Going gray to white
A veteran J'lem geriatrician contemplates old age through his parents’ and his patients’ eyes.
old age Photo: MCT photos
Old age often creeps up on people, and those who have not seen their elderly
relatives for some time may be shocked by the deterioration in their looks and
physical and cognitive abilities. But sometimes a sudden event, such as a hip
fracture or a stroke, shoots down active, vibrant individuals and makes them
totally dependent on others.
In both cases, relatives and friends are
confused about the symptoms, how to help and how much recovery to expect. Hebrew
speakers among them will be grateful for a new book by Herzog Hospital
geriatrician Dr. Efraim Jaul. Called Sipurim Shesipru Li Metupalei: Hitmodedut
Ma’asit Im She’elot, Levatim Umatzavim Gufaniyim Begil Hahizdaknut (My Patients’
Stories: A Practical View on the Fears and Physical Conditions of Growing Old),
the 268-page volume was published by Eshel, the Association for Planning and
Development of Services for the Elderly in Israel. It joins a growing list of
books, films and other Eshel publications meant to help educate and inform the
rapidly aging public in Israel, where average life expectancy is moving into the
Jaul, director of the expanding psycho-geriatric hospital
in Jerusalem’s Givat Shaul quarter, is director of its complex nursing
department and has been with Herzog for 20 years. A graduate of the University
of Rome and former director of an a prize-winning Clalit Health Services’ family
medicine clinic in Jerusalem’s East Talpiot neighborhood, he has written several
Hebrew-language volumes in his field, including The Geriatric Nursing Patient,
The Mature Traveler’s Guide and publications on diagnosis and treatment of
pressure sores and on enteral feeding of the elderly.
This latest book
covers complicated issues such as what age-related changes can be expected and
how can they be delayed or avoided; what tools measure functioning and why is
this often more important than diagnosis of a disease; what periodic tests and
examinations need to be performed and how conditions can be prevented at an
advanced age; and the importance of nutrition and physical exercise.
aim of this book is to shed light on the physiological and pathological
processes that occur in old age,” Jaul writes, adding that he hoped that after
reading it, patients and their families and caregivers would regard aging as
less threatening and easier to cope with. Throughout, the author illustrates his
points with moving true stories about his own parents and the many elderly
people he has treated.
He recommends that older people not think
constantly of diseases but of potential stumbling blocks – such as weaker
hearing or sight or stiff joints that usually accompany aging and can get in the
way but can be dealt with. “Your rich life experience and wisdom will help you
plan for it.
Don’t let it surprise you,” he writes.
He provides a
list of practical ideas that make life easier, such as: Think ahead. Don’t climb
on a chair or ladder to change a light bulb, clean a chandelier or take down a
book as you did 40 years ago. Ask for help so you don’t lose your balance and
fall. If you still drive, don’t do so at night, in bad weather or in unfamiliar
territory. Don’t cross streets except at a crosswalk, and when you do, only on a
green light. Don’t carry heavy baskets or packages in both hands so you’ll be
able to protect your head if you encounter an obstacle. Always hold the
bannister when on the stairs. Don’t sit on a low chair without a backrest so you
won’t have difficulty getting up or fall backwards.
relationships with relatives and friends so you have social support. Set goals
and find significance for your life so you’ll have a good reason to get up in
A long list of natural changes in the body that occur as
people age is presented over four pages. These include joints and bones; nerves,
eyes, ears, touch, smell and taste; kidneys, cardiovascular system; digestion;
respiratory function; skin, immune system and sexual function.
Jaul recalls when his mother had a stroke in 1995.
“When I entered her room, I
saw her lying with her right hand lifeless and her mouth wide open. She was
giving me a hollow look. I immediately diagnosed her with a stroke. That ended
the trip to rediscover their roots [in Austria] that I took with my parents. I
looked at her, and I couldn’t help her. She gazed at me with the desperate look
of ‘Help me!’ She was then 72, an independent woman, energetic and young in
She was hospitalized in a Vienna neurology department until she
could be flown home. In Jerusalem, she improved, until the last day of her
hospitalization, when she slipped in the corridor and broke her hip.
had surgery immediately,” Jaul recalled. “Her rehabilitation stopped. She had
low moods. Her motivation disappeared, and she sank into
They took her home, in the hope she would
“As a son and doctor, I felt great frustration and helplessness
in the face of all her nursing problems, problems I treated well in
His mother refused to get up and walk, wash or feed herself, and
the geriatrician and his sister carried the burden. Pressure sores developed. At
first, they didn’t know where to turn, despite his long
Finally, they ordered home care from their health fund, and
had a doctor, nurse, social worker, physiotherapist and occupational therapist
come for treatment.
