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Fri 27 Apr, 2007 12:05 pm
A terrifying New Yorker piece on ageing: a sort of memento mori for today:
Quote:Annals of Medicine
The Way We Age Now
Medicine has increased the ranks of the elderly. Can it make old age any easier?
by Atul Gawande
April 30, 2007
The hardest substance in the human body is the white enamel of the teeth. With age, it wears away nonetheless, allowing the softer, darker layers underneath to show through. Meanwhile, the blood supply to the pulp and the roots of the teeth atrophies, and the flow of saliva diminishes; the gums tend to become inflamed and pull away from the teeth, exposing the base, making them unstable and elongating their appearance, especially the lower ones. Experts say they can gauge a person's age to within five years from the examination of a single tooth?-if the person has any teeth left to examine.
Scrupulous dental care can help avert tooth loss, but growing old gets in the way. Arthritis, tremors, and small strokes, for example, make it difficult to brush and floss, and, because nerves become less sensitive with age, people may not realize that they have cavity and gum problems until it's too late. In the course of a normal lifetime, the muscles of the jaw lose about forty per cent of their mass and the bones of the mandible lose about twenty per cent, becoming porous and weak. The ability to chew declines, and people shift to softer foods, which are generally higher in fermentable carbohydrates and more likely to cause cavities. By the age of sixty, Americans have lost, on average, a third of their teeth. After eighty-five, almost forty per cent have no teeth at all.
Even as our bones and teeth soften, the rest of our body hardens. Blood vessels, joints, the muscle and valves of the heart, and even the lungs pick up substantial deposits of calcium and turn stiff. Under a microscope, the vessels and soft tissues display the same form of calcium that you find in bone. When you reach inside an elderly patient during surgery, the aorta and other major vessels often feel crunchy under your fingers. A recent study has found that loss of bone density may be an even better predictor of death from atherosclerotic disease than cholesterol levels. As we age, it's as if the calcium flows out of our skeletons and into our tissues.
To maintain the same volume of blood flow through narrowed and stiffened blood vessels, the heart has to generate increased pressure. As a result, more than half of us develop hypertension by the age of sixty-five. The heart becomes thicker-walled from having to pump against the pressure, and less able to respond to the demands of exertion. The peak output of the heart decreases steadily from the age of thirty. People become gradually less able to run as far or as fast as they used to, or to climb a flight of stairs without becoming short of breath.
*seven pages to follow online*
Source/full report
Yes, Gawande is one of my favorite New Yorker contributors. I had read the article, VERY interesting in its implications re medical practice in the United States.
I've looked at that and haven't read it yet. Gawande is also one of my favorites, though (he tends to write articles that I then refer to over and over again once I've read them) and I'm looking forward to it. Sort of. (Will probably be good writing and important information, looks extremely depressing though.)
Thanks Walter, that was really interesting.
Thanks Walter, that was really depressing.
No one ever said the Human Body Warrenty could be extended beyond three score and ten.
Vanity, vanity. All is vanity.
The way we age now
Yes, it was depressing, but not the description of the process. That had its consolations in a way. The depressing bit was the end, all about the growing lack of geriatricians.
I guess most primary care physicians (formerly known as family doctors) do pick up a lot of geriatric experience along the way, if their patients stay with them long-term. But that can be pretty scattered, hit-or-miss, and they often don't have the time (or, as Gawande points out, the inclination) to pull it all together.
Our medical emphasis is still on treating specific chronic or acute problems, especially if they are life-threatening, not in easing patients through the various miseries of aging. If the situation requires sophisticated action, American medicine is ready. If it requires gentle, common-sense supervision that's a different story. Heroic measures are glamorous, but keeping an 85-year old comfortable and functioning, with attention paid to quality of life, simply doesn't pay enough.
I want it understood, though, that I am NOT talking about our present primary care physician. He LISTENS!
I found some hope in the suggestion that the shortage of MD's could be offset by Nurse Practioners and Physican Assistants. Deep medical knowledge isn't required. Common sense and compassion are.
The way we age now
This should probably be posted separately, but due to the interrest in the Neew Yorker article and Gawande's writings in general I'll put it here for now: The NY Times for today has an article by him on the American health care system which should be read by everybody, and I do mean everybody.
