The New Age of Old Age

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The hardest substance in the human body is the white enamel of the teeth. With age, it wears away nonetheless, allowing the softer, darker layers underneath to show through. Meanwhile, the blood supply to the pulp and the roots of the teeth atrophies, and the flow of saliva diminishes; the gums tend to become inflamed and pull away from the teeth, exposing the base, making them unstable and elongating their appearance, especially the lower ones. Experts say they can gauge a person’s age to within five years from the examination of a single tooth–if the person has any teeth left to examine.

Atul Gawande, The Way We Age Now, The New Yorker, April 30, 2007.

Atul Gawande is a general and endocrine surgeon who — in the tradition of Chekhov, Lewis Thomas, and Oliver Sacks — is among that breed of doctors who can turn their careful observations into thought-provoking prose. We are all fans of Gawande’s work, from his books to his pieces for Slate and The New Yorker. But it is his most recent article on aging that has us thinking ‘this is the show to do with Atul Gawande.’ Perhaps this article suggested itself as a show becuse it is an extension of a converstion that we had last year on how to die a good death. This year we’re asking: as we get older can we live a good life in the face of death?

Within thirty years there will be as many people over eighty as there are under five. This is a demographic shift that we haven’t prepared for. We’re putting less money aside for our old age, we are having fewer children, many of us will reach our eighties and beyond without a spouse, so we may be destined to live longer and to live those older years alone. This new world order is also one that the medical community isn’t adapting to. There will no doubt be pediatricians to take care of all those kids under the age of five but will there by any geriatricians to look after their grandparents?

head shot of man

Aging in America

[David Shapinsky / Flickr]

Although the elderly population is waxing, the number of geriatricians is on the wane. This has something to do with the fact that geriatricians are among the lowest paid in the medical profession but it also has to do with the medicine itself. The art of the geriatrician is to make sure that his/her patient maintains the best quality of life for as long as possible. And when you are in your eighties this means the basics; like being able to trim your own toenails, drive to the grocery store, and walk your dog. Sustaining these daily functions is often more important, for both the patient and doctor, than having that pre-cancerous node removed from your lung. Effective geriatric medicine is like fighting global warming: the process is a slow one without much sizzle, and success is accumlative rather than instantaneous. Why go through medical school when the definition of victory is that your patient can get around with a walker at the age of ninety-four? Wouldn’t saving a teenager from a car crash, or performing emergency neurosurgery be more rewarding?

During this hour we’ll talk about what happens to our bodies as we age, and who will be around to treat us as we get older. As a society that is forever bombarded with gimmicks to extend our youth are we prepared to face our inevitable decrepitude? Is a medical system that has made remarkable progress in extending our lives prepared to deal with us as we slouch toward death? Have you experienced medical care that gives you hope for you and your family as you age? How do you see yourself living at the age of ninety, or one hundred plus?

Atul Gawande

General and Endocrine Surgeon, Brigham and Women’s Hospital

Staff Writer, The New Yorker

Author, Better: A Surgeon’s Notes on Performance, and Complications: A Surgeon’s Notes on an Imperfect Science

MacArthur Fellow 2006

Christine K. Cassel, MD

President and CEO of the American Board of Internal Medicine. Author of many books, among them, Fundamentals of Geriatric Medicine: A Case-Based Approach, Leading expert in geriatric medicine and end of life care.

Extra Credit Reading

Authors@Google: Atul Gawande

Atul Gawande, The Way We Age Now, The New Yorker, April 30, 2007: “There have been dozens of best-selling books on aging, but they tend to have titles like “Younger Next Year,” “The Fountain of Age,” “Ageless,” “The Sexy Years.” Still, there are costs to averting our eyes from the realities. For one thing, we put off changes that we need to make as a society. For another, we deprive ourselves of opportunities to change the individual experience of aging for the better.”

