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Redefining Aging (with transcript)

Louise Aronson is a geriatrician, writer, educator, and professor of medicine at the University of California, San Francisco where she directs UCSF Medical Humanities. A graduate of Harvard Medical School and the Warren Wilson Program for Writers, Dr. Aronson has received the Gold Professorship in Humanism in Medicine, the California Homecare Physician of the Year award, and the American Geriatrics Society Clinician-Teacher of the Year award. She is the author of the PEN America debut fiction award finalist, A History of the Present Illness, and the forthcoming non-fiction Elderhood: Redefining Aging, Transforming Medicine, Reimagining Life.



Frank Samson:  Welcome to Boomers Today. I’m your host, Frank Samson and each week we bring you very important and useful information on issues facing baby boomers, their parents and other loved ones. I’m thrilled to have Louise Aronson join us, not only because she’s going to provide us great information, but she comes from my area, from the Bay Area. So we’re really excited to have her on. Louise is a geriatrician, a writer, educator, and professor of medicine at the University of California, San Francisco where she directs UCSF medical humanities.

She’s a graduate of Harvard Medical School and the Warren Wilson program for writers. Dr Aronson has received the gold professorship of humanism in medicine, the California home care physician of the year award and the American geriatric society clinician teacher of the year award. She is the author of the Penn America debut fiction award finalist, The History of the Present Illness and forthcoming nonfiction Elderhood Redefining Medicine Life and Aging in America. Can I call you Louise?

Louise Aronson: Absolutely.

Frank:               Okay, Louise. thank you so much for joining us on Boomers Today. I really appreciate it.

Louise:             It’s a pleasure.

Frank:               Great.

Louise:             Thanks for having me.

Frank:               Yeah. So I’m in the senior care industry and I have been for quite some time and I can express the importance of a good geriatrician. But unfortunately, there’s not enough of you around to meet everyone’s needs. So can you explain what a geriatrician is, and why there are so few of you practicing?

Louise:             Just as a pediatrician specializes in the anatomy, physiology, developmental stage needs and medical conditions of children, a geriatrician does the same thing for older adults. There is one difference in that people go from medical school or nursing school or PT school straight into pediatrics, but for geriatrics, we actually train initially in adult medicine and then we get one to three extra years on the care of people over age 65 or 70.

So we have a good long four or five, six years of specialized training in older adults because it takes some time to master that. That’s likely not taught much in medical schools. Sometimes you get a couple of weeks and then the whole rest of the time is focused on adults. Even though we know treating old people the way we treat adults does them harm. So it’s a little bit crazy.

Frank:               With all due respect to our physicians out there who are general practitioners, but I have seen that sometimes maybe it’s best for a general practitioner to refer one of their patients to a geriatrician, but my experience says they don’t do that until there’s a problem or something. How do we overcome that? How do we get everybody to understand that maybe the geriatricians out there know more than the general practitioners as it relates to people who are elderly?

Louise:             Right. Oh, that’s such a good question. And so many good points. I do find that generally family physicians are a little better at old age than internists are, which will surprise many people, probably most particularly the internist. But that’s because family physicians really think about the whole lifespan and the changes across the lifespan. And they do tend to get more training. That said, it’s still not very much. Now, a lot of people who take care of adults will say, “I’ve been taking care of older people my whole career.” But my retort to that is, and not to be facetious, these are people doing precisely what they were trained and acculturated to do. So I want to make clear that it’s not that people mean badly. It’s literally if you only get a couple of hours of training in something, how do you even know what you don’t know? When I hear this I always think, well, I’ve been taking care of hearts since I was a medical student. I know a lot about the heart that doesn’t make me a cardiologist.

Frank:               Right, right.

Louise:             So it’s just not the same. Many things a person can handle, but we know that there is entrench ageism in medicine, which basically reflects the ageism in society. One of the reasons I wrote Elderhood was to reframe the conversation. The subtitle of the book is  Redefining Aging, Transforming Medicine, Re-Imagining Life. And I think at this point in time, most of us will be elders for much longer than we were children. And elders are different than adults. If we frame them just as so-called older adults, then often old people are seen as failed adults or deficient adults. Whereas if we acknowledge that the normal human lifespan begins with childhood, goes through adulthood and then goes into elderhood, we recognize that these three sort of big phases of life each have unique strengths and weaknesses and needs.

And then not only do you get doctors trained in that, but you have a whole society built for that. Like if you look at parks, they’ve got jungle gyms and fun places for kids, and then they’ve got like basketball and baseball courts for adults. And there are equivalents for older people. You know, where you need strength training or Tai Chi and yoga or pickle ball or a variety of things. And those simply don’t exist there. Hospitals, it’s the same things. We’ve got kids hospitals and adult hospitals and kids surgeons and adult surgeons and then very few people with expertise in old people. And then when old people do badly, we blame old age instead of like our policies and social structures, which are biased.

