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A Fantastic Voyage Into Aging Well

A geriatrician gives voice to the 90-plus set — and illuminates the importance of quality elder care

Book Review: How We Age

If I ever wind up in a nursing home, I want Dr. Marc E. Agronin to be my psychiatrist. Because more than anything, his new book, How We Age: A Doctor’s Journey Into the Heart of Growing Old, demonstrates his dedication, compassion and skill.

Take the story of Aron, an 84-year-old Auschwitz survivor. His children come into Agronin’s office pleading for a second opinion, even though their insurance won’t cover it. Aron's primary care physician has diagnosed him with Alzheimer’s and won’t approve further tests. Yet the children think their father’s symptoms — confusion, plus impaired speech and movement — have come on too quickly to constitute Alzheimer’s.

Agronin listens carefully, ultimately agrees with them and doggedly navigates a gantlet of insurance bureaucrats to order a brain scan. The test reveals a tumor that is affecting the man’s movement and speech — and that would have killed him quickly had it not been detected. After brain surgery, Aron recovers fully, then drives to Agronin’s office to thank him in person.

Agronin’s book is filled with good stories like this one — tales of the many patients (averaging 90 years of age) he has encountered as a geriatric psychiatrist at the Miami Jewish Home and Hospital, one of the country’s largest nursing homes.

Not all the stories are happy ones, though.

Agronin sees his fair share of people who have depression or dementia. But even these patients inspire hopeful reflection. In one chapter, a woman irrationally convinced that her children are stealing from her writes a cruel note disinheriting them — and never speaks to them again. Suddenly bereft of visiting relatives, she creates a thriving social network for herself at the nursing home. This reminds Agronin that his job is to focus on his patients’ present and future, not their past, and that this focus “is not an act of absolution but one of wisdom and adaptation, and serves as a necessary act of humanity in the final stages of life.”

His depictions of his patients — and his ruminations about what he has learned from them — are the book’s strengths. These stories give a voice to the often overlooked and dehumanized people who live in nursing homes, and they are illuminating and interesting in the way all good anecdotes should be.

But Agronin’s book lacks a cohesive thematic thread that would weave these sketches — and the doctor’s experience — together. Though the author says he wants to offer a “more balanced perspective on aging,” it’s hard to tell what that outlook is, or what he might balance it against. This makes How We Age a series of disjointed (albeit interesting) vignettes about his aging patients, interspersed with quotes from the likes of Cicero and George McGovern, as well as a smattering of psychological theory and science regarding what happens to the human brain and psyche as we age. Intriguing stuff, to be sure, but I waited in vain for the “Aha!” moment that would tie it all together.

What ultimately emerges from this book (though it clearly wasn’t his intent, as there is nothing self-congratulatory about his prose) is that Marc Agronin is an extraordinarily capable geriatric psychiatrist: He respects his patients, cares for them mindfully and well, and works hard to make their last years as fulfilling and meaningful as possible. That’s what makes the book readable. You can’t help liking the author, not to mention his sunny — even if fuzzy — take on aging.

In a December op-ed in The New York Times, Susan Jacoby (author of Never Say Die: The Myth and Marketing of the New Old Age) wrote, “It is chilling to think about becoming helpless in a society that affords only the most minimal support for those who can no longer care for themselves.” Viewed in the context of How We Age, Jacoby’s plaint makes you wonder why there aren’t more Marc Agronins to care for the elderly. It makes you wonder why more elder-care facilities don’t resemble the Miami Jewish Home and Hospital where he works, considered a model of how nursing homes should be run. How does such a large institution manage to care for its many patients so well? None of these issues are answered in the book.

Indeed, intent as he is on telling the stories of his patients, Agronin misses the opportunity to tell his own. What he has learned from his patients — and hopes to pass on to his readers — is “that aging equals vitality, wisdom, creativity, spirit, and, ultimately, hope.” But it’s not his aging patients who offer us the hope of growing old with dignity. It’s doctors like Agronin himself.

O’rya Hyde-Keller is a Rhode Island-based writer and editor.

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