Social Security Reform, U.S. Social Security Administration www.SocialSecurity.gov  Washington, D.C.

Florida Tax Watch Research Institute­­—A private, non-profit, non-partisan research institute devoted to protecting and promoting political and economic freedoms of the residents of Florida. www.FlordiaTaxwatch.org Tallahassee, FL

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