Elderhood: Redefining Aging, Transforming Medicine, Reimagining Life

by Louise Aronson

As revelatory as Atul Gawande's Being Mortal, physician and award-winning author Louise Aronson's Elderhood is an essential, empathetic look at a vital but often disparaged stage of life.

For more than 5,000 years, "old" has been defined as beginning between the ages of 60 and 70. That means most people alive today will spend more years in elderhood than in childhood, and many will be elders for 40 years or more. Yet at the very moment that humans are living longer than ever before, we've made old age into a disease, a condition to be dreaded, denigrated, neglected, and denied.

Reminiscent of Oliver Sacks, noted Harvard-trained geriatrician Louise Aronson uses stories from her quarter century of caring for patients, and draws from history, science, literature, popular culture, and her own life to weave a vision of old age that's neither nightmare nor utopian fantasy--a vision full of joy, wonder, frustration, outrage, and hope about aging, medicine, and humanity itself.

Elderhood is for anyone who is, in the author's own words, "an aging, i.e., still-breathing human being."

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

453 pages, Kindle Edition

First published June 11, 2019

About the author

Louise Aronson is a writer, leading geriatrician, educator, professor of medicine at the University of California, San Francisco (UCSF) and the author of the New York Times bestseller Elderhood: Redefining Aging, Transforming Medicine, and Reimagining Life. A graduate of Harvard Medical School and the Warren Wilson Program for Writers, Dr. Aronson has received the Gold Professorship in Humanism in Medicine, the California Homecare Physician of the Year award, and the American Geriatrics Society Clinician-Teacher of the Year award. Her writing appears in publications including The New York Times, Washington Post, Discover Magazine, JAMA, Bellevue Literary Review and the New England Journal of Medicine and has earned her four Pushcart nominations, the Sonora Review Prize, and a MacDowell fellowship. Her work has been featured on TODAY, CBS This Morning, NPR’s Fresh Air, Politico, LitHub, Kaiser Health News, and Tech Nation.

Reviews

[Elyse Walters · Rating 3 out of 5]

Medicine today
has become as much about prevention as well as treatment. It’s at least moving in that direction with many medical doctors today - re- educating themselves in Functional medicine — treating the whole person - looking for root causes rather than treatment alone.

It was only when Louise Aronson, a medical doctor herself - ( beginning in 1992), started having health problems in 2015 - face-to-face with the likelihood of ongoing discomfort and disability, that she began adjusting her new reality -
“her ability to understand how medicine fit into our larger social, cultural, economic, and political worlds became more acute”.

Louise asks:
“If geriatrics adequately addressed old age, wouldn’t the rest of medicine and everyone else have adopted our philosophy and strategies?
Clearly, geriatrics was to
elderhood what we doctors call ‘ necessary but not sufficient’”.
Louise began to wonder what was missing.

This book is the authors attempt to fill in those gaps by looking at old age in new ways.

Many of the stories in Louise’s book involve people who are old and sick but she makes it clear that this book is about life.

Part of this book didn’t keep my attention… Yet other parts did. I understand that at the beginning of the 20th century Americans rejected metaphysical and cosmological explanations of aging - putting their faith in the biological sciences - yet honestly some parts of this book just felt too heavy handed with historical facts.

After a while I didn’t want to hear names of researchers - or dates.
My interest for ‘everything’ elderhood
was slipping away.

But I am interested in knowing why our health system penalizes hospitals if they don’t fix people quickly -especially when doctors know they are sending sick people home.
I still remember when very sick children with anorexia where sent home before they were close to being well.
Doctors KNEW the child was still sick. MANY of those kids died when they got home.
Much has happened for OLD PEOPLE too... ( forgive me for not using the word Elderhood)... I’m getting sick of the fancy term myself.

It’s not fun feeling that you’re so old that you’re not worth treating. Of course not - but it’s also not a great feeling at any age.

“The Lines between normal and pathological aging and whether science can ‘cure’ aging remain unclear”.
Clear!!!

I’m not sure why I didn’t feel committed to each of the stories...
perhaps it’s my own residence popping up.
I’ll be 67 this month - and in the past few years I have certainly dealt with my share of hospital stays.

At a time when this book should be relevant to me....
I found myself wanting to stop reading.

This is an important book… Well researched... by a qualified expert...
I thought I wanted to read it...
I loved “Being Mortal” years ago by Atul Gawande —
but I’m simply feeling burn-out about everything ‘medical/health/and the discussion of aging’.

I got bored with details about the doctors post baccalaureate premedical program to complete her math and science classes that she had so carefully avoided...

It’s me… It’s not the book. Of course I recognize the diligence in which Louise applied her own inquiry- I respect her for it - about her divide between the goals of health care and the practice of medicine...
but my own mind was fighting reading about it.
I kept reading anyway...
in my snooty mood with all the vices - protein bar - tea - lying on the floor stretching - on the stationary bike - back in bed under my covers -

I honestly rather read a romance novel than read one more book about aging...it’s history, cultural influences, psychological aspects, and all the other sub-fields associated.
Hopefully- it’s only ‘temporary burn out’ - as in hoping I feel invested enough to not drop the ball on my own needs ...
but right now - I wasn’t excited about swiping my kindle ...
other than to quickly get to the end.