Charles McGrath, Atul Gawande Rocks in the O.R., The New York Times, April 3, 2007: “When that parathyroid turned out to be healthy, he started looking on the left, and he peered and probed for the better part of an hour — or the length of an entire Aimee Mann album on the iPod — before finally extracting a brownish, pea-size gobbet.”

Tim, The Hero Makes His Diagnosis, Short Schrift, May 5, 2007: “Atul Gawande strikes me as something like a protagonist out of a 19th-century play or novel: the intelligent, humane physician/scientist, as articulate as he is perceptive, slowly fighting to unearth the hidden dangers, to expose injustice, and to educate and cure what ails the body politic”

The Thin Man, If I grow old before I wake . . ., Abandon Text!, May 6, 2007: “It seems conceivable to us that life will someday end; we make estate plans, buy life insurance, arrange for succession in our roles. But very few seem able to accept simple diminishment — the fact that we will inevitably lose more and more of our physical and mental powers.”

Gray-haired Geezers, A Pilgrim’s Digression, May 8, 2007: “Fat, old, gray-haired…how could any of that be happening to us? We who were so young and carefree, once.”

Donald Crowdis, It Bothers Me That I Have To Go, Don to Earth, January 23, 2007: “I’ve floated on the remark ‘Been there, done that’ for some time now, but the notion that the moment is approaching when I can no longer say this bothers me. The truth is, I don’t want to go.”

Related Content


  • Cameron Brown

    I know of people – including some generally reasonable, intelligent, successful people – who are complete supplement nuts. They take something like 100 supplements a day, including exotic stuff like “ALT-711″ (alagebrium chloride) that isn’t FDA approved or (as far as I know, which isn’t far) backed up by mainstream science. When asked about it, they say that traditional medicine isn’t keeping up, and that there’s mounting evidence that supplements can substantially delay, or even reverse, the effects of aging on the body (at the molecular level).

    I’d be very interested to here Dr. Gawande’s thoughts on supplements like ALT-711, and where they fall on the spectrum of “demonstrably beneficial” to “demonstrably harmful”. Personally, I suspect most are somewhere in the middle (effects are small enough to be ambiguous, and are basically lost in the noise).

    Then there’s the whole “Strategies for Engineered Negligible Senescence” (SENS) scene, who talk freely about people who are living today living to 1,000 years old. This sounds like sheer quackery to me. Is it?

    Here’s a link to the SENSE website (I’m new here, and don’t know how to do inline links – I’d appreciate it if someone could show me…): http://www.sens.org/time.htm

  • http://www.radioopensource.org/user/sidewalker sidewalker

    My eye doctor said yesterday that he was surprised that my eyesight has actually improved slightly, not worsened over the past 5 years. I’m nearsighted and look at a computer screen too much, but I also practice Seitai – Japanese Physiotherapy. Seitai means “correct the body” and it focuses on rebalencing body symmetry by working on the head and neck, the spine and pelvis, and the feet. There are difference exercises that help the body find its natural way back to wellness, including neck, feet and hip rotation and rolling the eyes in three directions. Once balance is achieved, there is less stress on the body and the immune system can function better. There is far less need for medicines when with a proper diet and care for our bodies we have much of the healing ability within.

    Seitai, yoga and other forms of non-intrusive practice may be a good way to reduce the strains of time and gravity on our bodies. Now if only such practice could help reverse balding!!!

  • http://www.bicyclemark.org bicyclemark

    I intend to be a rebellious old man who refuses to stop using his old powerbook to record an old fashioned podcast that condemns the ruling class.

    My only fear is that, like many people in this world, having migrated to another country, I’ll find myself without the support structure of a very tight knit family.

  • rahbuhbuh

    “Rethinking Senior Housing” from Dwell magazine

    http://www.dwell.com/peopleplaces/profiles/2886966.html

    the basics are being shifted. lower shelving, raised electrical outlets, installing grab bars in bathrooms, etc… it’s the little things which make a building elderly friendly. “accessible design” is one of the friendlier terms, like “67 years young.” it is a booming business for architects, interior, and industrial designers. a grab bar does not have to look like the metal arm in the airport, that sort of thing. considering the elderly have less children and more money, housing is being rehabbed because no one wants to be shuffled off to a retirement home ghetto.

