Marc Agronin, MD, a geriatric psychiatrist and author of "How We Age: A Doctor's Journey Into the Heart of Growing Old" shares his thoughts and experiences caring for the aged as Medical Director for Mental Health and Clinical Research at Miami Jewish Health Systems, in Miami, Florida. He writes, "Even when memory fails, there are certain strengths that persist: humor, kindness, altruism, interpersonal connections, and sensory abilities. These strengths allow ongoing ways to sustain vital connections with individuals suffering from cognitive impairment."
Commitmentnow.com: As a geriatric psychiatrist for the Miami Jewish Health Systems, what have you discovered are the hidden strengths of aging that are not often talked about in our society? Can old age really be a period of 'vitality, wisdom, creativity and, ultimately, hope'?
Marc Agronin, MD: For so many older individuals, late life is certainly a time of vital and creative living. Research bears this out, finding the highest levels of well-being in later life. We gain in knowledge, experience, wisdom, positive outlook, and creativity as we age.
For other older individuals, especially those facing memory loss or chronic illness, late life is certainly a more challenging time. But even in those circumstances, it is still possible to remain vitally involved in life, but it requires the will, energy, and creativity of caregivers and younger generations to help out.
We cannot cure aging, but that doesn't mean there aren't solutions to most age-related challenges.
Commitmentnow.com: If there is so much potential in old age to be happy, why do we all dread getting old so much? What are the great opportunities that come with old age that are not often observed and discussed that you see everyday as you work with your patients?
Dr. Agronin: When we are younger, we greatly fear the loss of loved ones, independence, and the possibility of death. These are normal fears, but we tend to project them onto all older people and imagine late life to be quite miserable. We also overemphasize the values of strength, beauty, and physical independence, and anything less seems frightening.
As a result, we devalue the aged and have a blind spot to the strengths of late life. In my daily clinical work I see up close both the challenges and the opportunities people face as they age. I spend enormous amounts of time hearing about their lives, past, present, and future.
Most of the time I am deeply moved and inspired by how individuals adapt over time and learn to accept age-related changes and thrive in spite of them. They have shown me all of the strengths we retain even in the face of challenges in late life.
Commitmentnow.com: What compelled you to write this book? What message do you hope this book conveys about getting old?
Dr. Agronin: I am passionate about working with the elderly, and I wanted to share this passion and hopefully inspire it in others. I wanted to dispel many of the misconceptions we have about aging, and to show how older individuals can overcome challenges. A critical mission of the book is to present a more balanced perspective on aging than we typically imagine.
Commitmentnow.com: What are the advantages of the aging brain, even though the aging brain can experience memory loss? Can you share with us your thoughts on the potential for more creativity and wisdom in a senior citizen?
Dr. Agronin: Many discrete cognitive skills, like memory processing speed, verbal fluency, and mathematical ability tend to decline into our 70's and beyond. At the same time, we are growing in knowledge, experience, emotional maturity, and wisdom. Age gives even as it takes away, teaching us that we are more than the sum of our parts.
This lesson was made clear to me by a distinguished doctor I interviewed for the book, who described how even as his memory faltered a bit, his patients considered him a better doctor, more in tune with their conditions.
Commitmentnow.com: What is your advice for those in their 40s and 50s who hope to enjoy their old age?
Dr. Agronin: Most important is to adopt a brain-healthy lifestyle. This is very straightforward, and includes moderate exercise, a diet rich in fruits and vegetables, and keeping socially and mentally active. The good news is that regardless of our efforts, older brains tend to become more practical and positive with age.
Commitmentnow.com: You dedicated your book to your grandparents. What did your grandparents teach you about getting older?
Dr. Agronin: My grandparents all grew up during the depression and lived through World War II. They knew the value of family unity and they honored the elders in the family. Looking out for eachother was not ever a question but an obligation. Being older did not lessen this obligation in any way.
As I write in the book, I grew up with my maternal grandfather as my own doctor as well as the doctor for nearly the entire town of Kaukauna, Wisconsin. He tended to his patients with utmost dedication. Growing up imbued with such feelings of closeness and shared responsibility left me with the exact same instincts with both my family and my patients.
Commitmentnow.com: Can you share with our readers the story of Rosa and how you followed your intuition as a doctor in not giving up on her?
Dr. Agronin: Rosa was an elderly woman in our nursing home with dementia and severe and seemingly untreatable agitation. She had fled Cuba as a young mother in order to rescue her son from the instability and danger during the revolution in the early 1960's, and this fueled her family's dedication to her care. I tried everything I knew but was utterly failing in my attempts to improve her symptoms as well as the despair felt by both her son and husband.
