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Aging sees growth, loss: O’Neill

January 6, 2015

By Peter McDermott

GSA 2014

Dr. Desmond O’Neill, of Trinity College Dublin, was presented with the Joseph T. Freeman Award at the 67th annual scientific meeting of the Gerontological Society of America, held in Washington D.C in November. The presentation was made on behalf of GSA by Dr. Marilyn R. Gugliucci, director for Geriatrics Education and Research at the University of New England College of Osteopathic Medicine. DAVID ALEMAN/f-stop Photography [Click on image for larger picture.]

Story by Peter McDermott

Late Matisse. Late Turner. Late Rembrandt.

They were the themes of the big exhibitions in London galleries this past year. So pointed out Dublin geriatrician Dr. Desmond O’Neill, one of world’s leading researchers in his field.

“Arts people are smart and they can see the trends,” he said. “There’s this schlocky phrase that ‘artists are the storm troopers of consciousness.’”

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And in this instance, he believes, they’ve detected the seismic shift in attitudes in his profession about aging and increasingly in society at large.

“The narrative has been a simplistic one of loss and decline,” said O’Neill, professor of Medical Gerontology at Trinity College and consultant physician in geriatric and stroke medicine at the Tallaght Hospital campus. “There’s a huge swing back against that.

“We’ve got to recognize growth in later life. And also not only recognize growth, but also the extraordinary abilities of people in later life to cope with the existential problems they have.

“Older drivers have the highest levels of illnesses that might affect driving, yet they’re the safest group of drivers on the road,” O’Neill said.

“So, their adaptive abilities, their mastery of how they engage with their environment, is brilliant.

“Not only that, but if there’s an accident where a child’s in a car and if the grandparents are driving, you halve the risk of serious injury compared to the parents driving them. So they not only bring something to the roads on their own behalf but they bring it on behalf of others,” said O’Neill, whose research is rooted in gerontology and the neurosciences, with a strong emphasis on liaison with the humanities.

There is now a fascinating body of literature on the older worker, according to the Dublin physician.

“If you have come down in the Hudson and survive, do you want an almost 60-year-old with all his life experience or do you want a 25-year-old?” O’Neill said, alluding to Chesley Sullenberger’s successful navigation of Flight 1549 on Jan. 15, 2009.

Research shows, he reported, that older workers have less time off and are more productive than younger colleagues in many jobs.

“Older roofers, for example, seem to spend a little bit more time per tile, but actually get the job done faster because they know the shape of it,” O’Neill said.

Older hotel receptionists, he said, “take a bit long longer on the phone call, but they get more second reservations.”

For the Trinity professor, the American humorist P.J. O’Rourke summed it up best with the title of his 1995 collection: “Age and Guile Beat Youth, Innocence and a Bad Haircut.”

 

Social-economy model

On the other hand, he doesn’t believe what he labeled the “Pollyannaish” approach suggested in popular books like “Younger Next Year” is helpful.

“People used to talk about ‘successful aging.’ It means that if you didn’t reach the criteria of successful aging, you’d failed,” said O’Neill, who is a married father of seven children from 24 years down to 13.

Henri Matisse did not successfully age in a physical sense. After decades painting standing up, he was forced to adjust his style radically sitting down. “Through his disability, he grew and changed and produced something new,” O’Neill said.

Aging, therefore, must be seen in terms of gain and loss.

“So what we’re actually talking about is ‘optimal aging’ that understands the existential hits that we’re going to take in terms of disability and creates a system that frees you from unnecessary constriction by that disability,” O’Neill said.

That means building more “age-attuned” and livable societies, which are in the longer-term interest of all of us.

One way he promotes this is with his research work for ITN America, a non-profit that “supports sustainable, community-based transportation services for seniors,” both in this country and worldwide.

If the lack of a social-economy transport model in rural and suburban America is one issue about which he has a particular passion, another is the relative scarcity of people like him.

“They don’t recognize them,” he said of geriatricians in the U.S.

The fact that America has so few compared to other industrialized nations is a serious flaw in the system, he believes. He used the hypothetical of example of an ER with two options for the older patient: behind Door A is a geriatrician and behind Door B, the general medical service.

“You reduce the chances of death or going into a nursing home by 25 percent by going into the geriatrician,” O’Neill said.

“It can happen and it can change [in the U.S.]. The Canadians have changed direction,” he said.

So has the mixed public-private system in Australia, where he spent last summer as a visiting professor. “They know that a takes an hour to do a comprehensive geriatric assessment. They pay you A$400 to do it, and if you do it by telemedicine they pay you A$600,” O’Neill said.

