SENIOR LIVING: Can The Medical Profession Making Aging Any Easier</t= itle> <o:SmartTagType namespaceuri=3D"urn:schemas-microsoft-com:office:smarttags" name=3D"PlaceName"/> <o:SmartTagType namespaceuri=3D"urn:schemas-microsoft-com:office:smarttags" name=3D"PlaceType"/> <o:SmartTagType namespaceuri=3D"urn:schemas-microsoft-com:office:smarttags" name=3D"place"/>  <style>  </style>  </head> <body lang=3DEN-US link=3Dblue vlink=3Dpurple style=3D'tab-interval:.5in'> <div class=3DSection1> SENIOR LIVING= : Can The Medical Profession Make Aging Any Easier?<o:p></o:p> By FRANK KENN= EY Director, Grant County Senior Services <o:p> </o:p> This article is the first of a two part series based o= n an article by Dr. Atul Gawande of the Harvard School of Public Health, that ap= peared in the April 30th issue of the New Yorker.= Dr. Gawande has graciously given us permission to re-print excerpts = from that article. <o:p> </o:p> Why we age is the subject of vigorous debate. The classical view is that aging h= appens because of random wear and tear. </s= pan>A newer view holds that aging is more orderly and genetically driven. Certain species of bamboo, for ins= tance, form a dense stand that grows and flourishes for a hundred years, flowers a= ll at once, and then dies. Centu= ry Plants have a similar pattern of life and death. <o:p> </o:p> The idea that living things shut down and not just wea= r down has received substantial support in the past decade. However, scientists do not believe= that our life spans are actually programmed into us. If human life spans depend on our genetics, then medicine has the upper hand. <o:p> </o:p> For most of our 100,000 year existence—all but t= he past couple of hundred years- </span= >the average life span of human beings has been thirty years or less. “We = are, in a way, freaks living well beyond our appointed time,” according to Atul Gawande, an Medi= cal Doctor with Harvard’s <st1:place w:st=3D"on"><st1:PlaceType w:st=3D"o= n">School</st1:PlaceType> of <st1:PlaceName w:st=3D"on">Public Health</st1:PlaceName></st1:place>.</= p> <o:p> </o:p> If our genes explain less than we imagined, the wear-and-tear model may explain more than we knew. Leonid Gavrilov, a researcher at t= he <st1:place w:st=3D"on"><st1:PlaceType w:st=3D"on">University</st1:PlaceType> of <st1:P= laceName w:st=3D"on">Chicago</st1:PlaceName></st1:place>, argues that “human = beings fail the way all complex systems fail: randomly and gradually.” In addition, they have “back= up systems” designed into their structure. Gavrilov argues that “within= the parameters established by our genes, that’s exactly how human beings appear to work. We have an ex= tra kidney, an extra lung, an extra eye and extra teeth. If a key gene is permanently damag= ed, there are usually extra copies of the gene nearby.” <o:p> </o:p> Nonetheless, as the defects in a complex system increa= se, the time comes when just one more defect is enough to impair the whole, resulting in the condition known as frailty. Eventually, one too many joints are damaged, one too many arteries calcify.&nb= sp; There are no more backups. We wear down until we can’t wear down anymore. <o:p> </o:p> For nearly all of human existence, people died young.<= span style=3D'mso-spacerun:yes'> Life expectancy improved as we ove= rcame early death—in particular, deaths from childbirth, infection, and traumatic injury. By the 1970’s just four out of every hundred people born in industrialized countries died before the age of thirty. It was an extraordinary medical achievement, but one that seemed to leave little room for improvement; Thus medical efforts shifted to re= ducing deaths during middle and old age, and in the decades since, the average life span has continued upward. <o:p> </o:p> Today we have as many fifty-year-olds as five-year-olds. “In thi= rty years, there will be as many people over eighty as there are under five,” according to Atul Gawande. Americans haven̵= 7;t come to grips with the new demography.