Is old age a “disease” to be dreaded or an opportunity to plan for your future?
Dr. Louise Aronson, a Harvard-trained geriatrician believes it’s about how you view your advancing years and how you take care of yourself.
Seventy-five to 85 percent of all healthcare issues could be avoided with lifestyle changes and focus on prevention, she says, encouraging older adults to take charge of their lifestyle as early as possible. What you eat, how you exercise and how attached you are to stereotypical notions of what it means to be “old” are your personal responsibilities.
“At this very moment, we are living longer than ever before, yet we have turned old age into a disease to be dreaded and neglected,” Aronson says.
She is the author of “Elderhood: Redefining Aging, Transforming Medicine, Reimagining Life,” now in its fourth printing. She spoke to medical groups in Portland this summer.
Her message also focused on ageism in the healthcare system, which she says is too focused on treatment rather than prevention.
“The experiences of older people in the American healthcare system are indicative of how current medical care — and indeed, elderhood overall —is broken for all of us,” she says. “Doctors have minimal training on how to motivate self-care, including nutrition and what exercises are more appropriate than pounding joints. Tai chi, swimming and resistance training are recommended to keep muscles from atrophying.”
She does see some signs of change as boomers see what is happening to their parents and want something differently for themselves, yet there’s been no rush to actively question the system.
“Prioritizing prevention is not inherently profitable,” Aronson says. “There should be less emphasis on prescription drugs and more on preventative approaches and social caring, more counseling instead of resigning ourselves to someone falling down, for instance.”
One example she applauds is a San Francisco program that allocated $20 a month in vouchers to buy fresh fruits and vegetables. After six months, the program reported an increase in members continuing to buy fresh produce even without the vouchers.
“Look at what we could achieve for just $20 a month instead of high medical costs,” she says. “When people feel better, they take better care of themselves.”
This is a wiser move than multiple visits to the emergency room, surgery and hip fractures, she says. “Instead, the system pays for surgery, hip fractures and rehab, treatments after the fact. Our system is based on disease instead of behavior and training.”
She wants more nurse practitioners and physical therapists providing more counsel on lifestyle, which ultimately puts less burden on the healthcare system.
“You cannot counsel a patient in 15 minutes,” Aronson says. “A clinician needs two hours to really work with a patient. In the end, it will cost less than repeated hospitalizations.”
Treatment should be based not just on age, but also on a patient’s mobility. Life expectancy can be determined by assessing function status, how fast you can walk and grip something.
She advocates for paying closer attention to what you eat and recommends following the healthy Mediterranean and Japanese diets which are known to cause fewer cases of heart attacks, diabetes and cancers, and help keep weight within a normal range.
She advises weight training in your 40s, and balance and resistance exercises in your 50s and older, so you don’t lose mobility and strength.
Because many older adults see what is happening in the healthcare system, they are seeking out alternative practitioners, many of whom are supported by Medicare Advantage plans.
Aronson believes it’s time to advocate for change so older adults don’t feel like second-class citizens.
“Doctors need to understand your body, your physiology and your lifestyle,” she says. “Make some noise. Argue for change. Band together for caregiving help.”
She wants older adults to understand that you can improve your function and well being at any age. “We need to tell a patient who uses a cane or a walker they do not have to. If they have trouble climbing stairs, they can make their legs stronger. We need to be positive and tell patients they can get stronger if they believe they can.”
Some physical changes, like hearing loss, are natural to aging and should be treated properly. Don’t avoid wearing hearing aids, she says. “Be proactive and realize some things are normal as you age,” Aronson says. “Hearing aids can prevent early dementia.”
When she meets with her patients, Aronson says, “I ask questions. All of us should have a plan for advanced life.”