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The Human Condition—Video Series

Professor of Sociology and Gerontology Quinnipiac University 275 Mt. Carmel Avenue Hamden, CT 06518 E-mail: lynne.hodgson{at}quinnipiac.edu

As editor of this column, I often agonize over which audiovisuals should be reviewed and which should not be reviewed. Of course, I preview the audiovisuals before soliciting reviewers. The easy choices for me are the audiovisuals whose content and presentation inform, challenge, provoke, and even move me. Naturally, I want to share my enthusiasm with readers of The Gerontologist. Soliciting reviewers for such audiovisuals is a simple, straightforward process, and it is one of the joys of my work to see my enthusiasm reflected in the reviewers' positive response to those works. Another choice I make is not to seek a review of an audiovisual because I feel that it will not be of interest or potential use to readers. Sometimes I make a third decision: I may have misgivings about the quality of content, application for users, or technical expertise in a particular audiovisual—but I solicit a review because I think another perspective on the audiovisual may provide insights I missed in my previewing. In some respects, I look for confirmation of my misgivings or concerns, and yet I am willing to be shown that my initial judgment about the video was incorrect. For example, in a column relating to end-of-life concerns (Vol. 43, No. 1), I asked two reviewers to evaluate videos that fit into this third category. Reviewers Tom Tomlinson and Michael C. Kearl provided balanced and—as it turned out—predominantly negative appraisals of two videos, Grave Words: Tools for Discussing End of Life Choices, and Self-Deliverance: Assisted Suicide in Australia. I asked reviewer Lynne Gershenson Hodgson for a similar fair and balanced appraisal for the two videos reviewed in the current column—from the video series The Human Condition. I credit her for pointing out some of the redeeming qualities of the videos while focusing our attention on specific concerns raised by the content and presentation of the subjects.

"Age Happens" and "The Final Chapter" are part of a 26-video series called The Human Condition. The series, as a whole, is not focused on specific gerontology themes. Instead, the series attempts to survey broadly the spectrum of health care across the generations. Each of the programs in the series deals with one of many variables associated with health. Some examples include mental health; abuse; risk-prone pregnancies; health risks during infancy; addictions; environmental pollution; nutrition; physical fitness; AIDS; coronary disease; stroke; and cancer. "Age Happens" and "The Final Chapter" are programs 23 and 24 in the series. The last two programs—"The Medical Marketplace" and "What Price?"—emphasize the social and financial inequalities relating to health care in America.

The Human Condition also is promoted as a central feature of a "telewebcourse" on a website found at http://humancondition.jbpub.com/index.cfm. Information on the course format and resources, including the text Essential Concepts for Healthy Living (2nd ed.), written by Sandra Alters and Wendy Schiff, is available at that site.

—Robert E. Yahnke, PhDyahnk001{at}umn.edu

"Age Happens" and "The Final Chapter," from The Human Condition. Video/2000/30 min each. Produced by Intellecom. "Age Happens": Written by Rebecca Koppenhaver and Sally Beaty. Executive producer: Sally Beaty. Director of photography: Patrick Allen. Distributed by Aquarius Health Care Videos, Olde Medfield Square, 266 Main Street, Suite 33B, Medfield, MA 02052. 888-440-2963 Online: www.aquariusproductions.com. E-mail: info{at}aquariusproductions.com. Rental $50 (one day), $100 (one week), Purchase $899 (26-video series).

"Why do people grow old?" is a question that gerontologists pose almost as regularly as they ask "Is it possible to slow down the aging process?" These two questions provide the opening lines and the dual themes in "Age Happens," which is one segment in a series of 26 videos titled The Human Condition, focusing on health care in the United States. This particular segment offers a glimpse at the physical and mental changes that take place in aging individuals. Through the use of relevant visuals, expert testimony, and personal vignettes, the video offers a general overview of the aging body and mind.

One of the most important developments in the field of gerontology/geriatrics over the past few decades has been the recognition of diversity in all aspects of the aging experience. Nowhere has that been more clearly demonstrated than in the realm of physical and cognitive aging. Where variability is the rule, generalizations are difficult to make. Most discussions of biological aging, therefore, begin with two acknowledgments: (a) given some underlying universals, individuals age at different rates, and (b) normative aging is distinct from pathological aging. "Age Happens" does offer a subtle nod to these important truths, but it should offer its audience more than "subtleties." By failing to explicitly underscore the variability in physical and cognitive aging, the video runs the risk of perpetuating stereotypes. Because the action moves very rapidly from a recitation of the "natural and unavoidable" physiological and cognitive changes to a discussion of chronic illness in older Americans, there is a sense that aging equals disease. Noting that the optimum scenario would be to compress all diseases into the last year of life, the video offers glimpses of individuals who exhibit a variety of ills, including many of the most common diseases of age: arthritis, diabetes, Alzheimer's, and osteoporosis. With a nod to the prevalence of chronic illnesses such as these, the video introduces intervention strategies that are available to that one fifth of the older population who need some level of help with their activities of daily living. Several model programs are featured as illustrative of the types of assistance offered to disabled older men and women. These programs include both health care providers, such as the grassroots "Over 60 Health Clinic" in Oakland, California, and living facilities that offer tri-levels of care.

