The “green-pastured mountains of Fotta-fa-Zee” where “everybody feels fine at a hundred and three” seem far away in these pandemic-stricken times.
That utopia for the aging, described by Theodor Geisel, better known as Dr. Seuss, is from his best-selling book written for older adults, “You’re Only Old Once! A Book for Obsolete Children,” published on March 2, 1986, on his 82nd birthday.
Dr. Seuss’s recounting of his medical treatment 36 years ago illustrates how little some things have changed in the health care of older adults. In vintage Seussian-style, he parodied and caricatured the doctors and medical treatments he received for his oral cancer that would take his life five years later.
His struggles with seeing multiple specialists with differing recommendations and dizzying bills colored his views of the healing he thought and hoped he would receive. Ultimately, it led him to share a fanciful story of an older man (think Dr. Seuss himself) who was seeking care at the “Golden Years Clinic” and finding himself subjected to multiple ridiculous tests, strapped in baffling contraptions, and prodded by a menagerie of specialists.
When I was introduced to this book 20 years ago, I was taken back by the outrageous antics depicted in image and verse, but upon deeper reflection, this satirical memoir is nothing short of what an older adult and their family might still experience today.
Strangely, it served as a source of inspiration during my internal medicine residency, not only because it took place in the very hospital where I had trained, but also his honest recounting struck a deep chord within me. It motivated me to provide better care to older adults and eventually led me to pursue a specialty in geriatric medicine.
The intended audience for “You’re Only Old Once!” were the former kids of 1937, who had read his first book, “And to Think That I Saw It on Mulberry Street.” He figured at the time that these children-turned-adults were in need of medical care.
His hope was to give them some amusement while undergoing their own treatments, but also to acknowledge that these experiences “were not funny, no matter how you disguise it.” While alone in the waiting rooms, he doodled and sketched the machines and doctors he encountered, eventually leading to the idea for the book.
Thirty-six years later, the indignities Dr. Seuss described in “You’re Only Old Once!” remain familiar to older adults today. The COVID-19 pandemic has simply magnified the challenges confronting older adults in all care settings, with public health policies disproportionately affecting older patients in the name of keeping everyone safe.
Dr. Seuss knew then what we know now and the situation is no longer acceptable. The countless numbers of older adults left to die without family at the bedside or dementia patients unable to be comforted by loved ones is an abysmal reality of our health care system’s incapability of caring for older adults in such a way that is age-friendly and not ageist.
There is a way out of this: Age-Friendly Health Systems, a movement led by the Institute for Health Care Improvement and the John A. Hartford Foundation to improve elder care. It is built on a framework of four Ms:
- What Matters to older people with respect to their goals and preferences when getting treatment
- Medications that should be avoided or even scaled back
- An emphasis on Mentation to prevent, identify and treat dementia, depression and delirium
- Mobility to maintain function and independence
The age-friendly movement and 4Ms framework have spread throughout the nation’s hospitals and health systems, including where I practice now. UC San Diego Health is recognized as an Age-Friendly Health System.
With the last baby boomers scheduled to turn 65 in 2030, and the kids on Mulberry Street well-aged, we owe it to our older family members, friends and neighbors to expedite work toward age-friendly care everywhere, all of the time.
It is my hope that 36 years from now, a different geriatrician will not need to recount my experiences and observations of older adults seeking medical care. In light of Dr. Seuss’s birthday, perhaps we can pay homage to his medical journey by writing a new, age-friendlier one of our own.
Dr. Khai H. Nguyen is a geriatrician who is clinical services chief of geriatric medicine at UC San Diego Health and the national medical director of Community Health Accreditation Partner, a national accrediting and quality organization.