Trying to reach 120

The weekly Torah portion can serve as a guide to healthy aging, according to Jerusalem geriatrician Dr. Ephraim Jaul.

By
May 8, 2011 03:31
Dr. Ephraim Jaul

ephraim jaul 311. (photo credit: Courtesy)

As it’s common for older Jews to find consolation in religion, it’s clever – and an inspiration – for a new book on aging to base itself on the Torah portions of the week. What is amazing is that the author, Jerusalem geriatrician Dr. Ephraim Jaul, found relevant topics in each of the 54 portions, even though many of them make no mention of old age.

Jaul, director of complex nursing care at Herzog Hospital, has shown in his previous Hebrew-language writings on senior citizens that he enjoys working with the elderly.

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In 2002, Academon published Hamadrich Harefui Lametayel Hamevugar (Medical Guide for the Elderly Tourist). In 2004, his 223-page, softcover Hebrew-language book, Hazaken Hasiudi (The Geriatric Nursing Patient) was published by ESHEL (The Israel Association for Planning and Development of Services for the Elderly) of the Joint Distribution Committee. He also wrote a publication for physicians on the diagnosis and treatment of pressure sores, and on enteral feeding in the elderly.

Now he has published Ha’adam Hamevugar Baparasha (The Old Man in the Parasha) – a 112-page gem that will appeal not only to the elderly but also to their families, doctors, nurses and other caregivers, as well as to observant adults with no personal interest. The burden of the elderly increasingly falls on the “sandwich generation” of middle-aged people who have to take care not only of their growing children but also their aging parents.

JAUL, A graduate of University of Rome who for years ran a Jerusalem community health clinic and continues to lecture on geriatrics at the Hebrew University- Hadassah Medical School, dedicates the volume to his mother Rahel, who died in 2008 at the age of 85. A Hungarian-born Holocaust survivor who lived through Auschwitz and Bergen-Belsen, she was widowed and had a stroke, but nevertheless listened to him write chapters for the new book and gave her comments.

His mother was mentioned also in the second book, on the geriatric nursing patient, written after he noted the shortage of practical information when taking care of his own aging parents. Jaul wrote then that he felt especially helpless when Rahel, who was until then active and independent, had a stroke while visiting Vienna. Hospitalized for two weeks in an Austrian neurology ward, she was getting along well in rehabilitation in an Israeli hospital, but then slipped in a corridor and broke her hip.

“She had surgery, and her progress halted. Her mood was poor, her motivation disappeared, and she sank into depression. She lost control of her bodily functions and developed a bedsore,” recalled Jaul, who started as a family medicine specialist, and then went on to geriatrics because of his interest in the field.

He and his sister brought their mother home in the hope that she would become her old self. “As a son and a doctor, I was very frustrated: My mother ‘hit’ me with all the nursing problems with which I had coped so well in my patients.”

IN THE introduction to his new volume combining the Torah portions and aging, Jaul remembers that even when she was semi-paralyzed and living in a nursing home, his mother listened to topics he suggested. “She listened and moved her head, and her eyes laughed. Some of the subjects I wrote about came to me in an effort to make her happy or to express difficulty and frustration over her condition as a son and a physician.”

She died three years ago on the eve of Shabbat, when the Torah portion of Vayishlach was read; he wrote the text for the portion of Vayeshev, about giving consolation to mourners, when he was sitting shiva.

The Torah portions are presented in order, and occasionally include twinned portions frequently read together. Each chapter takes up just two pages, and includes a topic such as Loneliness, Operations, Communications and Language Problems, Children’s Sorrow in Caring for Parents, Heavy Heart, Fear & Suspicion and Cardiac Insufficiency, Salt Balance and Difficulty Walking.

CHAPTERS BEGIN with a short quotation from the Portion of the Week, followed by gray-tinted sections from Rashi, the Talmud and others. Then Jaul discusses the gerontological aspects of the subject in modern times, with another gray-backed section on what can be done to ease problems.

Who in the world could have been as lonely as Adam when he was created? The first chapter of Genesis deals with feeling solitary. Jaul quotes a 16th-century rabbi, Rav Shlomo Efraim Luntshits (known as the Kli Yakar), who suggested why God did not create Adam and Eve as separate bodies; instead, he took a rib from Adam to make Eve. The first man and woman, said the Kli Yakar, lacked love and unity, and if they came as two separate bodies, they would have fought.

Jaul notes that a fifth of the elderly population suffer frequently from loneliness; many are objectively alone because of a lack of social networks. As it is, natural losses of spouses, other relatives and friends, as well as suddenly facing retirement or medical problems can intensify this, as can subjective feelings, he writes.

As there is a strong connection between loneliness and ill health – both physical and emotional – and the low income of many elderly prevents them from traveling or having a social life, Jaul calls for interventions. Moving to a residence with others can help, or an elderly person can continue to live at home while joining social frameworks that can minimize loneliness, he suggests.