Thanks, TomKitten, I hadn't gotten to the NYT yet in my newspaper review for the day. Will definitely read that.
I *just* read it, funny. (Like 15 minutes ago.) Here's a link:
http://select.nytimes.com/2007/05/10/opinion/19gawande.html
(Does the link work? I'll copy and paste if not.)
OK, I thought that might be the case.
[b]Curing the System[/b]
By ATUL GAWANDE
Published: May 10, 2007
The American health insurance system is a slow-creeping ruin, damaging people and increasingly the employers that hire us. Yet there is another truth as well: the vast majority who have decent coverage are happy with the care we get ?- I am writing this, for instance, as I sit with my 11-year-old son waiting for an M.R.I. to check the cardiac repair that has saved his life for a decade. So most have resisted large-scale change, fearing that it could make some lives worse, even as it makes others better.
And the truth is it could.
There are two causes of human fallibility ?- ignorance and ineptitude ?- and health system change is at risk of both. We could err from ignorance, because we have never done anything remotely as ambitious as changing out a system that now involves 16 percent of our economy and every one of our lives. And we could err from ineptitude, underestimating the difficulties of even the most mundane tasks after reform ?- like handling all the confused phone calls from those whose coverage has changed; ensuring that doctor's appointments and prescriptions don't fall through; avoiding disastrous cost overruns.
Health systems are nearly as complex as the body itself. They involve hospital care, mental health care, doctor visits, medications, ambulances, and everything else required to keep people alive and healthy. Experts have offered half a dozen more rational ways to finance all this than the wretched one we have. But we cannot change everything at once without causing harm. So we dawdle.
We don't need to, though. It is possible to alter our system surgically enough to minimize harm while still channeling us onto a path out of our misery.
Option 1 is a Massachusetts-style reform, which follows a strategy of shared responsibility. Enacted statewide last year, the law has four key components. It defines a guaranteed health plan that is now open to all legal residents without penalty for pre-existing conditions. Using public dollars, it has made the plan free to the poor and limited the cost to about 6 percent of income for families earning up to $52,000 a year. It requires all individuals to obtain insurance by year end. And it requires businesses with more than 10 employees to help cover insurance or pay into a state fund.
The reform gives everyone a responsibility. But it leaves untouched the majority with secure insurance while getting the rest covered. As a result, it has had strong public approval. Experience with delivering the new plan is accumulating. And best of all, it offers a mechanism that can absorb change. The guaranteed health plan may cover 5 percent of the state at first, but as job-based health care disintegrates, the plan can take in however many necessary.
The reform has its hurdles, no question. Some residents are angry about being made to buy health coverage ?- 6 percent of income is not nothing. Next April, when the tax penalty kicks in (refusers will lose their personal tax exemption), you will hear about it. As enrollment and costs in the guaranteed plan rise, there will also be intense public pressure to increase the minimum employer contribution (currently just $295) and clamp down on the costs. But this is what a real system is for: gathering everyone in and enabling the hard choices.
The approach is not just a crazy Massachusetts idea (though Mitt Romney is running from parts of it). Reform plans recently put forward by everyone from the Republican Arnold Schwarzenegger to the Democrat John Edwards to a major new business coalition take the same tack. People don't want the mess we have ?- not families, not employers and not health professionals. This offers a viable way forward.
If it's still too much for people to accept, however, there is a second option, a fallback: we could guarantee coverage for today's children ?- for their lifetime. It could be through private insurance or through a Medicare plan that families must enroll them in. Either way, the subsidies required are very much within our means.
We might even pass the fallback plan first. Then, while we are stymied fighting about how to fix the rest, there'd be at least one generation that could count on something more.
[i]Atul Gawande, a surgeon at Brigham and Women's Hospital and a New Yorker staff writer, is the author of the new book "Better." He is a guest columnist this month.[/i]
@ossobuco,
hell sir how r u i see you read the article the way we age now and i was wondering if you can write me a summary of this article and please help me out i need it for my school and if u can can u send me the summary on my email
[email protected]
ty very much and i need it tommm if u can pleasee thank uu
@prince4lyf,
see if this link works for you -
http://www.newyorker.com/reporting/2007/04/30/070430fa_fact_gawande
If not, you can purchase the article, I think.
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