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Doctor Muriel Gillick

Doctor Muriel Gillick talks about the problems associated with care for the elderly. As life expectancy increases, how can we properly care for the elderly? Gillick's new book is called Lifelines: Living Longer, Growing Frail, Taking Heart.

19:14

Other segments from the episode on January 21, 2001

Fresh Air with Terry Gross, January 17, 2001: Interview with Bill Bradley; Interview with Muriel Gillick; Review of jazz recordings “Live at the Left Bank.”

Transcript

DATE January 17, 2001 ACCOUNT NUMBER N/A
TIME 12:00 Noon-1:00 PM AUDIENCE N/A
NETWORK NPR
PROGRAM Fresh Air

Interview: Bill Bradley discusses the state of politics today
TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

With our new president taking office on Saturday, politics is on our minds.
My guest, Bill Bradley, reflects on American politics in his recent book "The
Journey from Here." Not too long ago Bradley hoped to be the next president.
He ran in the Democratic primary. He represented New Jersey in the US Senate
from 1979 to '97. Before entering politics he was a basketball star, playing
with the New York Knicks from 1967 to '77. In 1982, Bradley was elected to
the Basketball Hall of Fame.

As we look ahead to the inauguration, I'm wondering if you're watching and
thinking, `It could have been me,' or, `I wish it was me.'

Mr. BILL BRADLEY: Well, in a way, yes, but I think that that passed during
the course of the campaign itself. I think that there's only one reason to
run for president of the United States and that is that you think that your
leadership is what the country needs at that particular time in its history.
That's why I ran. The people in the Democratic Party decided that that was
not to be me to have that chance, and so I think you adapt, you accept and
you move on.

GROSS: You know, in this inaugural week, I have a real question for you,
which is--and you've partly answered it but I want to hear more. Why would
anyone in their right mind want to be president? Now--not that anyone's
asking me to be president, but I know--you know, I can't imagine having that
kind of responsibility, the burdens--I mean, the burdens of the country and
the world on your shoulders.

Mr. BRADLEY: Well, I think that, as I said, there's only one reason to want
to be president of the United States and that is because you think that your
leadership at this particular time in our nation's history can improve the
quality of life for millions of Americans. I think that that is by far the
main reason to run. I mean, I suppose people run for other reasons; some
obvious, some less obvious, some deep in their psyche, some more clear to the
observer; relating to power, relating to their own unresolved issues. But I
think that the real question is--for me was the only reason to do this because
it is a tremendous sacrifice--you're essentially giving your life up for your
country--is because you think your leadership will make a difference in the
lives of people and it's a form of service and it's the ultimate service and
the ultimate dedication to your country.

GROSS: When you withdrew from the primary, was there at least a part of you
that was relieved to be getting out?

Mr. BRADLEY: Well, no. I would say I was not relieved to be getting out,
because I wanted to be president. I wanted to enact an agenda that meant a
lot to me that I thought the country needed in terms of health care and
education, the environment and race, etc. And so getting out was the loss of
the opportunity to do that. The president has the bully pulpit. He's the
only leader in the country. I mean, no other politician is really known
because the TV's in the president's face every day and so people get a chance
to really know him and that means that he has a chance to shape their view of
themselves as well as the country. So I was disappointed not to have that
chance. On the liberation side, I suppose a part of me was glad to get back
in a car and drive on the highways at my own speed. I mean, that's how I
relax, and when you're in a campaign, you can't really do that because of the
Secret Service.

GROSS: Let's talk about negative politics. When you started your primary
campaign, you said you hoped to run a completely positive campaign. Didn't
work out that way. Do you think it's possible to run a completely positive
campaign.

Mr. BRADLEY: Well, what I said was I wanted to--the premise of my campaign
was to go out and tell people what you really believe and win. And it proved
that I didn't win. There are probably reasons other than that, but one of the
factors is that in the course of the campaign, if you do not respond to
negative attacks on you, you essentially allow people to define you by the
negative attacks. And that is an experience that I had in the course of the
campaign that I think discouraged me from believing that you can run just a
positive campaign and win. That's what I tried to do and I was hurt by doing
that. In fact, a lot of people came up to me and said, `You know, you should
have struck back harder, sooner, longer, more intensely.' They wanted the
fight. They wanted the negative response to the negative attack. And
ultimately...