I lost heart - lost my caring about Dimitri’s story about Parkinson’s, dementia, and his other chronic diseases.
I was happy when his voice grew stronger - louder - and could sit up after a weeks time - and actually was no longer using a cane...
he even started an affair - the naughty geezer ...
but mostly it was like pulling my own hair out reading this book -
My inner voice was mean —and it’s not fair - I’m aware of ‘my’ problem...not the book..

So I’m rating this book 3 stars - more like a 2 star experience- but much of it was MY LACKING...
but I also feel ‘part’ was the author, too.
It’s just not a 4 or 5 star. I even found the structure of the book monotonous....
birth, toddler, childhood, adulthood, elderhood, death, and coda....

But I got the message - our healthcare system is in need of improvement!

Thank you Netgalley- Bloomsbury, and Louise Aronson.

[CanadianReader · Rating 3 out of 5]

At over 450 pages, ELDERHOOD, by San Francisco geriatrician Louise Aronson, is a big book. It’s an ambitious one, too. In the opening pages, the author states her intention to highlight relevant information from many disciplines about the last of the three acts in a human life: old age. (Childhood and adulthood are acts one and two respectively.) As the pages turn, several key themes emerge. One is that geriatrics (as a medical specialty) lags behind most others. Caring for the elderly has low status, it is not prioritized by the health-care system, and geriatricians are poorly remunerated relative to other specialties.

Like childhood, old age consists of a number of stages, but people only seem to realize this when they live them. What is generally true, however, is that the medical care of elders needs to be different from that of adults. The heroics, technical fixes, and dedication to saving lives for which modern medicine prides itself are of more benefit to people in the first and second acts of their lives than to those in the third. Insurance companies are another part of the problem. They will reimburse for chemotherapy and dialysis (which can be punishing treatments for the old), but not for basic services that would improve the health and daily functioning of elders with chronic diseases or debilitating conditions. Palliative care and hospice are also grossly underfunded. Clearly, a revolution—a complete system overhaul—is in order. Unfortunately, Dr. Aronson doesn’t offer many ideas as to how this might be achieved..

Since the life span of most in the developed world has essentially doubled over the last century (largely due to advances in public health/sanitation), a lot of us would benefit (when the time comes) from being cared for by a geriatrician, a physician who understands the critical social and psychological dimensions of aging, the changes in physiology that accompany old age, and the ways in which care (including pharmacological treatment) needs to be tailored for safety. An appropriate dose of a drug (for hypertension, depression, or arthritis) for a fifty-year-old can be dangerous, even deadly, for an eighty-year-old.

For me, the power of Dr. Aronson’s book is in the stories of her interactions with patients at various stages of elderhood. The author uses case studies well to illustrate key points and dilemmas.

In the end, I feel the author attempted a bit too much here. As well as dozens of stories, there are elements of memoir and long sections on the challenges of practising modern medicine—particularly burn-out, from which the author herself suffered. Furthermore, the book is rather meandering overall; the headings and subheadings often seem quite unrelated to the content; and the author addresses some topics multiple times. Organization is not a strength. While I did learn a great deal from the book, I believe the audience and topic would have been better served with a briefer, more focused discussion.

[Jill · Rating 5 out of 5]

Anyone who is already old, caring for someone old, or intending to grow old in the near or distant future needs to read this book. Now! And that not only includes readers; it also includes policy-makers.

Elderhood is not a “how-to” book that treads over the same old tired ground. Rather, it’s a book that tackles why aging must be understood and redefined and why the medical establishment’s usual goals of saving lives and curing disease is misplaced and ill-advised in many older patients.

I’m going to pause a moment in this review to say that I was the point person for my own once vibrant elderly mother, who died at age 93 after a 10-year downward spiral. I saw first-hand how healthcare, well-meaning though it was, often acted counterintuitively. Dr. Aronson makes many excellent points including these:

*All top-ranked health systems on the planet rely on primary care to keep people healthy. In the U.S., ranked 37th among nations by the World Health Organization, we have trouble recruiting physicians to primary care since those doctors are paid on average over $100,000 less than specialists. As a result, we focus on high-tech solutions rather than commonsense ones.

*Pharmaceutical trials focus mostly on middle-aged, not elderly, targets. As a result, the side effects in the elderly are often minimized or glossed over entirely. Moreover, many older patients (my mom was one of them) are prescribed multiple drugs that interact with each other and cause more harm than good.

*It is easier for the elderly to get a cochlear implant than a hearing aid or laser treatments instead of eyeglasses. Yet a simple “fix” can do wonders by providing the elderly with a healthier, fully-engaged life.

*Being “old” should not be classified as 65+. In reality, people in the Third Age of life (the young-old) have vast differences in health, activities and consumer roles. They are very distinct from the “old-old” who are truly infirm and dependent.

*Successful aging is possible for those who do not perceive meaning in aging itself, but instead, perceive meaning in being themselves in old age. Adaptability and self-acceptance are key.

I could go on and on – just about every page has insights on how we, as a society, can reimagine life and why it’s crucial to do so, since someone who is 65 years old and relatively healthy will very likely live to 90. This well-written, easily accessible book should be mandatory for anyone entering medical school or politics, and certainly for every person who is affected by aging (i.e., all of us).

[Antigone · Rating 5 out of 5]

On April 21, 2020, the Los Angeles Times ran an article that included the following:

California has made progress in protecting the healthcare system from a dramatic spike of sick patients during the COVID-19 pandemic.

