Experience is an Arch: geriatric medicine, older people and ageing

Dick Sainsbury has decades of experience in geriatric medicine – first as a medical officer, then as a consultant physician, and more recently as a researcher. His new book All Experience is an Arch, brings together all his knowledge in a collection of writing about geriatric medicine, older people and ageing. Dick provides a brief insight into what we can expect from the book and what drove him to write it.

Every person has their own life story which is unique to them. I have always encouraged older people to record interesting stories of their lives but sadly some are reluctant. They often say, ‘But no-one else would be interested’, when the reverse is true. It is good that an increasing number of older people are writing stories, particularly of their childhood, for their grandchildren. In my recently published book, All Experience is an Arch I discuss the value of narrative in the medical care of patients. It helps the health team to obtain a fuller picture of the person as a whole. We can learn a great deal from Māori about the central position of oral history.

I have written the book to discuss some of the issues involved in the health care of older people from my perspective of over 45 years as a consultant geriatrician. In doing so, I have used anecdotes and case vignettes about some of the many memorable older people that I have met. I have also considered older people who I have encountered in novels, short stories, and poetry. I believe that literature has a place in the understanding of older people and ageing. My personal favourite section of the book is ’Wordsworth’s Noble Elders’ in which I discuss a number of older people in his poetry that show particular strength and dignity when faced by hardship and tragedy. At times, the poet feels admonished by his own feelings of despondency brought on by far more minor problems and he vows to take courage from the people he has encountered.

All Experience is an Arch by Dick Sainsbury, Quentin Wilson Publishing, RRP $37.50

Another theme of the book is the way that geriatric medicine has developed as a specialty medical discipline, first in the United Kingdom and later in other countries including New Zealand. This raises a number of questions including:

  • What are the problems that particularly affect older people?
  • Should there be a separate department at all?
  • Is there a danger that older people become marginalised by having a separate department?

In my view, there is a need for specialty. This derives from the fact that a number of years ago, older people often had unmet medical and social needs and unless these were recognised and treated, the older person became much more dependent and likely to need residential or long stay hospital care. After an acute illness an older person often undergoes ‘deconditioning’ and needs a period of rehabilitation to restore their level of function. The two key phrases in older persons health are, ‘maintenance of function’ and ‘quality of life’ and these are the aims of a well-functioning geriatric medicine service. Other key components are effective multi-disciplinary teamwork and communication. I also discuss home visiting and service innovations such as stroke units and rehabilitation after fractures, particularly of the hip, and other orthopaedic procedures.

It is sad ageism is prevalent in society and seems to be accepted at times without question, unlike other areas of prejudice. My impression is that this is less common in the Health Service than it was twenty years ago. I describe some examples of this and how we have worked to try and overcome some of these problems and prejudices.

Overall, the book is positive and celebrates the advances that have been made, the memorable old people who I have had the pleasure of meeting and the team members from many disciplines who contribute so richly. The emphasis these days is on healthy and productive old age as older people have so much still to contribute.

All Experience is an Arch by Dick Sainsbury, Quentin Wilson Publishing, RRP $37.50

About Mason Head

Content Creator and Publication Lead at Eldernet

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