Every day, Marc Agronin witnesses how joy can enhance people's final years. As the medical director of mental health and clinical research at one of the nation's largest nursing homes, Florida's Miami Jewish Health Systems, for over a decade, Agronin plays an active role in improving the lives of people with varying degrees of dementia. Better than anyone, he knows how fulfilling the older years can be when people can live with dignity, warmth and creativity.
Blending the latest research with his patient's life stories, Agronin shares his expertise with us in his new book, How We Age: A Doctor's Journey Into the Heart of Growing Old. Agronin's message is simple but powerful: This aging process is not all decline; everyone — no matter how old — can experience renewal. And the more positive a living environment a person has — especially for those with dementia — the happier that growth can be.
Q. How did you get the idea for this book?
A. The biggest fear people have is losing their memory. Yet people can continue to grow and thrive even if they have impaired memory. So I really want to show what lies beyond that and the ways that life's final years can be fulfilling and wonderful.
Q. What experience did you draw on?
A. One thing that interests me in working with older individuals is hearing their stories and histories. After so many years of working with them, I was drawn to trying to write about them — to honor them through their stories and sharing the wonders of their lives with others.
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Q. What do you hope your readers take away from these stories?
A. Be open to possibilities for growth and change in your parents. That is really the essential message. We make assumptions that when humans reach a certain age, change is no longer possible, and life becomes about decline. But that is simply not the reality — it's only half the picture. People grow and develop and change in startling ways. And often the reason that individuals later in life can make these changes is that they are actively involved with other individuals, especially younger individuals who give them support and inspiration, and vice versa.
Q. Of all the people in your book, who comes to mind first?
A. I write about a woman who had been married many years and was newly widowed. At our first appointment, I was expecting her to talk about being so depressed. In fact, she was happy after losing her husband. He had been controlling and unloving, and she was finally free. That story illustrates the essential points of working with older individuals: Don't make assumptions about what aging means to a person.
Q. What was her life like in widowhood?
A. She lives in the nursing home where I work and is always delightful. She's a wonderful storyteller. She is busy with our arts and musical programs, and she visits with family all the time. She is very clear that she's an independent person and wants to participate in things. She's very happy here.
Q. Far from a stereotypical picture of a nursing home resident!
A. So often when I read about nursing homes, whether it's explicitly stated or not, there is always the underlying assumption that it's depressing. There is a social movement where people say it's a civil right to be able to stay home and not be forced into a nursing home. That's a valid point, but lurking behind that discussion is the assumption that you lose rights when you go into a home. I work every day in a nursing home, and it doesn't have to be that way.
Q. How not?
A. People can thrive in nursing homes, and it's our own efforts that make the difference. We're not dealing with trying to cure a terminal illness or sending a man to Mars. We are dealing with physical trials and limitations that we have found help for long ago. We just need to bring the energy and the spirit and the resources into making life's latest years as positive and meaningful as can be.
Q. Who else from the book comes to mind?
A. Without question, it is the man named Aron. In my two decades as a doctor, this is the most thrilling case I ever had. I feel like Aron was literally pulled from the brink and not only got better, but was better than before. He taught me that we just can't write people off — you never know what can be.
Q. Did Aron have Alzheimer's?
A. Aron was in his early 80s and suffered a precipitous decline in his memory and motor function within a very short time period. He was very forgetful and was losing the ability to speak, and the ability to walk. Within three to four months he went from being totally independent to needing assistance. And he saw a number of doctors who told his family, "This is Alzheimer's disease, there is nothing you can do about this."
Q. How did you get involved?
A. Aron's daughter-in-law called and begged me to see him right away. Since I run a memory center and my practice is 90 percent geriatric psychiatry, most people I see have dementia. He walked in and I knew that this was not Alzheimer's. With Alzheimer's, his walking and speech would not have deteriorated so rapidly, so I immediately thought that there must something neurological going on. Aron needed a brain scan.
Q. What was the result?
A. I keep a copy of Aron's MRI on my computer because it was so impressive — a mass the size of a small grapefruit was completely taking up a good portion of his cranium. He had brain surgery barely a week later. The tumor itself was quite small, and most of what they'd seen on the scan was a cyst. There was no permanent damage at all. Aron literally came back from near death.
Q. Did you see him again?
A. Three weeks later, he came for an appointment with his two sons. He drove down himself, walked in and gave me a big hug, and spoke beautifully. I was in shock.
Q. How is Aron now?
A. He lives in a retirement complex, and he's doing great. He's still driving, he's active, he has a new girlfriend. His family threw him an 85th birthday party a few years ago that was an amazing testament to his life.
Q. Why is his story so special?
A. There is always the potential for renewal and rejuvenation. The renewal might be something very small. It might not be coming back to life like with Aron, but if we give up the potential for growth, we've really closed the door on life.
Q. If parents do get a diagnosis of dementia, what are your practical tips and tricks for coping?
A. First, I would emphasize that it's important to make certain that it is actually dementia if someone has memory trouble. Lots of people have memory difficulties as they age, but there are lots of different causes, many of which are reversible.
Q. Do you recommend early screenings?
A. Early diagnosis is key. Dementia is a dynamic illness that changes in ways that have everything to do with how we intervene. Even if someone has a diagnosis, people do better when they are healthier, both physically and psychologically. They do better when they have more support, and when they continue to be involved in a meaningful and vital way.
Q. How can families relate to patients with advanced dementia?
A. Humans have certain strengths that are very enduring throughout almost the entire course of the illness, long after verbal memory is gone. Even if someone has an advanced case of the disease, there are almost always ways to still reach him: with creativity, humor, affection, sensory enjoyments. People often consider verbal ability as the be-all and end-all of communication. But when you think about it, consider how much we enjoy movement, music, touch — these aspects all stay with a dementia patient. Remember that, because it will give you avenues to stay involved with the person.
Q. How can readers maximize their own memory retention?
A. I frequently give talks on memory enhancement. People think you have to go to great lengths to make a difference in your memory, but that's just not true. Simple lifestyle choices make the difference, such as regular exercise, a diet rich in fruits, vegetables and omega-3 fatty acids, and keeping mentally active.
Q. How so?
A. That means doing something that challenges your brain — for some that's crossword puzzles, but it can also be surfing the Web, doing Google searches. If you always listen to the same type of music, try out a different type. Learn a new language — not so you can speak like a native speaker, but so you can stretch your brain's abilities. All these activities not only reduce the risk of Alzheimer's, but improve the well-being of those with the disease.
Q. Mental exercises can also help dementia sufferers?
A. We don't know if it makes an appreciable difference in the course of the disease, but it definitely improves a patient's well-being, emotional health and sense of purpose. It also makes an enormous difference for caregivers who engage with them in these activities.
Q. How so?
A. We have different types of memory, such as touch and smell, different ways of thinking about things. We know that when individuals with memory impairment have a really positive experience in one part of the day, the emotions and the good feelings carry through until later even if the verbal memory doesn't. I teach this to caregivers all the time, because they get frustrated and think their actions have no impact on the patient. Indeed the body has ways of remembering and being affected by experiences in ways that we don't even imagine.
Q. What do you find most hopeful about your work?
A. We would like to cure Alzheimer's, and we are getting closer, and we certainly cannot give up on the people who have it now. I do Alzheimer's research myself, and the pace of research has accelerated tremendously. We've made huge leaps in terms of understanding the disease. We are getting closer and closer, and you never know what day will bring an effective treatment.
Betsy Towner lives in California.
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