GROSS: Well, actually, I heard criticisms on both sides. Some people said
you said you'd stick to the high road. You should have stayed there. And
other people said...

Mr. BRADLEY: Well, that's the...

GROSS: ...you should have fought back harder and swifter.

Mr. BRADLEY: Well, that's the catch-22, isn't it? I mean, everyone wants
you to be the experiment and the reality is that, when I decided to respond
aggressively, let's say after Iowa, which I had lost, and I refused to go
negative in Iowa and I lost--when I went to New Hampshire, I actually took
some very poin--I made some very pointed criticisms of my opponent, and in a
week, I went from 18 points behind to 4 points behind, narrowly losing the
race. And so I think that, you know, you have to--it's not easy to say but
I think that you have to be clear about what you believe and decide you're
going to run a campaign that way, and when you do attack, not attack on the
basis of ad hominem attacks but on the basis of a record.

GROSS: Well, among the things you said about Al Gore was that he was using
scare tactics in the way that he described your health-care policy and that
you also accused Gore of meanness in politics. I'm wondering during a primary
if it's in the back of your mind, `Well, if I say negative things about the
other Democratic candidate now, will that be used against the party in the
latter part of the campaign.'

Mr. BRADLEY: Sure. That's always in the back of your mind because you're,
first of all, a Democrat and you want to win the race. So, yeah, that was in
the back of my mind.

GROSS: But--What?--you live with that.

Mr. BRADLEY: Well, you ultimately temper what you say so that you try to be
direct, but at the same time, you don't go so far overboard in one direction
that you might actually end up helping the other party.

GROSS: You know, what about like the whole charisma issue? I mean, one of
the things that you were criticized for by some people in the press was
sometimes giving dull speeches. And, you know, charisma is such, such the
thing now in politics.

Mr. BRADLEY: Well, I mean, charisma would make a difference if they carried
your whole speech, but they don't carry your whole speech. They only carry a
soundbite of the speech and then there's a judgment that, A, you're this or
that. And I found that, you know, when I was in rooms of 50, 100, 400 people
that I could talk to them and I felt that, you know, I was reaching them. I
could see their eyes. In the book I talk about, you know, speaking to a group
of people and seeing a connection in their eyes and seeing this as people who
were identified with me and wanting to knit them together into a broader
strain of idealism in the country. And the challenge--I saw that happening
when I spoke. I was not deceived by that. A lot of people didn't see that.
I did. And I think that the key thing here is that there is an inherent
limitation, and charisma is really what the press says it is. It doesn't
exist in the mind of a lot of people. People listen to you. They respond to
you and they respond to a lot of things. I mean, you can be flamboyant or you
can be sincere and, in some cases, sincerity beats flamboyance.

GROSS: We're looking at American politics with former senator, former
presidential candidate and former Knicks star Bill Bradley. His latest book
is called "The Journey from Here."

You served in the Senate from 1978 to 1996. What are some of the greatest
changes you've seen in congressional politics from the time when you started
in politics?

Mr. BRADLEY: Well, it used to be that you were elected in a campaign,
hard-fought. There was a winner and a loser. If you were the winner, you
went to the Senate, you became a senator. And then, you know, maybe 18 months
max, two years before your next election, you started in the candidate mode
again. Now the electioneering never stops. Amendments are offered from the
floor of the Senate that are not substantive amendments but are political
amendments meant to get people on the record so somebody can run a negative
commercial about that person. There are strategies that are primarily devised
by interest groups as opposed to senators and their staffs that are aimed at
essentially improving the chances of the interest group to raise money and to
polarize as opposed to legislate. And I think that those changes are
detrimental.

Money's a big difference. I mean, you know, I remember my first campaign for
the United States Senate in New Jersey. I raised about a million two or a
million three dollars. The person who won the Senate race in New Jersey this
year spent $60 million of his own money. That's different. And if you are a
politician, you're spending all your time raising money, you're not spending
time doing work that the people sent you to Washington to do. And because
more and more money is needed to run these campaigns, that's a big difference
than when I came into the Senate in 1978.

GROSS: What about the style of discourse in Congress? Do you think that's
changed?

