How We Age: A Doctor's Journey into the Heart of Growing Old

by Marc E. Argonin

In the tradition of Atul Gawande and Sherwin Nuland, Marc Agronin writes luminously and unforgettably of life as he sees it as a doctor. His beat is a nursing home in Miami that some would dismiss as “God's waiting room.” Nothing in the young doctor's medical training had quite prepared him for what he was to discover there. As Agronin first learned from ninety-eight-year-old Esther and, later, from countless others, the true scales of aging aren't one-sided—you can't list the problems without also tallying the hopes and promises. Drawing on moving personal experiences and in-depth interviews with pioneers in the field, Agronin conjures a spellbinding look at what aging means today—how our bodies and brains age, and the very way we understand aging.

Genres: Nonfiction, Health, Medical, Science, Psychology, Medicine

322 pages, Kindle Edition

First published February 1, 2011

Reviews

[Ellyn Lem · Rating 4 out of 5]

Another compassionate physician who knows how to write. . .just like Atul Gawande. Agronin is a geriatric psychiatrist who knows how to share details that truly humanize the patients he describes, many of whom are Holocaust survivors. It was interesting to read that the trauma of surviving the Holocaust does not help many prepare for old age since as one quote explains, there is no real preparation for that stage of life. I appreciated how the book included interesting anecdotes about famous psychology forefathers, particularly Erik Erickson who we see developing a theory on the last stage of life and, then, being that age himself in the Ivy League classroom when it was not easy. "How We Age" also includes a range of literary sources from Cicero to Bartelby with several poems weaved in as well. Perhaps most moving for me were his reflections on hope and how a doctor is trained to keep on hoping because "giving up" is the opposite of "treatment." His story of a woman in her late 90s who was without hope until her sister came back into her life is a telling example of how we never know what is around the corner and how it may change our attitude and disposition. Powerful stories by a master storyteller.

[Karl F. Schneider · Rating 5 out of 5]

A beautiful book

As I pass the threshold of 65, and begin to think of retirement, I find it easy to be afraid of what is to come, and to be depressed to realize that most of my life is done. More doors are closed, fewer remain open. Dr. Agronin's stories of the men and women he has treated have opened my eyes to the potential before me. Old age may not be for sissies, but life has given us the tools to continue to live meaningful lives, if we allow ourselves to open our hearts and minds. Again, a beautiful book.

[Wren · Rating 5 out of 5]

I'm rating this book among my Top 10 Books on Aging. It has a great mix of approaches to aging from the vantage point of the sciences (the author has a medical degree in psychiatry), the social sciences (he is also well-versed in psychology, history, and sociology), and the humanities (he draws on literature, religion and personal history to focus on the human heart).

Algronin works as a geriatric psychiatrist, serving older adults living in nursing homes. He works with people from all walks of life with all manner of diagnosis. His book alternates between sharing very specific case studies and contextualizing each person's unique journey through the aging process within a philosophical framework.

He meditates on the challenges and benefits of being an older adult. He doesn't shrink from the hardships but he also looks for hope and triumph that can occur in people's final years.

It's a beautiful book because it's smart and heartfelt at the same time. Agronin find beauty and meaning in people's lives -- even those who are difficult to understand or to love. He encourages me to show greater compassion to people of all ages, but particularly for our most mature citizens.

[D · Rating 3 out of 5]

A good book of anecdotes by a deeply caring and sensitive physician. Of course, his job is to keep them alive. However I (a 76-year-old) don't crave a long old age in spite of presently being useful, having friends, and being healthy. When we die, there's either "something" or there's "nothing." So I say, "Aren't you just a little bit curious?"
When the abilities that I have start disappearing and I can't make myself useful, I say "Let Nature take her course."

