Dynamics of Aging

Its interesting that we start off as children. Children, subject to the will and rules of others. Eventually, we become adults that control our own lives and shape them in the manner that we choose. Then we become elderly. The people around us stop trusting our decision making. We experience declines in physical ability. We become adult children, as our autonomy is usurped. Sometimes the usurping is done by family, other times nurses and other caregivers. I've heard this brought up in school when I was in undergrad, and Gawande has reverberated this notion to me. When our health is declining, the most fulfilling and gratifying aspect of life is to be able to make your own choices.

Let's jump into the continuation of my reflection upon Being Mortal: Medicine and What Matters in the End, by Dr. Atul Gawande. In my last posting I mentioned that one of the reasons I've been enjoying this book so much is because Gawande makes reference to medical and social trends/occurrences in our society. One such exmape that caught my eye, and one that has been a significant point of debate, is the issue of age demographics, retirement, and social security. Gawande simply writes, " Today [ in the U.S.], we have as many fifty-year-olds as five-year-olds. In thirty years, there will be as many people over eighty as there are under five. The same pattern is emerging throughout the industrialized world". Gawande doesn't specialize in population analysis; and he hasn't devoted his life to studying populations and the manner in which they have functioned throughout history. But for anyone paying attention, it is plain to see that people have been progressively living longer, as families are simultaneously producing less children. Less people have been dying, and fewer people are being born. With this in mind, I wonder if simply retiring and expecting social security will be a possibility. Gawande makes another point to mention that people are saving less money, having less children, and outliving there spouses. How can you expect to be adequately cared for in your old age if you dont' have enough money or family, and your spouse is no longer living. Not to mention the individualistic culture that I observe in the modern era. Many people do not have qualms about moving away from family and moving to different parts of the country/world. I'm not knocking individualism either. I'm simply asking us to consider who will take care of grandpa and grandma in California, when their children live in Illinois and Virginia.

Gawande mentions that a physician once told him that the job of any doctor is to support quality of life. I may need some time to fully analyze and digest this statement, but at the moment I agree. For geriatricians, keeping an elderly patient as free as possible from illness and maintaining their ability to be engaged in life are of the utmost importance. Of course, no scenario exists in a vacuum. There are always other influences, purposes, goals, guidelines, and procedures. Nontheless, elderly patients, especially those in assisted living and nursing homes should be treated in ways that give them the best chance at being engaged in life. Elderly patients should continue to have lives that are stimulting, interactive, and filled with relationships. Their bodies should be given the best chance to be healthy, while they're included in environments that invite purpose, love, creativity, interaction, etc. All of this becomes difficult, when we start to place hierarchies on health and quality of life. The waters can become murky when care providers begin to place restrictions on patients' lives in order to keep them safe above all else. Many of the health care professionals that Gawande used as exmaples in his book would argue that autonomy, fulfillment, life-purpose, and dignity are more important than the mission to deter physical ailment.

Fulfillment and life-purpose tie into a section of the book that I made note of. In this particular section, Gawande tells the reader about a research study that involved two large groups of elderly people. One group continued to see their primary physicians, the other group was assigned to a team of geriatric nurses and doctors. The group that had access to geriatric-specific care were 25% less likely to become disabled, 50% less likely to develop depression, and 40% less likely to require home health services. In other words, they were healthier on average. Gawande used this example to depict the positive results that medical care has the potential to bring about. I bring this up to point out the portion of this example that stood out to me. I noticed that 50% were less likely to be depressed. Depression is a function of many influences, but it is safe to say that depression is birthed out of the existence of an unhappy life. Therefore, when I looked back over this example in the book, I thought it was interesting that depression was 50% less likely in the elderly group that was allowed access to geriatric nurses and doctors. Whether the group was happier because of either improved physical health, improved human interaction, or the freedom to make decisions; the bottom line is that the patients were happier. Something about the manner in which their care taking was approached had a deeper affect than just alleviating the body of disease. These patients were happier. They experienced physical, mental, and spiritual improvements that exceeded the control group. Immediately follwing this example, Gawande revealed shocking news. A few months after the lead investigator of the study, whom was also a geriatrician at the university that served as the home base of the study, published these phenominal findings, the univserity closed the geriatrics division. This study plainly showed that geriatric care had the potential to avoid some of the devastating effects of aging. The study had given us proof that geriatric care could alleviate the issues that medical professionals and families struggle with when caring for an elderly patient. Our medicald system clamours for the latest and greatest technology, and this medical technology is not cheap. But we are willing to close down geriatric divisions. Ideally, geriatric nurses and physicians use knowledge, understanding, and care to improve the health and lifestyles of patients. The universities decision to close their geriatric division is a microcosm of the symptoms of a disfigured and perverse mindset. We want surgeons to fix our brains, we want surgeons to fix our faces, we want surgeons to fix our organs, and won't accept that aging is impossible to stop. We should not have the idea that if geriatrics can't keep us from declining as we age, then it has failed. Any person that is born will surely die. We are too narrow sighted and lost in a fantasy to realize that we are doing ourselves a disservice when we undercut geriatric care.