Marc E. Agronin

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.… (mais)

Publishers Weekly
Geriatric psychiatrist Agronin (Alz-heimer Disease and Other Dementias) draws on stories of his patients to examine the gifts of wisdom and experience that come through loss. Literate, generous, and compassionate, Agronin's ground-level view of aging (most of his patients at a large Miami nursing home are nonagenarians) opposes the current spate of books attempting to turn back the clock and preserve physical youth. Rather, Agronin argues for accepting, understanding, and appreciating aging as a nonreversible, frequently debilitating, but valuable condition. He sweetens sobering accounts of human development theorist Erik Erikson's dementia; a Czech woman whose husband and children were killed by the Nazis; a Native American Korean War vet suffering from post-traumatic stress disorder; a drug- and alcohol-addicted, bipolar millionaire, and others with instances in which they were able to find meaning and comfort through new challenges and the creative interplay of memory and imagination involved in life review. Throughout, Agronin is critical of impersonal "standard of care" even in seemingly hopeless situations. Referencing poetry, plays and parables, he makes an art of caring for the aged by restoring dignity to a dehumanized but growing segment of the population. (Feb.)… (mais)