Introduction
In her thought-provoking book "Elderhood," geriatrician Louise Aronson challenges our preconceptions about aging and calls for a radical rethinking of how we approach the later years of life. As our population ages and more people than ever before are entering their golden years, it's crucial that we reassess our attitudes, healthcare systems, and societal structures to better serve and understand the elderly.
Aronson's work is not just a medical text, but a compassionate and insightful exploration of what it means to grow old in America today. Drawing from her extensive experience as a doctor specializing in the care of older adults, as well as her own personal journey, she paints a vivid picture of the challenges and opportunities that come with aging.
This book is relevant to everyone, regardless of age. After all, if we're fortunate, we'll all reach elderhood one day. By understanding the unique needs and experiences of older adults, we can work towards creating a society that values and supports people at every stage of life.
The Bias Against Old Age
One of the most striking revelations in "Elderhood" is the pervasive bias against old age that exists in our society. Aronson points out that while we've made progress in combating other forms of discrimination, ageism remains widely accepted and often goes unchallenged.
This bias is evident in the language we use to describe older people. When asked to associate words with "old," many people, including medical students, tend to use negative terms like "wrinkled," "frail," or "sick." These associations reflect a view of aging as a decline from the prime of youth to a state of uselessness and decay.
Interestingly, Aronson notes that when people are asked to react to the word "elder," the responses are much more positive, including words like "wise," "experienced," and "knowledgeable." This linguistic difference highlights how our perceptions can be shaped by the words we choose.
The author argues that this bias has real-world consequences, particularly in healthcare. For instance, the U.S. Center for Disease Control's recommendations for care are much less nuanced for older adults than for children or younger adults. People over 60 are lumped into a single category, ignoring the vast differences between, say, a healthy 70-year-old and a frail 90-year-old.
To combat this bias, Aronson proposes a new term: "elderhood." By reframing this stage of life, we can begin to challenge our preconceptions and recognize the diversity and potential of older adults.
The Reality of Life After 60
Contrary to popular belief, life after 60 can be a time of great happiness and fulfillment. Aronson cites studies from the United States and Western Europe showing that people's well-being at around age 60 is similar to that of twenty-year-olds, and it often increases after that age.
Many older adults report feeling great and experiencing surprising happiness in their later years. This positive outlook is often at odds with society's perception of old age as a time of decline and misery.
However, the difficulty for many older people comes not from aging itself, but from how they are treated by society. Ageism manifests in many ways, from condescending language to the assumption that older people are less capable or valuable.
Aronson points out that American culture, with its focus on youth and productivity, often views older people through an "industrial lens" that values speed and efficiency over wisdom and experience. This cultural attitude can lead to the marginalization of older adults and a denial of the realities of aging.
The author argues that denying the existence of old age is not only unrealistic but harmful. It invalidates the experiences of older people and fails to recognize the unique challenges and opportunities that come with this stage of life.
The Importance of Relationships and Purpose
Drawing on long-term studies, Aronson emphasizes that relationships and a sense of purpose are crucial for happiness and health in old age. The Harvard Study of Adult Development, which has been ongoing for over 80 years, found that having quality relationships is the most important factor in long-term well-being.
However, the American healthcare system and many care institutions often fail to prioritize these needs. Nursing homes, for example, can be isolating environments despite being full of people. This isolation can have serious health consequences, with loneliness shown to increase mortality by 26 percent.
The author also highlights the problems with how patients are transferred from hospitals to nursing homes. Often, there's little consideration given to matching patients with suitable facilities, which can lead to poor outcomes.
Aronson argues that most elderly people would prefer to stay in their own homes, and those who can afford in-home care tend to be happier and healthier. This preference for aging in place should be taken into account when designing care systems for older adults.
The Unique Medical Needs of Older Adults
One of the key messages in "Elderhood" is that older adults have different medical needs than younger adults, and these differences are often overlooked in medical education and practice.
