Authors: Atul Gawande
5
Across not just the United States: A. Kellehear,
A Social History of Dying
(Cambridge University Press, 2007).
6
The late surgeon Sherwin Nuland: S. Nuland,
How We Die: Reflections on Life’s Final Chapter
(Knopf, 1993).
1: THE INDEPENDENT SELF
1
Even when the nuclear family: P. Thane, ed.,
A History of Old Age
(John Paul Getty Museum Press, 2005).
2
one child usually remained: D. H. Fischer,
Growing Old in America: The Bland-Lee Lectures Delivered at Clark University
(Oxford University Press, 1978). Also C. Haber and B. Gratton,
Old Age and the
Search for Security: An American Social History
(Indiana University Press, 1994).
3
the poet Emily Dickinson: C. A. Kirk,
Emily Dickinson: A Biography
(Greenwood Press, 2004).
4
surviving into old age was uncommon: R. Posner,
Aging and Old Age
(University of Chicago Press, 1995), see ch. 9.
5
They tended to maintain their status … Whereas today people often understate: Fischer,
Growing Old in America
.
6
In America, in 1790: A. Achenbaum,
Old Age in the New Land
(Johns Hopkins University Press, 1979).
7
today, they are 14 percent: United States Census Bureau,
http://quickfacts.census.gov/qfd/states/00000.html
.
8
In Germany, Italy, and Japan: World Bank,
http://data.worldbank.org/indicator/SP.POP.65UP.TO.ZS
.
9
100 million elderly: “China’s Demographic Time Bomb,”
Time
, Aug. 31, 2011,
http://www.time.com/time/world/article/0,8599,2091308,00.html
.
10
As for the exclusive hold: Posner, ch. 9.
11
increased longevity has brought: Haber and Gratton, pp. 24–25, 39.
12
Historians find that the elderly … The radical concept of “retirement”: Haber and Gratton.
13
Life expectancy: E. Arias, “United States Life Tables,”
National Vital Statistics Reports
62 (2014): 51.
14
Family sizes fell: L. E. Jones and M. Tertilt, “An Economic History of Fertility in the U.S., 1826–1960,”
NBER Working Paper Series
, Working Paper 12796, 2006,
http://www.nber.org/papers/w12796
.
15
The average age at which: Fischer, appendix, table 6.
16
“intimacy at a distance”: L. Rosenmayr and E. Kockeis, “Propositions for a Sociological Theory of Aging and the Family,”
International Social Science Journal
15 (1963): 410–24.
17
Whereas in early-twentieth-century America: Haber and Gratton, p. 44.
18
The pattern is a worldwide one: E. Klinenberg,
Going Solo: The Extraordinary Rise and Surprising Appeal of Living Alone
(Penguin, 2012).
19
Just 10 percent: European Commission,
i2010: Independent Living for the Ageing Society
,
http://ec.europa.eu/information_society/activities/ict_psp/documents/independent_living.pdf
.
20
Del Webb: J. A. Trolander,
From Sun Cities to the Villages
(University Press of Florida, 2011).
2: THINGS FALL APART
1
trajectory of our lives: J. R. Lunney et al., “Patterns of Functional Decline at the End of Life,”
Journal of the American Medical Association
289 (2003): 2387–92. The graphs in this chapter are adapted from the article.
2
By the middle of the twentieth century: National Center for Health Statistics,
Health, United States, 2012: With Special Feature on Emergency Care
(Washington, DC: U.S. Government Printing Office, 2013).
3
People with incurable cancers … The curve of life becomes a long slow fade: J. R. Lunney, J. Lynn, and C. Hogan, “Profiles of Older Medicare Decedents,”
Journal of the American Geriatrics Society
50 (2002): 1109. See also Lunney et al., “Patterns of Functional Decline.”
4
Consider the teeth: G. Gibson and L. C. Niessen, “Aging and the Oral Cavity,” in
Geriatric Medicine: An Evidence-Based Approach
, ed. C. K. Cassel (Springer, 2003), pp. 901–19. See also I. Barnes and A. Walls, “Aging of the Mouth and Teeth,”
Gerodontology
(John Wright, 1994).
5
the muscles of the jaw lose: J. R. Drummond, J. P. Newton, and R. Yemm,
Color Atlas and Text of Dental Care of the Elderly
(Mosby-Wolfe, 1995), pp. 49–50.
6
By the age of sixty: J. J. Warren et al., “Tooth Loss in the Very Old: 13-15-Year Incidence among Elderly Iowans,”
Community Dentistry and Oral Epidemiology
30 (2002): 29–37.