But state public health officials are still planning for a "worst-case scenario," quietly publishing a sobering set of detailed guidelines to answer the troubling ethical question of who lives and who dies should California face a new surge in the coronavirus outbreak, resulting in a shortage of ventilators and medical supplies.

A 38-page document by the California Department of Public Health, published last week-end, prescribes a method of prioritizing patients in the event that an outbreak overwhelms hospitals, preserving intensive care beds and ventilators for people with the greatest likelihood of surviving with treatment over those with serious chronic conditions that limit their life expectancy. If necessary, younger people and workers who are "vital to the acute care response" would receive care before others.

Upon reading this, I thought to share some concerns with my governor in a letter which began:

"Certainly you can see how jarring such information might be to a constituency that has been tasked with setting aside their livelihoods to shelter in place; with sacrificing their freedom of movement, their access to goods and services, their financial well-being and their peace of mind ostensibly for the benefit of 'the most vulnerable among us' when, in fact, our health care system plans to abandon those very individuals when the going gets tough."

It appears I was not alone in my concern. The document was pulled for re-consideration - which resulted, sadly, in mere re-wording and was not a satisfactory result at all. This stands, however, as evidence of the deep entrenchment of policy in the field of medicine; a reality which makes it beyond difficult to reach and address the implicit bias folded within.

I understand the rationale behind battlefield triage; the husbanding of resources; the direction of time, energy and supplies to those patients who have the best chance of survival. But it merits mention that we are not on a battlefield anymore. While the metaphor remains active it is largely unsustainable, begging as it does the recognition that we are no longer dealing with military recruits between the ages of eighteen and thirty-five who, prior to the injury that brought them to an operating table, were certified as physically fit for service. We are dealing, instead, with a country-wide population - few of whom would physically qualify for military duty. And I do wonder why we haven't thought to train a team of medical professionals who specialize in the care of those who are more vulnerable to illness and face a steeper climb to the recovery of their health. Why we don't, automatically, account for this eventuality in crisis medicine and prepare ourselves to launch that (currently non-existent) arm of health care into action - assigning time, allotting energy, and procuring supplies for this specific contingent of the population as a matter of course. Lest we imagine that group of people so small as to prove not worth the trouble, I would turn to the words of the head of the Los Angeles Department of Public Health - who has gone to great pains to assert that fully one-in-three of the residents of this city possess the "underlying conditions" that would slot them for rejection should our hospitals find themselves overwhelmed.

These concerns of mine found tremendous resonance in the work I've just read.

Louise Aronson's Elderhood addresses the plight of some of the most vulnerable among us, and the difficulties they face when it comes to a health care system that simply isn't designed to adequately meet their needs. Aronson is a Harvard-educated geriatrician and professor of medicine at the University of California, San Francisco. Her book, this book, was in the running for the Pulitzer. It is a magnificent (if troubling) assessment of the care currently available to the elderly in America, housed within the memoir of her professional career. She presents the stories of many patients, the systemic problems those stories illuminate; the why and the how and the path to possible solutions - all in a remarkably engaging and humanizing way.

"The most difficult part of patient care of any kind is dealing with the hardest parts of what it means to be human. But ask most people about their most significant, challenging, and worthwhile experiences in life, and most will name hard parts, from raising children to the death of a loved one. Hard isn't, of itself, a bad thing. What is bad is when, through avoidance, judgment, tradition, or neglect, we fail to do our best addressing problems that will affect almost all of us eventually, directly or indirectly. How much better and richer would life be for all of us in a society that cared for a ninety-two-year-old for the simple reason that the ninety-two-year-old is a human being, and we care about human beings."

This is not dry discourse. But it is sad in parts, and true throughout, and deserves the attention of anyone who plans to live to a ripe old age...if only to prepare you for what you'll find once you get there.

[India M. Clamp · Rating 3 out of 5]

There is an impending tragedy facing our culture today (2030). The lives of those who nurtured us, carried us within, sacrificed for us and who gave us their own milky sustenance---so we could live---are now being cared for in ways contradicting basic care. Outcomes are most taxed for minorities and men.

"Disease in man is never exactly the same as disease in an experimental animal, for in man the disease at once affects and is affected by what we call the emotional life (and, I would add, social environment)."
—Louise Aronson

Dr. Louise Aronson in "Elderhood: Redefining Aging, Transforming Medicine, Reimagining Life" ignites a candle so we may come to know the plight of disguised angels---needing basic care. Walks in the neighborhood and watchful eyes recognize these ambulating angels (Hans J. Klien) and how they still offer great wisdom, utility and care in our community. Care and SES are correlated.

[Barbara (The Bibliophage) · Rating 3 out of 5]

Originally published on my book blog, TheBibliophage.com.

Louise Aronson subtitles Elderhood with the following: Redefining Aging, Transforming Medicine, Reimagining Life. I submit that she focuses primarily on the second of these topics, rather than the other two. And that makes sense because she has many years of experience as a geriatric physician, much of it in a house calls practice.

I’m a former caregiver to my now deceased parents and a person over 50. When I started reading, I hoped for much more about “living my best life” while also being 50+ than about how poorly the U.S. medical system treats the elderly. Aronson writes a stem to stern indictment of both primary care and specialist physicians, medical training practices, hospitals, their staff, and administrators, as well as everything about nursing homes and home care.

Still, it’s best to go into my own elderhood with my eyes wide open, right? And Aronson definitely provides that. Elderhood taught me a tremendous amount about widely ranging topics. And I do mean widely ranging. I made a list of the topics that have stuck with me since finishing the book.

