Dr. Christine Karen Cassel

When I first began in this field, the standard rounds we would make in the hospital: we would come in, talk with the patient, listen to their heart and their lungs, maybe feel the abdomen. If the patient was in a wet bed it wasn’t our problem, it was a nursing problem. You would leave the room never knowing whether the patient was able to walk or not.

And if the patient was confused, all too often you said, “Well, that’s sundowning, that happens with older people.” So the whole range of functional issues that really make a difference between whether an elder person can live alone, or has to be in a nursing home, were things that we didn’t have a clue about how to address. Urinary incontinence, mental confusion, and walking or ambulation, and the strength of somebody’s ability to get themselves to the bathroom, or even out of bed.

And maybe I’m just a sensible woman or something, but it just seemed to me there needed to be a lot more attention on these common problems of older people, which we weren’t learning enough about. And so the idea of having a field of geriatric medicine where I could do that, that would be morally needed and make a contribution to people who needed help. At the same time that it would be full of important ethical issues that needed study and analysis, and that were philosophically challenging. The reason why intergenerational connection is so important is to give real meaning and vitality to our aging society. Because we’re moving from a society where a hundred years ago 5 percent of the population was over 65, to 20 years from now 20 percent of the population will be over 65. That means one out of five people, everywhere you go—in the movie theaters, in the grocery stores, in the airports, on the golf courses— wherever you are, are going to be “senior citizens.” To marginalize and make irrelevant one-fifth of the population is just not a smart thing for our society to do. Plus, people are healthier and more independent as they age these days, and that’s going to continue, too. So we can’t afford as a society not to take advantage of the skills and contribution of that whole segment of our population. So it’s very important to me that we find ways that younger people can interact with older people, to counteract stereotypes, ageism, negative attitudes about their own aging, and to help reinforce the connections within their own families.

Many of my colleagues in medicine say to me, “How can you do this. It’s so depressing, and it’s so frustrating, because nobody ever gets better.” Well, if you look at most of medicine, there are very few dramatic cures anymore. What we’ve done is we’ve managed to make people able to live better with chronic illness—with heart disease, even with cancer. And geriatrics is just like that.

When you help somebody live better, with multiple medical problems, or even help them die better, at the end of their life, their family and that patient are hugely grateful. And I find it very rewarding and so I tell people "what do you mean?" I think this is actually a very rewarding and satisfying field.