  • rc21

    If you can afford it HGH can do wonders for slowing the aging process.

  • jscientist

    what i worry about in france is are the electorate security gaurds sufficient to stop ballot box stuffing. A question for our guest. Are you ready enough security wise?

  • RobertPeel

    I recommend a Jungiian Analyst John Malecki PHD who lives in Albany for the show.

    At 80, he graduated from the Jung Institue. His dissertation was about ALZ disease. He began running the Boston Marathon at age 65. He would seem to embody the theme of the show. You can reach him through his friends at (802)254-6220.

    Also Erick Erickson(RIP)and his wife Joan wrote a book(when they were in the 80′s)

    “Vital Involvement in Old Age.”

    Perhaps Sir Paul, Sir Mick and Sir Elton are showing us that the 60′s are the new 30′s.(Forgive me Greta, Robin et al.)

  • http://del.icio.us/plaintext plaintext

    Hey good timing! I’m reading, Last Rights: Rescuing the end of Life from the Medical System by Stephen Kiernan Fresh Air on NPR had him on. Good stuff:

    Northwestern is attempting…with EPEC (Education on Palliative and End-of-life Care) … to provide choices so that people can maximize the quality of their remaining life … despite seven years of operating within the AMA, [the program] reaches only a hundred medical professionals at a time. With two sessions a year, EPEC can boast eighteen hundred graduates in its history. There are more than one million doctors in the US.

  • rahbuhbuh

    I first heard about these statistics during an interview with Scott Burns discussing his book “The Coming Generational Storm”:

    http://www.amazon.com/Coming-Generational-Storm-Americas-Economic/dp/0262612089/ref=pd_bbs_sr_1/103-4610615-5124662?ie=UTF8&s=books&qid=1178305606&sr=8-1

    from what I understand, it’s primarily an economics-lite book, but he might be worth talking to.

  • http://www.radioopensource.org/user/sidewalker sidewalker

    “As we get older can we live a good life in the face of death?”

    Okinawa, Japan, which has one of the highest concentration of centenarians (42 centenarians per 100,000 people in 2003) provides an insight into the keys to a long, healthy life. Here is a link to the Okinawa Centenarian Study. The study mentions invariable factors, such as genes and climate, and many variable factors, such as diet, eating habits (less caloric intake), exercise, attitude towards life and integrative health care (Eastern and Western methods).

  • Chelsea

    Indeed there are ways to extend life but this show isn’t about the quantity of life but the quality of life at the end. It’s about the last year or so of life that we’ll focus on. What kinds of decisions do doctors and patients and familiy members make to ensure our independce and ability to get around?

    In Gawande’s article, one of the geriatricians that he writes about spends a good part of his time with his patients looking at their feet. If the feet are in bad shape the elderly are more prone to falling. We all know that for many a fractured hip is the beginning of the end — Kurt Vonnegut died from complications from a fall.

  • http://www.radioopensource.org/user/sidewalker sidewalker

    That is my point Chelsea, as I mentioned above about Seitai, which focuses on feet, spine, neck and overall balance. If the feet and ankles are in bad shape any time in our life we are more likely to have all kinds of problems because we put stress on other parts of the body to compensate. The next door neighbour, a woman in her 80s, was seriously hunched over and started going for Seitai and it raised her from a 100 degree angle to about 160. If she had gotten help earlier she would not have declined so fast and suffered for so long. It may be surprising in Western medicine that the doctor would look at the feet, but not in Eastern medical practice, which is more holistic.