- The realities of being old or caring for someone who is
- Death and dying—the process and honoring people’s wishes
- The “exceptional” elderly, like Oliver Sacks or the author’s mother
- Ageism and institutional bias in medicine
- Doctoring in geriatrics or gerontology—pathologies and philosophies
- Inequities in physician specialties—in pay and prestige, for example
- Physician burnout, and the part EMR (electronic medical record) plays in it
- Proposals for improvement in medical facilities to better accommodate elders
- Proposals for changing how we care for elders (not necessarily better procedures)
- The author’s internal debates about embracing her graying hair

Structure
Aronson organizes her topics by the stages of life, starting with Conception, Birth, and Childhood, and continuing through various Adulthood and Elderhood stages, then ending with Death. At the same time she discusses her progression from medical student to doctor, to burnout and reinvigorated physician and writer.

Like a densely-layered cake, she adds patient stories to her own life experiences. And then philosophy, history, science, and many other topics. At times the layer cake threatens to topple with the weight of these varied and intense topics. But I progressed, bite by bite, through her book. I recommend taking your time with this one, in order to really absorb her topics.

Had the chapters been arranged by topic, a reader could review those areas whose content appealed or applied to them. Of course, they would then filter the information through their own lens of experience. But ignoring one part means not seeing the entire picture, as Aronson sees it. Her structural decisions force the reader to see elderhood through her lens, with its specificity and diversity.

My conclusions
This isn’t an easy book. And I mean that in terms of both content and style. Reading about age, declining function, bad medical experiences, and good death was ultimately pretty depressing. But everyone ages. There’s no avoiding it, despite rampant anti-aging culture. Aronson provides a valuable perspective, one I’ll recommend to many people.

Aronson’s writing style doesn’t read easily. She’s spent a career reading medical journals and sometimes it shows in the duller sections. Conversely, her ability to tell the highly nuanced patient stories is terrific. And there are definitely moments when it feels like she’s trying to hard to make philosophical connections.

Nevertheless, if you are her intended audience, I think you’ll like Aronson’s book. Elderhood itself is just as complex as this book, so be aware going in. I’m giving it 3.5 stars, for its depth of content if not always its organization and style.

Acknowledgements
Thanks to NetGalley, Bloomsbury USA, and the author for a digital advanced readers’ copy of this book in exchange for this honest review.

[Darryl · Rating 4 out of 5]

I first heard about this book while I listened to an episode of Fresh Air with Terry Gross on my local National Public Radio station last year. Dr Aronson is a geriatrician on the faculty of the School of Medicine at the University of California, San Francisco, and because I was fascinated with her comments and insights about the care of elderly patients during the interview I purchased this book shortly afterward.

Louise Aronson was a nontraditional medical student, as she majored in history in an undergraduate college that did not require its students to take maths or sciences. She volunteered in a camp for South East Asian refugees, and observing doctors who worked in the camp was influential in her desire to become a physician. She trained in internal medicine, and her love of older people led her to specialize in geriatric medicine.

'Elderhood' is a multifaceted reexamination of old age, from the vantage points of not only medicine and science, but also history, anthropology, literature and popular culture. Aronson uses vignettes of patients who have come under her care, and her own elderly parents, to effectively demonstrate the substandard care that many older people receive in the U.S. health care system, and the medical and non-medical interventions that can help them lead better and more productive lives. She also explores the failings of modern medicine and the larger society as a whole in their treatment of the elderly. She notes that medical schools in the U.S. provide very little education about the field of geriatrics to their students, and due to the emphasis on curative over caring medicine, technological and pharmaceutical interventions over patiently listening to the stories of the elderly, subspecialty care over holistic approaches, and the disparity in pay between generalists and specialists, geriatrics is viewed as a far lesser field of medicine by medical faculty, residents, and students alike. As a result there is a severe shortage of geriatricians practicing in the United States, which is a major barrier in ensuring that most older people receive adequate medical care.

She makes a strong case for dividing older people into groups, based on their age (early, middle and advanced old age), similar to the distinctions between infants, toddlers, young children, tweens and adolescents in pediatrics. There is a huge difference between a healthy working 60 year old, a retired 75 year old with chronic but manageable health conditions living independently, and a 90 year old suffering from advanced dementia who is wheelchair bound and living in a nursing home. And, not all elderly people of similar ages are the same. We all know people in their 60s who could run circles around us, and at the same time others of the same age who will likely die soon. Serious illnesses like cancer can quickly transform an active and healthy septugenerian into a markedly aged person, and many of us have watched as a seemingly invincible older parent, relative or close friend transforms into a frail elderly adult in seemingly the blink of an eye.

Aronson describes the barriers she has faced from her immediate supervisors and the UCSF administration in trying to provide care to her patients, and that combined with her growing physical problems led to a severe case of burnout. Her frustrations with UCSF's electronic medical record system and with administrative bureaucracy match those that nearly all physicians face at some point in their careers, but she successfully overcame them and designed a workplace that was both personally fulfilling and beneficial to her elderly patients.

