Author Louise Aronson Offers Insight On How to Redifine Your Outlook on Aging
In her comprehensive new book, “Elderhood: Redefining Aging, Transforming Medicine, Reimagining Life,” noted Harvard-trained geriatrician Louise Aronson uses stories from her quarter century of caring for patients, and draws from history, science, literature, popular culture, and her own life to weave a realistic a vision of old age, a vision full of joy, wonder, frustration, outrage, and hope about aging, medicine, and humanity itself.
1) What are common misconceptions about aging and the elderly?
People often think of aging as an exclusively negative process and of old people as failed adults. In reality, aging and living are essentially the same process, socially and biologically, and elderhood is a highly varied life phase that lasts twenty to forty years. We change and grow throughout life, not just as we move from infant to teen in childhood. It often surprises people to learn that adulthood is the time of greatest anxiety and least happiness for most of us. As people move toward their sixties, things begin to look up. Life satisfaction rises, reaching its lifetime peak over the next decades of elderhood, and remaining well above adult levels until people reach their nineties. Happiness follows a similar pattern and anxiety plummets. In elderhood, people tend to me comfortable with who they are and more confident about their priorities. They often have less stress, both personally and professionally, and more time for all the things people complain about not being able to do as much as they’d like during adulthood. It’s not that the physical changes and health challenges of aging don’t matter; it’s that they are one part of larger and much more interesting story.
2) How can we turn the negative perception surrounding the aging process into something positive, a time of life to look forward to? Can you share some uplifting stories as examples?
We can start by telling the truth about it. That means talking about its advantages and opportunities alongside its challenges. It means not pretending that old age only begins when we become frail and viewing the later sub-stages of old age as normal and expected. It means acknowledging that aging isn’t just about decline, it’s about personal development and evolution. It means recognizing that life has three main phases: childhood, adulthood, and elderhood and that it’s counterproductive to judge any of those phases by the norms of one of the others. And last but not least, it means recognizing that when we construct a world–restaurants, medical centers, transportation systems, gyms, and everything else–for children and adults, we can’t then blame old age when elders find it difficult or unpleasant to use those places and institutions.
We are all surrounded by uplifting stories of aging and old age. Across cultures and for millennia, old age has been defined as beginning between the ages of 60 or 70. That means there are old people all around us; we just don’t see them as old if we consider them competent or interesting or attractive. Elders are running for president and driving our buses. They are rock stars and television hosts, plumbers, and cashiers. People in their seventies are the fastest growing segment of the American workforce. Elders often work fewer hours than adults so they are also the people volunteering at museums, theatres, schools, and places of worship and the people in the dog park or tennis court or hiking trails on sunny weekdays. At the same time, if we equate uplifting with productivity, we are applying adult metrics to elders. We are also setting ourselves up for failure and disappointment. In advanced old age, life is smaller and simpler. But that’s only a bad thing if we judge it by the standards of middle age. The more important questions to ask are not for old age analogs to adulthood but does this life have meaning, pleasure, and purpose? If the answer is yes, that’s an uplifting story!
3) Thanks to longer life expectancy, the number of older Americans is on the rise while birthrates are declining. Are you concerned about the future of healthcare and caregiving?
Many people are sounding alarms about our demographic shift. Fortunately, other people across sectors are looking at the shift as an opportunity for innovation. Examples include new community care programs, robot caregivers, and specially designed units of emergency departments and hospitals. But we can all be proactive in easing this transition. Why do we assume parents will care for their children but not that later in life those same children will care for their parents? That’s a cultural standard that can and should change. Equally important, so much of caretaking–whether of children, elders, or anyone else–has been seen as women’s work and consequently has been un- or underpaid, even though our daily lives and society would fall apart without it. It’s past time for this country to recognize that caregiving is essential work and should be prioritized and compensated accordingly.
Healthcare similarly needs to adjust its priorities. Medical advances mean we live decades longer than our forebears, yet we continue to prioritize extending lives and don’t adequately address preventing and managing the chronic conditions that dominate people’s health and lives in elderhood. Our disease-focused healthcare system doesn’t adequately appreciate the impact of worn but not necessarily diseased body parts like ears, joints, and teeth that weren’t built to last seventy or a hundred years. In our current health system, it’s much easier to get costly surgery after a fall and fracture than fall-preventing exercise classes. And a very old person can always get intensive care even when their prospects of survival are slim but they can’t get basics like hearing aids that enable both health and quality of life. Basically, medicine waits for problems to develop then comes to the rescue with procedures and drugs. It doesn’t value proven interventions that aren’t procedures or pharmaceuticals but significantly improve health. Shifting healthcare priorities will allow more of us to remain healthy and functional longer, thereby decreasing our healthcare and caregiving needs while increasing the quality of our lives in old age.
4) What do you hope readers will learn from reading “Elderhood?”
So much(!) but most importantly to think and feel differently about aging and old age– their own and generally. The book combines personal stories, patient stories, history, science, literature, and popular culture, and my hope is that it’s a fun, interesting read that surprises, motivates, and inspires. Though medicine and health care figure prominently, they are not its only focus and serve as much as examples of what we can do individually and societally as a new lens on modern medicine. There’s so much great information about aging these days, but I wasn’t seeing anything that pulled all those parts and ideas together to create a new vision of life after age 60 or 70. I hope the book gives readers that and more.
Louise Aronson is the author of the new book Elderhood: Redefining Aging, Transforming Medicine, Reimagining Life, and the short story collection A History of the Present Illness now available for pre-order (to be released on 6/11). She has an MFA in fiction from the Warren Wilson Program for Writers and an MD from Harvard Medical School, and has won numerous awards for her writing and work. She is an Associate Professor of Medicine at the University of California where she directs UCSF Medical Humanities. She lives in San Francisco.
This Q & A was featured in the June 9th edition of Maria Shriver’s Sunday Paper newsletter. The Sunday Paper is the paper of record for individuals who want to be Architects of Change, lead meaningful lives and Move Humanity Forward. To get inspiring and informative content like this essay delivered to your inbox each Sunday morning for free, click here to subscribe.