    I still don’t buy the reductive notion that there is anything radically different to be done towards the very end that shouldn’t be done at an earlier stage of life to make the twilight brighter. After all, geriatrics is, says Wiki “the branch of medicine that focuses on health promotion and the prevention and treatment of disease and disability in later life.” Of course there are some new and greater challenges for health, but from how I read Gawande’s article, he is concerned with helping elderly people carry out their daily affairs without falling down or losing weight. The woman he wrote about had sturdy legs. This is probably because she was quite active and not sitting in front of a television for long hours. If she had practiced better eating habits (I’m speculating here), she may not have just gone in for mainly potatoes and would not have lost weight.

    I’m looking forward to learning more about this.

  • rahbuhbuh

    The people running AARP might be worth talking to. They’ve had to revamp their image, magazine’s (highest circulation in the US?) editorial tone, and content to reflect active septuagenarians doing physically more than they ever could in history.

    Currently reading an old issue of Granta with a story by Helen Simpson, this line struck me:

    “Prolongation of morbidity is what they’re calling this new lease of life after seventy.”

    It recalls the “living with HIV” versus “dying of AIDS” lingo shift.

  • katemcshane

    To be honest, I, personally, would not look to the medical profession to provide anything that related to the quality of my ordinary life at my current age (59) or later. I’ve known a number of doctors who specialized in the health of older people and, at the very least, their bias against this group was no different, sometimes worse, than the average person in a youth culture. They seemed to push pharmaceuticals for everything, just as they do with all ages here. When I’ve talked to them about older people I know who live self-determined lives, they’ve thought someone should be taking better control of them, e.g. an 85-year-old man I know (an author) who fixed the plumbing underneath his house, people even older who drove and were good drivers. I realize that I tend to know the older people who are interesting, active even during illness, usually political, but many of these doctors didn’t make that distinction. A friend of mine once objected to a doctor prescribing xanax for her father, because of reports of damage done by the drug and because of the difficulty in going off of it. The doctor said to her, “What does it matter? He’s 72.” As you can see, and it’s probably no surprise, I’m not a fan of doctors, and I think much of holistic medicine is making the approach of the AMA to human beings anachronistic. I think of the way many ob-gyn doctors were forced to change, because of what women demanded, and the same will have to happen when my generation is older. You cannot expect that people who go into a profession largely because of the money will do much to improve the quality of life. I realize that in this society, I sound like a crackpot — but less and less so.

  • http://www.marcmcelroy.com Marc McElroy

    This is my take on aging: I look forward to the challenge. I am currently writing a short essay called “My First Heart Attack,” which antisipates what seems to be to be the inevidible, and why not plan ahead? I have a history of heart disease in both sides of my family, my father died of heart failure, and although I am 35, I think I should start considering that I will have problems, and how to get through it. Oh to boot I am an un-insured 35 year old at that. Why do people always assume they will live to a ripe old age? Why don’t people usually consider that they will have trouble along the way. Since my father lived to 62 and my mother to 58, I am very in tune with this idea. I’d like to live to be old, but I’m not taking it for granted.

  • http://www.circles-salon.com allison

    When people have asked me what my goal in life is, I have answered since being in my 20s, “To be in my 90s sitting on a porch with a friend and saying, “It’s been good, hasn’t it?”

    In my vision, I’m still feeling good about life. That is, I’m not decrepid. I imagine most people hope for this. But I’m not sure that many focus their health care on preparing for it. I’m in my 40s now and face serious health issues – from poisoning, not natural causes or bad health habits – and I haven’t once heard any of the plethora of doctors I’ve been sent to in the last two years speak to me about how to help my body be in a condition to enjoy the elder part of my life.

    Here, I will echo katemcshane, my naturopath and my acupuncturist do discuss these things. They think of the long-term impact of treatment plans and they approach a treatment plan as a path to health, not a management of illness. Is anyone seeing a movement towards this in the conventional medical institutions?

    A random thought: perhaps it would be helpful to create a PR campaign that improves our perception of the value of elders; and then we can create adopt-an-elder programs where people offer to care for elders in their homes in exchange for the benefits of having an elder in the home.

  • nother

    An elderly gentleman I work with is dealing with depression. He has had numerous health issues and he recently encountered housing problems as well.

    Oh yea, and he is lonely.

