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Exploring the myths and realities of aging and health

Aging, April-May, 1984 by C. Everett Koop

We have become so specialized in medicine as in so many other things, that we sometimes truly believe that human growth moves from one neat little category to the next.

One day we are known as "infants." The next, we are in early childhood. Then, perhaps pre-pubescence, followed by adolescence and young adulthood. Then we are "working adults," as opposed to other kinds of adults who are fortunate enough not to have categories of their own. And then, of course, we become "older people" and the "aged."

It is certainly a handy way to deal with the normal life-span. But this kind of pigeon-holing tends to give the impression that health problems occur for the individual, almost spontaneously, as soon as he or she leaves one category and enters the next one. Fortunately, that's just not so. Prophecies and Predictions

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Certainly the last category, that of aging, comes replete with misconceptions and contradictions. Too often we perceive the aging process as a series of self-fulfilling prophecies, described as a chain of successive and anticipated events.

A physician or a counselor will say, "You know, your father is getting on in years. You can expect such-and-such to happen, and you should prepare your family for this or that other thing to happen." And superficially this sequence of events may indeed occur much as it is described.

We tend to accept those predictions because they are orderly and, therefore comforting, although we know from our own personal, hard experience that life really doesn't unfold that neatly. Events tumble in one upon the other. Cause and effect is very often a shrewed guess at best. Other people and the environment itself will trigger some events to occur early and delay or prevent others from occurring at all.

Often an older person becomes the victim of preconceived ideas of how the elderly are supposed to act, react or respond. For instance, if we expect deterioration to take place, we might feed and medicate the aging person as if deterioration were in fact taking place. As a result, the person may become malnourished and then deteriorate, fulfilling the prophecy. Over-medication is another dangerous outcome of this kind of behavior by the medical profession toward the elderly. We may anticipate that the aging person will require certain drugs and medicines, so we go ahead and administer them too soon, and then we witness the very decline we thought would take place, right on schedule.

The whole problem of aged persons being erroneously judged "senile" is yet another aspect of the aging process seen as a sequence of anticipated events in the eyes of the forewarned beholder. The truth is that senility is not a normal sign of growing old; in facT, it is not even a disease. For the small percentage of older people who show signs of mental impairment through multi-infarct dementia or Alzheimer's disease, the facts are that some 100 orders, caused by minor head injuries, a high fever, poor nutrition, or adverse drug reactions. Drawing Arbitrary Lines

One of the most puzzling aspects of the American conception of the "aged" or "senior citizen" is the hypothetical beginning point of the aging process, dictated by economic and other aspects of our particular culture. It is generally accepted that, following one's 65th birthday, a person begins going downhill. You are "retired." You are literally "withdrawn" from the world you've known for six and a half decades. You are paid off in some way by pension, social security or some other means to help you negotiate this last, finite period of time.

That magic number, 65, does vary a bit. A number of companies want to "withdraw" their managers when they reach 55. Others have a productive role between age 60 and 70. Even social security permits some to retire at 62 under a reduced annuity and then compounds, the anomaly by restricting outside income until the recipient reachs age 70 when the restriction is entirely removed.

Generals and admirals in the military are retired when they reach the mandatory retirement age of 62. Only a presidential appointment can keep them in uniform. I know something about that system, since the Office of the Surgeon General carries the flag rank of Admiral of the Navy, but the incumbent is also a presidential appointee. It took an act of Congress to enable me to assume my position and at age 67 I am Surgeon General and in uniform five years after most other admirals have retired. And I must confess that I just don't know why that is.

I think all Americans need to develop a philosophy on aging. Those of us who work in public health need such a philosophy for both our efforts to maintain good health in an aging population and also as our contribution to society's understanding of aging in general.

Before very long, we as members of American society will have to make some difficult decisions about the role of older people in American life; decisions that could affect public policies toward pensions and retirement, job seniority and security, home ownership, insurance coverage, medical benefits, and so on.

Health Care Industry

Exploring the myths and realities of aging and health

Aging, April-May, 1984 by C. Everett Koop

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