'Elderhood' is a refreshing, insightful and holistic analysis of the elderly from different disciplines, both within and outside of medicine, and is an excellent addition to written work about this increasingly more important population in Western societies. I was personally somewhat disappointed, though, as I unfairly expected 'Elderhood' to focus primarily on the medical aspects of the care of the elderly, and assist me in caring for my octogenarian parents. The different topics covered in this book made it seem somewhat disjointed, and her repeated insistences that elderly people need to be respected and treated differently by the medical community in particular and society at large was overkill. Despite my criticisms I highly recommend this book to medical professionals, and to those who are or soon will care for elderly parents or relatives, or enter elderhood themselves

[Sam · Rating 4 out of 5]

The author criticizes flaws and limitations in present medical care from the point of view of an elder care physician, with multiple personal and professional examples to support her argument. Recommended for those with little education on the topic since it will affect all of us.

[Elissawolf · Rating 2 out of 5]

While I completely agree with the points that the author is making, it feels waaaayyyy too drawn out. Yes. We (as a society) need to take better care of our beloved seniors. Yes. They absolutely need someone to advocate for them and to help them negotiate the ridiculous amount of red tape that has turned the American health care system into the dumpster fire that it is. But this reads more like a memoir of all the evils of our health care system, over and over and over. Ten members of our book club read it.....but all of them freely admitted that they just COULDN’T read it all, and skipped much of it, because it was just too tedious for a layman. Perhaps better suited for medical professionals.

[Steve · Rating 2 out of 5]

I was disappointed in this book. There was little new here for me. This book was 400 pages of stating the obvious, a rehash of multiple other books on the subject and very tedious repetition. The author repeats the premise of the book multiple, multiple times. The elderly are not treated well by the healthcare delivery system. We get it. The other reason I didn’t like this book is because the author indulges in WAY too much information and description about herself, her trials & tribulations and personal emotional struggles. That’s not why I bought this book. I wanted to learn something new about how the elderly can negotiate the medical industry. Instead I was subjected to 400 pages of repetitive anecdotes making the same point over and over and about the author’s personal problems. This book is a self-indulgent memoir and not the thoughtful analysis of being elderly in America, the way it was described. I will not recommend this book to anyone.

[Bob H · Rating 5 out of 5]

This is a sensitively written account of Dr. Aronson's career in geriatrics -- an autobiography centered on her life experience and medical career -- and a critique of geriatrics, US medicine generally and of how our society deals with aging. Along the way, she shows us a medical system almost caste-ridden in its hierarchy of specialties, in which geriatrics is low-rated, as well as US medicine's fragmented approach to patients, funding, medical training and hospital vs. home care generally. She tells of the shortcomings -- horrors, sometimes -- in senior acute care and senior facilities. She talks about the gap between doctors' objectivity and simply "not caring", and in the wider view, what she terms a lack of imagination.

There's some unexpected revelations. She tells of the very real hazard of doctor burnout, something she suffered as a sudden "snap", as she put it, after long and rising tensions in her work. She has much insight into palliative and end-of-life care, what it could be and what it often is. She writes frankly, and with empathy, of her own patients' and her parents' aging and suffering. She takes the larger view of medicine, the US ranking at 38th in the world, 50% of its doctors at risk of burnout.

Much of it is upbeat. She accepts the inevitability of aging and death -- hers, her parents, in lifespan generally, and speaks of it as something that can be more natural and serene than it often is. She talks of robotics as an emerging help, and possible problem, in geriatrics and senior care. She shows that a patient-centered care model, as opposed to care fragmented by department and specialty, as something that can enhance aging patients' needs.

For all its length, the book reads fairly quickly, even if much of it can be sad. Her prose is warm, empathetic, often enthralling, and usually direct. It's all written in a way that laypeople can understand, and empathize. It's also something that anyone in the business of providing care of any sort to seniors, or in the medical profession generally, would do well to read, and ponder. And, the book speaks with a voice, her voice, someone the reader might like to know, and befriend. Highest recommendation.

(Read in advance-reading copy from Amazon Vine).

[Keeley · Rating 5 out of 5]

Louise Aronson tackles the rampant ageism that is alive and well in the medical field in the US today. She covers how old age has been defined historically and how it has morphed to represent fear and death in current western society. She brilliantly knocks down ageist stereotypes not only in the medical field, but in society as a whole. Elderhood is a collection of stories from Aronson's career working as a geriatrician beginning with her training as a medical professional.

I have never made so many notes in a review copy (good ones!). I immediately pre-ordered a copy and have been recommending this book to all of my colleagues both in the aging field and in "aging adjacent" fields. She so succinctly covers everything that I've been seeing with the older adults I work with and I love that she is able to do it from a field entirely separate from my own.

With approximately 10,000 people turning 65 every day in the United States, this book could not come at a more perfect time. An absolute must read for anyone working working with older adults in any capacity.

[Kathleen Flynn]

This book has some of my favorite things: Good writing. A doctor thinking about what it means to be a doctor, and telling interesting stories about her patients. Reflections on aging, dying, and the purpose of life.

Did I mention good writing? Elderhood was a pleasure to read, and I recommend to anyone who is currently old, taking care of someone old, or planning to be old one day.

[Cindy · Rating 2 out of 5]

While there were things I learned and liked about this book, it is a disorganized mess.

[Geri chesner · Rating 5 out of 5]

I heard Louise Aronson on NPR talking about this book last summer. Due to my interest in working with elderly persons related to nurturing their creativity, I checked this book out of the library. I read it, slowly, learning so much from it.