&nbs= p; We cling to the notion of retirement at sixty-five. A reasonable notion when life expe= ctancy was only ten years longer, and there was only a tiny percentage of folks ov= er 65; but completely untenable = as they approach twenty per cent of America’s population. <o:p> </o:p> Equally worrying, according to Atul Gawande, “bu= t far less recognized, medicine has been slow to confront the very changes that it has been responsible for- or to apply the knowledge we already have about h= ow to make old age better. Despi= te a rapidly growing elderly population, the number of certified geriatricians f= ell by a third between 1998 and 2004. Applications to training programs in adult primary-care medicine are plummeting, while fields like plastic surgery and radiology receive applications in record numbers. Partly, this has to = do with money—incomes in geriatrics and adult primary care are among the lowest in medicine. And partl= y, whether we admit it or not, most doctors don’t like taking care of the elderly.” And, most eld= erly folks don’t have just one chief ailment; most will have range of medi= cal problems. A medical professio= nal can soon become overwhelmed trying to cope with all of them. Besides, most ailments have been a= part of a senior’s life for quite a few years. A medical professional is not goin= g to cure something he/she has had for twenty years. They may have high blood pressure,= and diabetes, and arthritis. Dr. Gawande comments that “there’s nothing glamorous about taking c= are of any of those things.” <o:p> </o:p> There is, however, a skill to it, a developed body of professional expertise, skills geriatricians have been taught to administer. Conventional trea= tment would use triage by zeroing in on either the most potentially life-threaten= ing problem or the problem that bothers them the most. “Give us a disease and we ca= n 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,” states Dr. Gawande. <o:p> </o:p> Most doctors treat disease, and figure that the rest w= ill take care of itself. If a patient is becoming infirm and heading toward a nursing home—well, that isn’t really a medical problem is it?<s= pan style=3D'mso-spacerun:yes'> To a geriatrician, though, it is a medical problem. People can&#= 8217;t stop the aging of their bodies and minds, but there are ways to make it more manageable, and to avert at lest some of the worst effects. <o:p> </o:p> “Little of what geriatricians do is high-tech me= dicine: they don’t do lung biopsies or back surgery or PET scans. Instead, they simplify medications= . They see that arthritis is control= led. They make sure toenails are trimme= d and meals are square. They look f= or worrisome signs of isolation and have a social worker check that the patient’s home is safe,” says Dr. Gawande. <o:p> </o:p> How do we reward this kind of work? Chad Boult, a geriatrician at the University of Minnesota, sums it up saying, “A few months after I published the study, demonstrating how much better people’s lives were with specialized geriatric care, the University closed the division of geriatrics.” He added, “The university said that it simply could not sustain the financial losses.” <o:p> </o:p> But the finances are only a symptom of a deeper realit= y: people have not insisted on a change in priorities. Dr. Gawande described the dilemma = this way, “ We all like new medical gizmos and demand that policymakers ma= ke sure they are paid for. They = feed our hope that the troubles of the body can be fixed for good. But geriatricians? Who clamors for geriatricians? What geriatricians do—bolste= r our resilience in old age, our capacity to weather what comes—is both difficult and unappealingly limited. It requires attention to the body and its alterations. It requires vigilance over nutriti= on, medications, and living situations. And it requires each of us to contemplate the course of our decline,= in order to make the small changes that can reshape it.” <o:p> </o:p> With the declines in those planning careers in geriatr= ics, there is truly a crisis developing in the ethical care of our seniors. What do we owe our elderly? And what will have to be done to d= raw more interest in this medical field. We will address these questions and others in our next column, to be published Tuesday, June 5th. <o:p> </o:p> If you have any questions on this article or the issue= of medical care of the elderly, contact this writer at 505-388-2523 or <a href=3D"mailto:rsvpgrant@zianet.com">rsvpgrant@zianet.com</a>. <o:p> </o:p> <o:p> </o:p> <o:p> </o:p> </div> </body> </html>

