A Different Perspective on Aging and Caring
by Paul E. Ruskin, MD
I was invited to present a lecture to a class of graduate nurses who were studying the "Psychological Aspects of Aging." I started my lecture with the following case presentation:
"The patient is a white female who appears her reported age. She neither speaks nor comprehends the spoken word. Sometimes she babbles incoherently for hours on end. She is disoriented about person, place and time. She does, however, seem to recognize her own name. I have worked with her for the past six months, but she still doesn't recognize me.
"She shows complete disregard for her physical appearance and makes no effort whatsoever to assist in her own care. She must be fed, bathed and clothed by others. Because she is toothless, her food must be pureed; because she is incontinent of both urine and stool, she must be changed and bathed often. Her shirt is generally soiled from almost constant drooling. She does not walk. Her sleep pattern is erratic. Often, she awakens in the middle of the night, and her screaming awakens others.
"Most of the time she is very friendly and happy. However, several times a day she gets quite agitated without apparent cause. Then she screams loudly until someone comes to comfort her."
After the case presentation, I asked the nurses how they would feel about taking care of a patient as the one described. They used words such as, "frustrated," "hopeless," "depressed," and "annoyed" to describe how they would feel.
When I stated that I enjoyed taking care of her and that I thought they would too, the class looked at me in disbelief. I then passed around a picture of the patient: my six-month-old daughter. After the laughter had subsided, I asked why it was so much more difficult to care for a ninety-year-old patient, than a six-month-old with identical symptoms.
We all agreed that it's physically easier to take care of a helpless baby weighing 15 pounds than a helpless adult weighing 100 pounds, but the answer seemed to go deeper than this.
The infant, we all decided, represents new life, hope, and almost infinite potential. The demented senior citizen, on the other hand, represents the end of life with little potential for growth.
We need to change our perspective. The aged patient is just as lovable as the child. Those who are ending their lives in the vulnerability of old age deserve the same care and attention as those who are beginning their lives in the vulnerability of infancy.