[EDITORIAL NOTE: I am proud today to launch a new category at Time Goes By, The TGB Geriatrician. It's been a long time in planning and I'm proud that Dr. Bill Thomas has agreed to take on the duties of writing this column which will appear in the first and third weeks of each month.
Dr. Thomas is a world-renowned geriatrician and advocate for the dignity of elders. Long-time readers of TGB will be familiar with him from the many times I've quoted from his book What Are Old People For? You can find out more about Dr. Thomas here, and he also keeps his own daily blog, Changing Aging. I know you will welcome him to the TGB fold.]
I am excited about guest blogging here with Ronni Bennett. TGB is a terrific blog and if I can add something of value to this community, I will be happy.
I am a physician and my background is in Family Medicine and Geriatrics.
My approach to medical issues tends to focus more on the big questions of emphasis and interpretation and less on specific remedies. (Although I do get into that from time to time.) In medical school we used to joke that certain professors seemed to have favorite molecules that they studied exhaustively. That's never really been my thing.
What do I mean by big ideas? Well, how about this: I believe that older people are the healthiest people on the planet.
Aren't old people sick most of the time? What about all of the billions of dollars we spend on Medicare? What about the statistics that show older people using the most health care resources per capita of any age group?
Those objections are valid, but they miss the deeper reality. In order to become an older person one must first have a healthy childhood, then it is on to decades of healthy adulthood. When the second half of life arrives, a person can already boast of a long span of very good health. The people who are really unhealthy, sadly, do not make it to old age.
Furthermore, statistics show that almost half of all Medicare expenditures are made in the last six months of life. Before the last six months, older people do pretty darn well.
It is true that the second half of life includes experiences related to loss, but it is also true that elderhood is not limited to these things. As we age, we encounter an unexpected and highly significant rise in the power of adaptation. The emergence of adaptability is perhaps the most important and least acknowledged of the virtues of aging.
The young grow accustomed to running faster and jumping higher with each passing year and the middle decades are marked by a struggle against the workings of gravity and time. Fortunately, elderhood provides us with new and supremely useful perspectives on flexibility and the reality of change over time.
An older person wakes up to a new body with new requirements and limitations not once, but many times. This reality batters our relationship to the status quo. Mental, physical and spiritual changes require elders to develop and deploy a string of enterprising strategies and subtle adaptations.
While it is true that muscles weaken in late life, it is also true that older people are less likely to report symptoms of depression than younger people. Hair may turn white, get thin and fall out but, when surveyed, older people often report an enhanced sense of wellbeing. We grow shorter rather than taller, our toenails turn yellow and our arches fall and still, many older people report that their health is good or even very good.
These seeming paradoxes are actually the fruits of adaptation which grow in tandem with and are nourished by the decline in physiological function.
A young man, transported magically into the body of his 80-year-old self would struggle to complete even the most basic tasks. Sitting, standing, dressing and walking would be difficult for him because the thoughtless ease of youth had left him ill-prepared for life in elderhood.
We need old age because it allows the body to instruct the mind in patience and forbearance while the mind tutors the body in creativity and flexibility.
Our culture discounts the fruits of aging. For example, we value (without even realizing that we are doing so) the long springy stride and narrow tandem gait of youth. The young trumpet their virtuosity, wearing preposterous shoes and paying no mind to the terrain underfoot. Actors and politicians have long understood how we unconsciously judge others by their stride. They lengthen and narrow their stride when they are in public and, in doing so, give the appearance of youth.
Trackers can easily determine a person's age by examining their footprints. Compared with the fluid stride of youth, the marks made by an older person can seem tentative and ungainly. This appearance is deceiving. The reality is that when elders walk, they execute a highly evolved, richly detailed strategy that maintains upright ambulation even into the last decades of life.
Old people alter their gait in specific ways that account for very real changes in strength, endurance, coordination, sensation and reaction time. The "shuffling gait" keeps the feet close to the ground and maximizes input from position sensors. The stance is widened to improve balance. The number of steps taken per minute is decreased to accommodate changes in endurance and to allow for increased reaction time.
Keeping a human body upright and moving is a spectacular feat of coordination and reaction under any circumstances. Doing so in the ninth decade of life magnifies rather than diminishes the beauty of this achievement.
When the world's best golfers come together to play a tournament, the course is lengthened and the rough deepened so that their skill might be tested fully. Olympic divers challenge themselves with the most difficult dives, not the easiest. The Tour-de-France includes the most taxing climbs on its route, including some that are rated as "beyond category" in difficulty.
When you see an old woman walking, you are witnessing a similarly exciting, high-level performance. This is a tightly choreographed ballet, the product of decades of refinement. Watch and marvel. Miracles are all around you, once you know where to look.
[NOTE: You are welcome to suggest topics for future columns of The TGB Geriatrician by leaving a note in the Comments section below or sending an email via the Contact link in the upper left corner of this page.]
[At The Elder Storytelling Place today, an announcement.]