Mr. BRADLEY: Well, it's become less a place where people make speeches and
more a place where people speak soundbites. And there are still speeches made
on the Senate floor, but it is not the same as it was on an evening in a
heated debate when Russell Long of Louisiana would take the floor and wax
eloquent and funny and threatening to, you know, the assembled senators. Now
it is much more a matter of fewer bipartisan coalitions and more lining people
up in your party and having two sides go to war.

For example, there were a lot of bills in my first term in the Senate, and
there were bills in my second term in the Senate, where you put together a
bipartisan coalition. You might have a regional coalition. You might have
the upper Midwest and the Northeast that would be against the South and the
Southwest. You might have the far West and the East against the Midwest. Or
there could be a lot of different regional coalitions and then you found a lot
of people who were essentially commonsense legislators. And they would
occasionally buck their party. And they would do so on a somewhat regular
basis. And that meant that there were always a floating number of votes, 15
or 20, that if you were a serious legislator, you could put together, and if
you worked with them on both sides of the aisle, you had a chance to get
something done. Now it's primarily two leaders negotiating a deal before
anything happens and then just simply playing out the deal.

GROSS: My guest is Bill Bradley. His latest book is called "The Journey from
Here." We'll talk more after a break. This is FRESH AIR.

(Soundbite of music)

GROSS: My guest is Bill Bradley and we're talking about the state of American
politics. He's a former senator, former presidential candidate and former
star of the Knicks.

What role would you like to see President Clinton play after he leaves the
White House? What role would you like to see him play within the party?

Mr. BRADLEY: I'd like to see him have a lot of time for reflection and write
his memoirs. I think that that's the best thing that he could do.

GROSS: Why?

Mr. BRADLEY: I think--well, because I think that he could have something to
say that the country would benefit from. I think his role in the party is
going to be determined really by the dynamic of the next couple of years. I
think that--I don't think there's ever been a president who's retired and
essentially sought to play a role in the party. Now maybe he will. I mean,
certainly I wouldn't put it past him for trying to do that and I think some
people will want him to do that. And it'll focus on...

GROSS: It sounds like you don't want him to do that.

Mr. BRADLEY: Well, I think that he ought to take a little time off--that's
what I think--and write his memoirs. He can always come back. But I think
that, you know, if anyone should play the role of the leader of the party,
it's the person who was nominated by the party, which is Al Gore. And I think
that that is, unfortunately, difficult to do if you have a president who seeks
to do that himself--a former president. So I question whether, in the long
run, it'll be that helpful for the party, but I think he's a man of great
talent and he has deep conviction about some issues and he likes the fray and
so I don't know what ultimately he'll end up doing.

GROSS: What role would you like to see Al Gore play in the Democratic Party?

Mr. BRADLEY: Well, I think that he is the person who was the nominee and I
think that he should be given certain right to be heard and the right to lead
the party when they're in opposition.

GROSS: Now it's interesting to hear you say that about him since he was your
opponent.

Mr. BRADLEY: Well, but I lost to him and, you know, to the victor goes the
spoils. And part of the spoils is appointing--is taking over that role. I
mean, certainly I'll try to have my voice heard but I think ultimately--for
example, the head of the Democratic National Committee--I think that Al Gore
should have had as great a voice as President Clinton in who that person would
be. And I think that, to me, that's a good way to proceed.

GROSS: How do you see the Clinton legacy, for better or for worse?

Mr. BRADLEY: Oh, I think that there will be some things that people look back
and say he did very well. The budget agreement in 1993 that really set the
stage for the balanced budget, the NAFTA agreement, the World Trade
Organization agreement and the most-favored nation status for China all kept
America engaged in the world, kept pushing open trade further, kept
acknowledging the extent to which our future's inextricably entwined with the
rest of the world. I think those are things that you can look at and say, you
know, those were significant accomplishments. I think you can look on the
other side and say that, you know, there were issues that he didn't handle
well. I don't think that Russia was particularly a distinguished
accomplishment. To the contrary, I think that we've lost a decade with
Russia. You can look at some of the things that he did, for example, in terms
of welfare reform which, when it passed, was basically a Republican bill and
which people supported with his urging, risking a bill that was destructive
ultimately to children. Now he ameliorated that with future actions, but the
original bill was one that was difficult to take.