[Judie · Rating 4 out of 5]

Marc Agronin is a psychiatrist at a nursing home in Miami. In HOW WE AGE, subtitled A Doctor’s Journey into the Heart of Growing Old, he observes “Aging is a process of perpetual change.” How people react to those changes has a great deal influence on the quality of people’s later years.
He states that “Aging is not a disease and thus it cannot be cured.” Even brains will adapt and grow new nerve connections reacting to body changes as they age. Comparing people to cars, he posits that human cells, like automobile parts, eventually fail without proper care and maintenance. However, there is a limit to how much human body parts can be repaired or replaced. In addition, extending people’s lives brings on new problems, such as dementia.
During wartime, young people perform acts of bravery which older people may view as reckless. Youth lives in a state of denial (I’m going to avoid being hurt or killed) and ”may behave impulsively because of a lack of information and experience coupled with poor insight into impending possibilities. Their brain’s frontal lobes have not fully matured allow for excessive risk-taking, aggression, and impulsivity.” In an older person, same denial may cause the person to refuse treatment which might prove beneficial.
Throughout life, people will review their memories. The result is not always the same because of different experiences. It may be similar to parents suddenly realizing they sound and act just like their parents do even though they reacted negatively when they were the child.
Agronin cites Dr. Gene Cohen, “postformal reasoning helps integrate the subjective and objective....and becomes more facile deal[ing] with conflicting opposites .” He continues by quoting Dr. Judith Stevens-Long: “[They] see not only how truth can be a product of a particular system but how the thinker participates in creating the truth.”
He states that aging can be a positive experience, In fact, a 2010 survey showed that levels of well being declined from ages 18-50 than began to improve, peaking at age 85.
He again mentions Dr. Cohen who noted life phases with a surge of energy that promotes new activities and interests. There is the Liberation Phase during the fifties through seventies which provides freedom and creativity for new pursuits. Then comes the Summing-up Phase from the sixties to the nineties which involves searching for larger meaning to life, energized by wisdom and desire to contribute to the world. And the Encore Phase from the late seventies brings about personal reflection and reaffirmation and celebration of the major themes of person’s life
Agronin identifies the “Four Horsemen of Old Age depression, dementia, delirium, destitution” and observes that nearly every case of aging, one or more of these reapers are in attendance. The good news, he states, is “We can do something about each of them.” Even without mental rationality, a person has perception, emotion, and imagination. I had a ward who had advanced dementia when I first met her. She was the happiest person I knew. Each day she would find a friend and walk around the unit holding hands and smiling. Later on, when she lost her ability to walk or speak, she still smiled and tapped her foot when she heard music.
Through stories of his experiences from his days in medical school to the present time, he provides genuine examples of some problems and how they affect not only the elderly person but also the people interacting with that person. For example, he tells a story of a woman who kept complaining about all the bugs in her room. That is a frequent problem with people who have some psychiatric problems and the staff was trying different methods of curing her. Finally, at the doctor’s suggestion, her daughter checked her room and found there really were a lot of bugs there.
In another example, an elderly man had been diagnosed as having Alzheimer’s Disease. When Dr. Agronin met with him, something didn’t seem right about the diagnosis. A series of tests revealed that the man had a brain tumor. He underwent successful surgery, the tumor was benign, and the man returned to a normal status. Many elderly people are labeled as having dementia when they actually suffer from depression, a small stroke, an infection, or a brain tumor. From a personal perspective, I had a ward who had a stroke which left him unable to speak or write. The nursing home where he resided said he had dementia. As his guardian, I was able to determine that he did not have dementia. He couldn’t speak or write, but his brain functioned very well. Elderly people, especially those in nursing homes or hospitals, need advocates to make sure they are receiving appropriate treatment because sometimes the staff, for various reasons, isn’t able to spend enough time with the person to really get to know them and spot errors.
A few weeks ago, I was at a dinner honoring a man who had provided two decades of service to an organization. More than two hundred people were in attendance and the honoree enjoyed meeting with the guests and the recognition he received. Five days later, he died from cancer. It was so nice that all these people could pay their respects while he was still alive. Dr. Agronin also mentions the importance of helping people before their deaths.
Everybody ages. Almost everybody at some point either knows an elderly person is is one. HOW WE AGE offers, in layman’s terms, an insight into what happens to people at that time and how we can make it a positive experience.

