Summary

Louise Aronson, a geriatrician, argues that we should create Elderhood as the third era of human aging, joining the earlier Childhood and Adulthood. This new concept will allow us to re-evaluate the richness of this later time, its challenges as body systems decline, and, of course, the choices of managing death. This important and valuable book is a polemic against modern medicine’s limits, its reductive focus, and structural violence against both patients and physicians. She argues for a wider vision of care that emphasizes well-being and health maintenance for not only elders but for every stage of life.   
          
Aronson argues that contemporary society favors youth and values of action, speed, and ambition, while it ignores—even dislikes—aging, older people, and the elderly. She says ageism is more powerful than sexism or racism—as bad as those are. Medical schools ignore the elderly, focusing on younger patients, especially men, and medical students perceive geriatrics as boring, sad, and poorly paid. Primary care, in general, seems routine and dull. By contrast, medical treatments, especially high-tech, are exciting and lucrative. In medical schools a “hidden curriculum” focuses on pathophysiology, organ systems, and drugs, ignoring patients’ variability as well as their suffering and pathos. Further, business and industrial models make “healthcare” a commodity, and nowadays “doctors treat computers, not people” (p. 237). Aging has become “medicalized” as a disease. Medicine fights death as an enemy, often with futile treatment that may extend a dying process.
        
Instead, Aronson says we need to bring back the human element, putting care of people at the center, not science. She calls for a new paradigm with ten assumptions (p. 378). Number 2 reads: “Health matters more to both individuals and society than medicine.” Number 9 claims, “As an institution, medicine should prioritize the interests of the people over its own.”  
      
Many practical changes would follow, from redesigned “child-proof” drug containers to buildings and public spaces that are more congenial to older people—and, in fact, to everyone else. We should change our attitudes about old age. For example, we might use the adjective “silver” for a medical facility that is friendly to and usable by older people. Changing our attitudes about aging can help all of us imagine more positive futures for each one of us and for all of our society.

Commentary

Elderhood sheds light on old age, our social values that demean old age, and our short-sighted care and prejudicial for the elderly. It’s a pleasurable book to read and includes a wide range of concepts and sources

As a doctor making house calls, Aronson visits older patients in a variety of settings (some low-income) and finds pleasure in what she can provide for them. Even with chronic illnesses, many people find happiness in old age. There’s a wide range of examples, some just a paragraph, others extending over several pages. We meet Aronson’s father and mother at different points of the book; she reports on their health issues and her care of them, even her father’s death and its management. She discusses her own health history (including cancer) and awareness of increasing limitations as she ages. All these illustrate Aronson’s points and give drama and variety to the book.  
                  
Aronson reports at length on her burnout as a doctor and her recovery. She writes that over half of American doctors suffer from burnout, an “evidence-based” finding that should spur us to make changes. Besides patient loads, computer overload, and overspecialilzation, there is often moral distress for doctors, from social injustice issues, the limits of medicine, bureaucracy, economics, and more.             

Further, despite large expenditures on medicine, the U.S. ranks 37th internationally, especially because of poor care to poor people. Trained primarily to treat illnesses, doctors often ignore the personhood of patients and their resources for healing. Seeking a single diagnosis, they overlook the complexity of patients’ lives, their backgrounds, and mental status. Although religious and spiritual dimensions of patients are briefly mentioned, they are not pursued; these are important for persons of faith, especially when they face death.  
        
The book is intelligent, wise, and smoothly written. (Aronson is also author of A History of the Present Illness.) It is interdisciplinary, drawing on history, technical literature, belles lettres, science, and current events. A delightful passage discusses Isabella Rosselini, “the face” of Lancôme’s cosmetics for 15 years. Considered “too old” for the job, she was fired at 42. At 65, however, later managers recalled her to advertise products intended for women of many ages, not just the young.   

Publisher

Bloomsbury Publishing

Place Published

New York

Edition

2019

Page Count

450

Secondary Source