The beginning starts with a depressing look at what exactly happens to our body as we age. Not a pretty sight. In subsequent chapters Dr. Gawande goes through what people in their declining years have endured: Poor houses in 1912 that housed elderly paupers along with out of luck people, drunks and those mentally ill.
Studies were done in later years of those over the age of 70. Half a group was assigned geriatric nurses and doctors and the others referred to their own usual physicians. Those with the geriatric group were 25% less likely to become disabled or develop depression. Unfortunately the successful study conducted by the University of Minnesota, rather than encourage further care through their geriatric group, was followed by the closure of that division of their hospital which they said was too costly to continue.
One experiment at Chase Memorial Nursing Home called The Eden Project brought in dogs, cats and birds and found that by introducing animals caused a 50% drop in prescription drugs and deaths fell by 15%.
A 1908 Harvard philosopher, Josiah Royce, wrote that we need more than being housed and fed. We need to seek a cause beyond ourselves: a building project, a family or pet - we need loyalty.
NewBridge Nursing Home had a different approach and has set up small "households" with 14-16 residents. Residents of the home also work as tutors and school librarians for a school that shares its grounds. When studying WWII, the children were able to speak with veterans at the home. They jointly hold shows, musical performances and fitness classes.
The book also discussed care versus hospice in terminal cases. In most cases people will take whatever action a doctor suggests for a few more months of life often with horrendous side effects from drugs or treatments rather than managing pain and dying peacefully. Ironically, studies have shown that those choosing hospice care had a longer survival rate of 3 months - 3 years.
In the epilogue, the author notes that doctors concentrate on survival not well-being. The question, the author says should be asked when considering surgery or life prolonging medications (along with the side effects) is: What are the trade offs you are willing or not willing to take? What are your fears and what are your hopes?