7
Under a microscope: A. Hak et al., “Progression of Aortic Calcification Is Associated with Metacarpal Bone Loss during Menopause: A Population-Based Longitudinal Study,”
Arteriosclerosis, Thrombosis, and Vascular Biology
20 (2000): 1926–31.
8
Research has found that loss of bone density: H. Yoon et al., “Calcium Begets Calcium: Progression of Coronary Artery Calcification in Asymptomatic Subjects,”
Radiology
224 (2002): 236–41; Hak et al., “Progression of Aortic Calcification.”
9
more than half of us: N. K. Wenger, “Cardiovascular Disease,” in
Geriatric Medicine
, ed. Cassel (Springer, 2003); B. Lernfeit et al., “Aging and Left Ventricular Function in Elderly Healthy People,”
American Journal of Cardiology
68 (1991): 547–49.
10
muscle elsewhere thins: J. D. Walston, “Sarcopenia in Older Adults,”
Current Opinion in Rheumatology
24 (2012): 623–27; E. J. Metter et al., “Age-Associated Loss of Power and Strength in the Upper Extremities in Women and Men,”
Journal of Gerontology: Biological Sciences
52A (1997): B270.
11
You can see all these processes: E. Carmeli, “The Aging Hand,”
Journal of Gerontology: Medical Sciences
58A (2003): 146–52.
12
This is normal: R. Arking,
The Biology of Aging: Observations and Principles
, 3rd ed. (Oxford University Press, 2006); A. S. Dekaban, “Changes in Brain Weights During the Span of Human Life: Relation of Brain Weights to Body Heights and Body Weights,”
Annals of Neurology
4 (1978): 355; R. Peters, “Ageing and the Brain,”
Postgraduate Medical Journal
82 (2006): 84–85; G. I. M. Craik and E. Bialystok, “Cognition Through the Lifespan: Mechanisms of Change,”
Trends in Cognitive Sciences
10 (2006): 132; R. S. N. Liu et al., “A Longitudinal Study of Brain Morphometrics Using Quantitative Magentic Resonance Imaging and Difference Image Analysis,”
NeuroImage
20 (2003): 26; T. A. Salthouse, “Aging and Measures of Processing Speed,”
Biological Psychology
54 (2000): 37; D. A. Evans et al., “Prevalence of Alzheimer’s Disease in a Community Population of Older Persons,”
JAMA
262 (1989): 2251.
13
Why we age: R. E. Ricklefs, “Evolutionary Theories of Aging: Confirmation of a Fundamental Prediction, with Implications for the Genetic Basis and Evolution of Life Span,”
American Naturalist
152 (1998): 24–44; R. M. Zammuto, “Life Histories of Birds: Clutch Size, Longevity, and Body Mass among North American Game Birds,”
Canadian Journal of Zoology
64 (1986): 2739–49.
14
The idea that living things shut down: C. Mobbs, “Molecular and Biologic Factors in Aging,” in
Geriatric Medicine
, ed. Cassel; L. A. Gavrilov and N. S. Gavrilova, “Evolutionary Theories of Aging and Longevity,”
Scientific World Journal
2 (2002): 346.
15
average life span of human beings: S. J. Olshansky, “The Demography of Aging,” in
Geriatric Medicine
, ed. Cassel; Kellehear,
A Social History
.
16
As Montaigne wrote: Michel de Montaigne.
The Essays
, sel. and ed. Adolphe Cohn (G. P. Putnam’s Sons, 1907), p. 278.
17
inheritance has surprisingly little influence: G. Kolata, “Live Long? Die Young? Answer Isn’t Just in Genes,”
New York Times
, Aug. 31, 2006; K. Christensen and A. M. Herskind, “Genetic Factors Associated with Individual Life Duration: Heritability,” in J. M. Robine et al., eds.,
Human Longevity, Individual Life Duration, and the Growth of the Oldest-Old Population
(Springer, 2007).
18
If our genes explain less: Gavrilov and Gavrilova, “Evolutionary Theories of Aging and Longevity.”
19
Hair grows gray: A. K. Freeman and M. Gordon, “Dermatologic Diseases and Problems,” in
Geriatric Medicine
, ed. Cassel, 869.
20
Inside skin cells: A. Terman and U. T. Brunk, “Lipofuscin,”
International Journal of Biochemistry and Cell Biology
36 (2004): 1400–4; Freeman and Gordon, “Dermatologic Diseases and Problems.”
21
The eyes go: R. A. Weale, “Age and the Transmittance of the Human Crystalline Lens,”
Journal of Physiology
395 (1988): 577–87.
22
the “rectangularization” of survival: Olshansky, “The Demography of Aging.” See also US Census Bureau data for 1950,
http://www.census.gov/ipc/www/idbpyr.html
. Additional data from Population Pyramid online,
http://populationpyramid.net/
.