Frank:               Right. Of course. So, going back to your book briefly. What did you learn while you were writing Elderhood Redefining Medicine, Life and Aging in America? Did anything surprise you?

Louise:             It’s funny because often we go to write a book and we think, well, I know a lot about this, which can be true. And also one of the fun things about writing a book is all the things you learned. So I’d been a geriatrician for over 20 years when I went to write the book, but I hadn’t thought about aging sort of anthropologically. I mean, for this book I have some stuff from history, I have some stuff from science, I have literature, I have pop culture. And it was sort of fascinating pulling all those things together. So among the key things I learned that surprised me is that throughout history and across cultures, old age has been defined as beginning between 70 and 80. Now, a lot of Boomers might hear this and think, what, no, not me!

No, that’s my parents. That’s not me. And what’s totally fascinating is when people look at other people, they recognize old. And when we look in the mirror, we don’t. What I also learned, which was fascinating, is that the people who embrace their elderhood basically are not only happier, but they’re healthy. There’s evidence that people who have positive attitudes about aging are less likely to have Alzheimer’s markers in their cerebral spinal fluid, get heart disease seven years later, recover better after hospitalizations and surgeries. So there’s something about how our attitudes and adjustments to our own aging really influence our health and wellbeing and that can sound scary to people.

You know, it’s our American mindset that we tend to think of old age as something that happens to us and that actually tells us there’s a way that of course we’re going to grow old. The only alternative still, despite our scientific advances, is to die young, which is not a good choice, but we can actually influence how we age and how happy we are as we age by really just owning it and realizing that, you know, yes, 75 is different than 55 is different than 35. So what is it I want to be doing and how can I do it and enjoy it?

Frank:               Yeah. I know. I have literally, I’m sure you have too, but I have literally because of the business I’m in, have visited many nursing homes, literally thousands. Around the country, the female to the male population is probably somewhere in the vicinity of two thirds, one third, 75%, 25% female to male.So it appears that women are outliving men. But help us understand why that is. Why could you outlive me most likely?

Louise:             There’s kind of a men’s health crisis and nobody’s talking about it. If you had another population in which one gender was vastly out living the other, which is completely true in old age, like overall women are maybe 50, almost 51% of the population. You get into people in their 60s and it’s like 57%. you get over age 80 and it’s like three quarters and you get over age 100 and it’s 80 some percent of people are female. And that’s actually all the more fascinating because women have more chronic disease as we age and yet men are more likely to die. And some people will say, like when I discussed this with audiences, people will say, “That’s because my husband won’t go to the doctor when he doesn’t feel well.” Or something like that.

And they could be right – our behaviors may be part of it. It’s also true that we tell men to tough it out. And sometimes that means they show up too late for conditions we could have done more to help with earlier. Like we need to make it, I’m thinking of also like Andrew Luck’s retirement from football, which happened recently. He discussed for many years how people were like calling him a wimp for retiring when he’d been this major football star and he values his life. I think a man should be allowed to value his life and health at any age.

Frank:               That’s right.

Louise:             But there are also these biological differences, which seem to give women more chronic diseases and make men die more. And this is one of the ways that we see ageism play a role in our society as well. You know, if men were dying that disproportionately at any other age, there would be a social outcry. Right? I mean, traditionally men have had more power and most research has been on men, but as men grow older, they aren’t perceived as being as valuable, which I find just heartbreaking and deeply disturbing.

Frank:               Yeah, great. Well, that’s very, very interesting. Next, I’d like to see if we can solve the medical care system in the US in the next half half, all right?

Louise:             Absolutely. So we already discussed earlier about how people have very little training in older bodies, physiology, pharmacology, all those things. People in the medical field aren’t really trained to work on older bodies, which we all know are different. The other thing is that the National Institutes of Health, finally passed a law this year called Inclusion Across The Lifespan. And that was because traditionally most research, even on conditions that primarily affect old people, you know, so people over age 65 or 70, most research would exclude people over age 70 blatantly due to their age.

Or they would be listed as meeting exclusion criteria, being at risk for a bunch of diseases that are very common as people age. So even when they were studying aging disease, they would mostly study it on people in their 40s, 50s or 60s but then they would apply it to people in their 80s and 90s and when the outcomes were bad, they would blame old age instead of the fact that the research actually didn’t address the bodies and lives of older people.

I tell stories in the book about new drugs where they’ll say, “This side effect doesn’t happen.” And there’s one where I go back and forth with cardiologists, like a woman in her 90s gets a new blood thinner, and starts getting confused. I stop it, she gets better.