I have had the book and have renewed it the maximum number of times- for 12 weeks. The book is due today and I have just successfully finished it and am happy that I spent the weeks (three months really) taking the time with it. This is a book that has not only taught me so much, but has helped me to change my worldview and misconceptions about aging. I love reading my old journals from the past and seeing the exact moments or time in my life when my ideas and perspectives were formed or changed. This book, and the notes in my current journal about it, will be something I look back at in years to come and feel this was a turning point for my beliefs and appreciation.

I really appreciated Aronson's focus on "history, literature, philosophy, anthropology, sociology and stories as to science."(p. 403) This made her research and writing and ultimate message so grounded for me. I was continually amazed at how much important research (medical, philosophical, literature and memoir) and reading went into writing this book and I am left with a list of references that I would like to follow up with.

Aronson's book is now on my short list of books that have influenced me and allowed me to spend much quality time learning and appreciating the message and also the well written form and talent of the author. Now to get the book back to the library before I get fined after having it for the allowable time!

[Abby · Rating 5 out of 5]

“In the twentieth century, American medicine became more interested in cosmetics and catastrophes than in promoting and preserving human health and well-being. In the twenty-first century, it worships machines, genes, neurons, hearts, and tumors, but cares little about sanity, walking, eating, frailty, or suffering. It values adults over the young and old, and hospitals and intensive care units over homes and clinics. It prioritizes treatment over prevention, parts over wholes, fixing over caring, averages over individuals, and the new over the proven.”

Clear, compassionate, and urgently needed. As people who all plan on getting to elderhood, this book strikes me as essential reading for all Americans who need to prepare themselves to navigate the pitfalls of our nation’s medical system and the ways that it does serious (even life-threatening) disservice to the elderly. Louise Aronson, as a geriatrician, is perfectly poised to sound this call, and she’s also a talented writer, which makes the whole project even more compelling and persuasive. Highly recommended. I am tempted to buy a copy for our parents right now...

[Annie · Rating 3 out of 5]

Aronson reminds us that beauty is defined as “a quality of a person or thing that gives pleasure to the senses or pleasurable exalts the mind and the spirit.”

I think this book has helped me articulate what beauty has been drawing me to geriatrics lately. the elderly are peak representation of humanity: vulnerable, imposing, intimate, humbling and humbled.

Great case studies and review of social history provide enriching context.

Maybe one out of every 5 pages there was a sentence I had to reread like 10 times to understand which interrupted the flow unfortunately. Maybe I’m just stupid though heh.

Took me a little over a month to finish so slightly marathon. Sometimes she gets on a moral podium and yaps (loquaciously pontificates) there for too long, though I understand the urge to vent on the American health system.

Where my humanity girls at??

[Lisa · Rating 5 out of 5]

If you are over 50, run, walk, or hobble if you have to in order to read this book, and switch ASAP to a geriatrics practice if you are over 65 and want a doctor who will look at your entire life and all your chronic conditions rather than focusing on fixing your presenting problem without looking at the big picture. If you are under 50 but love someone who is over 50, you should read this book, too.

Aronson is a geriatrician (a doctor for older adults, just as a pediatrician is a doctor for children). She tells her own story in the context of the way we treat and provide health care to older adults in our society. We think that getting old is something to be avoided (as though we could) and think of "old" as the very frail elderly (people in their 80s and 90s or even older who are struggling with a lot of conditions). Actually, "elderhood" includes the young-old (say, 60s and part of the 70s) as well as the old-old, and where you land in those categories in terms of functionality depends on your genes, how well you have been able to take care of yourself through exercise, diet, and getting treatment for life's vicissitudes, how much support you have, and the luck of the draw.

We would do better to treat elderhood as the third phase of a life that includes childhood, adulthood, and elderhood. Nonetheless, in America these days people are terrified of getting or looking old (witness all the hair-dying and transplanting and all the products designed to keep you looking 30 when you are 60--and witness how well they work and how much time and money are wasted on them). Many people don't want to have anything to do with the elderly, for the most part, and so many things that could be designed to make life easier for those who are experiencing some of the problems of aging (this means you, eventually) are not so designed, whether in building design or healthcare practice or presentation of the aging in the media or not having almost everything in the world be in 4-point type--my current pet peeve.

Those who care for the elderly are often untrained and underpaid. Those who love the elderly have no idea how to help them as they get older. And so many people think physical death is the worst thing that could happen to a person, whereas a neglected, abused, lonely, undignified, radically unhealthy, or demented old age could be better avoided and death recognized as a natural and sometimes welcome part of life when a person's time comes, if only we would help people who are experiencing some of the problems that come with age. Too often medical providers and family members believe they must do everything medically possible, even if the tests, treatments, and hospitalization are going to make the patient's life miserable and actually deprive him or her of functionality and ability to enjoy life during the remaining time. Aronson skillfully and humanely makes the case for changing the way we view elderhood at the personal, professional, governmental, and policy levels. I just turned 65, and my first appointment with my new doctor--a geriatrician--is in a couple of weeks. READ THIS BOOK.

[David · Rating 4 out of 5]

My response to this book is complicated by the fact that it is too long (and the structure is terrible). The book is a badly jumbled and repetitive mess of memoir, social critique, good ideas for how to think about aging, and how medicine could be different. With judicious editing, this book could have used all the same elements, been half as long, had much more impact for readers, and thus reached many more people who really need this message. I feel that it is a terrible missed opportunity. But I urge anyone over 40 to read at least some of it, and if you have any connection to medicine, nursing, or social work, please check it out no matter what your age. (Having said all that, I'd love to meet the author. She's obviously a great person, trying hard to make a difference in this messed-up world, and I'd just like to say "Thank you" to her about a million times.)

