Excerpts from WHAT ARE OLD PEOPLE FOR?

Dr. William Thomas writes

• On society’s view of aging as a disease

Dermatologist Nicholas Perricone opens his New York Times best-selling book The Wrinkle Cure by claiming, “Wrinkled, sagging skin is not the inevitable result of growing older. It’s a disease and you can fight it.” If that is true, wrinkles represent a most unusual form of illness….Diseases need treatment and treatments cost money. Aided and abetted by hundreds of millions of dollars in marketing, the antiwrinkle business sows fear and reaps a rich financial harvest. Page 7

• On the need for a new perspective on what aging is

The development of a new perspective on age and aging is both necessary and possible. Given the importance of aging in our lives, and the impact of aging on our families and society, a new openness and even curiosity about human aging would seem more than warranted. The time has come for our wondrous longevity to emerge from the long shadow cast by the vigor and virtues of youth. Page 36

• On the role of grandparents

The human impulse to share food, energy, resources, and risk across the generations (summarized in the grandmother hypothesis) outranks all other human developments in its importance. …A million years ago the first grandmother attended to the cries of a hungry grandchild. In doing so she increased the reproductive success of her own daughter. Over time, those families that were blessed with older females who were inclined to give this kind of assistance grew in number and power. Families that could not master this strategy were overwhelmed. They became evolutionary dead ends. We take the constellation of traits that define our humanity for granted, little realizing that they are, in fact, the gifts of perhaps sixty thousand generations of elders. Page 57

• On the traditional model of elder care

Society has traditionally assigned responsibility for the support and protection of the aged to the family. This ethic grew out of long experience with the high birth rates, stable extended family structures, and small numbers of older people that characterized early agricultural and pastoral societies…To grow old in a traditional society that “takes care of its own” is to rely almost exclusively on a stable network of family relations and a deep reservoir of unpaid female caregiving….Those who come to depend on their families are expected to minimize the burden they place on those who love and care for them. There is a deep-seated belief that to complain is to make oneself into a burden, and to become a burden is a terrible thing. Page 75

• On the pitfall of defining the needs of the elderly in financial terms alone

[Social Security and Medicare] have indeed done immeasurable good for older people and their families. Far less obvious is the way that publicly provided resources and services have gradually replaced the idea that the bonds that unite young and old must also include important non-economic dimensions. We have created, and continue to maintain, a massive bureaucracy that serves the financial needs of the elderly. The fact that it does so completely without affection or tenderness is seen as beside the point. Page 87

• On the institutionalization of the elderly

People are placed in nursing homes, often against their will, because they no longer display the behaviors expected of independent adults. The decision to surrender a loved one to a nursing home is emotionally traumatic and is usually made only after all other options have been exhausted. That alternatives are few (relative to demand) and underfunded (relative to what is spent on institutionalization) is rarely acknowledged. Page 159

• On the often dehumanizing impact of nursing homes

Because nursing homes are operated as therapeutic institutions, machinelike efficiency is their ideal. The best facilities are thought to be those that deviate to the minimum extent possible from predetermined schedules and routines…This approach to daily life has a deadening effect on all who must live and work under its sway. Everyone needs to feel the fresh breeze of the unexpected, even if it does not blow every day. Spontaneous events and happenings are the source of interesting conversation. Conversations grow into stories that can be told and retold. Stories become memories. To live in a typical nursing home is to endure a famine of new memories. Page 183

• On the need to act now