The portion of Noah focuses on language and communication problems, as demonstrated by the generation of the Tower of Babel. But Jaul refers not to different peoples speaking a variety of tongues but to the elderly having difficulty speaking due to aphasia.

The Patriarch Abraham underwent surgery – circumcising himself at the age of 99 when ordered to by God to join the covenant. Unlike Abraham, the patient today needs to be prepared using all the preoperative information and procedures, as well as proper nutrition to prevent confusion, imbalance of salts in the blood and too much fluid. Weakness of the body and visiting the sick is discussed with Vayera, as Abraham recovers while sitting in the entrance to his tent in the heat of day waiting to greet visitors. Jaul explains that he has often had to treat geriatric patients who have an unclear complaint of weakness, making it very difficult to determine the cause such as emotional problems or improper medications. The patriarch, he notes, gives us an example of “not being centered on ourself and our suffering” while finding targets connected with giving and doing merciful deeds to others.

In Hayei Sarah, the wife of Abraham is given as an example of “successful aging” – a woman who brings her husband joy and is full of life. Various psychosocial factors can ensure successful aging, whether they are autonomy, a positive self image, support from relatives and friends and feeling significant.

Proceeding to Jacob and his dream of a ladder to heaven while fleeing from his brother, Jaul discusses the causes of sleep disorders in the elderly. Acid reflux into the esophagus can cause distress, as can leg cramps; the author makes suggestions on how to ease them.

Being old is not a disease, he notes when discussing the portion of Veyehi. Many doctors and paramedical workers view the complaints of the older patient as the result of ageing. Disease appears suddenly. Ageing, a process connected to genetics, lifestyle and the environment, proceeds for years, he says. Damage from heart disease, osteoporosis and other chronic disease can be minimized and even prevented if the person takes care of himself.

The Israelite slaves in the portion Shmot crying out inspire him to discuss pain and suffering. Quality of life can be improved by proper pain relief, he writes, and even terminal patients can be helped by palliative techniques that allow a reasonable quality of life.

The hardening of Pharoah’s heart in Va’era was not due to atherosclerosis but divine intervention, yet Jaul uses it as an opportunity to discuss cardiac insufficiency, in which the heart muscle is not able to do its job properly. A multidisciplinary team, plus suitable medications and nutrition can ease the problem, he says. Maimonides (Rambam), the great sage and philosopher, is discussed for Beshalah, when God says He treats His people’s ills. The Rambam, who treated Sultan Saladin, kept him well. The best physicians, notes Jaul, will make sure their patients do not abuse their health and adopt healthful lifestyles, catching medical problems early. Even the elderly can benefit by adopting a better lifestyle, he continues.

When Moses broke the first set of Ten Commandments over the sin of the Golden Calf, they were not tossed away but kept together with the second set of stone tablets carved by the prophet. This can refer to the whole and the broken. “The old person who took sick is compared to the broken tablets,” he said. But one doesn’t abandon the patient with an incurable, terminal illness. Even if he seems broken, his suffering and pain can be relieved, Jaul writes. The sick person was a complete world with a personality and spirituality that should be understood, rather than treating him as a hopeless case. “As a doctor, I should not give up,” he says, insisting that he get to know the patient, what he did in his life and what type of person he remains. Hospital workers often cease talking to patients even though he is able to communicate, as if physical limitations always mean mental ones.

The Israelites lusted after the meat of Egypt when they wandered in the desert, but many elderly have too little appetite for food. In the chapter on Beha’alotcha, Jaul notes that eating fish, eggs, poultry and meat or vegetarian sources at this age is important to preserve muscle mass and the immune system. There is a tendency in the elderly, especially those living alone, to get too little protein, with no time or drive to prepare it, an inability to afford it, a reduced sense of smell or failing to eat regular meals. Instead, they may consume simple prepared foods, including junk food with “empty calories.” Caregivers and relatives should pay close attention to what the elderly eat.

Opening clenched hands to give charity is discussed in the portion of Re’eh, but Jaul uses the chance to discuss conditions of the joints, nerves and connective tissues. Whenever he meets a patient, Jaul says, he shakes his or her hand. This gives him a good indication of hand-grip strength, nutrition, vitality, functioning, mood and disease risk.

Finally, the importance of joy is expressed by Ki Tavo §and the bringing of the first fruits on pilgrimages to Jerusalem. Old people who see the fruits of children and grandchildren must give thanks. “He must give of his experience, wisdom, knowledge and even his worldly goods to the expanding family. He can serve as their teacher and mentor,” but must not rest on his laurels, Jaul advises. He must try to make others happy with small deeds of voluntarism, giving to others, having an optimistic view and seeing the cup as half full rather than half empty.


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