As a book editor myself, I know that sometimes things work out this way, and a book is only good when it could have been great. So, if you have time, by all means read this book, I suspect it will be very rewarding, start to finish. If you don't have that much time, but are curious, maybe read a bit of the beginning, and then jump to the Elderhood section. That's what I ended up doing, when I realized that the strangely jumbled and repetitive nature of the content made it too tiring to continue through 400 pages.

If I had time, I'd copy whole pages into this review, but I don't have time for that. However, on page 378, the author presents 10 assumptions she'd like to see in a new health care paradigm. They seem repetitive to me, but I wonder if that is because they are basically going up against all the basic assumptions of our current approaches, so the ideas really need to be hammered home from different angles. I'll share a few of my favorites:

5. When we make data all that matters, we often count what can be counted rather that what counts (with thanks to Albert Einstein).
7. Separating the medical from the human leads to a separation of the medical from the human.
10. The primary goal of medicine is optimization of patient health.

Now that last one may seem obvious to anyone outside the USA, but those of us in the USA can tell you that is not the primary goal of medicine in this country. The primary goal in this country is increasing the profits of the insurance industry (and Big Pharma). This is not to say that any medical providers want it to be that way, only that it is that way. We can change that, but whether we will or not is still an open question. Vote in those midterms, friends, it matters!

[Lynn · Rating 4 out of 5]

My father is 98, his wife is 85. His wife of 60 years (my mother) died in 2008. Five month’s later, after “courting” her just a few times, he proposed to his present wife. They married five months later once they found a date that would accommodate all their distant children. They traveled, partied, ate out most of the time, and went to the theater & symphony until, after almost 8 good years, my dad had a massive heart attack at age 95. His doctor told us Dad wouldn’t survive, but he did. However, he has rapidly declined since then and now sleeps most of the time. His wife has developed dementia and is legally blind. They see a vast variety of doctors, all working for different heath “care” entities, and so their medical care is completely uncoordinated.

After a serious fall (one of many previous, I learned) they reluctantly moved to assisted living. After just 2 months, they were evicted from that facility for non-compliance (Dad wasn’t taking care with his urinary catheter and his wife was sneaking OTC meds into their apartment). They are now both in an extended care facility, but they hate it and believe they don’t need to be there with all those old, decrepit other folks. They intend to go back home, despite a complete lack of understanding of what would be required for them to manage this.

To people who do not see them regularly (their accountant and lawyer) or outside of social situations, they both seem “fine”. We are told they are doing very well by the extended care staff. To me, with Dad’s obvious memory lapses and his wife’s flights of fancy, they appear to have lost the capacity to make rational decisions about their care. Dad complains that he feels terrible, but when asked if he has discussed this with the doctors, his angry response is “what would I say?” Their extended care facility does have a certified geriatrician on staff, but she is a recent immigrant to the US and speaks heavily accented English that Dad cannot understand...or relate to.

I read Aronson’s book to try to reach a better understanding of the situation, both with their own care needs and with the limitations of the American heath care system. What I read is encouraging for the long term, but very frustrating in the short term. From hundreds of miles away, there seems to me that there is little I can do at this point to improve their quality of life.

[Jill Meyer · Rating 4 out of 5]

I'll admit I was a bit disappointed in Dr Louise Aronson's new book, "Elderhood: Medicine, Society, and Life's Third Act". I thought it would be a bit more practical and cover specific topics about aging. Instead, the book is really a series of essays about Dr Aronson's introduction and then choice to specialise in gerontology.

Now, that's not a bad direction for a book, and Dr Aronson's a pretty good writer. I enjoyed her writing on the various stages of life - as she sees them - beginning with "Birth" and ending about 90 years later with "Death". The reader meets those in Childhood, Adulthood, Middle Aged, and Senior, finishing up with Aged. Will we all reach "Aged"?

Dr Aronson's book is a great choice for general reading on gerontology. I think all of us will catch a glimpse of themselves or ones we love in her pages.

[Brett · Rating 3 out of 5]

As someone interested in geriatric medicine, the author was already preaching to the choir. She makes clear how prevalent ageism is in our society and healthcare system. Unfortunately, I found the book hampered by repetitive points and some meandering ideas. I find a book like “Being Mortal” by Atul Gwande is able to communicate similar ideas in a more focused manner. This book is still a good starting point for discussing how we can better address aging and death in our society both for the sake of our current elders and our future selves.

[Stephanie Lynn · Rating 3 out of 5]

Listen, we're all going to grow old and die one day, at least I'm hoping to be afforded such an opportunity. It doesn't have to be a miserable experience. The world that we're building now is the one that we will inhabit in the future. We need to do better, not just for the older adults that are alive right now, but for the ones that we are planning to become.
A great many topics were covered in this book that centered on the experience of aging in America through the lense of an award winning Geriatrician. Working as a Social Worker in a geriatric primary care practice, it spoke to me on many levels, often times repeating sentiments I express to my colleagues on a daily basis.
Fair warning, this book is dense, at times seeming to be a never ending stream of academic consciousness. Take it in strides, but read it you must. It took me nine weeks to get through it, with a big push this last week (mainly because I've run out of library renewals). There were also times when I didn't much care for the overall organization that sometimes meandered here, there and everywhere without clear transitions. But it was worth it. I highly recommend it to anyone caring for older adults, in any capacity, or anyone that hopes to be one some day. Our future depends on it.