And then I think that people will look back and see a man of enormous talent,
great talent, with a very large ambition for himself and for the country and
find that it was squandered from time to time by his other failings. And I
think that will be the judgment of history. I think that the most significant
accomplishment, of course, will be the booming economy of this period and his
attempt to redefine the Democratic Party as a party of the center and to take
small steps as opposed to big steps. Now that's not always good, in my
opinion, if you're a leader.

GROSS: What are you going to be doing on Inauguration Day?

Mr. BRADLEY: You know, I haven't thought about it. I'll probably be working.
I mean, I'll probably tune in and listen to George W. Bush's inauguration
speech because I'm, you know, a political speaker. I like to hear what he's
gonna say, how he's gonna say it. Other than that, I'll be getting up with my
family and going to work and having a full day.

GROSS: Do you feel that his legitimacy as president is at all compromised by
what went on during the Florida aftermath?

Mr. BRADLEY: Well, I think that there are a number of things. First, I
think that ultimately the Supreme Court made the decision, not the people.
And that is a precedent that is somewhat ominous, but what struck me was after
the decision was made, how quickly people came behind and I think that Al
Gore's concession speech went some direction toward ending the conflict,
because he, I thought, was very gracious and made the point very well. And so
I think that Bush is accepted as the president now.

Now this could be like 1824. 1824, John Quincy Adams beat Andrew Jackson in a
disputed election that went to the House of Representatives. So it went even
further than to the Supreme Court, or at least it took a different direction,
because it ended up in the House of Representatives. And, of course, that was
the beginning of the movement that four years later culminated in Andrew
Jackson being elected president of the United States. So the real question is
how Democrats handle this. And my hope is that Democrats will cooperate and
try to get an agenda passed but start to build toward 2004 when we'll have a
chance to demonstrate that we actually got more votes in 2000 but we're going
to get more votes in 2004 in the right states.

GROSS: Bill Bradley, I have one last question for you that has nothing to do
with politics. And this is something that you write about a little bit in
your latest book. You said that your father was disabled and that he suffered
from calcified arthritis of the lower spine. He lived in constant pain. He
couldn't walk more than a couple of blocks. Your mother had to dress him
every morning. You became an athlete. I mean, you had glory in your body and
I'm wondering if you thought a lot about your father's imprisonment in your
body during your years as a basketball star.

Mr. BRADLEY: You know, the biggest thing about my father's circumstance was
that--how much I considered it just who my father was. I mean, there was no
concept of disability in those years when I was growing up and he never
complained and it was just who he was. It's true I never saw him tie his
shoes or drive a car or throw a ball or walk further than a couple of blocks
and my mother did help dress him in the morning and I'd fix his suspenders and
pick up the paper from the steps in the morning. But I never thought of my
father then.

And so when I think of disability today, I think of all of those Americans who
we consider disabled who have the same spirit and determination as my father
and who--it puts the onus on us to view them as Americans, as human beings who
have different attributes than we do but who can make as large a contribution.
So I never thought of my father's disability in the sense when I was playing
basketball. I guess--well, I'll take that back. Maybe I thought how lucky I
was to be able to run and jump and shoot and have my body carry me forward in
ways that I never saw my father able to do. So if anything, that experience
created a little humility in me and also a deep sense of appreciation for good
health.

GROSS: Bill Bradley, thank you very much for talking with us.

Mr. BRADLEY: Thank you.

GROSS: Bill Bradley's latest book is called "The Journey from Here." I'm
Terri Gross and this is FRESH AIR.

(Soundbite of music)

(Announcements)

GROSS: Coming up, caring for elderly people who have grown frail. We talk to
elder care specialist Dr. Muriel Gillick, author of the new book "Lifelines."
And Kevin Whitehead reviews a new series of recordings called "Live at the
Left Bank."

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Interview: Dr. Muriel Gillick discusses quality of life for the
elderly as the life expectancy in the US is getting longer
TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

Life expectancy is longer than it used to be in the US. But the question is:
What is the quality of life in those later years? Many people who live into
their 80s and 90s endure a prolonged period of failing health and progressive
disability. Many older people are faced with a constellation of health
problems that leave them frail and unable to handle even basic activities like
dressing and toileting. My guest, Dr. Muriel Gillick, directs the Harvard
Geriatrics Fellowship Program. She's written a new book about living longer
and growing frail called "Lifelines."