    The good news is that he recognized the issue and checked himself into the Psychiatric ward two weeks ago. They prescribed him anti-depressants and he is already outside gardening again.

    Moving forward, I hope the mental health of our elderly will be as much of a focus as the physical health. That includes fighting the stigma that is associated with taking these drugs – a stigma that might even be more prevalent in our golden agers.

  • http://www.math.uiowa.edu/~treadway bft

    Along with omission of excessive pharmaceuticals, let doctors—and their office staff—also refrain from going to work wearing products that give their patients “personal” fragrance chemicals to breathe…as they do in Halifax, Nova Scotia. Lots of older people, over a long life, have one way or another collected enough body burden of chemicals to be extra-sensitive to more of them.

  • Potter

    My mother is 93. When she was 90 she had a couple of chest x-rays before and after a bout of bronchitis/pneumonia. The x-rays showed a mass in one of her lungs. Her doctor who happened to have a specialization in geriatrics, sent her to a pulmonologist. Between the two of them they decided the mass looked suspicious; it might be cancer and she should have a petscan followed by a needle biopsy of the lung and a two-week course of radiation. Both doctors said she could go through it easily. My mother refused. She said she was thankful for her life and she was ready to go. It must be said now that my mother was otherwise in very good health, yes slowing down quite a bit and forgetful. She had been living by herself and taking good care of herself and was interested in life.

    My mother refused the very strong push of the doctors which came with an equally strong warning about the suffering that she would go through if she did nothing. I had a hard time convincing her but she agreed to the petscan. The results indicated she should go for the biopsy and treatment. This time my mother dug her heels in. She wanted nothing to do with biopsy or radiation. We had arguments. Then I realized that she was telling me that she did not have the strength to go through that. If she did not want to go through this I figured she would not be able to go through it. What helped me was being able to Google information about needle biopsy of the lungs and radiation treatment. I finally understood my mother’s intuitive wisdom. The tests and the treatment would have upset her equilibrium, and have been very stressful physically and emotionally at the very least. This might have destroyed her will to go on as well since being independent is extremely important to her.

    At that point mother turned on her doctors( it had been building), got angry insisted on a new doctor. She networked and found one. Her new doctor is a Russian woman in her 50’s, very sweet and caring, a pain specialist and trained in the Soviet Union, running a no-frills office in Brooklyn NY near where my mother lives. (There is quite a Russian community there.)

    I was impressed. Her first visit was one hour and fifteen minutes (I go along). This is unheard of. Subsequent visits have been just as leisurely and focused. We made it clear –after presenting the doctor with the whole story and the medical records that my mother wanted palliative care. The doctor agreed and understood and after explaining all her options again. She even encouraged my mother. We agreed to take things as they come. The doctor said she would also make a home visit if it was necessary.

    So here we are three years later. We have no definitive diagnosis, which can only be obtained with a biopsy, but my mother has had three more pretty good years, doing pretty well considering, getting more tired, including, at times being tired of living, more forgetful and mixed up but still trying to take care of herself. There are times when she really appears to be enjoying herself too- still very interested in life, sharing a little wisdom and being funny here an there. At the moment she and a friend are listening to soundtracks of the old Broadway shows, Rogers and Hammerstein, Lerner and Lowe ( My Fair Lady) that I sent her- and we are listening too now. She is making her way through Tony Judt’s book on postwar Europe at the moment. (Don’t ask her what it’s about when she finishes.)

    I don’t know if I will live that long, but she is my model.

  • katemcshane

    Potter — I will never forget this story. It made me cry. She’s so lucky to have you, that you could support her. I’ve seen a lot of older people “shouted down” by their doctors and/or families. Thanks so much.

  • joshua hendrickson

    My father died at 57 of a heart attack. My mother will be 62 this year; she’s fine. Her parents are not: in their 80s, they are both declining fast. My father’s parents died years ago…

    Our lives are either too short or too long. I just don’t know what kind of “middle ground” is possible, even in a future of advanced medicine.

