Simplifier le fardeau de la vieillesse

Sujet austère et tabou s’il en est, le New Yorker nous offre néanmoins un article de fond très intéressant sur ce qu’est devenu l’art de vieillir au début du 21^e siècle (ici). Les perceptions médicale, sociale et personnelle sont couvertes avec brio, notamment en ce qui a trait à l’importance d’axer les priorités sur les détails de la vie d’une personne âgée autonome davantage que sur les aspects qui pourraient à prime abord nous sembler évidents. Extraits :

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“[Jean Gavrilles] was in good condition for her age, but she faced everything from advancing arthritis and incontinence to what might be metastatic colon cancer. It seemed to me that, with just a forty-minute visit, Bludau [her geriatrician] needed to triage by zeroing in on either the most potentially life-threatening problem (the possible metastasis) or the problem that bothered her the most (the back pain). But this was evidently not what he thought. He asked almost nothing about either issue. Instead, he spent much of the exam looking at her feet.

“Is that really necessary?” she asked, when he instructed her to take off her shoes and socks.

“Yes,” he said. After she’d left, he told me, “You must always examine the feet.”

(...)

She was doing impressively well, he said. She was mentally sharp and physically strong. The danger for her was losing what she had. The single most serious threat she faced was not the lung nodule or the back pain. It was falling. Each year, about three hundred and fifty thousand Americans fall and break a hip. Of those, forty per cent end up in a nursing home, and twenty per cent are never able to walk again.

(...)

“The job of any doctor (...) is to support quality of life, by which he meant two things: as much freedom from the ravages of disease as possible, and the retention of enough function for active engagement in the world. Most doctors treat disease, and figure that the rest will take care of itself. And if it doesn’t—if a patient is becoming infirm and heading toward a nursing home—well, that isn’t really a medical problem, is it? To a geriatrician, though, it is a medical problem.”

(...)

In the story of Jean Gavrilles and her geriatrician, there’s a lesson about frailty. Decline remains our fate; death will come. But, until that last backup system inside each of us fails, decline can occur in two ways. One is early and precipitately, with an old age of enfeeblement and dependence, sustained primarily by nursing homes and hospitals. The other way is more gradual, preserving, for as long as possible, your ability to control your own life.

Good medical care can influence which direction a person’s old age will take. Most of us in medicine, however, don’t know how to think about decline. We’re good at addressing specific, individual problems: colon cancer, high blood pressure, arthritic knees. Give us a disease, and we can do something about it. But give us an elderly woman with colon cancer, high blood pressure, arthritic knees, and various other ailments besides—an elderly woman at risk of losing the life she enjoys—and we are not sure what to do.”
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Alors que la population vieillit aussi rapidement qu’elle se fait accroire le contraire, la gériatrie est malencontreusement en voie de devenir une science incorrectement reléguée aux oubliettes par la médecine contemporaine. Au lieu de faire face à l’inévitable, il semble bien que la société d'aujourd'hui préfère se réfugier dans la chirurgie plastique, qui elle connaît une hausse d’intérêt étonnante partout sur le contient. Mais à quel prix ?

“When the prevailing fantasy is that we can be ageless, the geriatrician’s uncomfortable demand is that we accept we are not.”