Louise Aronson wrote ELDERHOOD in order to share her views about "Redefining Aging, Transforming Medicine, and Reimagining Life." Aronson is a geriatrician and professor of medicine at the University of California, San Francisco. She freely admits that "this book doesn't always walk a straight line from here to there" and I did find it to be rather rambling. Plus, since I had a digital preview (with no index and limited formatting), I found added difficulty in following her flow. However, her tone is conversational and comforting as she describes embracing a universal trajectory with a "third act:" childhood, adulthood and then elderhood, "the longest, most varied period of our lives." Aronson's writing is absolutely filled with stories and observations from her own life, and that of her patients and others. Just a smattering of examples would be her "summer of sickness" as a nine-year-old with a ruptured appendix at a sleep-away camp or comments on Bruce Springsteen's view of turning old despite his almost daily three hours of highly physical entertaining in his mid-sixties. Near the end of the text Aronson presents a care paradigm with an outline of ten assumptions (e.g., medicine and healthcare, while often used interchangeably, are not equivalent). It seems that she is inviting reflection and more research. Throughout, she offers a new perspective and acknowledges "powerful thinkers [who] have created an enormous body of work on old age that should have far more influence on our aging lives and policies." Aronson's text is both fact- and story-based, with about ten percent devoted to notes. ELDERHOOD received starred reviews from Kirkus and Publishers Weekly, with the later labeling it "one of the best accounts around of the medical mistreatment of the old."

Louise Aronson subtitles Elderhood with the following: Redefining Aging, Transforming Medicine, Reimagining Life. I submit that she focuses primarily on the second of these topics, rather than the other two. And that makes sense because she has many years of experience as a geriatric physician, much of it in a house calls practice.

I’m a former caregiver to my now deceased parents and a person over 50. When I started reading, I hoped for much more about “living my best life” while also being 50+ than about how poorly the U.S. medical system treats the elderly. Aronson writes a stem to stern indictment of both primary care and specialist physicians, medical training practices, hospitals, their staff, and administrators, as well as everything about nursing homes and home care.

Still, it’s best to go into my own elderhood with my eyes wide open, right? And Aronson definitely provides that. Elderhood taught me a tremendous amount about widely ranging topics. And I do mean widely ranging. I made a list of the topics that have stuck with me since finishing the book.

- The realities of being old or caring for someone who is
- Death and dying—the process and honoring people’s wishes
- The “exceptional” elderly, like Oliver Sacks or the author’s mother
- Ageism and institutional bias in medicine
- Doctoring in geriatrics or gerontology—pathologies and philosophies
- Inequities in physician specialties—in pay and prestige, for example
- Physician burnout, and the part EMR (electronic medical record) plays in it
- Proposals for improvement in medical facilities to better accommodate elders
- Proposals for changing how we care for elders (not necessarily better procedures)
- The author’s internal debates about embracing her graying hair

Structure
Aronson organizes her topics by the stages of life, starting with Conception, Birth, and Childhood, and continuing through various Adulthood and Elderhood stages, then ending with Death. At the same time she discusses her progression from medical student to doctor, to burnout and reinvigorated physician and writer.

Like a densely-layered cake, she adds patient stories to her own life experiences. And then philosophy, history, science, and many other topics. At times the layer cake threatens to topple with the weight of these varied and intense topics. But I progressed, bite by bite, through her book. I recommend taking your time with this one, in order to really absorb her topics.

Had the chapters been arranged by topic, a reader could review those areas whose content appealed or applied to them. Of course, they would then filter the information through their own lens of experience. But ignoring one part means not seeing the entire picture, as Aronson sees it. Her structural decisions force the reader to see elderhood through her lens, with its specificity and diversity.

My conclusions
This isn’t an easy book. And I mean that in terms of both content and style. Reading about age, declining function, bad medical experiences, and good death was ultimately pretty depressing. But everyone ages. There’s no avoiding it, despite rampant anti-aging culture. Aronson provides a valuable perspective, one I’ll recommend to many people.

Aronson’s writing style doesn’t read easily. She’s spent a career reading medical journals and sometimes it shows in the duller sections. Conversely, her ability to tell the highly nuanced patient stories is terrific. And there are definitely moments when it feels like she’s trying to hard to make philosophical connections.

