Medicine’s Desertion of the Elderly

elderly“There’s no escaping the tragedy of life, which is that we are all aging from the day we are born,” writes Dr. Atul Gawande in his latest book, Being Mortal: Medicine and What Matters in the End.

Accordingly, I’ve reached that point in life when I wish I could consult with a geriatrician, or specialist on the aging process. Given that we are increasingly an aging population, you’d surmise it’s no problem finding one.

Count yourself lucky, if you do. And if you do, that you’ll get in.

I live in a city of 300,000, and home of a major university with a respected medical school and first class hospitals. Still, I couldn’t find one.

In fact, it may surprise you to learn that geriatricians are an increasingly rare breed.

Take the University of Minnesota, for instance. It recently shut down its Department of Geriatrics, despite its success in enhancing the quality of life for many seniors, reducing disability, both physical and mental, remarkably and, what’s more, the need for costly home services.

Unfortunately, treatment costs exceeded any savings (Gawande 45).

Other medical centers have followed suit, reducing or eliminating their geriatric services.

The medical establishment prides itself on fixing things, when for the elderly it’s management, not healing, that should define appropriate treatment.

Technology, however, is where the big bucks are and even Medicare, tailored for those 65 and over, falls short in paying for services specific to seniors.

Additionally, doctors often feel overwhelmed by elders coming to them with not one, but several ailments. Think hypertension, diabetes, asthma, arthritis, anemia, failing hearing and eyesight, etc.

in the meantime, most Americans will ultimately spend at least a year in a nursing home at considerable expense, which quality geriatric care might well have preempted.

I can’t help but think this sorry state of affairs is somehow related to our general disregard of older people in America, often the butt of jokes or derision.

One study indicates that 68% of the elderly believe that the public is indifferent to its older citizenry.

I don’t think it was always this way. I grew up in a time when we revered age. It’s still this way in countries like China, Japan, Korea and in Latin America. China recently enacted an Elderly Rights Law, mandating its citizens “never snub or neglect the elderly.”

In Korea, turning 60 and 70 are celebrated events.

In contrast, American culture–as in other Western countries–is youth-centric, with emphasis on independence.

Maybe it’s because, thanks to many of modern medicine’s achievements, there are too many of us now, with 20% of Americans projected to be over 65 in the next twenty years.

Currently, those over 65 constitute 26% of all doctor visits, 47% of all hospital stays, 34% of all prescriptions, and 90% of all nursing home stays (Institute of Medicine Report: Retooling for an Aging America).

Unfortunately, there are only 7,000 geriatricians, and that number is declining. As such, it’s only half of what’s needed to meet a growing need (americangeriatrics.org).

The elderly often have emotional as well as physical needs. Sadly, only 3% of psychologists devote the majority of their practice to those over 65.

Geriatric psychiatrists number only about 2,000 and, like geriatricians at large, that number is declining, according to the American Association for Geriatric Psychology.

How foolhardy all of this is, since the elderly constitute a minority most of us are destined to join.

Most of us don’t like to go there when it comes to thinking about growing old and confronting our mortality. Certainly, we don’t prepare ourselves for it very well, though it may be closing in on us sooner than we think.

The UN associates age 60 with elderly status.

In the USA, several states use the same criterion.

The bottom line is that sound medicine isn’t about money. It’s about compassion

–rj

Looking, Thinking and Feeling Young

Nicoya Peninsula seen from space (false color)
Nicoya Peninsula seen from space (false color) (Photo credit: Wikipedia)

In my last post, “We are all Ponce de Leon” (August 13), I noted the robust euphoria increasingly prevalent in medical circles that perhaps in the next 25 years, given science’s increasing sophistication in manipulating the DNA’s genetic formulae, many of humanity’s worst diseases like cancer and arteriosclerosis will be harnessed, if not eliminated.  One of its principal advocates is Dr, David Augus, whose best selling book, auspiciously titled, The End of Illness, aggressively pursues this notion. In Hamlet mode, it’s something to be doubtfully wished, but unfortunately untrue.  Served up in a specious brew, it trivializes the idiosyncratic nature of disease, its pernicious fall out in anguish and grief; above all, the individuality of each victim.

We live continuously in a biological world fraught like life at large with unknowns, randomness and the onset of new specters replacing those we’ve vanquished.  While the incidence rates for heart attack and stroke have indeed lessened, high blood pressure and diabetes are way up and cancer abounds (Merck Institute of Aging and Health).  If longevity has increased, it’s primarily due to the drop in child mortality and not medical breakthroughs.