There is a problem inherent in the basic objective of "Age Happens": it is a daunting task—in a 25-minute video—to cover the physical and mental changes that occur to men and women as they age. Clearly, the discussion can only touch on broad points, leaving much unsaid and major questions unanswered, including the questions that were posed at the beginning of the video. So, for example, the most current theories about why people age are not offered and only cursory discussion of findings about healthful practices is included. Nor is there any attempt to make distinctions between the young old, the old old, and the oldest old, which would seem to be particularly pertinent to the topic of physical and mental aging. The medical experts, who are generously interspersed throughout the segment, offer the voices of research findings and practical experience but they cannot, in their brevity, raise the level of discourse beyond a surface treatment of the topic.

There are some aspects of the video that should be applauded. The filmmakers have offered a rainbow of older people in their visuals, reflecting an ethnically and racially diverse population. And, to some extent, they allow the older folk to speak for themselves about their own perceptions of aging. Woven throughout the video are reminders, mostly from older people themselves, that declines in aging can often be delayed or offset. Rather than succumbing to the notion of disengagement as one ages, involvement and activity is prescribed. Healthy, vigorous men and women are portrayed who maintain a "sensible" regimen of exercise and involvement. There is a brief but rewarding interlude with an older Hispanic woman, for example, who finds that she is successful as long as she stays involved, and another marvelous clip of a woman in a wheelchair being whirled around the dance floor by her partner. These portraits are in stark contrast, however, to the more frequent stereotypical shots of the vacant stares by dementia patients and unkempt nursing home residents.

Because the treatment of the theme is so general, "Age Happens" is better suited for a popular rather than an academic audience; it is too basic a portrayal of aging to use effectively in gerontology or health care courses. Nor would it be particularly helpful to school children who want to learn about aging because it might actually reinforce some of the more negative stereotypes associated with aging as disability. Educating people about the health conditions and care concerns of older people is important, but this video does not afford the kind of portrait that will effectively achieve that goal.

In another segment of the series, attention turns to "The Final Chapter." Using the same mix of voice-over narration, expert testimony, and case studies, this 25-minute video explores various issues related to death and dying. Beginning with a brief discussion of the changing face of death over the last centuries, the video emphasizes the taboos associated with death in the modern world. The subject of death is rife with contradictions: not only is the modern family loath to discuss and plan for death because it is so far removed from the dying process, but doctors and health care professionals often are equally unprepared to approach the subject with their patients.

Medical practitioners, ethicists, and legal researchers offer their views on the best ways to help dying patients deal with the last phase of life. A legal expert begins the discussion when he raises the issue of preparing patients and their families for death through the use of advance directives. This opening leads nicely into the major focus of the video—the proper role of medical personnel in enhancing the quality of life for people who are dying. In the view of one physician who acknowledges that "death is the enemy for doctors," a fundamental shift is taking place in the way that the medical community deals with those who are dying. Patients' rights and the recognition of personal autonomy are supplanting the traditional norms of paternalism in all areas of health care, and that extends to the decisions and treatment of those with terminal illnesses.

Much of the emphasis in the video is on the importance of honesty in dealing with the dying patient. The case studies that are woven throughout the segment focus on two people with AIDS: a young boy of 10 with AIDS (who is only presented through the description of his social worker) and a middle-aged woman, dying of AIDS, who, when first introduced to the audience, states, "I deal with facts, however gruesome and unpleasant, [which is] much better than not knowing." In the experience of the doctors and nurses who speak on camera, dying patients do not fear death so much as they fear being abandoned by those they love; they also fear pain, the knowledge of unfinished business, the unknown, and being forgotten. Given such fears, these experts agree, health professionals can offer much reassurance. The final portion of the video comes back to the subject of patients' self-determination rights, including the most controversial of those rights, physician-assisted suicide. All featured medical personnel speak against any form of physician-assisted suicide, arguing instead that palliative care, modeled after the hospice framework, is the more desirable path for dying patients. Here again, the case studies are used as cautionary tales.

Although this final segment of The Human Condition series is more effective in presentation and substance than the preceding one, it also raises some concerns. While the major drawback of the former segment was that it was too general to adequately explain aging processes, this video offers more sophistication in its approach to its subject. Admittedly, it is also a brief look at weighty issues and does not cover in any depth the relevant perspectives represented in the literature, but it does touch on many important themes that can be used as points of departure for classroom discussion. The major concern, however, is that it so clearly takes sides on the controversy of physician-assisted suicide, presents one perspective as fact, and does not acknowledge the unresolved controversy surrounding the issue.

As a visual presentation, the video portrays some hard realities of death. The image of the dying woman is striking; and her words are powerful and brutal despite the understated way in which she delivers them. Equally effective is the case study of the young boy as told by the social worker who counseled him throughout his final years with AIDS. It is commendable that the video speaks to death at all ages and not just to older people. Because it does so, it might find its best audience in the popular sector. It is, as was the previous video, too general for a conventional death and dying class because it lacks the cohesion or the detail to add to such a specialized curriculum. Because it also lacks objectivity, it would be hard to recommend for introductory gerontology or health and aging classes. It is certainly desirable to make students think about such issues as advance directives, patient autonomy, palliative care, and physician-assisted suicide, but "The Final Chapter" does not set the right stage for a meaningful learning experience.

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