Some older people experience a taste of the so-called `golden years' after
retirement, but eventually find themselves too frail for an independent
lifestyle.

Dr. MURIEL GILLICK (Author, "Lifelines"): We certainly like to paint the
picture of old age as a time of exploration and travel and playing. And I
think that that works to some extent for vigorous older people, and the
majority of older people are vigorous. But a significant fraction are not,
and the older they get the less likely they are to remain vigorous and to be
able to engage in those sorts of pastimes.

The other observation I would make is that it may be fine to play, to indulge
in all sorts of things that are just pleasurable after you've worked hard for
many years for a few years, but we're talking about people retiring at age 65
and having a life expectancy of 20 years easily, and that may increase.
That's a long time to spend engaged in solely pleasurable activities. So I
would add that even if people are not impeded from doing all kinds of things
that they think they would have liked to do because of physical frailty, they
still want to do something meaningful with their lives given that it's a large
chunk of time.

GROSS: Mm-hmm. You write in your book the vigorous elderly are media idols;
those who stay strong and independent well into old age and then have the
fortune to die rapidly with little fuss. Are you frustrated when you see
these `media idols,' as you put it?

Dr. GILLICK: Well, I think it's great that people are able to remain
vigorous into old age. I just think that we shouldn't, as you suggest, delude
people into thinking that they will necessarily have that fate, and that we
need to acknowledge that for many people old age is not just a time of being
full of pep and being able to travel and do all the things that you never had
time to do before.

And I think that as physicians, we need to recognize that we're not going to
be able to prevent frailty by encouraging people to exercise better and to eat
better and lead righteous lives, that those are all good things to do and they
may play an important role in preventing frailty or delaying its onset for
some people, but it's not going to obliterate frailty.

GROSS: Well, what do you think is the difference in the approach you might
take to seeing an older person who has medical problems and side effects
problems, as opposed to, like, a general practitioner who'd be seeing the same
patient?

Dr. GILLICK: Well, hopefully, we'd have the same approach. But I think that
the physician who's experienced with dealing with frail, elderly individuals
would start, for example, by looking at all their medications. One thing that
we teach our fellows who are becoming specialists in geriatrics to do is to do
`brown-bag medicine,' by which we mean make sure that patients, if they're
coming to the office, bring all their pills in a little brown bag and dump
them all out on the table, and find out just what it is that a person is
taking. And if they're not in bottles that are labeled--they are the pink
pills and the white pills and the red pills--that tells you something, also.

Another thing that the geriatricians are particularly comfortable doing is to
get information from both the patient and from caregivers. That may be family
members, it may be a hired caregiver, other individuals who are in close
contact with that person, to fill out the story, to get different aspects of
the story, to understand how the person is really doing.

And I guess a third facet of geriatric care that's very important is to pay
attention to function. Not just to ask, `Do you have pain? Do you have
trouble with your breathing?,' but to figure out how much that pain or the
breathing problem actually gets in the way of the person leading his life.

GROSS: Do you find that older people are sometimes less good at accurately
describing their symptoms, or giving you a kind of accurate report of what
they're capable of doing? And I guess what I'm asking is: Do they sometimes
try to cover up for what they're feeling? To put on a good face or to make it
seem like they are more capable than they've really become?

Dr. GILLICK: I think if people are asked about what they can do, they will
usually say. I think the problem is more often that they're not asked. I
think it is true that people will often not volunteer symptoms. They'll
assume that it's perfectly normal to have chest pain every morning because,
after all, they're 88 years old and they expect to have a certain amount of
discomfort. So they may not come right out and tell a physician about a
problem that would be important to divulge.

I think the other fact that is important here is that older people often have
atypical symptoms. So that an older patient with a heart attack may not have
the crushing substernal chest pain going down the left arm with sweating and
shortness of breath that's in the textbooks and that often describes what
younger patients feel. So it may not be that the person is covering up or
refusing to tell. It's that they actually have symptoms that are trickier to
pin down.

GROSS: Why are they trickier?

