MEDICAL SELF-CARE

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COMFORT: Certainly, and I'll present both the commonly believed fables and the often surprising facts. Fable: Most old people live in institutions. Fact: Less than 4% of those over 65 are institutionalized. Fable: Most old people are confined to bed by illness. Fact: They are subject to fewer acute illnesses than are younger people... 1.3 per person a year compared with 2.1 for all ages. Now it's true that 81% of the people over 65 have some chronic health problem—compared with 54% of those below that age—but it's often nothing worse than short sight or hay fever. Fable: Old people live alone, abandoned by their children. Fact: About 80% of all people over 65 live with others, and 86% see at least one relative each week. Of oldsters who have children, 28% live in the same house, 33% live no more than ten minutes away, and 23% live within an hour's drive. Fable: Older workers can't do a decent job. Fact: They are typically more productive, have a lower rate of absenteeism, and have fewer injuries and accidents on the job. Fable: Old folks are past having sex. Fact: A large proportion of elders are fully able to enjoy sex. Fable: After 65 you can expect to become senile. Fact: Only about 1% of older people become senile, which is less than the proportion of the total population who go insane at earlier ages. Fable: Most handicaps common to older people are physical. Fact: About 75% of the handicaps related to oldness are social, cultural, and imaginary. The physical changes are trifling by comparison.

FERGUSON: Do you have any tips to help older people deal with health workers?

COMFORT: Don't put up with being addressed as "Granny" or "Pop". Point out that you have a name, and if they don't know it, they can damn well ask. You may have to be pretty bloody-minded at times. Get suspicious if you're told that ill health is what you should expect at your age. There's a story going around about a 104-year-old man with a stiff knee who was told he couldn't expect to be agile at his age. He replied, "But my other knee's 104, too, and it doesn't hurt." Try to find a physician who's actively involved in geriatrics. It can be very disconcerting for an older person to go into a hospital and have the doctor open up with, "Do you know what year it is? Do you know who's President?" We're only beginning to teach health workers not to do a mental status exam in that manner.

FERGUSON: How do you feel about nursing homes?

COMFORT: Old people used to fear the workhouse . . . now they fear nursing homes. Some primitive tribes kill off their aged and infirm citizens, but we often bury them alive in institutions. Commercial nursing homes can be operated by anyone with enough cash to start one . . . and the wages required to hire competent staff are a big drag on profits.

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