In the U.S. however, geriatrician pay and conditions simply don’t match up with the other specialist areas.

“Many who do it here are extraordinary people in the face of this very problem,” he said.

henri matisse

Henri Matisse.  [Library of Congress]

 

Keynote lecture

O’Neill has come to know some through his attendance each year at the scientific meeting of the Gerontological Society of America, which gathers the nation’s – and some of the world’s – leading experts on the various aspects of aging.

At the most recent, the 67th annual, attended by more than 4,000 people in Washington DC in November, O’Neill was honored with the Samuel T. Freeman Award. It is given to a “prominent physician in the field of aging – both in research and practice – who is a member of the Society’s Health Sciences section.” As part of that, he will give a keynote lecture at the 2015 conference in Orlando.

O’Neill is the first European recipient in the award’s 37-year history. The GSA cited, in particular, his more than 300 peer-reviewed scientific papers and chapters.

The Dubliner is also the author of the 2013 book, “Ageing and Caring,” which is aimed at older people and their adult children, and writes a monthly column for the Irish Times as well as a regular blog for the British Medical Journal.

O’Neill attributes his productivity at least partly to genetics. He’s a speed-reader, just like his mother. She was home-schooled in Sligo by her parents – one a domestic-science instructor and the other an antiquarian who worked for the Land Commission.

“She had an hour of French a day and an hour of Irish a day. She and her two sisters – she’s the surviving sister – would speak the most beautiful Connemara-type Irish,” he remembered.

After careers as a nurse and an Aer Lingus hostess, his mother, between child three and eight, studied to become a doctor. His father, a native Dubliner, was an accountant before becoming a pediatric surgeon.

O’Neill watched his physician parents deal with late-life dementia in his grandparents with a mix of “care and distress.” He considers himself fortunate to have positive memories of his four grandparents and is glad also that his own children have had time with their grandmothers.

He described his upbringing as “supportive and nurturing,” adding “I had a very enriched environment.” It gave him a curiosity that is, he believes, an essential, even defining quality for the geriatrician.

An early influence as an adult was his year in Marseilles with the non-profit Les petit frères des Pauvres (the Little Brothers of the Poor), which aims to relieve isolation and loneliness among seniors.

“Their motto was ‘Flowers Before Bread,’” O’Neill said. “The state will take care of the basics, but who makes you feel special, remembers your birthday, takes you on holidays?

“I remember thinking: ‘That’s trimmings on the cake,’” he said. “But I began to realize that’s what it’s about.”

 

Slightly above middle

O’Neill summarized one of his research tracks in Ireland thus: “Instead of going in with a music group to a bunch of people in a nursing home or doing painting activities with them, find out what it is they feel they no longer have that they used to have and how can we help with it.”

Seniors can suffer from not just esthetic deprivation but also esthetic injury, he said, “because often in a nursing-home or hospital environment there’s a lot of noise and horrible things on the walls.”

In his view, a “very vibrant arts program” can lift the morale of patients and staff.

O’Neill, who is the director of the National Centre for Arts and Health at Tallaght Hospital, offered by way of a concrete example: “We had a composer in residence in our stroke unit and our Parkinson’s unit.”

Asked where Ireland ranks in the international league table on care for seniors, O’Neill replied: “Somewhere in the middle, possibly slightly above the middle. The Nordic countries are at the top.”

Now all the public hospitals in Ireland have geriatricians, whereas none of the private hospitals has.

“The will is there,” he said about official attitudes. “There’s no doubt.

“We now have geriatricians in acute medical units. There’s a national clinical program for older people. Only Austria, Belgium and Ireland have done this.”

O’Neill added: “The National Aging Strategy is a bit bland and lacks teeth I must say, though we’ve a good minister for older people in Kathleen Lynch from Cork. She is the best one there has been yet. She really has her heart in the right place.”

The U.S.-based Atlantic Philanthropies helps by supporting geriatric and gerontological projects in every university.

Overall, the position of geriatrics has improved since he returned from posts in England in the early 1990s.

“You had to be tough. There was much greater amount of ageism in the system when I arrived. You had to be bloody-minded and ignore it,” he recalled. “Now it’s really changed. It’s respected.

“I’m enjoying working in this area here,” O’Neill said. “If I were reincarnated, I’d be doing it again”

Peter McDermott wrote this article with support from the Journalists in Aging Fellows Program, a project of the Gerontological Society of America and New America Media that is sponsored by AARP.

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