The psychology of aging and the aged is complex and wrought with intrapsychic conflict. Perhaps the biggest challenge is confronting one's mortality. Although the clock ticks for all of us, it ticks louder when we're 70.

Psychologically, aging makes us more and more normal as we lose our protective sense of "specialness" - our bodies betray us with medical comorbidity, the company we "gave our life to" suffered little, if at all, after our retirement, and prospects of living forever through great, creative works seem dim.

Even the notion that we will live forever through our children and our children's children seems unlikely. Do you know the first names of your eight great-grandparents?

Elders who age successfully rarely ask themselves what they can do to not die - that question is futile. The more important existential question to ask is, What are you doing to live? Elders who age successfully are aware that although death is what takes life, the idea of death is what allows us to live at all. Because we die, we live.

We get up in the morning, we go to the places we want to go, and we're with the people we want to be with. We take the trips we want to take, we call our children whether they want to hear from us or not. If they don't want to talk, then we call our grandchildren. Trying not to die should never get in the way of living.

Perhaps some elders' reluctance to engage in end-of-life planning stems from knowing that perfectly thought-through wills and living wills do not necessarily decrease death anxiety. It may even increase it by forced confrontation with one's mortality. However, end-of-life planning may decrease the anxiety of those we love, and it may give some sense of control over the process.

When discussing end-of-life planning with our loved elders, one path is to frame the need for what it is - a reduction of our anxiety, not necessarily theirs. By acknowledging our anxiety, we allow for loved ones' altruism to facilitate these sometimes necessary conversations.

Jason E. Schillerstrom, MD