On Aging and Medicine

"The job of any doctor, Bludau later told me, is to support quality of life, by which he meant two things: as much freedom from the ravages of disease as possible, and the retention of enough function for active engagement in the world. Most doctors treat disease, and figure that the rest will take care of itself. And if it doesn’t—if a patient is becoming infirm and heading toward a nursing home—well, that isn’t really a medical problem, is it?

"...In the story of Jean Gavrilles and her geriatrician, there’s a lesson about frailty. Decline remains our fate; death will come. But, until that last backup system inside each of us fails, decline can occur in two ways. One is early and precipitately, with an old age of enfeeblement and dependence, sustained primarily by nursing homes and hospitals. The other way is more gradual, preserving, for as long as possible, your ability to control your own life.

"Good medical care can influence which direction a person’s old age will take. Most of us in medicine, however, don’t know how to think about decline. We’re good at addressing specific, individual problems: colon cancer, high blood pressure, arthritic knees. Give us a disease, and we can do something about it. But give us an elderly woman with colon cancer, high blood pressure, arthritic knees, and various other ailments besides—an elderly woman at risk of losing the life she enjoys—and we are not sure what to do."

The Way We Age Now
Atul Gawande, for The New Yorker

I like the balance here, between science-y statistics and personal descriptions. My own family's story bears out his analysis: doctors who treat the elderly need to refocus their treatment less on curing specific diseases and more on managing the decline. In our experience, the only people capable of managing treatment have been the folks in the Hospice program - a system usually reserved for those with less than six months to live - which is why my grandmother has been put on Hospice care four times in the last year and a half.