Dr. GILLICK: Because they're not the classic symptoms. I give you an
example. Often, acute confusion is the presentation of severe disease. And
that disease can be pneumonia, it can be a heart attack, it can be a urinary
tract infection. It's a lot easier to figure out what's going on if the
person with the urinary tract infection has pain when he goes to the bathroom,
or the person with pneumonia has cough and fever and shortness of breath. For
reasons that aren't entirely clear, older people may not have any of those
things and, instead, just have confusion. And you're left with trying to
figure out what the cause of the confusion actually is.

GROSS: You know, a lot of the patients that you see are, you know, quite
elderly. And they're probably very different now than they were when they
were younger. When they were younger, they might have been active
professionally or had a very vigorous home and family life. Do the patients
often want to tell you who they used to be before they became frail or before
they became sick?

Dr. GILLICK: Often, patients do want to talk about their lives. And
sometimes for people who don't volunteer that information, I find it,
nonetheless, useful to ask them about their lives. It gives me a deeper,
richer sense of who they are now if I can understand who they were before.

GROSS: How does that help you?

Dr. GILLICK: Oh, it helps me in understanding what's important to them. If
there's certainly--I said before that in contemplating medical treatment
people have to think about what they're trying to achieve, what their goals
are. I also talked earlier about how sometimes a person may not want a cane
or a walker because they would rather not be safe in exchange for a sense of
dignity. So understanding who they've been all their lives can give me a
better sense of what's likely to be important to them today. Now people
change. So it's not necessarily the case that the person who's always been
fiercely independent is still going to be fiercely independent today, but it
certainly gives a strong clue.

GROSS: My guest is Dr. Muriel Gillick. Her new book is called "Lifelines."
We'll talk more after a break. This is FRESH AIR.

(Soundbite of music)

GROSS: My guest is Dr. Muriel Gillick. She directs the Harvard Geriatrics
Fellowship Program, and she's the director of medical education at the Hebrew
Rehabilitation Center for the Aged. She's written a new book called
"Lifelines: Living Longer, Growing Frail, Taking Heart."

I'm sure that you're often in the position of suggesting to one of your older
patients that it's time to use a hearing aid or get a walker or start using
oxygen regularly. And I think those kinds of things indicate that somebody
has crossed a line. They can no longer walk on their own, they need an aid.
They can no longer breathe on their own, they need an aid. Or they can't hear
on their own. And because those aids are visible, it's like saying to the
rest of the world, `I can no longer walk myself. I can no longer hear
myself.' And as a result of that, I think, sometimes older people are very
reluctant to take the step that they need to take because it symbolizes
something to them and the rest of the world. Do you find that to be true a
lot?

Dr. GILLICK: I do. I think it's interesting when older people move into,
for example, an assisted living facility; a building where everybody has their
own apartment, they have some degree of privacy, but they also have communal
areas and dining room for everyone, have some degree of assistance. The
reaction of many of my patients on entering such a facility is, `Everybody
else here is very old.' And what they are often saying is they don't see
themselves as needing those kinds of aids that you described. They have a
hard time recognizing that they're in that position, too. And amusingly,
perhaps, if someone enters a nursing home where 90 percent of the residents
are using a walker, if often is a lot easier to persuade an individual to use
a walker because that's par for the course. That's what everybody's using.
It's much more socially acceptable. So I think that these kinds of devices do
have a great deal of symbolic meaning to people, and make it hard for them to
accept them.

GROSS: Are you often in the position of trying to convince an older person
that even though they don't want to use it, even though it will make them feel
uncomfortable on the outside, that they have to use the cane or they have to
use the oxygen?

Dr. GILLICK: Well, I do sometimes try to persuade people to use things that
they don't want to use. But I think we also have to respect their autonomy.
And if their sense of self is so devastated by using a cane, for example, and
they're willing to take the consequences of a fall, perhaps even a fracture,
in exchange for holding on to the sense of who they are a little bit longer,
then that's ultimately their choice to make.

GROSS: Now what about depression? Do you find that that's a pretty
widespread problem among older people?

Dr. GILLICK: It is a very common problem. And I found in thinking about
frailty for this book, that there are a lot of people who are tipped over the
edge because on top of all their physical ailments, they develop depression.
And they were perhaps able to cope if they had to take so many pills for blood
pressure and insulin for diabetes and wear trifocals, but when they become
depressed on top, it just makes it very difficult to keep going.