Aronson shares a personal story of prescribing an antidepressant to an elderly patient without realizing that the medication could cause dangerously low sodium levels in older adults. This mistake highlights a broader issue: many medications affect older people differently, but this isn't always reflected in medical training or drug trials.
The author points out that until recently, drug trials were not required to include older people, even though they are often the primary users of these medications. This gap in research can lead to dangerous situations where drugs are prescribed without a full understanding of their effects on older patients.
Moreover, Aronson warns against the common practice of treating side effects with additional drugs, which can lead to a "prescribing cascade" where patients end up taking multiple medications, each treating the side effects of another. This can be particularly dangerous for older adults who may be more sensitive to drug interactions.
Challenging the Disease Model of Aging
Another important theme in "Elderhood" is the need to challenge the view of old age as a disease with inevitable symptoms. Aronson argues that this perspective can lead to missed diagnoses and inadequate care.
She shares the story of Lynn, a 79-year-old woman whose stroke symptoms were initially dismissed as normal age-related confusion by paramedics. This case illustrates how assumptions about aging can have serious, even life-threatening consequences.
The author emphasizes that while many older adults do experience health issues, being old doesn't automatically mean being senile or confused. Each older person should be treated as an individual, with their symptoms evaluated based on their unique health history rather than assumptions about their age.
The Gap in Healthcare Coverage
Aronson highlights a significant issue in the U.S. healthcare system: many of the resources that aging people need to maintain their independence are not covered by insurance because they're considered "nonmedical."
Items like walkers, hearing aids, dentures, and glasses are often essential for older adults to maintain their quality of life and independence. However, these are often not covered by health insurance, putting them out of reach for many people.
The author argues that this classification of certain items as "nonmedical" is more political than practical. It benefits industries that produce pharmaceuticals and medical devices, often at the expense of patients who need simpler, more affordable solutions.
This gap in coverage can lead to absurd situations where invasive and expensive procedures are covered, but simpler and more appropriate solutions are not. For example, a patient might be able to get laser eye surgery covered by insurance, but not a pair of glasses.
Changing Our Approach to Aging
Throughout "Elderhood," Aronson calls for a fundamental shift in how we approach aging, both in healthcare and in society at large. She argues that our current medical system is designed to cure diseases rather than provide holistic care that might prevent their development.
The author emphasizes the need for a more nuanced understanding of aging, one that recognizes the diversity of experiences among older adults and values their wisdom and contributions to society.
Aronson also challenges the societal obsession with youth, pointing out that defining "looking good" as "looking young" creates unrealistic and harmful expectations for older adults.
Final Thoughts
"Elderhood" is a powerful call to action, urging us to reconsider our attitudes towards aging and to work towards creating a society that values and supports people at every stage of life.
Aronson's book reminds us that we're all aging, and how we treat older adults today will shape our own experiences of elderhood in the future. By challenging our biases, improving our healthcare systems, and fostering a culture that respects and values older adults, we can create a world where elderhood is a time of joy, fulfillment, and continued growth.
The author encourages us to talk openly about aging and death, difficult as these topics may be. By acknowledging the realities of aging and mortality, we can better prepare for our own later years and support the older adults in our lives.
Ultimately, "Elderhood" is a hopeful book. It envisions a future where aging is not seen as a decline but as a natural part of life, rich with its own opportunities and experiences. By reframing our understanding of what it means to grow old, we can work towards making this vision a reality.
As we face an aging population globally, the insights and recommendations in "Elderhood" become increasingly relevant. Whether we're healthcare professionals, policymakers, or simply individuals thinking about our own futures, this book provides valuable perspectives on how we can improve the experience of aging for everyone.
In conclusion, "Elderhood" is not just a book about aging – it's a book about life, in all its stages and complexities. It challenges us to think differently about what it means to grow old, and in doing so, offers a path towards a more compassionate, inclusive, and fulfilling approach to the entire lifespan. As we all journey towards our own elderhood, Aronson's work serves as both a guide and an inspiration, reminding us of the dignity, wisdom, and potential that exists in every stage of life.