: Perspectives

I started my lecture to a class of graduate nurses studying the "Psychological Aspects of Aging", with the following case presentation:

The patient 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, respond to her own name. I have worked with her for the past six months, but she still shows complete disregard for her physical appearance and makes no effort to assist in her own care. She must be fed, bathed, and clothed by others. Because she has no teeth, her food must be pureed. Her shirt is usually soiled from almost incessant drooling. She does not walk. Her sleep pattern is erratic. Often she wakes in the middle of the night, and her screaming awakens others. Most of the time, she is friendly and happy, but several times a day, she gets quite agitated without apparent cause. Then she wails until someone comes to comfort her.

I asked how the nurses would feel about taking care of such a patient. They used such words as "frustrated," "hopeless," "depressing," and "annoyed." When I said that I enjoyed it and thought they would too, the class looked at me in disbelief. Then I passed around a picture of the patient - my six-month-old daughter.

Why is it so much more difficult to care for a 90-year-old than a six-month-old with identical symptoms? A helpless baby may weigh 15 pounds and a helpless adult 100, but the answer goes deeper than this. The infant, the class and I agreed, represents new life, hope, and almost infinite potential. The aged patient represents the end of life, with little chance of growth. We need to change our perspective. Those who are ending their lives in the helplessness of old age deserve the same care and attention as those who are beginning their lives in the helplessness of infancy.

Paul E. Ruskin, M.D.

Journal of the American Medical Association