MIME-Version: 1.0 Content-Location: file:///C:/D04B3112/KenneyArticle5-15-07CanDoctorsMakeAgingAnyEasier.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" SENIOR LIVING: Can The Medical Profession Making Aging Any Easier</t= itle> <o:SmartTagType namespaceuri=3D"urn:schemas-microsoft-com:office:smarttags" name=3D"PlaceName"/> <o:SmartTagType namespaceuri=3D"urn:schemas-microsoft-com:office:smarttags" name=3D"PlaceType"/> <o:SmartTagType namespaceuri=3D"urn:schemas-microsoft-com:office:smarttags" name=3D"place"/>  <style>  </style>  </head> <body lang=3DEN-US link=3Dblue vlink=3Dpurple style=3D'tab-interval:.5in'> <div class=3DSection1> SENIOR LIVING= : Can The Medical Profession Make Aging Any Easier?<o:p></o:p> By FRANK KENN= EY Director, Grant County Senior Services <o:p> </o:p> This article is the first of a two part series based o= n an article by Dr. Atul Gawande of the Harvard School of Public Health, that ap= peared in the April 30th issue of the New Yorker.= Dr. Gawande has graciously given us permission to re-print excerpts = from that article. <o:p> </o:p> Why we age is the subject of vigorous debate. The classical view is that aging h= appens because of random wear and tear. </s= pan>A newer view holds that aging is more orderly and genetically driven. Certain species of bamboo, for ins= tance, form a dense stand that grows and flourishes for a hundred years, flowers a= ll at once, and then dies. Centu= ry Plants have a similar pattern of life and death. <o:p> </o:p> The idea that living things shut down and not just wea= r down has received substantial support in the past decade. However, scientists do not believe= that our life spans are actually programmed into us. If human life spans depend on our genetics, then medicine has the upper hand. <o:p> </o:p> For most of our 100,000 year existence—all but t= he past couple of hundred years- </span= >the average life span of human beings has been thirty years or less. “We = are, in a way, freaks living well beyond our appointed time,” according to Atul Gawande, an Medi= cal Doctor with Harvard’s <st1:place w:st=3D"on"><st1:PlaceType w:st=3D"o= n">School</st1:PlaceType> of <st1:PlaceName w:st=3D"on">Public Health</st1:PlaceName></st1:place>.</= p> <o:p> </o:p> If our genes explain less than we imagined, the wear-and-tear model may explain more than we knew. Leonid Gavrilov, a researcher at t= he <st1:place w:st=3D"on"><st1:PlaceType w:st=3D"on">University</st1:PlaceType> of <st1:P= laceName w:st=3D"on">Chicago</st1:PlaceName></st1:place>, argues that “human = beings fail the way all complex systems fail: randomly and gradually.” In addition, they have “back= up systems” designed into their structure. Gavrilov argues that “within= the parameters established by our genes, that’s exactly how human beings appear to work. We have an ex= tra kidney, an extra lung, an extra eye and extra teeth. If a key gene is permanently damag= ed, there are usually extra copies of the gene nearby.” <o:p> </o:p> Nonetheless, as the defects in a complex system increa= se, the time comes when just one more defect is enough to impair the whole, resulting in the condition known as frailty. Eventually, one too many joints are damaged, one too many arteries calcify.&nb= sp; There are no more backups. We wear down until we can’t wear down anymore. <o:p> </o:p> For nearly all of human existence, people died young.<= span style=3D'mso-spacerun:yes'> Life expectancy improved as we ove= rcame early death—in particular, deaths from childbirth, infection, and traumatic injury. By the 1970’s just four out of every hundred people born in industrialized countries died before the age of thirty. It was an extraordinary medical achievement, but one that seemed to leave little room for improvement; Thus medical efforts shifted to re= ducing deaths during middle and old age, and in the decades since, the average life span has continued upward. <o:p> </o:p> Today we have as many fifty-year-olds as five-year-olds. “In thi= rty years, there will be as many people over eighty as there are under five,” according to Atul Gawande. Americans haven̵= 7;t come to grips with the new demography.