With persistence and close work with the family, however, we eventually found a treatment that worked. This is a key lesson with older patients. Join together with the family and do not give up. Have hope. There are almost always ways to improve someone's situation, despite not being able to cure the underlying disorder. Too often doctors and other clinicians lose hope and then abandon the patient.
Commitmentnow.com: What are some ways you have found eases the pain of Alzheimer's in your patients? Can you share with us some of the things you do in the Memory Fit class?
Dr. Agronin: Even when memory fails, there are certain strengths that persist: humor, kindness, altruism, interpersonal connections, and sensory abilities. These strengths allow ongoing ways to sustain vital connections with individuals suffering from cognitive impairment.
In our day programs we focus on these strengths through warm social interactions, music, art and pet therapy, and mentally and sensory stimulating activities. These experiences not only ease the burden and isolation of memory loss, but bring new meaning and connections to people.
Commitmentnow.com: What can the story of Francine and the bugs in her room teach all of us? Do you think older persons are often mistaken like Francine?
Dr. Agronin: Francine was almost misdiagnosed with psychosis because she saw bugs in her room -- that we later learned were quite real. We have to be very careful in our assumptions of what older people are like, especially when we are too eager to see decline, loss, depression, and mental impairment in situations based more on our own projections and less on reality.
I think what happened with Francine happens all the time, and leads to unnecessary treatments. By the same token, we have to vigilant for memory impairment and other ailments early on that can be treated. The lesson here is to take the time to listen to what older individuals have to say before we jump to conclusions.
Commitmentnow.com: For those reading this who are terrified of getting older, what words of comfort or advice can you offer them?
Dr. Agronin: Most people adjust quite well to getting older. They experience new depths of meaning and vitality. Worries and stresses from earlier in life ease. And we have both the time and the potential -- with some planning and attention to healthier life habits -- to explore and create in new and meaningful ways.
In the end, there is great hope. How can we best get there? Learn from our elders who are already there!
Commitmentnow.com: Your 'Rules of Four' were absolutely wonderful. How did you come with these rules? Can you explain #2: "Every hair on your head is important to me."
Dr. Agronin: I have three sons, and like any parent I love them deeply and would do anything to keep them safe. In my daily work I realize that my aged patients had similarly caring and devoted parents who loved them unconditionally -- although they are no longer here to guard them. So who stands in their place?
As I reflected on the "rules" I have for unconditional love for my then four year-old son, I realized that such feelings never leave us, and account for the ferocity of care that many spouses and adult children bring to an aged loved one. We have to understand and support these caregivers, just as we would want to ensure eternal care for our own children and loved ones.
Commitmentnow.com: Can you tell us about one of your patients who you feel is an example of successful aging, despite adversity and even physical ailments?
Dr. Agronin: A Haitian man in his 80's who lives in our nursing home is suffering from severe kidney disease and physical disability. He admits that he is suffering, but he also speaks of having much happiness and contentment, which he attributes to the relationship with his family and his deep faith.
He is a perfect example of someone who is able to see beyond the day-to-day struggles of aging and focus on what is most important in his life. It is a key lesson for us all, that regardless of what we face in life, we always have choices in terms of how we will meet our challenges. I am his doctor, but he is my inspiration!
To Purchase How We Age: A Doctor's Journey Into The Heart of Growing Old click here.
About the Author: Marc E. Agronin, MD is a board-certified adult and geriatric psychiatrist who has served since 1999 as the Medical Director for Mental Health and Clinical Research at the Miami Jewish Health Systems (MJHS), Florida's largest long-term care institution.
He is also an Affiliate Associate Professor of Psychiatry and Neurology at the University of Miami Miller School of Medicine.
He is a graduate of Harvard University with a degree in psychology and philosophy summa cum laude, and received his medical degree from the Yale School of Medicine. Dr. Agronin trained in psychiatry at Harvard Medical School (McLean Hospital and Massachusetts General Hospital) and later completed a fellowship in geriatric psychiatry at the VA Medical Center in Minneapolis, MN.
In 2008, Dr. Agronin was named the "Clinician of the Year" by the American Association for Geriatric Psychiatry, awarded annually to one of its members who has demonstrated a "profound commitment to the field of clinical geriatric psychiatry by providing, promoting and assuring access to quality mental health care for older adults."