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Society gives little importance to old age. This distinct phase of life does not receive the same attention as that devoted to childhood. And the special characteristics of people aged 60, 70, 80 and over are poorly understood.
Medicine reflects this narrow-mindedness. In the medical school, doctors are learning that people in the prime of life are "normal" and that they have little time left to study aging. In practice, doctors too often tend not to understand the special needs of older people or to tailor treatments appropriately.
Imagine a better way. Older people would be considered "different from", not "less than". The phases of the future life would be mapped and expertise in aging would be valued and not updated.
Dr. Louise Aronson. Anna Kuperberg Photography
With the growth of the elderly population, it is time for this to happen, says Dr. Louise Aronson, a geriatrician and professor of medicine at the University of California at San Francisco, in her new book "Elderhood".
It is an in-depth and exceptionally frank exploration of prejudices that distort society on old age and shape dysfunctional health policies and medical practices.
In an interview published for the sake of clarity and length, Aronson developed these themes.
Q: How do you define the term "older people"?
The elderly are the third major phase of life, which follows childhood and adulthood and lasts 20 to 40 years, depending on the length of our lives.
Medicine claims that this part of life is not really different from that of early adulthood or middle age. But he is. And that requires a lot more recognition than it currently receives.
Q: Does old age have distinct stages?
It's not like the stages of a child's development – be a baby, a toddler, a school-aged child or a teenager – that occur in a predictable sequence at about the same age for almost everyone.
People age differently – in different ways and at different rates. Sometimes people skip steps. Or they go from one previous step to a later step, and then go back.
Suppose that a person over 70 years old with cancer receives a really aggressive treatment for one year. Before, this person was vital and robust. Now he is thin and fragile. But let's say that the treatment works and that this man starts to eat healthy, to exercise and to receive a lot of help from a social network of solidarity. In another year, he may feel and look much better, as if the weather had receded.
Q: What might the steps of old age look like for a healthy older person?
In their 60s and 70s, people's joints can start causing them problems. Their skin changes. Their hearing and sight are deteriorating. They start losing muscle mbad. Your brain still works, but your treatment speed is slower.
From age 80, you start to develop more rigidity. You are more likely to fall or have problems with continence, sleep, or cognition – the so-called geriatric syndromes. You start to change the way you do what you do to compensate.
Because bodies change with aging, your response to treatment changes. Take a common illness like diabetes. The risks of tight blood sugar control are becoming more important and the benefits are diminishing as people move into this "old step". But many doctors are not aware of the evidence or follow it.
Q: You have started an old people's clinic at UCSF. What are you doing here?
I see someone over 60 at all stages of health. Last week, my youngest patient was 62 years old and my eldest was 102 years old.
I focused on what I call the five P. First, the whole person – not the disease – is my main concern.
Prevention comes next. Evidence shows that you can increase the physical strength and reduce the frailty of people under 100 years old. The more unfit you are, the greater the benefits of even minimal physical exercise. And yet, doctors do not routinely prescribe exercise. I do that.
It is very clear that this goal, the third P, makes a huge difference in terms of health and well-being. So, I ask people, "What are your goals and values?" What makes you happy? What do you do that you prefer or would you like to do that you do not do more?" And then I try to help them get there.
The fourth P. Many people have not yet established their priorities. I recently saw a man over 70 years old who was suffering from HIV / AIDS for a long time and who thought he would die decades ago. He had never considered aging or planning his care in advance. That terrified him. But now he's thinking about what it means to be an old man and what his priorities are, something he's finally ready to help me with.
Perspective is the fifth point. When I work with people, I ask, "Let's find a way to continue doing what's important to you. Do you need new skills? Do you need to change your environment? Do you need to do a bit of both? "
The perspective is about how people see themselves in old age. Are you ready to adapt and compensate for some of the changes you have made? It's not easy at all, but I think most people can do it if we give them the support they need.
Q: You are very direct in the book on ageism in medicine. How is this common?
Do you know the famous 97-year-old man's anecdote about painful left knee? He goes to a doctor who takes a history and exams. There is no sign of trauma and the doctor says, "Hey, knee is 97. What are you waiting for?" And the patient says, "But my right knee is 97 and it does not hurt at all."
It's ageism: reject the concerns of an elderly person simply because that person is elderly. It happens all the time.
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