&nbs= p; We cling to the notion of retirement at sixty-five. A reasonable notion when life expe= ctancy was only ten years longer, and there was only a tiny percentage of folks ov= er 65; but completely untenable = as they approach twenty per cent of America’s population. <o:p> </o:p> Equally worrying, according to Atul Gawande, “bu= t far less recognized, medicine has been slow to confront the very changes that it has been responsible for- or to apply the knowledge we already have about h= ow to make old age better. Despi= te a rapidly growing elderly population, the number of certified geriatricians f= ell by a third between 1998 and 2004. Applications to training programs in adult primary-care medicine are plummeting, while fields like plastic surgery and radiology receive applications in record numbers. Partly, this has to = do with money—incomes in geriatrics and adult primary care are among the lowest in medicine. And partl= y, whether we admit it or not, most doctors don’t like taking care of the elderly.” And, most eld= erly folks don’t have just one chief ailment; most will have range of medi= cal problems. A medical professio= nal can soon become overwhelmed trying to cope with all of them. Besides, most ailments have been a= part of a senior’s life for quite a few years. A medical professional is not goin= g to cure something he/she has had for twenty years. They may have high blood pressure,= and diabetes, and arthritis. Dr. Gawande comments that “there’s nothing glamorous about taking c= are of any of those things.” <o:p> </o:p> There is, however, a skill to it, a developed body of professional expertise, skills geriatricians have been taught to administer. Conventional trea= tment would use triage by zeroing in on either the most potentially life-threaten= ing problem or the problem that bothers them the most. “Give us a disease and we ca= n 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,” states Dr. Gawande. <o:p> </o:p> Most doctors treat disease, and figure that the rest w= ill take care of itself. If a patient is becoming infirm and heading toward a nursing home—well, that isn’t really a medical problem is it?<s= pan style=3D'mso-spacerun:yes'> To a geriatrician, though, it is a medical problem. People can&#= 8217;t stop the aging of their bodies and minds, but there are ways to make it more manageable, and to avert at lest some of the worst effects. <o:p> </o:p> “Little of what geriatricians do is high-tech me= dicine: they don’t do lung biopsies or back surgery or PET scans. Instead, they simplify medications= . They see that arthritis is control= led. They make sure toenails are trimme= d and meals are square. They look f= or worrisome signs of isolation and have a social worker check that the patient’s home is safe,” says Dr. Gawande. <o:p> </o:p> How do we reward this kind of work? Chad Boult, a geriatrician at the University of Minnesota, sums it up saying, “A few months after I published the study, demonstrating how much better people’s lives were with specialized geriatric care, the University closed the division of geriatrics.” He added, “The university said that it simply could not sustain the financial losses.” <o:p> </o:p> But the finances are only a symptom of a deeper realit= y: people have not insisted on a change in priorities. Dr. Gawande described the dilemma = this way, “ We all like new medical gizmos and demand that policymakers ma= ke sure they are paid for. They = feed our hope that the troubles of the body can be fixed for good. But geriatricians? Who clamors for geriatricians? What geriatricians do—bolste= r our resilience in old age, our capacity to weather what comes—is both difficult and unappealingly limited. It requires attention to the body and its alterations. It requires vigilance over nutriti= on, medications, and living situations. And it requires each of us to contemplate the course of our decline,= in order to make the small changes that can reshape it.” <o:p> </o:p> With the declines in those planning careers in geriatr= ics, there is truly a crisis developing in the ethical care of our seniors. What do we owe our elderly? And what will have to be done to d= raw more interest in this medical field. We will address these questions and others in our next column, to be published Tuesday, June 5th. <o:p> </o:p> If you have any questions on this article or the issue= of medical care of the elderly, contact this writer at 505-388-2523 or <a href=3D"mailto:rsvpgrant@zianet.com">rsvpgrant@zianet.com</a>. <o:p> </o:p> <o:p> </o:p> <o:p> </o:p> </div> </body> </html>