[Linda · Rating 4 out of 5]

If you are not yet old but see it coming, this is a good book to help you not panic. If you are already old, not sure it tells you much but at least it still considers older people as worthy. Aging is not for sissys.

[Janet · Rating 3 out of 5]

Not exactly what I expected, more anecdotal than medical/psychological, but important read nonetheless.

[Cathy · Rating 2 out of 5]

A topic of interest but couldn’t get into this book.

[Jean · Rating 3 out of 5]

3.5 stars

[Jay · Rating 4 out of 5]

Written in the voice of compassion for fellow human that is so lacking in today's modern practice of medicine.

[Rae Simpson · Rating 3 out of 5]

Minuteman. His perspective from his practice in Florida. Later book better?

[Emily]

From NPR.com:

any people fear growing old. The multibillion-dollar cosmetic surgery industry alone is a testament to how desperately some Americans cling to the appearance of youth.

But geriatric psychiatrist Marc Agronin has a different perspective — particularly when it comes to mental health. "I don't see aging as a disease," he tells NPR's Rebecca Roberts. "I see this as an inherent part of living ... so the idea of curing it, to me, doesn't make sense."

In his book, How We Age: A Doctor's Journey Into the Heart of Growing Old, Agronin argues that among seniors, mental disorders rarely receive the attention or treatment that they might in younger people.

Society has embraced the concept of hospice care, says Agronin, the idea that, until "the very second that someone's life ends ... we will provide them with as vital and meaningful life as possible."
Cover of 'How We Age'

How We Age: A Doctor's Journey Into The Heart Of Growing Old
By Marc Agronin
Hardcover, 320 pages
Da Capo Press
List price: $25

Read An Excerpt

But hospice care is typically reserved for a person's final days or weeks of life. And there are many older people, says Agronin, who "have years, if not a decade or more, ahead of them. We need to bring that same spirit and that same energy to helping them as well."

Unfortunately, says Agronin, "this is where I'm certain we sometimes fail." When it comes to disorders such as anxiety, depression or even Alzheimer's disease, "we make assumptions that this is simply old age, or this is a disease state that we can't do anything about."

Agronin, psychiatrist at the Miami Jewish Health Systems, treats patients with a wide variety of mental health symptoms — and in some cases, he says the medical community's willingness to regard serious problems as an inevitable part of the aging process can have very serious consequences.

In one case, says Agronin, he saw a patient who had "been completely written off as suffering from very rapidly progressive Alzheimer's disease." The man was losing the ability to speak or to walk. "It would have been quite easy to simply say, this is a man in his early 80s; there's not much we can do; let's prepare for the end."

But after giving the man a full medical workup, Agronin and his team found that the source of the patient's symptoms was actually an operable brain tumor. "He emerged, I would say not 100 percent, but 110 percent from this surgery," Agronin says. "It speaks to the fact that we can sometimes miss very simple things."

Agronin has also been cheered by a growing number of elderly people who are increasingly open to the idea of therapy.
More Stories On Aging
Atul Gawande
Dr. Atul Gawande: Make End Of Life More Humane

The surgeon and New Yorker writer explains the difficulties of caring for incurable patients.
A Better Lifestyle for a Longer Life Feb. 14, 2008
What Science Says About Aging and Depression Sept. 11, 2007

"What's wonderful is to see ... the 80- or 90-year-olds who might in the past have never have considered seeking psychiatric care" come in for both group and individual psychotherapy. Those patients have "learned that there's change that's still possible, regardless of their age."

Agronin recently treated a nonagenarian patient who had been suffering from depression for several years. "He really felt that there was just nothing we could do for him. And indeed I would say, this is probably the way a lot of us look at old age, as if we hit a certain point where change is simply not possible."

But with therapy, says Agronin, his patient has had dramatic results. "Just the other day he came in and said, 'Dr. Agronin, my life has been turned around.' " The patient told Agronin that through individual therapy, he was able to change his outlook on his depression, his marriage and his familial relationships.

"At 96," says Agronin, "for someone to make such a change, should really give all of us incredible hope."

[Kathleen · Rating 5 out of 5]

This book wasn't what I expected when I first saw it. I thought it would be more factual and more about the physicality of aging.

