Book Review

The Art of Aging: A Doctor's Prescription for Well-Being

N Engl J Med 2007; 356:2660June 21, 2007

Article

The Art of Aging: A Doctor's Prescription for Well-Being
By Sherwin B. Nuland. 302 pp. New York, Random House, 2007. $24.95. ISBN: 978-1-4000-6477-9

As a geriatrician, I am familiar with most of the biological and medical topics discussed in this book. But as Sherwin Nuland is above all an excellent and thoughtful writer, I simply enjoyed reading it. The book does not, it seems to me, speak primarily to physicians or their aged patients but speaks to anyone interested in human aging. As Nuland points out, the purpose of the book is “to tell of human aging and its rewards — and also of its discontents . . . to tell of how best to prepare for the changes that inevitably demand accommodation, demand a shift in focus, and demand a realistic assessment of goals and directions.”

Nuland, a retired surgeon who had a long career in general surgery at Yale–New Haven Hospital and is currently a clinical professor of surgery at Yale University, has written a number of popular and well-received books on subjects both medical (How We Die: Reflections on Life's Final Chapter. New York: Vintage, 1995) and nonmedical (Maimonides. New York: Schocken, 2005). Perhaps it was inevitable that as he began to age, Nuland would turn his formidable analytic and literary skills toward the universal biological process of aging.

This is not a long book, and it does not try to exhaust the subject of gerontology. It does, however, touch on many aspects, from the basics of the biology of aging to the sociology of senescence. Nuland reports on his interactions with superstars of aging — including Michael DeBakey, pushing 100 and going strong — as well as with more ordinary people to show how they have tried (more or less successfully) to deal with their own aging. This literary device is useful, but the book does not offer enough examples of the many unfortunate people who feel defeated by their old age or who just hang on by the skin of their increasingly loose teeth. Given that Nuland has written an award-winning book on dying, I was surprised that so little of this book deals with the subject — one of the many concerns of older people, their caregivers, and (though perhaps not often enough) their physicians.

Nuland builds a strong case for the “use it or lose it” school of thought, and he gently but effectively debunks the notion that the human lifespan may be increased to hundreds, if not thousands, of years. Nuland, along with most gerontologists, thinks that such a lifespan would render our world unlivable. His critique, primarily ethical and sociological, is convincing.

The Art of Aging offers a lot of good advice and thoughtful ideas for the interested lay reader, and it wouldn't hurt for doctors to read the book — especially those who hope to reach a healthy old age themselves. They could do worse than to recommend this fine work to their patients, especially to baby boomers, who are not likely to go so gently into that good night. Those who take Nuland's advice will be spared a lot of grief as they age.

A. Mark Clarfield, M.D.
Ben-Gurion University of the Negev, Beersheva 84101, Israel
markclar@bgu.ac.il