23
We cling to the notion of retirement: M. E. Pollack, “Intelligent Technology for an Aging Population: The Use of AI to Assist Elders with Cognitive Impairment,”
AI Magazine
(Summer 2005): 9–25. See also Federal Deposit Insurance Corporation,
Economic Conditions and Emerging Risks in Banking: A Report to the FDIC Board of Directors
, May 9, 2006,
http://www.fdic.gov/deposit/insurance/risk/2006_02/Economic_2006_02.html
.
24
Equally worrying: Data on certifications in geriatrics from American Board of Medical Specialties and American Board of Internal Medicine.
25
350,000 Americans fall and break a hip: M. Gillick,
The Denial of
Aging: Perpetual Youth, Eternal Life, and Other Dangerous Fantasies (
Harvard University Press
,
2006
).
26
Several years ago, researchers at the University of Minnesota: C. Boult et al., “A Randomized Clinical Trial of Outpatient Geriatric Evaluation and Management,”
Journal of the American Geriatrics Society
49 (2001): 351–59.
27
In a year, fewer than three hundred doctors: American Board of Medical Specialties, American Board of Psychiatry and Neurology; L. E. Garcez-Leme et al., “Geriatrics in Brazil: A Big Country with Big Opportunities,”
Journal of the American Geriatrics Society
53 (2005): 2018–22; C. L. Dotchin et al., “Geriatric Medicine: Services and Training in Africa,”
Age and Ageing
41 (2013): 124–28.
28
The risk of a fatal car crash: D. C. Grabowski, C. M. Campbell, and M. A. Morrissey, “Elderly Licensure Laws and Motor Vehicle Fatalities,”
JAMA
291 (2004): 2840–46.
29
in Los Angeles, George Weller: J. Spano, “Jury Told Weller Must Pay
for Killing 10,”
Los Angeles Times
, Oct. 6, 2006,
http://articles.latimes.com/2006/oct/06/local/me-weller6
.
3: DEPENDENCE
1
In 1913, Mabel Nassau: M. L. Nassau,
Old Age Poverty in Greenwich Village: A Neighborhood Study
(Fleming H. Revell Co., 1915).
2
Unless family could take such people in: M. Katz,
In the Shadow of the Poorhouse
(Basic Books, 1986); M. Holstein and T. R. Cole, “The Evolution of Long-Term Care in America,” in
The Future of Long-Term Care
, ed. R. H. Binstock, L. E. Cluff, and O. Von Mering (Johns Hopkins University Press, 1996).
3
A 1912 report: Illinois State Charities Commission,
Second Annual Report of the State Charities Commission
, 1912, pp. 457–508; Virginia State Board of Charities and Corrections,
First Annual Report of State Board of Charities and Corrections
, 1909.
4
Nothing provoked greater terror: Haber and Gratton,
Old Age and the Search for Security
.
5
the case of Harry Truman: M. Barber, “Crotchety Harry Truman Remains an Icon of the Eruption,”
Seattle Post-Intelligencer
, March 11, 2000; S. Rosen,
Truman of Mt. St. Helens: The Man and His Mountain
(Madrona Publishers, 1981). Two bands have put out songs inspired by Truman: R. W. Stone’s 1980 country rock hit, “Harry Truman, Your Spirit Still Lives On,”
http://www.youtube.com/watch?v=WGwa3N43GB4
, and Headgear’s 2007 indie rock single, “Harry Truman,”
http://www.youtube.com/watch?v=JvcZnKkM_DE
.
6
In the middle part of the twentieth century: L. Thomas,
The Youngest Science
(Viking, 1983).
7
Congress passed the Hill-Burton Act: A. P. Chung, M. Gaynor, and S. Richards-Shubik, “Subsidies and Structure: The Last Impact of the Hill-Burton Program on the Hospital Industry,” National Bureau of Economics Research Program on Health Economics meeting paper, April 2013, http://www.nber.org/confer/2013/HEs13/summary.htm.
8
Meanwhile, policy planners: A key source for the history of nursing homes was B. Vladeck,
Unloving Care: The Nursing Home Tragedy
(Basic Books, 1980). See also Holstein and Cole, “Evolution of Long-Term Care,” and records from the City of Boston and its almshouse: https://www.cityofboston.gov/Images_Documents/Guide%20to%20the%20Almshouse%20records_tcm3–30021.pdf.
9
As one scholar put it: Vladeck,
Unloving Care
.
10
The sociologist Erving Goffman: E. Goffman
Asylums
(Anchor, 1961). Corroborated by C. W. Lidz, L. Fischer, and R. M. Arnold,
The Erosion of Autonomy in Long-Term Care
(Oxford University Press, 1992).
4: ASSISTANCE