My father was almost 94 when he died. Looking after him opened my eyes to a world I don’t want to move into – the world of the old.

Everyone gets old. None of us should be surprised or angry; it’s a fact of life. But what’s also a fact of life is this: We don’t treat older people as people. We treat them as a commodity to be used, abused and disposed of as we see fit. We somehow learn to raise our children well; we try to give our pets a good life. Why can’t we extend the same efforts to our older people?

I am as guilty as the next person. On the highways, I become impatient with older, slower drivers. In lineups at the grocery store, I want to hurry an older person fumbling with her change so I can get home.

How did our world get like this? There are too many reasons to discuss here. However, I think one of the biggest is that the young and old have never really learned to communicate with each other.

We, the young, have not figured out how to respect our older people. Thus we don’t know how to talk to them or learn from them. Too often we ignore older people or treat them like children, particularly if they are chronically ill or cognitively impaired.

I remember a wise friend telling me one day when I was going through a very tough time with my dad: “Remember what your father has lived through – a depression and economic collapse, two world wars and the fathering of five children. Your dad is a survivor and should be honoured as such.”

Years ago my aunt (dad’s sister) was telling me stories about life during the war, things I never knew about my father and his family. I so wanted to ask my dad about this. But it was too late; his dementia was so far along that he could not communicate any more. He did not speak up and I did not ask. What a waste for him and for me. As Alex Haley wrote, “The death of an old person is like the burning of a library.” I didn’t spend enough time with dad in his library.

On the other hand, many older people have not learned to speak up for themselves. According to author Joan Cleveland of New York, too often older people buy into the myth that they are useless. They allow younger people to tell them what they are or are not capable of.

In Another Country: Navigating the Emotional Terrain of Our Elders, Mary Pipher reveals no deep, dark secrets about how our society treats the old. What she does is show us how the patterns were formed. She writes: “We make it almost impossible (for old people) to be dependent yet dignified, respected, and in control. The old must learn to say, ‘I am grateful for your help and I am still a person worthy of respect.”

Have we done anything for the old we can be proud of? Certainly not in the area of health care – medical ageism is rampant. You would be shocked at the scant number of hours allotted to the study of aging in Canadian medical schools. Needless to say, we don’t have enough geriatricians to properly meet the demands our aging society will soon place on the health-care system.

The May 1999 issue of Canadian Family Physician reported that even though the highest rates of depression, dementia and suicide occur among the elderly, seniors are one of the most under-treated populations for mental health.

When Helen Henderson (The Toronto Star, October 1999) asked her readers if doctors treat older people fairly, she was astounded and dismayed by the “shocking nature of many experiences readers described.” Lack of time and concern, and attribution of serious symptoms to merely “old age,” were only a few.

I could go on. Instead I want to focus on two easy but very effective solutions each of us can implement with elders in our lives.

My father used to keep telling me: “Slow down, you’re always in a hurry.” Starting today I ask everyone (from family caregivers to physicians) to honour our older people by spending more time with those you know, treat or love – more uninterrupted, quality time.

The other thing we can do is to listen to what older people have to say. Help give them the opportunity to be proud of having lived 80 plus years.

These are a start – but just that. Our older people don’t ask for much. It’s precious little for us to give.

Aging and Caring: A Piece of My Mind
Paul E. Ruskin, MD
Baltimore, Md

I was invited to present a lecture to a class of graduate nurses who were studying the “Psychosocial Aspects of Aging.” I started my lecture with the following case presentation: The patient is a white female who appears her reported age. She neither speaks nor comprehends the spoken word. Sometimes she babbles incoherently for hours on end. She is disoriented about person, place, and time. She does, however, seem to recognize her
own name. I have worked with her for the past 6 months, but she still does not recognize me. She shows complete disregard for her physical appearance and makes no effort whatsoever to assist in her own care. She must be fed, bathed, and clothed by others. Because she is edentulous, her food must be pureed, and because she is incontinent of both urine and stool, she must be changed and bathed often. Her shirt is generally soiled from almost incessant drooling. She does not walk. Her sleep pattern is erratic. Often she awakens in the middle of the night, and her screaming awakens others.

Most of the time she is friendly and happy. However, several times a day she gets quite agitated without apparent cause. Then she screams loudly until someone comes to comfort her.

After the case presentation, I asked the nurses how they would feel about taking care of a patient such as the one described. They used words such as “frustrated,” “hopeless,” “depressed,” and “annoyed” to describe how they
would feel.

When I stated that I enjoyed taking care of her and that I thought they would too, the class looked at me in disbelief. I then passed around a picture of the patient: my 6-month-old daughter.

After the laughter had subsided, I asked why it was so much more difficult to care for a 90-year-old than a 6-month-old with identical symptoms. We all agreed that it is physically easier to take care of a helpless baby weighing 15 pounds than a helpless adult weighing 100, but the answer seemed to go deeper than that.

The infant, we all agreed, represents new life, hope, and almost infinite potential. The demented senior citizen, on the other hand, represents the end of life, with little potential for growth.

We need to change our perspective. The aged patient is just as lovable as the child. Those who are ending their lives in the helplessness of old age deserve the same care and attention as those who are beginning their lives
in the helplessness of infancy.

“Aging and Caring” was first published in the November 11, 1983, issue of JAMA.