Almost midway through Dr. Louise Aronson’s new book, “Elderhood: Redefining Aging, Transforming Medicine, Reimagining Life,” the S.F.-based geriatrician-author describes a chance meeting with a kind, thoughtful, older woman who suffered from quite a number of physical, psychosocial and pragmatic problems.
A lack of medical attention, however, was not one of them. Quite the opposite, in fact.
Aronson, an M.D. and professor of medicine at UCSF, soon learned that Eva “had made 30 visits to our medical center” over the past few years: “nine ophthalmology appointments, five visits for radiology studies, four appointments with her lung doctor, four visits to the incontinence clinic, three appointments with her cancer doctor, two emergency department visits, and one appointment each with her cardiologist, a nurse in the oncology clinic and her primary care doctor.”
And this was not even accounting for Eva’s missed appointments, Aronson notes in “Elderhood,” part memoir, part meditation on her 25-plus years caring for older patients, and part call for a new mindset and paradigm for elder care.
You don’t have to be a Harvard Medical School-trained physician, as Aronson is, to apprehend pretty quickly that Eva (not one of her patients) wasn’t getting optimal care. Her well-meaning, often excellent physicians seldom coordinated her treatments, and Eva was taking a number of medications that exacerbated some of her pre-existing conditions.
On top of that, Aronson noted, Eva was severely arthritic and could barely make it up and down the several dozen steps to her rent-controlled apartment in San Francisco, and she was lacking home services that would have made staying in place safer and saner.
Eva is hardly an isolated case of an older person getting the short end of the stethoscope, as Aronson makes abundantly clear.
There are many reasons for this problem, she said, but one of the greatest, most salient causes is the overall failure to acknowledge that people in the latter part of their lives are experiencing a developmental stage that is as potent and distinct as childhood and adulthood. Significant physical and cognitive changes take place as people age, Aronson points out in “Elderhood,” and the way that an 80-year-old responds to a medication often differs vastly from a 50-year-old’s response.
But that reality is not frequently a consideration in hospitals, clinics, and doctors’ offices across the country.
“Older patients often are cared for as if they were just like younger patients,” Aronson writes, noting that “drugs and treatments developed in studies of middle-age adults are given to old patients irrespective of age, other medical conditions, incapacity, or life expectancy.”
Improving senior care, Aronson said in a recent interview, “starts with medical training.”
With a few exceptions, she said, “students get 12 hours on older adults” during their medical school training. The upshot of giving short shrift to geriatric medicine is that in a country with a fast-growing aging population and a stagnant-to-declining birth rate, there are “5,000 to 7,500 geriatricians and 15 to 20 times as many pediatricians.”
The medical establishment must also confront its own age-related bias, she said, a topic she covers amply in her book. It’s not uncommon these days to hear that “70 is the new 50.” Yet the truth is that no matter how fabulous a 72-year-old may look on the outside, and how “vital” she may feel, her “kidneys and liver are still 72,” Aronson said.
There is a bitter irony in this country in relation to older people, said Aronson. On the one hand, “we often write them off too soon,” failing to recognize that many people well into their 80s and 90s can lead active and productive lives, she said. On the other hand, we “don’t let them go” when compassionate, life-extending treatment options have been exhausted for those suffering from painful illnesses, she said.
Throughout the book, Aronson, 55, shares her own journeys with aging and writes openly about her family, which she described as “secular but decidedly Jewish in sensibility.” She chronicles the decline of her father, the late Dr. Samuel Aronson, who had been an ophthalmologist and researcher, and writes lovingly of the intellectual influences from both her father and her mother, Mary Ann Goldman Aronson, 85, who is descended from an old German and French Jewish family in the Bay Area.
“My mother is a big reader,” she said, and before Aronson ever considered medicine as a career, she was a diehard bibliophile, devouring the works of Maxine Hong Kingston, Bharati Mukherjee, John McPhee and Peter Matthiessen, among others.
Aronson also wrote the 2013 short story collection “A History of the Present Illness,” which, according to a publisher’s blurb, “takes readers into overlooked lives in the neighborhoods, hospitals and nursing homes of San Francisco.”
On and off the page, the love that Aronson expresses for her family, which includes her wife, British-born Jane Langridge, a nonprofit professional, extends to the thousands of patients she has served over the years.
“There is a depth of intimacy in our interactions,” she said. They give me their affection and their stories … and they are trusting me with their lives and health. I feel an affinity to them.”