She had a turn for the better, her pain receded, and
she became more motivated.
She lived in sheltered housing and was alert,
walked with a cane, learned to play bridge, was active daily, learned to draw
and wrote two books on her Holocaust experiences. She died 12 years after
suffering her stroke.
Jaul’s father suffered for years from orthopedic
problems due to erosion of his joints – the result of being shot in his right
leg by an Arab sharpshooter in the War of Independence. But although he limped
for the rest of his life and his weight was carried by his left side, causing
the joint problems, he enjoyed a very active life. When he reached the age of
82, he developed cardiac insufficiency, three clogged coronary arteries and a
serious heart valve problem, and a specialist recommended open-heart
Shifting to the role of a son, Jaul was leery of a seven-hour
operation, fearing it could affect his father’s cognitive functioning. The
attending physician was surprised by their decision – which turned out to be the
right one, because Jaul’s father lived to the ripe old age of 88.
me, as a son and a doctor, every year that my father lived and functioned
physically and mentally with a good quality of life showed we were right not to
approve the surgery,” he writes in his chapter on operations.
Jaul’s middle-aged and elderly patients insisted that there was no use changing
their lifestyle because “genetics determines everything.” A Jerusalemite
carpenter named Menashe – a tall, hefty and broad-shouldered smoker – who came
to consult him about his wife and parents hadn’t come to the clinic about
himself, even though he was nearing 60.
Jaul suggested tests for early
diagnosis of various conditions.
The doctor advised him to quit smoking,
lose weight and reduce his consumption of sugar and white flour.
first, he turned me down, saying he knew centenarians who never needed to see a
doctor ‘because they had good genes.’” But he agreed to take the tests and was
shocked to learn that he had high cholesterol, triglyceride and sugar levels,
and when Jaul took his blood pressure, it too was too high. But he ignored the
data and told everyone he was fine.
“Welcome to the club,” the doctor
said, and finally persuaded him to prevent disease by walking, changing his diet
and giving up cigarettes.
The book includes helpful charts that list
tests and vaccinations that the middle aged and elderly need to undergo and when
to have them. One chapter is devoted to medications, which are commonly abused
by old people. Either they take too many – because their various specialists
have not made sure that the drugs don’t clash or have become unnecessary – or
they don’t take those their doctors have prescribed.
“I never take these
pills,” Elizabeth said, referring to little yellow ones she brought in a bag.
Jaul identified them as being to reduce blood pressure. Elizabeth came with
complaints about being weak and unstable when walking, which made her fear
falling. When asked why she avoided taking them even though that could be
responsible for her symptoms, the patient said: “I really value my doctor, but I
know what’s good for my body.”
Absorption in the stomach and diffusion of
drugs in the bloodstream change as people age. Jaul also explains the connection
between drugs, food and herbal preparations, as well as when generic drugs can
be taken safely.
Preparing for and coping with retirement and with the
death of a spouse fill up other chapters, as do elder abuse, suiting the home to
older people, sleep problems, dementia – all subjects of great importance to
readers. Regarding retirement, Jaul tells the tale of a very well known Israeli
female singer. The geriatrician estimated her age at about 75 even though she
still sang beautifully, was well groomed and moved like a young
But when he got closer during a performance, he noticed things
that showed she was not ageless: She forgot the order of songs, and her pianist
had to constantly remind her. She also had difficulty hearing, and the whole
audience heard the pianist’s shouting the name of the next song. The songstress
was clearly in need of a hearing aid.
He also recalls a famous surgeon
admired by generations of younger doctors. But even though his hands shook so
badly, he continued to perform some operations.
As he refused to put down
his scalpel and work only as a consultant, his younger colleagues were forced to
halt his work completely and send him home.
The author provides much
information about the physician’s and the family’s dilemma regarding whether to
allow older people to drive.
The author notes that chronological and
biological ages are very different and that motivated and active elderly people
are able to continue working at least part time and could provide their
workplaces with many benefits. Doctors themselves generally prefer to continue
in their profession after reaching retirement age. A study published in Harefuah
of the Israel Medical Association that he cites showed that many retired
physicians were unhappy with their lives due to reduced income and and reduced
status, but those who continued working, at least part time, had no such
If continuing to be employed at the same job is not possible,
advises Jaul, keeping busy in hobbies and volunteer work is just as good. As the
well-known billionaire publisher and businessman Malcolm Forbes, who died in
1990, once said, “Retirement killed more people than hard work.”