  • rahbuhbuh

    Regarding mental health amidst advanced medicine: society’s norms have shifted and it is no longer taboo for seniors to date and remarry considerably late in life after a death or separation. Old dynamics of searchng for love and companionship applied to a new age. People refer to extreme old age as a second adolescence, now there is also a second awkward social puberty. A coworker is having difficulty introducing rakish Grandpa’s newest girlfriends to his children year in year out. They begin to ask questions he’s never considered about the longevity of love and marriage. He’s happy his father is happy, but he’s concerned about the example Grandpa sets.

  • Potter

    Thank you kate- I feel better. I was not going to post that. I wrote it a few days ago.

    Joshua it’s tough to lose a parent especially, I imagine, one so young. Even though we don’t know when out time will come- I think we think we are owed at least four score and ten. My mother’s mother in fact died at 62 from lung cancer. She did not smoke- but I think my grandfather did. he wasn’t around much – I think it was the coal burning in NYCity in those days. My mother sat by her mother giving her morphine to ease the pain on her death bed. I was about 6 years old at the time.

    When I look at my mother’s body I see what happens when you live so long. She has little energy; she has bursts of it then rests. She can’t hear well or see well. There are bumps all over, on her head, on her back. She says she is like an old tree, gnarled and with warts. When I tell her to have the growths checked b/c it might be skin cancer- she gives me a blank stare. She says “everybody gets cancer don’t they?”. So much for that.

    By the way she wears jeans and is very interested in fashion… always was. If she is going to go somewhere she is immediately planning what she will wear. If someone is coming over- she is beside herself about what to serve. This is what I mean about being interested in life. As well she reads the classics and pulls a volume of poetry off the shelf to read the lines she’s been remembering. She loves Wordsworth. She has an antique copy of the complete poems in tiny tiny print that she scrounged from somewhere.

  • nother

    While I’m on the subject of coworkers, I’ll mention two more. I just arrived at work and talked to (interviewed) an Irish bartender and a Brazilian waitress about how they treat their parents in their respective cultures.

    My Brazilian friend flatly stated, “in Brazil, you do not put your mom and dad in nursing homes. It doesn’t happen in my country.”

    My Irish friend said, “they are more compassionate over there.” (Ireland)

    Both agreed that “money, money, money,” is the driving factor in how Americans treat their parents.

  • W.M. Palmer

    When I took molecular cell biology at Harvard College in the late 80s the professor remarked that aging was an accumulation of a great variety of biochemical errors (in DNA, etc.) and therefore that almost certainly there never were going to be drugs to slow or counteract aging. His view now seems mistaken. We know now that certain species have organs that do not age (turtles, as reported in the NYTimes recently) or seagulls (as discussed in N. Lane’s book fascinating book Mitochondria: Power, Sex and Suicide). There are two biotech firms headed by reputable medical professors essentially devoted to anti-aging research (if under the guise of addressing diseases whose predominance rises with aging), Elixir Pharmaceuticals and Sirtris Pharmaceuticals.

    My sense is that within a few to ten years, there will be an anti-aging pill that will extend lives on average a certain degree – say ten to thirty percent. Not only will this be significant, but it will dramatically increase the focus on such research, leading to significant societal change (how will people view themselves, their work their familial relationships if they expect to live decades longer . . .?).

    I would tie the conversation into the larger social dynamic. We are already sensing as a society how manipulable the body will be to the new technologies that are rapidly developing due to the combination of genomics, bioinformatics, etc. I see that feeling of empowerment as behind the very forward attacks on religion that have come out in book form recently (Dawkins, Dennett, Hitchens) – as what is God in the main but he who will welcome us after our death – when we finally fall to the ravages of age . . .. My sense is that the apparent focus of this program, on the massive aging of the baby boomer portion of the population, five years hence will be seen as not having looked around the bend of the curve in technology.