Children still get cancer, a disease that we usually associate with aging,  along with other afflictions.  I lost two siblings, mere babes, from heart disease.  I lost an older brother, doomed quickly by a brain tumor within a few months of his initial symptoms.  He was 47.  I love baseball.  My favorite player, Lou Gehrig, succumbed to ALS at 41.  I noted that Augus contradicts his own optimism in forecasting–“inevitable” is the word he uses–a pandemic that like the Spanish flu of 1918, will kill millions.

It’s good to dream, so long as it’s tempered by reality.  While we’ve made progress in some areas of medicine, our best bet is probably a preventative approach, especially through lifestyle changes such as giving up smoking, monitoring our calorie intake, and exercising more.  Ironically, though we live in an information age that staggers with its seeming infinitude, we still know relatively little as to the etiology of most of our diseases, treating symptoms, not causes.

All of us want to look, think, and feel young–the Ponce de Leon quest again–but let’s not promulgate nonsense.  Aging is a fact we must live with, but it doesn’t have to mean a cane, incontinence, dementia, cancer, heart disease or stroke.  The most recent research indicates that 70% of the ills of aging lies within our control.  We can learn to live with it and live well and for a very long time.

I have some pointers, though not a panacea, that can help us in preventing or delaying many of our ills.  They’re confirmed by recent studies of demographic specialists on longevity and you can find a succinct probing, in layman’s terminology, in Dan Buettner’s Blue Zones, 2nd ed., an analysis of five global hotspots for centenarians, places where men and women still toil in the fields though in their eighties and even nineties and cancer, heart disease and diabetes are rare.

The locales, by the way, are Sardinia, Okinawa, Loma Linda, CA (large Seventh Day Adventist population), the isle of Ikaria in Greece, and Costa Rica’s Nicoya Peninsula.  I should add that these biblical paradises are quickly succumbing to outsiders who bring fast foods and sedentary living with them, eroding aeons of life-enhancing routine and a quality of existence salient in simplicity and minimal stress.

Diet:  In all of these Blue Zones, little meat was consumed, usually once a week or just on a festival occasion due to economics rather than choice.  With Seventh Day Adventists, it was a conscious choice to exclude meat.  Beans, whole grains, garden vegetables, nuts and fruit characterize the several cuisines, not processed or refined food products.  I’ve always found it a good axiom:  “If it’s white, don’t take a bite.”  If giving-up meat isn’t a palatable option for you, then eat less of it and when you do, lean portions only, avoiding red meats in particular.  Or try cutting out meat altogether two days a week.  One other thing, but central: be careful about not only what you eat, but how much.  Centenarians are far and away thin people.

Movement:  People who work physically demanding jobs tend to live longer.  New studies show that sitting more than two hours regularly can shorten life expectancy.  For those of us whose lives are largely sedentary, it’s important to engage in aerobic exercise 30-minutes, 5 times a week, to lower bad LDL and raise HDL, the good kind.  But even brisk walking (3 miles in 45 minutes) counts.  Along with aerobic exercise, it’s wise to add weights to your regimen to protect and strengthen your muscles.  Walk more, sit less.  If space allows, do a garden.  When traveling, use the motel’s exercise room or bring along resistance bands.

Connection: Those who have friends and a support network such as religion can provide are consistently happier people living longer lives.  Pursue something you can commit yourself to.  Find a congregation, book club or lodge; discover a cause; volunteer.  Hang out with positive friends.  Find something that makes you want to jump out of bed each morning.

Serenity:  Those living long lives seem to have found mastery over stress.  It isn’t that they don’t suffer stress, but that they’re able to transcend it, living lives of daily, defined routine, with simplicity a cornerstone.  We help ourselves by reducing overload and unshackling ourselves from the wrenching worry synonymous with materialism, competition, and hurry.  Yoga, Tai Chi and meditation–traditional staples of the East–reduce tension and lower blood pressure, that silent source of many of our diseases.  Tranquil music muffles our pace; a good book provides timeout; a walk along a bubbling  brook restores.  Study quietness and discover peace and with it, longer life.

Family:   Most centenarians center their lives around their families, marrying young and having children.  There is a ritual of togetherness and mutual obligation that informs their lives.  The elderly usually live with their children and thus fare better in their physical and mental capabilities.  America, however, has been trending in the opposite direction, with active families finding quality time together difficult.  Shared activities and  a daily meal spent together are increasingly atypical now.  Mobility often spaces family members widely apart.  On the other hand, those living long, happy productive lives have made family a priority, live in proximity, and exhibit a we-ness in their interaction.

While there aren’t any guarantees, given life’s caprice, individuals mirroring these trademarks tend to fare much better in living long and healthy and productive lives.

–rj

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