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Edited by Goerge L. Spaeth, MD

Aging Is No Excuse

Attributing a poor condition to aging is the easy way out and does not serve patients well.


 It must happen at least five times every day in my office. In response to the question, “How are you doing?” or “How’s your energy?” the patient answers, “Oh, not as good as before, of course, because, after all, I am 80!” A variation of this, which happens just as frequently is, “And how well are you seeing?” to which the patient responds, “Well, of course, not as well as before. After all, I am getting older, you know!”

The question inquires about some aspect of health. The answer explains away some type of deterioration by attributing it to “aging.” The question could have been about energy, memory or any number of similar characteristics. The answer is always given in terms that show that the person answering believes that an inevitable part of aging is deterioration, specifically, deterioration to a point that there is significant loss of function.

Nor is it only patients who share this view. Virtually never have I heard a physician challenge such a response from a patient by saying something like, “Wait a minute. You can’t just properly attribute your fatigue to getting older. Fatigue is not a necessary attribute of aging.”

When the odometer rolled past the 200,000 mile mark on my father’s Mercedes, the car looked and ran better than many new cars. How could that be? In the first place, it had good “genes.” It was an excellent car. In the second, it was cared for beautifully. The analogy is totally appropriate for people. Some octogenarians are intellectually brilliant, physically dynamic, still competing in bike races, fathering children, starting new industries, and in other ways being creative, energetic, productive people.

Physicians know, or certainly should know, that there is a marked difference between phenotype and genotype, not just in fruit flies and bacteria but in humans. How we live has a major effect on who we are. We use lifestyle characteristics of the patients frequently to explain why patients “don’t do well.” We physicians ascribe their heart attacks to their “overeating,” their progressive glaucoma to “non-compliance,” and their hypertension to their “type-A personality.”

In years past, before physicians had such powerful surgical and medicinal therapies, their job was largely limited to prognosticating and advising changes in lifestyle. There was little likelihood of a physician trying to substitute “pill for will,” because there were not many effective pills. But how things have changed! Patients who are overweight are advised to take a pill to reduce their appetite, have liposuction to remove the fat, or have a major surgical procedure so they don’t absorb their food. The pharmaceutical industry spends vast sums of money developing products that can be taken once a day rather than four times a day.

Many patients, of course, do not like the thought that they carry a heavy responsibility for determining who they are and whether they are healthy. Knowing that, we physicians are not likely to venture into such discussions. To tell a patient that he needs to alter his lifestyle is both risky and time-consuming. Also, it may not be effective.

For many years physicians tended to act paternalistically, believing they knew what was best for the patient and advising the patient based on that belief. More recently, with the recognition that physicians do not always “know best,” patient autonomy is being emphasized. But helping patients to control their own lives, that is, to act autonomously, is very different from simply doing what it is that the patient wants, such as providing liposuction rather than advice on exercise and a healthy diet, or avoiding discussions that relate to health, but might be difficult. True autonomy demands self-control, and physicians who are truly interested in helping patients become autonomous need to recognize that.

How nice to attribute a symptom such as fatigue to “aging.” It eliminates the physician’s need to search for the cause of the symptom. How easy to overlook that that fatigue might be due to the beta-blocker or alpha agonist that the patient is using for her glaucoma. Were that the cause for the fatigue, it would require changing therapy, perhaps upsetting the patient, perhaps referring the patient for surgery, or some other difficult option. And, though it is also easy for patients to attribute their problems to their family, their spouse or anybody but themselves, “aging” is the best excuse of all! Nobody could possibly question the fact that they are aging.

It is not fair to patients and it is not fair to the medical profession for physicians to be enablers, people who allow themselves or their patients to explain away real problems with convenient untruths, such as, “Well, I am getting older, you know.” 

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