Elderhood | Louise Aronson

Summary of: Elderhood: Redefining Aging, Transforming Medicine, Reimagining Life
By: Louise Aronson

Introduction

In ‘Elderhood: Redefining Aging, Transforming Medicine, Reimagining Life,’ Louise Aronson explores how society’s negative perceptions of old age lead to biased opinions regarding older adults and insufficient care. This book delves into the importance of changing the way we talk about aging to dismantle age-related biases and create a more vibrant and fulfilling experience for our elderly population. Topics explored include aging stereotypes, ageism, relationships during old age, the flawed healthcare system, and the consequences of prescribing multiple medications for older people. Ultimately, Aronson seeks to redefine old age as ‘elderhood,’ celebrating the wisdom and experience that come with it.

Embracing Elderhood

Aging often leads to negative stereotypes, such as frailty and feebleness. However, changing our perception of aging can help us recognize and appreciate the vibrancy and wisdom that comes with old age. By redefining “old age” as “elderhood”, we can begin to dismantle these biases and better serve the needs of an increasingly diverse older population.

Each year, Professor Guy Micco, of the University of California, Berkeley, asks his medical graduate students to reflect upon their associations with the word “old.” Common responses include words like “wrinkled,” “bald,” “bent over,” “frail,” and “feeble.” These associations fuel a bias that equates aging with a decline in physical health and abilities.

This bias arises partly from historical unfamiliarity since most people in the past didn’t live long enough to reach old age. As a result, humanity has dedicated more time to studying children and younger adults. Today, however, with baby boomers reaching retirement age, the older population requires much more attention.

One issue contributing to this bias is the lack of diverse classification for older people. The US government’s Center for Disease Control (CDC) currently has 17 age subcategories for people under 18 and five for adults, but everyone over 60 falls under one category. This implies that there’s no difference between a healthy 70-year-old and a debilitated 90-year-old, leading to inadequate care for many older individuals.

Louise Aronson suggests that changing how we talk about aging is crucial to dismantling this bias. A crucial step is utilizing the term “elder” instead of “old.” When asked about the word “elder,” people associate it with wisdom, power, experience, and knowledge – all positive traits.

Aronson believes we should replace the term “old age” with “elderhood,” recognizing the valuable knowledge and experience that comes with reaching old age. By embracing elderhood, we can not only appreciate older individuals’ contributions to society but also provide better care and understanding tailored to their diverse needs.

Embracing Aging with Happiness

Aging does not equate to diminished happiness; quite the contrary, many individuals above 65 find life to be fulfilling and enjoyable. Society’s negative views on older people, accompanied by the outspread ageism in Western countries, is the bigger challenge. By acknowledging and understanding that old age is an inevitable part of life, we should learn to treat our elderly population with kindness, respect, and dignity.

When 93-year-old sportswriter Roger Angell said, “I feel great,” he wasn’t an exception to the rule. Many older individuals share a similar sentiment, and studies from the United States and Western Europe validate this by revealing that people over 60 possess levels of well-being comparable to 20-year-olds, and the levels keep growing with age. Despite this, elderly individuals often face negativity from society, encountering derogatory terms like “old fart” or “geezer.”

The condescending language used towards older people is a representation of the ageism deeply embedded in our society. Coined by gerontologist and author Robert Butler in the 1960s, ageism remains prevalent in the United States. This is due, in large part, to the cultural fixation on success and youth, which devalues wisdom and experience in favor of qualities like speed and efficiency. To exemplify this, an older professional may decide to hide signs of aging to avoid the perception of being “over the hill.” Such a mindset only serves to uphold the damaging belief that old age is something undesirable.

By ignoring or dismissing the reality of aging, society denies elderly individuals the recognition of their existence. As author Ursula K. Le Guin so eloquently stated, “To tell me my old age doesn’t exist is to tell me I don’t exist.” It’s essential to recognize that aging is not a disease, but a natural part of life’s journey. Embracing this fact can lead us to treat older people with the kindness, dignity, and respect they deserve.

Uncovering Happiness and Health

Harvard psychiatrist Robert Waldinger brings attention to the importance of relationships for happiness and health. Quality relationships and a strong sense of purpose contribute to greater well-being. However, current health-care systems, particularly nursing homes, often fail to address social needs, leading to detrimental effects on elderly patients.

In a thought-provoking TED talk, Harvard psychiatrist Robert Waldinger asks, “What makes us happy and healthy as we go through life?” Grounded in over 80 years of data from the Harvard Study of Adult Development, the answer is quite straightforward – it’s all about relationships.

Rather than the number of connections, such as the example of Facebook friends, the essence lies in the quality of these relationships. Just a few close and reliable bonds are sufficient to promote happiness. Having a loving, stable partner is also an undeniable asset. Another crucial factor for lasting happiness is a sense of purpose or having a reason to look forward to a new day.

Regrettably, the American health-care system, including nursing homes, often overlooks these vital aspects. Many elderly individuals in nursing homes feel isolated, despite being surrounded by others. Research published in Perspectives on Psychological Science reveals that loneliness can increase mortality by a striking 26%.

Hospital-based physicians frequently face challenges when transferring patients to nursing homes. An article published in the Journal of American Geriatrics Society in 2017 indicated that doctors are pressured to discharge patients without considering suitable nursing homes, leading to devastating consequences.

For instance, an elderly woman named Neeta experienced detrimental neglect after undergoing hip surgery and being transferred to a nursing home. She faced malnutrition, severe sores, and limited options towards hospice care. Despite some happy endings in nursing homes, most elderly individuals would prefer to remain in their own homes. Those who can afford in-home care experience greater happiness and health, demonstrating the significance of addressing social needs in health-care systems.

Unveiling Age-Specific Treatments

A young medical trainee learns a critical lesson about treating elderly patients when her assumptions about prescribing antidepressants cause unforeseen complications. The experience reveals the fundamental differences between treating adult and elderly patients and uncovers the need for age-inclusive drug trials.

In her initial year as a medical trainee, the author believed that treating elderly patients was essentially the same as treating adult patients. Her perspective changed when she encountered Anne, a jovial 90-year-old lady whose deteriorating health forced her to put her sister Bess in a nursing home. Anne’s subsequent depression left her unable to eat, sleep, or enjoy activities she usually loved, prompting the author to prescribe an antidepressant.

However, the author made a critical mistake—she treated Anne’s depression as if she was treating a younger patient. This mistake was understandable considering that until the National Institute of Health’s 2019 Inclusion Across Lifespan Policy, medical drug trials were not required to include older people. Surprisingly, most people who require such drugs are elderly.

Drugs used to treat atrial fibrillation, for instance, often cause confusion in older patients. Yet, these “trial proven” drugs continue to be prescribed, despite their potentially harmful side effects. Similarly, the antidepressant prescribed to Anne could cause extremely low sodium levels in elderly patients, leading to lethargy, confusion, or even death. The author only realized this after discovering recently published case reports.

Unfortunately, the damage was done—Anne had been readmitted to the hospital, in need of urgent care, while her son Jack questioned the author’s competence. This humbling and educational experience opened the author’s eyes to the importance of understanding and addressing the unique challenges that older patients face. The medical community must recognize the need for age-inclusive drug trials and adapt treatment approaches to ensure safe and effective care for the elderly population.

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