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How We Age: A Doctor's Journey into the Heart of Growing Old

Agronin's Book Shows Both Sides of Aging

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Geriatric psychiatrist Marc Agronin will shake up many of your conceptions about growing old.

Geriatric psychiatrist Marc Agronin will shake up many of your conceptions about growing old.

Photo © Da Capo Press
Most of the people that I know are more frightened of old age and disability than they are of death. They often agree with the sentiment expressed by one of Marc Agronin's friends: "Just take me out and shoot me before I ever end up in a nursing home." Agronin, a geriatric psychiatrist who has extensive experience with the aged and with nursing homes, has quite a different perspective, which he elucidates in How We Age: A Doctor's Journey into the Heart of Growing Old. Readers will find no Pollyanna promises and no anti-aging elixirs, but they will gain a much greater understanding of the final stages of human life.

How We View the Aged

Focusing on the infirmities of old age and the nearness of death prevents us from appreciating the more positive aspects of aging. Agronin blames our "age-centric perspective," our tendency to "view our own age as the most normal of times, regarding it as representative of how all life should be." This skewed point of view keeps us from realizing what Agronin learned in his years on a nursing home staff: that old age can be a time of vitality and even of hope. Agronin found this to be true even though the facility where he worked was home to many Holocaust survivors who had lost friends and family members in the most tragic ways. His patients' stories (used by permission, of course, or fictionalized) would have formed a fascinating book even without the clinical perspective.

Agronin also believes that many doctors, even those who work with the aged, view aging more negatively than the layman. Agronin attributes this attitude in part to the fact that most medical students' first clinical experience with an aged person is in cadaver lab, which he characterizes as a "dehumanizing rite of passage." Early on, doctors learn to associate aging with "decay, decline and disease until the ultimate demise of the body."

A New Way of Looking at Getting Older

When Agronin began working with the aged, his experiences led him to a quite different view of aging, a view that says that "aging equals vitality, wisdom, creativity, spirit, and, ultimately, hope." His thinking began to echo the work of other geriatric experts, notably Gene Cohen, who has proposed looking at aging as a serious of phases, each rich with its own possibilities. Cohen's phases include the following:

  • Liberation (50s to 70s) in which individuals take advantage of increased freedom from personal responsibilities, such as parenting, to explore new avenues
  • Summing-up (60s to 90s) in which individuals engage with the larger meaning of life and often search for ways to make a contribution
  • Encore (70s to 90s) in which individuals reflect, reaffirm and celebrate
The overlap in the phases is, of course, due to our maturing and aging at different rates. Agronin aligns these phases with real-life examples, including George McGovern, Alex Haley and Martha Graham and extending to his own colleagues and patients.

The Bugaboo of Memory Loss

Agronin has no magic bullets for the problem of declining memory that most experience as they age. Like other contemporary researchers, however, he sees aging brains as having advantages over younger brains: They have a greater database of experience to draw upon and a greater wisdom, which Agronin defines as the "ability to see both sides of the coin." Here he concurs with Barbara Strauch, author of The Secret Life of the Grown-Up Brain. Agronin relates teaching a "Memory Fit" class but recounts no startling breakthroughs about decreasing memory lapses. What he does do well is put them in perspective, including discussing how social settings impact mental function and how reminiscence can play a role in healthy aging.

Last Acts

As individuals near the final stages of their lives, many struggle with what Agronin calls the "Four Horsemen of Old Age": depression, dementia, delirium and destitution. These forces are so powerful that "any talk of potential quality seems comical." No wonder that some younger family members stop trying to interact with their beleaguered oldsters, basically asking, "What's the point?" Agronin, however, has a contrary view. Surveying the way in which most cultures care for deceased bodies--the cleansing, the rituals, the enshrining--Agronin argues that individuals in their final days deserve this same type of respectful attention. As throughout the book, Agronin does not prettify his descriptions of his patients' struggles, but he does present them sympathetically.

In summary, Agronin occasionally gets bogged down in his narratives, but he does impart a fuller understanding of the aging process. Many of Agronin's points have been powerfully reinforced by my own interactions with my nonagenarian father. And, while conciseness is not one of his assets as a writer, eloquence can be, as when he says, ". . . when we see only the silent darkness of old age, we miss the million sparks of life still present."

Disclosure: A review copy was provided by the publisher. For more information, please see our Ethics Policy.

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