Instead, it's about the brain, which is definitely related to physicality, but this book focuses on emotions, memory, spirituality. Marc Agronin, the doctor who wrote the book, is a psychiatrist who works with elderly clientele in Miami, Florida.

Agronin approaches the elderly people he interacts with daily as part of his job at a nursing home with a profound respect, which is rare. I hope it's not rare within his profession, but it's definitely rare in the outside world. As he writes, "All of us lapse into ... mistaken impressions of old age from time to time. Our mistake stems in part from an age-centric perspective in which we view our own age as the most normal of times, regarding it as representative of how all life should be."

Agronin, ever so gently, with his stories of his conversations with older people -- and Agronin frequently talks to people in their 80s, 90s and beyond -- emphasizes the emotional lives that aren't all that different from those of younger people while also talking about the areas that are different.

I also appreciate the memoir-ish aspects of this book. Agronin talks about medical school, where he learned about anatomy from the donated body of a 90-something woman and where he encountered dismissive attitudes about older and other less functional patients. He describes his relationship with his aging grandfather, also a doctor, as well as his brief interactions with noted psychologist Erik Erikson (who coined the term "identity crisis"), whom Agronin met when he was an undergraduate and Erikson was nearing the end of his life.

It's a lovely book, if marred a little by the misleading title.

[Jen · Rating 3 out of 5]

Through a mix of anecdotes about his patients and interviews with notables in the field of psychology, Dr. Marc Agronin’s How We Age shows the reader that there are still sparks of life even when death is near. Agronin, who serves as the psychiatrist at a large nursing home run by the Miami Jewish Health Systems in Florida, expresses a clear point of view about how patients should be treated with respect and greeted with optimism. In one memorable anecdote, he points out that sometimes an elderly patient who is seeing bugs everywhere really needs an exterminator, not a doctor.
Although Agronin has written other books for health professionals, this one is geared more toward the lay person. Literary and cultural references, including a great deal of poetry, are sprinkled throughout his narrative, creating a writing style that is reflective and easy to read. The book contains lessons for patients and caregivers — and perhaps even some medical professionals. It is recommended for public libraries as well as academic and medical libraries whose clientele are interested in the mental health of geriatric patients. However because many of the cultural references draw heavily from the Judeo-Christian tradition, libraries representing large populations from other religious backgrounds may wish to balance this with additional titles.

- Read and reviewed for LIS 2970: Information Resources, Services and Technology for an Aging World

[Robin A. · Rating 5 out of 5]

I enjoyed this book very much. Dr. Agronin presents both the clinical and his personal view on the process of aging. Without using overwhelming medical jargon, he provides the reader with a unique view on how individuals arrived at his facility, some of their history, and how they did or did not adjust to assisted living or nursing home care.

Sprinkled throughout are references to the history of psychiatry and gerontology. We get a glimpse of how medical science is learning about the brain's functions and disfunctions as it reaches 70, 80, and 90+ years. Dr. Agronin shares his interactions with patients, including some mistaken beliefs about aging.

Some of the information presented is pretty blunt. Statements that caught me by surprise include: "When reduced to objects, the aged don't seem so bad, we reason, because "they" are nut "us;" and, "Pity the person who spends countless hours exercising, eating right, and engaging in any of the imagined saviors of time and age and then prematurely drops dead."

This is a very good book for anyone searching for a better understanding of the aging process.

[Nic · Rating 5 out of 5]

Marc Agronin, superhero of the geriatrics! This new book will surely change the field of geriatric care, for the better; especially, the resigned attitudes commonly held in the treatment of elderly patients. Through personal stories and experiences, Dr. Agronin demonstrates the vitality, dignity, and worth of each patient, until their final moments of life. The point is convincingly made that everyone is deserving of quality care and treatment, until their final days, no matter their age. Another plus, I predict this book may change some of the practices, in medical school, which desensitize doctors regarding individual respect for their patients and their patients' physical bodies. I only hope, that when I'm in my declining years, I have a doctor as talented and caring as Dr. Agronin.

