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The End of Old Age: Living a Longer, More Purposeful Life

Yale Medicine Magazine, 2018 - Spring


A couple of years ago, Marc E. Agronin, MD ’91, attended a friend’s 50th birthday party. One of the gifts was Dr. D. Crepit’s Over the Hill Survival Kit, which included “50 sucks” lollipops and a bag of marbles for the “old geezer” being feted, who had presumably lost his.

Agronin, a geriatric psychiatrist, was dismayed by a gift that ridiculed old people. “How would we react to a similar gag gift that denigrated one’s gender, ethnicity, or religious identity?” Agronin asks in his new book, The End of Old Age: Living a Longer, More Purposeful Life.

“If, already at 50, we’re putting down aging, it’s sending a negative message from the get-go,” Agronin said in a recent interview. “It doesn’t allow us to think about aging in terms of the power it can give us.”

Agronin asks his readers to reject the idea that each year after midlife portends nothing more than loss. “We have to look at aging in a more positive light. It’s not a Pollyannaish approach; it’s more accurate. If we measure creativity, purpose, and wisdom, we see enormous increases with age.”

Agronin grounds his optimism in the 20 years he spent as a clinician and researcher at Miami Jewish Health Systems, a large long-term care provider in retiree-rich South Florida. Agronin believes that an affirmative picture of old age can be self-fulfilling. “There is an increasing body of research showing that such elements as a positive attitude and a sense of purpose are as powerful as diet and exercise in improving health, wellness, and longevity,” says Agronin, who directs mental health services and the Alzheimer’s disease clinical research program at Miami Jewish Health. “This mind-body connection is really profound. To a large extent, we age to our expectations.”

Seeking enjoyment despite diminishing abilities can take people in surprising directions. Agronin tells the story of a woman with Parkinson’s disease who at 85 was depressed and listless, unwilling to try new activities. Then one day, hearing music, the woman began to dance. She joined a Zumba class that welcomed disabled people, and dancing opened a door: she became more agile and animated.

Another story: After cancer surgery, a bedridden man of 71 suffered months of pain and hallucinations. He began to draw on the wall beside his bed and to cut shapes from colored paper. That man, artist Henri Matisse, went on to create his famous cutouts and to design the Chapelle du Rosaire de Vence (Chapel of the Rosary) in Vence, France—which some art critics call his masterpiece. Matisse told a friend: “I have needed all that time to reach the stage where I can say what I want to say. ... Only what I created after the illness constitutes my real self: free, liberated.”

Even lesser mortals can call upon their “wise selves” as they age. Agronin delineates five embodiments of wisdom: the savant, who passes on knowledge; the sage, who provides advice and mediates conflicts; the curator, who provides care and support (often to grandchildren); the creator, who takes risks while finding novel approaches to art and other endeavors; and the seer, who shows exceptional gratitude and spirituality.

The 52-year-old Agronin discovered geriatric psychiatry during his first year at the School of Medicine, on a rotation with associate clinical professor of psychiatry Alan Siegal, MD. Agronin noticed that Siegal and his colleagues did more than push through lists of clinical tasks. “Staff working with the elderly often by necessity have to be more patient, gentler, have to spend more time developing a relationship,” says Agronin. “In a flash, I decided I wanted to go into geriatric psychiatry.”

He acknowledges that growing old means facing loss. But people can use the challenges of aging as tools for reinvention. When we do that, Agronin writes, “our strengths burst forth.”