GROSS: So many older people are already on so many drugs treating, you know,
heart problems and blood pressure problems and breathing problems, and so on,
so if you add an antidepressant to that, what are the odds that the
antidepressant is going to interact badly with one of the many drugs the
person is already taking?

Dr. GILLICK: Well, certainly interaction amongst drugs is a big issue in
frail, elderly patients. The newer antidepressants, the SSRIs, Prozac and its
cousins, tend to have fewer side effects and fewer interactions. The
tricyclic antidepressants, which are still very good drugs, and in certain
circumstances are the drugs of choice, are more likely to cause problems. In
my book I talk about one gentleman who developed urinary retention--couldn't
go the bathroom--when he was started on the tricyclic antidepressant. And in
fact, the physician caring for him thought that he needed to have prostate
surgery. When really what he needed to have was his antidepressant
discontinued. And if he needed an antidepressant, to be put on a different
one. So, yes, drugs are perilous, but they also can be terrifically helpful.

GROSS: If you're just joining us, my guest is Dr. Muriel Gillick, and she
directs the Harvard Geriatrics Fellowship Program. She's the author of the
new book, "Lifelines: Living Longer, Growing Frail, Taking Heart."

Are there times when you're really not sure whether treating a problem is the
correct thing to do because the person is so frail that the new drug or the
new treatment might worsen their quality of life in a way that doesn't make it
pay off?

Dr. GILLICK: Yeah. I think there are lots of treatments that would make
great sense for someone who's very vigorous and where one has to ask whether
the side effects of that treatment, the long-term consequences of that
treatment, make it worthwhile for a frail, older person. And one of the
things that I really enjoy doing is trying to make people and their
families--because families are typically a very important part of decision
making--understand what the ramifications are of engaging in a certain course
of therapy. The most extreme example is something like surgery, or being in
an intensive care unit, or having attempted cardiopulmonary resuscitation, not
just, `Will these things work short term?' but what will the long-term
consequences be? And is it worthwhile to undertake those risks?

GROSS: How do you help a person decide whether the risks are worth it or not?

Dr. GILLICK: What I like to do is to try to talk to people about what
matters to them most at that stage of their lives. And the way I tend to
think about this is: Are people primarily interested in a treatment that will
offer them a chance of life prolongation, no matter what the costs? Is that
the most important goal for them? Is their most important goal maintaining
the functions that they have: hearing, seeing, walking, talking, whatever it
is that they are engaged in on a daily basis that really matters to them? Or
are they at a point in their lives when the major goal is just to be kept
comfortable? And of course, most people want all three of those things. So
what I like to do is to talk to people about establishing priorities; trying
to figure out which of those is most important at a given point in time. And
then looking at whatever intervention we're talking about, whatever treatment
we're talking about, and trying to explain to them what consequences I think
that treatment will have in terms of their goals. Which form of treatment is
most likely to achieve the goals that they have for themselves?

GROSS: You write in your book that when you see patients who are old and
frail, you can't help but wonder what keeps them going? What sustains them
spiritually as their bodies disappoint or betray them. What are some of the
answers that you've found to that question about what keeps people going?

Dr. GILLICK: Well, I think one of the major things that keeps people going
is relationships. That in all the individuals that I describe in the book,
their friendships, their family, are probably the most important in sustaining
them. I think that people often need, even more than that, and they need to
have some sort of occupation, if you will, that they can find meaningful, and
that's sometimes not possible to do in a way that's similar to what they've
ever done before. And that creates a challenge. But I've had patients who
delight in spending time with preschoolers, reading to them, or children in
elementary school telling them what life was like in earlier days. Many
frail, older people have incredible recollections.

I remember having one patient who died when she was 98, and I think I took
care of her the last two or three years of her life. And she had grown up in
New York City. And she remembered New York City in the '20s. And it was
fascinating to listen to her talk about what life was like then. She was a
great social historian. I think that we need to tap into recollections that
people have about different times and places, and that that's a meaningful and
rewarding kind of activity for the teller of the story and for the listener.

