By Ryan Choi, Fall 2019.
Throughout human history, death has been a sudden event, hitting at the most unexpected of times. It is unpredictable, and an individual who is healthy today could be dead tomorrow.
Until the 19th century, life expectancy hovered around 40, and children under the age of 14 were unlikely to survive [1]. The economic implications of these problems were huge. A limited population meant a limited workforce, decreasing the productive capacity of the economy. Often, longevity correlates to experience, and with limited lifespans, individuals have less information and less time to resolve existing problems. It gradually became an issue of effectively working on our jobs while simultaneously passing down knowledge for continuous improvement. With limited time this was extremely difficult to implement, and for thousands of years the ultimate goal was simply to delay mortality.
Today, however, we are beginning to question this goal. We are questioning present geriatric structures: the sector of healthcare that deals with old age. While we often correlate longevity to greater happiness, is this really the case? Are the current medical practices effective in addressing both the physical and psychological problems associated with old age? For centuries, the goal was to live longer – evident by the exponential increase in global health expenditures since the 1800s [2] – yet today, the ultimate question has become: do we really want to live longer?
Conflict of Patient Needs
The problems with current geriatric structures originate in the foundation of medicine and the relationship between doctors and their patients. Ideally, when a doctor provides a proper diagnosis of their patient, the patient is expected to follow the doctor’s instructions to the best of their ability. But is the doctor always right?
Undoubtedly, doctors are well prepared for their job. They endure an extensive academic journey to become specialists in their field. However, do doctors truly understand the needs and desires of their geriatric patients? The norm of doctors is to provide a diagnosis that optimizes the longevity of the patient by resolving their health condition, yet it is not always easy to fully consider the greater psychological and personal needs of the patient.
Consider a 90-year-old patient, who has recently been instructed to move into a nursing home. She is too old to take care of herself and it is too dangerous for her to be living alone. She is relocated to a nursing home where she is consistently taken care of. Her medications are routinely checked, she gets her exercise, she is fed, washed, and her health is consistently monitored. The doctor’s instructions are completed perfectly, and the system seems flawless.
But to the nurses, she is just another patient to be fed and washed – just another checkbox in an endless agenda. What are the psychological implications of this system? The patient is stripped of her independence, her autonomy to live freely as she pleases. Already with her chronic conditions, she is limited in her physical activities. The patient may be physically healthy, but is she happy?
Accumulating research suggests a flaw in this system. More often than not, new residents to nursing homes are depressed and lack the attention and services necessary for a quality life [3]. In fact, recent research showed that a high number of nursing home residents had mental disorders [4]. Sadly, in the past decade, most of these disorders were diagnosed after entry into a nursing home and consisted of severe depression and schizophrenia [4]. Research is showing major problems associated with nursing homes without providing clear solutions. While not all nursing homes fail to meet the needs of the patient, a vast majority of nursing homes face these problems, which questions the very structure of their existence.
As of now, the lack of awareness of the present problems with geriatrics is the biggest obstacle. We need not only the general public to see the detrimental effects of the current geriatric system, but rather the greater geriatric institutions to realize the inherent problems and make an effort to improve on the status quo. Undoubtedly, these changes will not be cheap, but they are necessary in order to fulfill the values these institutions exist to maintain. With a continuously aging population, these demographic issues will become even more difficult to resolve, and changes need to be implemented now.
A look to the future
By no means does this article seek to denigrate the methods and work of doctors, nor does this article seek to deny our desire to live longer. Rather, this article seeks to question the trade-offs between quality and longevity of life.
In the end, it’s not that we want to live shorter lives. We want to live a quality and controlled life, where all of our needs are understood and considered, rather than focusing on the physical. When we are constantly fighting discomfort and a life stripped of independence, where we are constantly dependent on the diagnosis of a doctor, we begin to question if this is the life we really want to live. In many cases, current medical practices fail to empathize with patients. If those structures are changed, life – especially at old age – becomes much more livable.
[1] Office for National Statistics. 2015. “How Has Life Expectancy Changed over Time?” https://www.ons.gov.uk/peoplepopulationandcommunity/birthsdeathsandmarriages/lifeexpectancies/articles/howhaslifeexpectancychangedovertime/2015-09-09.
[2] Roser, Max. “Our World in Data.” https://ourworldindata.org/the-link-between-life-expectancy-and-health-spending-us-focus.
[3] Ferreira, Ana R. et al. 2016. “Needs in Nursing Homes and Their Relation with Cognitive and Functional Decline, Behavioral and Psychological Symptoms.” Frontiers in Aging Neuroscience 8, no. 72 (2016). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4838629/.
[4] Achterberg, Wilco et al. 2006. “Depressive Symptoms in Newly Admitted Nursing Home Residents.” International Journal of Geriatric Psychiatry 21, no. 12 (2006): 1156–62. https://doi.org/10.1002/gps.1623.
[5] “Geriatrics – The Mount Sinai Hospital.” Mount Sinai Health System. https://www.mountsinai.org/locations/mount-sinai/care/geriatrics.