  • http://nowcough.blogspot.com barthjg

    We don’t have any good guides for how to age and age well. Take my parents (please!)…reasonably healthy compared to all of their near-death or dead friends. But their lives are consumed with doctors, health care fears and confusion, the bureaucracy of health care, insurance and frankly the overwhelming burden of the downside of getting old.

    And I see this among many parents of my friends: health and decline are their primary focus.

    We now have a Boomer generation ill prepared for retirement, no meaningful savings, a fantasyland sense of healthcare and ‘feeling good.’ I think our generation is in for an even greater and worse shock because we think we can live (without planning) forever.

    Who will take care of us? I dont see the health care system getting easier or more efficient for the elderly.

    We don;t talk nearly enough about death and loss, an intense focus on preparing NOW for feeling healthier in old age. Aren’t we a society built on crisis? We think of treatment when our bodies begin to break but not before.

    By the way i LOVED Dr. Gawande’s ‘Better.’

  • jazzman

    My mother is 84 and my father is 87. My mother was diagnosed with Alzheimer’s about 4 years ago and prior to that, we (my sister and I) had prepared to provide for their care by building an apartment in my sister’s & her husband’s house with wheelchair access and handicapped equipped living quarters.

    They moved from a 9 room suburban house full of 50 years of accumulations (most of which was grudgingly divested) into 3 rooms. Last year a fall caused my mother to break several vertebrae and during the exploratory scans, it was determined that she had had many mini-strokes and the Alzheimer’s diagnosis of mental impairment was abandoned for a stroke model. Because we could not care for her in this condition she was sent to a nursing home for rehabilitation. Medicare would only subsidize the cost as long as she showed rehabilatory progress and then the allowed term was only for 3 months.

    After 3 months she was to be transferred to a long term care nursing home from which her doctors said she would never leave. In order to be admitted to the nursing home she was required to forfeit all but $100K of my father’s and her assets to pay for the care. If she died before using up the assets, the balance would be returned to my father. Against her doctors’ advice we arranged for her to be returned to my sister’s house and pay for 24 Hr. private nursing care, which would more than halve the cost of the nursing home. My father continues to be active and my mother while wheelchair bound has actually improved mentally to a large degree by this arrangement.

    The cost of elder care in this country could in many cases be reduced significantly by similar creative arrangements instead of the 1 size fits all plan that currently is in place. Suggestions such as Allison’s “adopt an elder” and many other alternatives are available but due to geriatric lobbying and vested interests and the medical industrial complex it needs bold leadership or a full blown crisis to affect the needed changes.

    I personally have not patronized a Dr. (other than a dentist) in over 30 years, and have no plans to start unless I create a situation that is beyond my immediate control. I believe I am responsible for all my experience and believe I’ll manifest good health as long as it serves my purpose. If or when my purpose is no longer served by being healthy, I’ll cross that bridge when I come to it but unlike Marc McElroy I’m not planning on it.

    Peace

  • loki

    My dad was 97 when he died. He broke his hip 3 times. Every time he went to the hospital MDs would say he is 90 or that he was an “old “90 year old

  • acSusan

    I am very concerned about the folks with Alzheimers Disease.

    Like my mother-in-law, I’m sure that many compensate VERY well. Given enough information, they can answer your question with enough confidence (to you) that they know what’s going on.

    I am very pleased that she is in a wonderful Alzheimer unit close to me, and my 4 year old son and I volunteer and play “crazy games” with the residents on the floor for 2 hours once a week.

  • loki

    Speaking about”not being ready.” When my Dad turned 90, someone suggested that he write his Will- my father’s response was “rigor mortis has not set in yet!”

    (he was Irish.)

  • janeer

    Question: How “young” can you be to qualify for seeing a gerontologist? I am 59, but have a handicapped son with a progressive disease, and feel like I need to stay healthy for as long as possible. Of course I think I’m still 30, but alone in bed I night, I worry about being there for him when he really, really needs me…

    Another note: in the 1960s, I worked for a gereontologist as a college student at my university. They lost their funding…and I lost my job.

