https://www.wsj.com/articles/elderhood-review-the-way-we-age-now-11579281407

If books, like movies, were given ratings, Louise Aronson’s “Elderhood” ought to be rated PG-80. Not all that many people 80 or older are likely to have living parents, true, but some warning is nevertheless necessary if you have attained to that august (november? december?) age and plan to read her book. Here are just a few gloomy facts that Dr. Aronson, a geriatrician, bestows upon her readers: 5.3 million Americans had one form or another of dementia in 2015, and more than 80% of these were older than 75; 13 million Americans are incontinent (if the phrase “adult diapers” doesn’t shiver your timbers, nothing will). Half of all adult Americans over 65 will have some form of arthritis. Immunity from infection and disease lessens with advancing age. Loss of acuity in hearing begins in one’s 50s and diminishes further with advancing age. Of sexual activity, about which Dr. Aronson graciously does not provide any dismaying details, let us, too, not speak. Then there are Dr. Aronson’s case studies, scattered throughout the book, of elderly patients who suffer from every illness and disease going, with the possible exception of dandruff. Here is a characteristic sentence, recounting a visit Dr. Aronson made to the home of one of her patients: “Inez, obese and bedbound with moderately severe vascular dementia, lay propped up in her hospital bed, her mouth open and chest visibly rising and falling.” Then there is Eva, who is “very weak, has audible bone-on-bone arthritis in all major joints, frequent spasms in her left hip, minimal clearance of her right foot and could not move her left foot,” not to mention “a blood cancer that she hoped was cured, asthma, some kind of heart problem, and both glaucoma and macular degeneration.” And you think you’ve got problems. Photo: Martin Parr/Magnum Photos “Live long enough,” Dr. Aronson writes midway through her book, “and eventually the body fails. It betrays us. Our flesh wrinkles, sags, and sinks. Strength wanes. We lose speed, agility, and balance. . . . Sometimes the mind follows the body’s descent, words, logic, insight, and memories dropping away. We fall ill more often and more gravely. We become frail. The smallest, most ordinary tasks—eating, showering, walking—become time-consuming, difficult, dangerous, or impossible.” One could go on, and Dr. Aronson, relentlessly, does, closing this particular paragraph with: “We fight and flirt with death.” Having duly warned readers of the horrors in “Elderhood,” I need now to go on to say that it also happens to be a serious, useful, and important book. Wedged in between its overwhelming sadness, the book has an upside. According to a study cited by Dr. Aronson—and she cites many studies—life, so to say, begins at 60. “Data from the United States and Western Europe,” she writes, “confirm that most people are around sixty before they achieve levels of well-being comparable to those of twenty-year-olds, and rates climb thereafter.” Arriving at 60 and beyond presumably brings freedom from worry, lessened depression and anger, a firmer sense of one’s self and what one values, greater contentment and happiness. And so it often does, providing one arrives at 60 or beyond without too lengthy a list of regrets. “Elderhood” is divided among reports on the conceptions and conditions of old age, chiefly in America, but also through history; case studies of people undergoing the trials of aging; a running account of its author’s own medical career; and an impressive critique of what is wrong with medicine’s dealing with people in old age. What gives the book its heightened relevance is the striking increase of older people in America and in Western Europe. Owing to improvements in public health, nutrition and medical advances, the percentage of people older than 70 in the United States in 2017 was 15% and climbing. Dr. Aronson writes: “Eleven million Americans—the fastest-growing segment of the population—are over age eighty. In the current century, the number of older adults is expected to surpass the number of children, this owing to increased longevity. “In the United States in 1900,” Dr. Aronson reports, “the average life expectancy was forty-six years; by 2016 the average had reached age seventy-nine. If you make it to eighty,” she adds, “you have a good chance of making it to ninety or beyond.” That is the good news. The bad news is that the aged are too often degraded as irrelevant, useless, burdensome, ugly if not grotesque—or, not to put too fine a point on it, a pain in the butt. This is all the stranger when one comes to think that, with a bit of luck, so many will get to old age and that those who do may one day before long constitute fully a quarter of the nation. Then there is the fact that old age, assuming that it kicks in at 60, will itself take up roughly a third of nearly everyone’s life. The precise time old age kicks in is not altogether clear. For some years 65, the age that Social Security began and in many institutions when retirement was enforced, marked the beginning of old age. Of course many people 65 and well beyond neither looked, nor felt, nor acted old. One of the cliches of the current age is that “70 is the new 50.” (I had an older friend who some years ago told me that “90 was the new 120.”) Diversity is considerable among the aged, and people arrive at actual as opposed to chronological old age at markedly different times. People now refer to the young-old, the old-old, and the oldest-old, also sometimes referred to as the Fourth Age, the final stage of life before death. “There is no set age when we transition from adult to elder,” Dr. Aronson writes, “and both the speed and extent of aging vary widely. As geriatricians are fond of saying: ‘When you’ve seen one eighty-year-old, you’ve seen one eighty-year-old.’ ” “Elderhood” is a book with an argument. The argument is that older people are misunderstood and thereby often mistreated by the medical profession. Most physicians, reliant on science and determined to cure even to the exclusion of their patients’ well-being, fall back on surgery or drugs. Too often surgery and hospitalization, Dr. Aronson argues, are not the answer for older patients; and drugs that might be effective on younger adults can have deleterious effects on the elderly. Health professionals tend to concentrate on the body exclusively, when among the aged one’s situation in life and past experiences can be crucial. “Our society,” Dr. Aronson writes, “equates disability with lives not worth living and aging with bad news. Yet their presence doesn’t necessarily deprive people of happiness.” Dr. Aronson, who is herself in her 50s, writes throughout as an advocate of older people in a time when, she claims, “the second-class citizenship of older patients in medicine is entrenched and systematic.” Aligned with this is her regret at the low status of geriatrics, her own medical speciality, a status that she views as concomitant with the misunderstanding generally of the needs of the elderly. Surgery holds top status in the medical profession, as shown by financial reward. Technology in medicine also confers status, so that radiologists earn more than pediatricians. As a medical speciality geriatrics, Dr. Aronson reports, “only emerged in the United States in 1978.” Understanding of it—its methods, its mission—remains foggy even today, within the medical profession itself and with the population at large. Dr. Aronson notes a patient who, asked what a geriatrician was, answered “a person who scoops ice cream at Ben and Jerry’s.” Geriatric medicine is not only ill-understood, but understaffed and of low, if not non-existent, status within the medical profession Dr. Aronson recounts what was behind her own decision to make geriatrics her own specialty: taste and temperament, chiefly, but also a preference for human encounters over cold science. Surgery and other medical specialties seemed to her “repetitive and dull,” while geriatrics attracts those, like herself, with a “tolerance for ambiguity and complexity, and [an] interest in questions that lend themselves as much to philosophy, psychology, and sociology as to science and statistics.” (Ever the good student, while practicing medicine Dr. Aronson managed to find time to do a master’s degree in creative writing, and her book is larded with literary references, from Shakespeare to Ursula K. Le Guin. ) In the end, in choosing geriatrics as her specialty, she found “work that makes the most of my interest, values, strength,” adding that “I chose my specialty because I found working with very old, frail people endlessly interesting and deeply fulfilling.” Yet geriatrics is badly scanted in standard medical training. Medical school, Dr. Aronson writes, “doesn’t just erode doctors’ empathy: it brainwashes the common sense right out of us.” More alarming, she notes that, owing to ignorance in the profession about treating the elderly, “it’s likely that medical care harms and kills old people in ways and numbers far beyond what gets reported.” “Elderhood” highlights the deficiencies of most retirement homes, no matter how expensive and well-appointed. Remaining at home is invariably the desideratum for most among the elderly, and this includes the wish to die at home. Dr. Aronson speaks to the complicated matter of caregivers—in England less euphemistically called “minders”—who are both in short supply for the rising elderly population and often underpaid. She has a number of interesting pages on the ill-design of homes, public buildings, and even many health-facilities in their disregard for the disabilities of the elderly. (A sad short film could be made of people on walkers attempting to enter a building through its single, revolving-door entrance.) She refers only in passing to nursing homes, though makes plain that most aged regard them as a fate, to coin a phrase, worse than death. Dr. Aronson takes up the matter of longevity, and how best to achieve it. To do so one obviously does best not to smoke, booze heavily, take work as a stunt man. Best, too, to be wealthy, for the wealthy, owing to their being able to acquire better health care, tend to live longer than the poor. (I had a wealthy friend who seemed to go to the Mayo Clinic more than I went to the barber; he died in his 90s, choking on a cookie.) Women, as is well known, live longer than men. Loneliness can contribute to an earlier death, religion, interestingly, to a later one. Dr. Aronson cites three of the places whose denizens are longest lived: Okinawa, Sardinia and Loma Linda, Calif. Loma Linda, it turns out, owing to its large Seventh-day Adventist population, who outlive their neighbors by five to 10 years, because “they abstain from alcohol, cigarettes, and other drugs, have strong spiritual lives, a close community, a vegetarian diet—and lower levels of stress hormones.” Some of the cards determining the length of one’s life are dealt at birth, but far from all. Nurture in the matter of longevity, according to Dr. Aronson, frequently looms quite as large as nature. “How and when we age, and how we experience that aging,” she writes, “also depends on our environment, coping mechanisms, health, behavior, wealth, gender, geography, and luck.” When she is asked for the recipe for a good old age, Dr. Aronson provides a list of four items: “good genes, good luck, enough money, and one good kid, usually a daughter.” Not at all a bad list, though I would alter it slightly by putting “luck” first and last in the list, both times in boldface italics. —Mr. Epstein is the author, most recently, of “Charm: The Elusive Enchantment.” Copyright ©2019 Dow Jones & Company, Inc. All Rights Reserved. 87990cbe856818d5eddac44c7b1cdeb8