I talk about examples of people becoming involved in whatever community
they're in, even if it's a nursing home; to be involved in some kind of
council or committee in which the residents of that nursing home help
influence policy, help shape their lives in that environment. Those are
things that benefit others and benefit the individual in question that help
give meaning to life, even someone who's quite physically frail.

GROSS: Well, Dr. Gillick, I want to thank you very much for talking with us.

Dr. GILLICK: Thank you.

GROSS: Dr. Muriel Gillick is the author of the new book "Lifelines." She
directs the Harvard Geriatrics Fellowship Program.

Coming up, Kevin Whitehead reviews a new series of live jazz recordings. This
is FRESH AIR.

(Soundbite of music)

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Review: New series of live jazz recordings
TERRY GROSS, host:

Jazz fans may know Baltimore, Maryland, as the birthplace of pianists Eubie
Blake and Cyrus Chestnut, drummer Chick Webb and saxophonists Gary Bartz
and Gary Thomas among others, and as a place where Billie Holiday grew up.
Nowadays it's become known as a town jazz musicians went to as well as came
from. Critic Kevin Whitehead explains.

(Soundbite of song)

KEVIN WHITEHEAD reporting:

Stan Getz, Baltimore, 1975. According to some versions of jazz history, the
'70s was the dark ages when musicians either sold out and got funky, or went
into hibernation. In fact, a lot of jazz mainstreamers didn't give up and
kept working the club and concert trail. One likely stop was the Famous
Ballroom, 1717 North Charles Street in Baltimore. From 1966 to '84, the Left
Bank Jazz Society presented concerts there on Sundays from 5 to 9 PM. Many of
them were taped, and some of those recordings are now being issued by Label
M. Four volumed dribbled out in the fall with eight or 10 more expected this
year. The first batch is heavy on tenor saxophonists including that Stan Getz
tape we just heard from with bassist Dave Holland and drummer Jack Dejohnette.
And a 1968 face-off between tenors Al Cohn and Zoot Simms.

(Soundbite of song)

WHITEHEAD: Zoot Simms with the audience at Baltimore's Famous Ballroom.
These amateur recordings by the Left Bank Jazz Society's Vernon Welch(ph) do a
good job of catching the ambience of the room. I spent a lot of Sundays there
myself in the '70s and '80s, but only after moving away did I realize how
special that place was. Jazz has rarely been so user friendly. You could
bring the kids and get that home by bedtime. You could also buy cheap beer or
set-ups and exemplary fried chicken and collard greens then sit at one of the
long picnic tables in front of the bandstand and pig out on three full sets of
music.

(Soundbite of song)

WHITEHEAD: The audience at the Famous was always predisposed to having a good
time, but a long way from being a pushover. That attitude often inspired
musicians to give a little extra. Not that the music was always brilliant.
The first four Left Bank CDs range from the OK to the very good. Unlike the
shows, they tend to be a bit short, averaging about 53 minutes each. The
standout is a 1971 trio date by Sonny Stitt on electric saxophone, which gave
him an odd but oddly appealing tone. This is from "Who Can I Turn To?"(ph)

(Soundbite of "Who Can I Turn To?" recording)

WHITEHEAD: Sonny Stitt, organist Don Patterson and drummer Billy James.
The Left Bank Jazz Society presented concerts at various halls around
Baltimore before and after the Famous Ballroom. But gradually their
activities tapered off until they suspended operations in 1998 due to a
shortage of funds. But there's a happy ending. The money the Left Bank makes
from licensing these CDs has enabled them to resume their Sunday concerts, at
least occasionally. I've heard jazz at hip venues all over continents, but
for atmosphere, nothing has surpassed those Sunday evenings in Baltimore.
It's good that they survived live and on record.

GROSS: Kevin Whitehead is based in Chicago. He reviewed the Left Bank Jazz
series on Label M. Four recordings on the series has been released; more
are on the way.

(Soundbite of song)

(Soundbite of applause and whistling)

(Credits)

GROSS: I'm Terry Gross. We'll close with a track from a Sonny Stitt
recording from the live at the Left Bank series. He's playing a song by
Brazilian guitarist and composer, Louis Bonfa, who died Friday at the age
of 78.

(Soundbite of song)
Transcripts are created on a rush deadline, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of Fresh Air interviews and reviews are the audio recordings of each segment.

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