Taking A New Approach To 'How We Age'

An elderly woman's hands. i i

Geriatric psychiatrist Marc Agronin says that late in life, mental health concerns are often dismissed as an inevitable part of the aging process. iStockphoto.com hide caption

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An elderly woman's hands.

Geriatric psychiatrist Marc Agronin says that late in life, mental health concerns are often dismissed as an inevitable part of the aging process.

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Many people fear growing old. The multibillion-dollar cosmetic surgery industry alone is a testament to how desperately some Americans cling to the appearance of youth.

But geriatric psychiatrist Marc Agronin has a different perspective — particularly when it comes to mental health. "I don't see aging as a disease," he tells NPR's Rebecca Roberts. "I see this as an inherent part of living ... so the idea of curing it, to me, doesn't make sense."

In his book, How We Age: A Doctor's Journey Into the Heart of Growing Old, Agronin argues that among seniors, mental disorders rarely receive the attention or treatment that they might in younger people.

Society has embraced the concept of hospice care, says Agronin, the idea that, until "the very second that someone's life ends ... we will provide them with as vital and meaningful life as possible."

Cover of 'How We Age'
How We Age: A Doctor's Journey Into The Heart Of Growing Old
By Marc Agronin
Hardcover, 320 pages
Da Capo Press
List price: $25

Read An Excerpt

But hospice care is typically reserved for a person's final days or weeks of life. And there are many older people, says Agronin, who "have years, if not a decade or more, ahead of them. We need to bring that same spirit and that same energy to helping them as well."

Unfortunately, says Agronin, "this is where I'm certain we sometimes fail." When it comes to disorders such as anxiety, depression or even Alzheimer's disease, "we make assumptions that this is simply old age, or this is a disease state that we can't do anything about."

Agronin, psychiatrist at the Miami Jewish Health Systems, treats patients with a wide variety of mental health symptoms — and in some cases, he says the medical community's willingness to regard serious problems as an inevitable part of the aging process can have very serious consequences.

In one case, says Agronin, he saw a patient who had "been completely written off as suffering from very rapidly progressive Alzheimer's disease." The man was losing the ability to speak or to walk. "It would have been quite easy to simply say, this is a man in his early 80s; there's not much we can do; let's prepare for the end."

But after giving the man a full medical workup, Agronin and his team found that the source of the patient's symptoms was actually an operable brain tumor. "He emerged, I would say not 100 percent, but 110 percent from this surgery," Agronin says. "It speaks to the fact that we can sometimes miss very simple things."

Agronin has also been cheered by a growing number of elderly people who are increasingly open to the idea of therapy.

"What's wonderful is to see ... the 80- or 90-year-olds who might in the past have never have considered seeking psychiatric care" come in for both group and individual psychotherapy. Those patients have "learned that there's change that's still possible, regardless of their age."

Agronin recently treated a nonagenarian patient who had been suffering from depression for several years. "He really felt that there was just nothing we could do for him. And indeed I would say, this is probably the way a lot of us look at old age, as if we hit a certain point where change is simply not possible."

But with therapy, says Agronin, his patient has had dramatic results. "Just the other day he came in and said, 'Dr. Agronin, my life has been turned around.' " The patient told Agronin that through individual therapy, he was able to change his outlook on his depression, his marriage and his familial relationships.

"At 96," says Agronin, "for someone to make such a change, should really give all of us incredible hope."

Excerpt: 'How We Age'

Cover of 'How We Age'
Da Capo Press
How We Age: A Doctor's Journey Into The Heart Of Growing Old
By Marc Agronin
Hardcover, 320 pages
Da Capo Press
List price: $25

For nearly every doctor, the very first encounter in medical school with an old person is with a corpse. I discovered this fact on the first day of gross anatomy class when our instructors led us up to the dissection lab and introduced us to the rows of human cadavers that would serve as our teachers and companions for the next six months. Everyone was a little uneasy that morning, and I welcomed the nervous glances and smiles of classmates as we filtered through the room searching for what we hoped would be the perfect body. "Look for a thin woman," my labmates Steve and Jimmy each whispered to me, recalling the sage advice of an older classmate trying to steer us toward an easier dissection experience. "Who can tell?" I shot back, staring out at the dozen black slate tables in the room, topped off with human forms wrapped in heavy white gauze and covered with translucent plastic sheets. I reasoned to my labmates that it was like trying to find King Tut among a room full of mummies, and so we quickly abandoned our original plan and went for a table near the window. Even in the few short minutes we had spent in the room, the fumes of the formalin solution used to preserve the bodies were overpowering, and so I hoped that at least an open window would provide some respite from the smell.