Cardiologist says, “It doesn’t do that. I’ve looked it up.” Starts it again, she gets confused, I stop it, you know? So we go back and forth on this topic, and realize that truly any drug could have any effect on older people. And the reason why we need more research done using older patients is to understand how we can adjust our doses and our medicines so as not to harm them. Think about if you go to the pharmacy, some medicine will say, “Don’t take this if you’re pregnant”, you know, “Change the dose in kids.” Well, the people who are harmed most by over the counter meds are actually older people.

I talked a lot in the book about how we can structurally transform medicine and then re-imagining life. I think if we do that, we make all our lives better because almost all of us either are or will be old people and the health system does a lot of harm even though it means well.

Frank:               Yeah, and for those that watch regular station television that have commercials, you can’t watch television anymore without being inundated with all these new drugs, medications, et cetera. You know, we laugh about it, but do you think that that’s harmful? I mean, obviously they can’t get the medications without a prescription in most cases, but I’ve asked some doctors, “Do people really come to you and say I want that. I saw a commercial?” And they say, “Yes!” I mean, it just blows me away that they don’t rely on the doctor to do what’s best versus watching a commercial. I mean, what’re your thoughts on all that?

Louise:             Well, I actually find it interesting because that has been so dangerous, they now make people list side effects on those commercials. Part of the problem with that information is it’s sort of telling you like here’s the best case scenario and here’s the worst case scenario, but it doesn’t do anything, which is what the physician with his or her, you know, 7 to 14 years of training should be able to do, which is to say for you, in your particular life and health status, what are the chances of this killing you or giving you leukemia versus helping you with this constellation of symptoms?

I think we have to be careful and remember that big pharma companies don’t exist to do good for people. They exist to make money. Even if there are people who work for them who are trying to do good for people. The company is about making money. It’s not about helping you live a better, healthier life.

Frank:               Right, right. So I want to make sure we leave enough time for you to talk a little bit about your book. So number one, tell us how people can get your book and secondly, tell our listeners what they would expect if they were to get your book that might be different than what they are seeing on the shelves or online.

Louise:             Right. So when I was doing my research, I saw a lot of manual-type books, and a lot of memoirs, but nothing that really pulled it all together for me. So in my book I talk about my own aging, my parents aging, patients over 25 years. But then I also pull in the latest science and the history of old age, which kind of tells us like certain questions human beings have been asking forever.

You know, it’s not like ponderous history, but it’s just interesting to say like this is part of our human existential experience, if the ancient Egyptians and Greeks were asking the same questions. And then how pop culture can help or take away from this experience. So my goal was really to write a book that reads like a good novel but really informs you and shows how the different pieces of our biases as people inform medicine and how medicine informs life, et cetera. You can purchase the book pretty much anywhere. But if you go to my website, www.louisearonson.com, it’ll link you to a variety of bookstores.

Frank:               That’s great. What advice do you have to somebody listening, on how to live a happy and healthy lifestyle that will allow them to live into old age?

Louise:             Definitely. We already discussed earlier about attitude that turns out that it actually makes a colossal difference in people’s health. You’re not going to do something at 80 the same way you did it at 50 or 20. And the people who remain functional and independent, happier and healthier are the people who say, “Okay, I can’t do it quite the way I’ve been doing it, but I still like to do it. So how am I going to make that work?” Either by changing the how or by using some help from somewhere and then they still feel healthy and active, et cetera. The other thing to know is that exercise is always helpful. You know, this has been proven through age 100, that people can build muscle and increase their function.

Does it take work? What I often tell my patients is exercising is a bit like dust, right? You can do a really good job one day, but if you don’t keep dusting or keep exercising, then the problem just comes right back. But really, exercise enables people to be independent and function and feel better.

The third thing that’s really important is planning. A lot of people don’t make their house friendly for aging or make plans for their later life, whether that’s moving into their 60s or moving into their 90s, whatever’s on the horizon. And the less you plan for something, the more likely you are to get what you don’t want. The way to maintain control is not to wait till things are a crisis, but to really sort of reimagine your life.

And that actually includes people’s death because as I sort of jokingly say, human mortality is holding steady at 100%. American medicine will tell you it can keep you alive forever, but it actually can’t. And so the best way to have a death that’s in keeping with who you are is to really work on your life and plan for your death hoping it won’t happen for a long time.

So to sum it up, it’s about keeping a positive attitude, it’s remaining physically and socially engaged and it’s staying in control of things by thinking forward about how you’d like your life to be.

Frank:               That’s great advice. So tell us, what is the best way for someone to reach you?

Louise:             They can go to louisearonson.com, and there are lots of ways to contact me on the website. I’m also on Twitter and Instagram.

Frank:               Great. Dr Louise Aronson, thank you so much for joining us on Boomers Today. I really appreciate it.

Louise:             Great conversation. Thank you.

Frank:               Thank you and I want to thank everybody for joining us on Boomers Today. Just be safe out there and we’ll talk to you all soon.

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