[Lisa]

This book is living in my head rent free and I’m not sure what to make of it. I read it slowly along with other books on dying and aging and it made me think a lot about my parents and in laws and myself. It also made me mad at modern medicine and our entire society. I think my challenge with the book is how loose and unorganized it was. There was no progression (even tho the chapter titles make it seem like there will be). At least half are her own experiences being a doctor and her deep frustration with that. Her anger at her colleagues and profession make it hard sometimes to read through it for information or knowing what is actually possible. But I was confronted with how much more we should be adapting to aging, to my own prejudices. Do I see older people as ugly when I could see them as cute, for instance? I can’t tell what she’s saying for sure about care for the dying (though she makes it clear we need to think more now about aging because we conflate it with dying and more people are talking today about dying). On the one hand, we shouldn’t not care for people because they are old, and on the other hand we are doing too much medically for them and not letting them die. It is super complex and she doesn’t avoid it or give easy answers. In fact, no answers other than we should be discussing this.

[Julia Nock · Rating 5 out of 5]

This is a wonderful book about the intersection of the later stages of life, medicine, and society. Just as children are not simply, as once thought, small adults, but a time of life with its own developmental stages and needs, so aging is an articulated time of life with a broad spectrum of stages and a complex diversity of presentation. Aronson, a geriatrician, uses stories of patients, her own family, and her path in medical training and practice to show how we as a society and as individuals can begin to imagine ways to approach this time of life with dignity, recognizing its specific needs, and seeing elderhood as a valued and rewarding part of life. Essential for anyone trying to navigate the treacherous waters of medical care for oneself or others as we/they age. Important reading for everyone.

[Gijs Limonard · Rating 4 out of 5]

Highly anecdotal, the narrative tends to meander a lot but does include an abundance of interesting patient stories; the book incrementally grows on you; slowly but surely the admirable and interesting subject is properly fleshed out.

[Donna · Rating 4 out of 5]

Excellent, conversational in tone, and erudite in execution. Filled with examples of how aging patients are viewed and devalued by the medical establishment. Should be required reading for anyone with aging parents and definitely medical school students who won't have time to read it.

[Farid Medleg · Rating 2 out of 5]

I really wanted to love this book. I did my best. As a newly minted geriatrician, I brought this on my graduation trip to read in preparation for staff life. I was sorely disappointed. In short, Dr. Aronson needs a new publisher and a new editor. The book is meandering and excruciatingly repetitive. It also tries to do too much, at once trying to be a historical exposé, op-ed, social commentary, rallying cry, and memoir.

There are section titles, chapter titles, chapter subheadings, and large paragraph breaks. The utility of all of these remains unclear, even after having finished the book. Dr. Aronson, parallels this infrastructure with elements of her career throughout the book, but even the clear chronological structure of this element vanishes in the middle 200 pages. I was also very thrown by the overuse of introductory clauses and sentences. There is absolutely no flow to this book.

Structure and grammar aside, the content is disappointing. Dr. Aronson clearly believes medicine fails in the service of older adults, as does society, that we need to reimagine aging both in clinical and social terms, and that we need to treat elders with more dignity. I agree on all fronts, but it didn't need 400 pages.

I was hoping that a book by a doctor and historian would be illuminating, fact-laden, and incisive. Instead, it read more like a series of shower thoughts that could have been fit into 100 pages.

I appreciated the effort to be socially progressive, but she outs two undocumented workers in one section, all while patting herself on the back that she didn't turn them in. My anger was surpassed only by my incredulity.

I recognize that thousands of people have read this book and felt enlightened and inspired. It should also go without saying that Dr. Aronson is a pillar in her community and has undoubtedly benefited the lives of thousands of patients. I just lament the missed opportunity for a profession and discipline that could have been put on the map with such a wide-reaching platform.

[Sandy Brehl · Rating 4 out of 5]

This is a weighty book, in length, complexity, and content. The anecdotal examples throughout lift the reading and make it more digestible and human, applying statistical and medical and societal realities to individual lives.
I tend to plow through books or pass on them, but this is one worth reading a chapter or two per day, and i've already recommended it to friends and relatives of many ages. One of the reviews below indicated that it is an important read for anyone who is now aging, nearing aging, has aging dependents or loved ones, , or expects to age in then future.
Well, duh- in case you didn't notice, that means ALL of us. each of whom will read it from different prerspectives, but gain greatly in the reader's grasp of the current state of life patterns and the likely future for themselves and those they care about. The recommendation for anyone with political power should also read it extends to those with roles as spiritual advisors, medical students and practicioners, community planners, etc.
There are more and more books surrounding these topics, but this one feels like its author has the most gravitas to address the subject fully and with authority.

[Carlos · Rating 3 out of 5]

Although the book could certainly have been shorter, most of the stories Aronson tells are interesting enough to keep the reader’s attention. She interweaves her formative years in medical school, her family’s history with elder relatives and the many, many stories of the elder patients she saw in her geriatric practice. She shares with the reader her observations of how society as a whole and medical school in particular, neglect the due attention for this stage of life that is growing both as a share of the population and as a share of people’s lives. The book contains observations in everything from beauty standards, medical care, family live, adult caregivers, retirement homes, hospice and much more. While not as full of hands-on practical advice as I would have liked, the book is wonderfully informative and thought-provoking as to our personal and familial relationship to elderhood she describes.