Tuesday, 8 May 2007

Atul Gawande's eight-page feature in the 30 April issue of The New Yorker, on the subject of ageing, covers many issues that Australia shares in common with the United States.

The piece begins with an overview of what ageing means for the average human body. It's not pretty, but Gawande is clinical (as you'd expect from a doctor) and objective. "The process is gradual and unrelenting", but "people naturally prefer to avoid the subject of their decrepitude". In more ways than one, it seems. "Americans haven't come to grips with the new demography," he writes.

"People are putting aside less in savings for old age now than they have in any decade since the Great Depression." And practitioners are not keeping up, in absolute numbers: "the number of certified geriatricians fell by a third between 1998 and 2004".

To illustrate what a geriatrician does that a regular GP does not do, Gawande steps into the consulting room with Jean Gavrilles, 89. As well as examining Gavrilles, Juergen Bludau, the geriatrician, "asked her to tell him about her life". Getting information in this way, it seems, is essential to prevent accidents, especially falling, which is a scourge for the elderly.

He also takes a lot of time to examine her feet. "The job of any doctor, Bludau later told me, is to support quality of life, by which he meant two things: as much freedom from the ravages of disease as possible, and the retention of enough function for active engagement in the world."

Gawande then gets in touch with Felix Silverstone, a retired medical practitioner, who now looks after his blind wife in a "retirement community" near Boston. It is "not the average retirement community", Gawande notes. Annual rent is US$32,000. Most retirees would not be able to afford such a place, as "the median income of people eighty and older is only about fifteen thousand dollars".

It is a brilliant article, as usual for this talented physician-cum-author.

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