"Please help your labmates remove the plastic coverings on your cadaver," the professor called out, "and then strip off all of the gauze to expose the entire body." A shudder went through my own body, and I cringed. The entire body? "Yes, the entire body," the instructor continued, as if she were reading my mind, "and then pick it up and flip it over — get a good look." This was surely a technique not meant to teach as much as to flood our psyches with the glory of gross anatomy, dispensing all mystery and anxiety in one fell baptism of formalin. Entering the room had been unsettling enough, but at least then the cadavers had been covered. I had honestly never seen a dead body before and was hoping to put off the experience as long as possible. But within minutes I was surrounded by teams of sweating medical students piling up strips of smelly, greasy gauze and struggling to pick up rigid and very heavy formalin-logged bodies. I remember one particularly surreal moment as I watched four classmates bearing the strangest of grins as they hoisted the cadaver off the table, grunting at its weight and struggling to grip the slippery, leathery skin.

The unmasking of the face of our cadaver unnerved me the most. I had hoped in vain to skip that altogether and heed the words of the second anatomy instructor, who was strutting through the room and cautioning against removing too much gauze so as not to dry out the body. He argued gruffly with the first instructor that her shock treatment was unnecessary, finally shouting, "If they can't stand looking at the body, they shouldn't be in medicine!" My labmates were more obedient to the initial instructions and summarily removed the plastic bag from the head and began to unravel the gauze. I stood back and envisioned seeing what archaeologists had discovered in the mummified faces of pharaohs — coal-black visages with bony physiognomy and time-scorched skin that resembled cracked china. Those ancient, royal faces looked more skeletal than human and lacked all of the machinery of expression that might have betrayed a final emotion.

When the last strip of gauze was peeled away, I looked down on the face of our cadaver, mesmerized by her silent, still expression, her upper cheek muscles and eyelids slightly scrunched as if a puff of air had been blown into her face at the moment of death. The face appeared inert, like a totem permanently carved into clay or stone and so different from the blushing, breathing face of a living person. And yet this had been a person, I realized, who once had walked the earth and lived a life like everyone else in the room — working, loving, running, eating, perhaps bearing and raising children. Although the identities of and any biographical information about the cadavers used in medical school anatomy courses are never revealed to the students, the unmasking of our cadaver revealed numerous deep facial wrinkles and a few thin strands of silver hair matted on her head that betrayed one critical fact: She had been quite old when she died. We later learned that she had been ninety-eight at the time of her death from a heart attack.

***

For many months after completing the gross anatomy course, I continued to wrestle with my experiences of working with a dead person. I would hearken back to a particularly vivid memory from class when the dissection required the corpses to be sitting upright on the slate table. Despite a somewhat human pose, everything sacred about both the body and its persona seemed stripped off the cadaver. Any small fantasies or fears of rejuvenation or zombification of the body that I still harbored by that point in the class faded away completely, and I said to myself, "There's no coming back." I now understood what the words "from dust to dust" meant. But this understanding did not bring satisfaction. I was particularly worried about how my growing lack of sensitivity toward the corpse could easily creep one step back to the extremely debilitated, aged patient. The two seemed, at times, to merge into one. I asked myself, "How does a doctor — how does anyone, for that matter — maintain a positive regard toward aging while simultaneously having to witness the loss, suffering, and utter degradation that it brings?"

I have learned since then that these dismal equations of aging with decrepitude along with the rigid and defensive attitudes that they inspire are only one side of the story. The other side is too often overlooked in our dread of aging. This realization first came to me several months after completing gross anatomy when I began volunteering at a nursing home down the street from the medical school. I was assigned to visit Esther, a one-hundred-year-old woman who, I must admit, looked uncannily like the cadaver I had just spent the previous six months with! Surprisingly, this realization was not eerie but comforting. And Esther could not have been more of a delight to be with. Her mind and wit were sharp, she smiled constantly, and she reveled in our time together. One day she described to me in detail the births of her three children, then extended their life stories over decades to the present. One moment I was hearing about her beloved young children, and the next moment I was meeting them in person — then in their seventies! There were many moments when I closed my eyes and simply listened to Esther, losing track of the nearly eighty years between us. And I began to see age in a different context: Someone living with the daily infirmities of aging and approaching death could still enjoy most of the same human experiences we find so precious in younger years. Unfortunately, we often fail to see these positive elements in the lives of our elders because we are so focused on the physical or mental decline of aging. The body will certainly reach its limits, with death beyond our ability to predict or control. But the true failure here is not old age; rather, it is the failure of our own creativity and willingness to conceive that life up until its last moments has its own ways and meanings.

In the spring of my second year in medical school, Esther died several weeks after suffering a stroke. During our last visit she struggled to talk and reach out to me despite the loss of speech wrought by a small clot in her brain. As with so many of the older patients with whom I had grown close over the years, I had put the possibility of her death out of my mind, imagining that she was actually my own age but just looked a little different. In fact, I have often employed such mental gymnastics to deal with aging and death in my own family. Shortly after my grandparents passed away, I compressed much of my grief into an odd fantasy that in the afterlife they had moved down to Miami Beach and were experiencing eternal bliss together, with endless sunny beaches and Early Bird Specials. Florida, I imagined, was actually some form of Shangri-La where all of our deceased elderly could be found happily wandering around if we just looked hard enough.

From How We Age: A Doctor's Journey into the Heart of Growing Old by Marc Agronin, M.D. Copyright 2011 by Marc Agronin, M.D. Reprinted courtesy of Da Capo Lifelong Books.

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