In this chapter, Gawande explains some of the physical effects of aging on our bodies from a medical perspective. It was both difficult and eye-opening to read; difficult to realize that many of these changes will soon become manifest in my own life, and eye-opening to understand what causes these changes.
For example, our brains shrink.
[A]t the age of thirty, the brain is a three-pound organ that barely fits inside the skull; by our seventies, gray-matter loss leaves almost an inch of spare room. That’s why elderly people are so much more prone to cerebral bleeding after a blow to the head—the brain actually rattles around inside.
The first places to shrink are areas that house memory and critical thinking, which explains why older adults may have trouble remembering things and also be more prone to falling victim to scams.
The most poignant point so far is his observation that we often feel the need to apologize for the physical limitations imposed by the natural aging process. Instead of accepting and accommodating the changes, we often push ourselves to maintain the activity level of our younger selves. And when we fall short, we feel as though we have failed.
I run into this with my own mother. She often expresses frustration with her limitations, and I can sympathize. At half her age, I already recognize ways I have begun to slow down physically. I can no longer jump up on counters and now rely on a stepstool. I’m unable to garden or cook all weekend and still be functional on Monday at work.
And on some level I recognize but cannot fully relate to, she is facing the end of life in a stark and unvarnished way that only someone who has outlived her family and spouse can face. I can’t help her with that; I can only, I hope, listen and provide a compassionate presence.
The questions then remain: how do we support aging individuals while also accommodating their increasing needs? How do we help people remain as independent as possible given their physical and cognitive limitations? How do we create a structure that brings the old and variously infirm together with the younger and less aware in healthy and rewarding ways? How do we learn to live with long life?