Nevertheless, if you are her intended audience, I think you’ll like Aronson’s book. Elderhood itself is just as complex as this book, so be aware going in. I’m giving it 3.5 stars, for its depth of content if not always its organization and style.

Acknowledgements
Thanks to NetGalley, Bloomsbury USA, and the author for a digital advanced readers’ copy of this book in exchange for this honest review.

Unfortunately, I didn't get a chance to finish this before it was archived, but I did really appreciate what I was able to read through. I love that we have more books entering this field discussing aging and i will absolutely be recommending it aging colleagues.

At over 450 pages, ELDERHOOD, by San Francisco geriatrician Louise Aronson, is a big book. It’s an ambitious one, too. In the opening pages, the author states her intention to highlight relevant information from many disciplines about the last of the three acts in a human life: old age. (Childhood and adulthood are acts one and two respectively.) As the pages turn, several key themes emerge. One is that geriatrics (as a medical specialty) lags behind most others. Caring for the elderly has low status, it is not prioritized by the health-care system, and geriatricians are poorly remunerated relative to other specialties.

Like childhood, old age consists of a number of stages, but people only seem to realize this when they live them. What is generally true, however, is that the medical care of elders needs to be different from that of adults. The heroics, technical fixes, and dedication to saving lives for which modern medicine prides itself are of more benefit to people in the first and second acts of their lives than to those in the third. Insurance companies are another part of the problem. They will reimburse for chemotherapy and dialysis (which can be punishing treatments for the old), but not for basic services that would improve the health and daily functioning of elders with chronic diseases or debilitating conditions. Palliative care and hospice are also grossly underfunded. Clearly, a revolution—a complete system overhaul—is in order. Unfortunately, Dr. Aronson doesn’t offer many ideas as to how this might be achieved..

Since the life span of most in the developed world has essentially doubled over the last century (largely due to advances in public health/sanitation), a lot of us would benefit (when the time comes) from being cared for by a geriatrician, a physician who understands the critical social and psychological dimensions of aging, the changes in physiology that accompany old age, and the ways in which care (including pharmacological treatment) needs to be tailored for safety. An appropriate dose of a drug (for hypertension, depression, or arthritis) for a fifty-year-old can be dangerous, even deadly, for an eighty-year-old.

For me, the strength of Dr. Aronson’s book is in the stories of her interactions with patients at various stages of elderhood. The author uses case studies well to illustrate key points and dilemmas.

In the end, I feel the author attempted a bit too much here. As well as dozens of stories, there are elements of memoir and long sections on the challenges of practising modern medicine—particularly burn-out, from which the author herself suffered. While I did learn a great deal from the book, I believe the audience and topic would have been better served with a briefer, more focused discussion.

Medicine today
has become as much about prevention as well as treatment. It’s at least moving in that direction with many medical doctors today - re- educating themselves in Functional medicine — treating the whole person - looking for root causes rather than treatment alone.

It was only when Louise Aronson, a medical doctor herself - ( beginning in 1992), started having health problems in 2015 - face-to-face with the likelihood of ongoing discomfort and disability, that she began adjusting her new reality -
“her ability to understand how medicine fit into our larger social, cultural, economic, and political worlds became more acute”.

Louise asks:
“If geriatrics adequately addressed old age, wouldn’t the rest of medicine and everyone else have adopted our philosophy and strategies?
Clearly, geriatrics was to
elderhood what we doctors call ‘ necessary but not sufficient’”.
Louise began to wonder what was missing.

This book is the authors attempt to fill in those gaps by looking at old age and new ways.

Many of the stories in Louise’s book and involve people who are old and sick but she makes it clear that this book is about life.

Part of this book didn’t keep my attention… Yet other parts did. I understand that at the beginning of the 20th century Americans rejected metaphysical and cosmological explanations of aging - putting their faith in the biological sciences - yet honestly some parts of this book just felt too heavy handed with historical facts.

After a while I didn’t want to hear names of researchers - or dates.
My interest for ‘everything’ elderhood
was slipping away.