  • clamdog

    I lost my father, mother and father in law to the same precipitating event: the loss of the ability to swallow correctly. Is there any research being done in this? Currently there are no treatments. All three had other issues, but it was the loss of the ability to swallow without aspirating that took them into hospice and to their deaths.

  • capewavedancer

    The dearth of primary care providers and gerontologists is being supplemented in part by the work and care of Nurse Practitioners.

    As a nurse, the focus of my education and experience has been to look at the “big picture” in terms of treating the whole person. We have spent many hours at the bedside or in the homes of elders providing physical, emotional, and spiritual care to the individuals and their families. With further education and experience to become a nurse practitioner, we are able to work collaboratively with other providers to diagnose and treat illness as well as promote health and well-being.

    I see us providing some of the care that young physicians are not choosing to provide as they seek to become doctors in more lucrative specialties. The quality of the care we provide has been shown to be on a par with that of physicians and I think our nursing focus adds an additional humanistic approach to the complex care of elders.

  • Sue Deppe, MD

    Not only do all insurance plans under-reimburse for the thinking and talking/listening aspects of primary care medicine (vs procedures), Medicare requires patients to pay a fifty percent copayment instead of twenty percent for any psychiatric diagnosis!! This is overt discrimination. It makes it harder for seniors to find care, and to pay for it.

    Susan Leigh Deppe, MD, DFAPA

    Board Certified in General Psychiatry and Geriatric Psychiatry

    Faculty, The Silvan S. Tomkins Institute, Philadelphia, Pennsylvania

    and

    Clinical Assistant Professor of Psychiatry

    The University of Vermont College of Medicine

    Private Practice, Colchester, Vermont

  • katemcshane

    Jazzman — As usual, your story was wonderful. I went for 17 years without seeing a doctor and when I did, she prescribed drugs that made me extremely ill, even though I told her that a single aspirin put me to sleep for hours. Instead, she overdosed me. If I had been more self-confident and centered at that time, I never would have agreed to take anything. It’s the single most regrettable decision I’ve ever made. Since then, I’ve paid attention to the intuition I’ve always had about my body and my health, and I do not plan to see a doctor again. I, too, am convinced that I have something to do with manifesting good health. Actually, I have been learning some things about healing, which I don’t want to describe in this setting, and I’ve healed in a remarkable way from a cracked rib and a torn rotator cuff, and these are not unusual (healing) experiences for me. It’s just that 10 years ago when I went to that doctor, I wasn’t able to trust myself enough to accept that I knew something about healing. When you wrote that your mother has improved from these decisions, I felt really nice feelings welling up inside, because of course this makes the most sense. I felt happy for her. Sometimes it seems that the most obvious solutions are the last thing the doctors I’ve known are able to look at. Like, when I was prescribed those drugs, it never occurred to anyone to just be a warm, decent, supportive human being.

  • http://www.liftport.com Brian Dunbar

    Fascinating – some random thoughts

    * Dr. Gawande sounds – in tone and general manner a great deal like my family doctor as he’s dealt with my wife and children. That’s a high compliment – I think the world of Dr. Goldslach.

    * It’s been some years since I’ve seen the man for my annual physical – time to change that.

    * But first I’ll make sure my toenails are trimmed ..

  • Potter

    Dr. Gawande had a good column ( part of a series, he is subbing for a regular) in the NYTimes today on our health care system and possible solutions. Like other world problems, it seems the thing that is lacking most is collective will. The articles are behind another kind of wall than the ones we have been talking about on the other thread.

    Jazzman: Thank you so much for your story. It’s a great model.

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  • http://hydroxatone101.com/ hydroxa

    I generally find it quite sad that we focus so much on superficial youth…Not to say that youth and young people are not important, because they are the future…BUT….There is so much wisdom, intelligence and experience that is stored in the grey matter of the elders in our societies, that is often overlooked and disregarded, while everyone is out there just trying to re-invent their own little wheels, instead of standing on the shoulders of geriatric giants…!!..