[Nancy · Rating 3 out of 5]

Dr. Agronin is a geriatric psychiatrist at Miami Jewish Health Systems. This series of essays is based on his experiences. Most of his patients are over 70 and Jewish, many holocaust survivors.

I though the title was a bit deceptive. I'd hoped for a lot more "how" and a little less of an attempt to write an Oliver Sacks like book about his patients.

Still, many of the essays are interesting and a not surprising theme does run through many of them: Having friends to talk with and who depend on you makes a huge difference in how a person perceives his or her life, often countering depression better than drugs and talk therapy.

[Christy · Rating 3 out of 5]

After reading this book, I know I would feel privileged to have the author care for my elderly loved ones. And there are some fascinating case studies here that overturn many of our stereotypes about aging and remind us how we often give the elderly short shrift when they deserve the opposite. But I wanted a bit more science and a little less literary license--the prose is rathwe purple at times. All the same, I recommend this book to anyone who enjoys volunteering with and advocating for the elderly. It might be a touch too close to home for anyone who is caring for a struggling older friend or relative at the moment.

[Bobby · Rating 3 out of 5]

Dr Agronin is a geriatric psychiatrist and in this book he mostly presents anecdotes about his patients. He clearly cares about his patients deeply and seems to be an excellent physician. However, I found the book to be lacking in any new insights into the problems or challenges of aging, which I felt was implied by the title. He does touch upon this topic via his anecdotes but he does so in a rather superficial and anecdotal manner. This approach makes for good storytelling for the lay public but those looking for a deeper understanding into this topic will likely not be satisfied.

[Bill · Rating 4 out of 5]

A sobering dose of reality -- but with an ample sprinkling of hope. Written by a wonderful Miami doctor with a deep caring for the aging and aged. An insightful view of what may lie ahead if you continue living into old age, with examples of how others have found meaning or peace amidst poor health, disabilities and dementia.

[Gayle · Rating 5 out of 5]

Everybody should read...we all age and most all of us will care for some one old. Author offers a more balanced look at the last years of life.

I found it hopeful and Dr Agronin writes well.

[Libby · Rating 5 out of 5]

A beautiful, touching book by an incredible psychiatrist who doesn't see medicine as the be-all and end-all of treatment. He is a humanitarian and the whole world is family to him. Unforgettable, hopeful, and inspiring.

[Kitty · Rating 3 out of 5]

I only made it halfway through this book. I was impressed by this doctor's dedication and compassion for his patients. However, I was expecting more of a generalized book on aging and hadn't realized this would all be about psychiatry.

[Michelle Weeks · Rating 3 out of 5]

This book wasn't what I was expecting, but the author was a good writer and it kept my interest. He is a psychiatrist who works with the elderly and it was mostly case studies/stories, not really anything to take away and learn personally from, but interesting to read about.

[Dee · Rating 4 out of 5]

Liked this book very much, but wished the author had expanded on the "How" part. It seemed more anecdotal, but nevertheless interesting to me at age 75 with my mom alive & well at 96. Perhaps he'll write more like this. BTW, IMO, he's a very good writer.

[Loretta Matson · Rating 4 out of 5]

Aging has always been scary, I think. But now what’s scary is being kept alive in a state in which you can’t make all the important decisions yourself! I’m someone who can deal with the truth if I know what it is. I found this book reassuring. Recommended for readers with aging parents.

[Tania · Rating 4 out of 5]

Cmment at time of choosing the book - I love the fact that this book is set in Miami. Although I am a kiwi my first daughter was born there. Book randomly chosen from the multitudes of books about me. More on the read as it goes

[Jess B · Rating 2 out of 5]

The author lost me when he told the story about how he persisted with a patient for the sake of pushing the boundaries of science (v. actually caring for the patient) (the story does have a happy ending).

[GraceAnne · Rating 3 out of 5]

Open-hearted and full of thoughtfulness and tenderness. There is much to learn here.

[Linda · Rating 4 out of 5]

I was expecting medical--this was philosophical. An appreciation of the process of growing old, warts and all...