But I am interested in knowing why our health system penalizes hospitals if they don’t fix people quickly -especially when doctors know they are sending sick people home.
I still remember when very sick children with anorexia where sent home before they were close to being well.
Doctors KNEW the child was still sick. MANY of those kids died when they got home.
Much has happened for OLD PEOPLE too... ( forgive me for not using the word Elderhood)... I’m getting sick of the fancy term myself.

It’s not fun feeling that you’re so old that you’re not worth treating. Of course not - but it’s also not a great feeling at any age.

“The Lines between normal and pathological aging and whether science can ‘cure’ aging remain unclear”.
Clear!!!

I’m not sure why I didn’t feel committed to each of the stories...
perhaps it’s my own residence popping up.
I’ll be 67 this month - and in the past few years I have certainly dealt with my share of hospital stays.

At a time when this book should be relevant to me....
I found myself wanting to stop reading.

This is an important book… Well researched... by a qualified expert...
I thought I wanted to read it...
I loved “Being Mortal” years ago by Atul Gawande —
but I’m simply feeling burn-out about everything ‘medical/health/and the discussion of aging’.

I got bored with details about the doctors post baccalaureate premedical program to complete her math and science classes that she had so carefully avoided...

It’s me… It’s not the book. Of course I recognize the diligence in which Louise applied her own inquiry- I respect her for it - about her divide between the goals of health care and the practice of medicine...
but my own mind was fighting reading about it.
I kept reading anyway...
in my snooty mood with all the vices - protein bar - tea - lying on the floor stretching - on the stationary bike - back in bed under my covers -

I honestly rather read a romance novel than read one more book about aging...it’s history, cultural influences, psychological aspects, and all the other sub-fields associated.
Hopefully- it’s only ‘temporary burn out’ - as in hoping I feel invested enough to not drop the ball on my own needs ...
but right now - I wasn’t excited about swiping my kindle ...
other than to quickly get to the end.

I lost heart - lost my caring about Dimitri’s story about Parkinson’s, dementia, and his other chronic diseases.
I was happy when his voice grew stronger - louder - and could sit up after a weeks time - and actually was no longer using a cane...
he even started an affair - the naughty geezer ...
but mostly it was like pulling my own hair out reading this book -
My inner voice was mean —and it’s not fair - I’m aware of ‘my’ problem...not the book..

So I’m rating this book 3 stars - more like a 2 star experience- but much of it was MY LACKING...
but I also feel ‘part’ was the authors, too.
It’s just not a 4 or 5 star. I even found the structure of the book monotonous....
birth, toddler, childhood, adulthood, elderhood, death, and coda....

But I got the message - our healthcare system is in need of improvement!

Thank you Netgalley- Bloomsbury, and Louise Aronson.

Louise Aronson tackles the rampant ageism that is alive and well in the medical field in the US today. She covers how old age has been defined historically and how it has morphed to represent fear and death in current western society. She brilliantly knocks down ageist stereotypes not only in the medical field, but in society as a whole. Elderhood is a collection of stories from Aronson's career working as a geriatrician beginning with her training as a medical professional.

I have never made so many notes in a review copy (good ones!). I immediately pre-ordered a copy and have been recommending this book to all of my colleagues both in the aging field and in "aging adjacent" fields. She so succinctly covers everything that I've been seeing with the older adults I work with and I love that she is able to do it from a field entirely separate from my own.

With approximately 10,000 people turning 65 every day in the United States, this book could not come at a more perfect time. An absolute must read for anyone working working with older adults in any capacity.

Getting old is not easy. I remember geriatric medicine when it was still relatively new back in the early 70's. I'm not surprised much hasn't changed, and I'm a senior now myself. By no means among the ancient, though I have a few friend who are or soon will be. The book is a good overview. Louise Aronson started feeling the aches and pains about the same time I did, I assume, and I most certainly did not think of my self as old, but I was getting an ikling of an idea about aging as time went on.... I think maybe 30 somethings should read this.. Too many of them think they are still teens; I've always viewed 30's as middle aged. it's a prelude to aches and disease that's just around the corner.... great book! Maybe doctors should take a peek, too. I assume most of us will enter these "golden years" so maybe we all should read this book.