European Geriatric Medicine?(?IF?3.8?)?Pub Date?:?2019-04-10?, DOI:?10.1007/s41999-019-00187-z
老年病學(xué)家不同于更廣泛的老年病學(xué)家群體，因?yàn)樗麄兪亲钣锌赡芘c老年人日常接觸的學(xué)科[1]。這既是優(yōu)勢(shì)又是劣勢(shì)：優(yōu)勢(shì)在于他們不斷接觸老年人的現(xiàn)實(shí)，而劣勢(shì)在于這主要限于那些通常具有復(fù)雜醫(yī)療保健需求的人。醫(yī)療保健范式意味著我們的話語(yǔ)可能有意識(shí)或無(wú)意識(shí)地反映了衰老的失敗模型 [2]，而且我們可能不太了解越來(lái)越健康和不斷增長(zhǎng)的老年人口中更廣泛的老齡化經(jīng)歷。然而，盡管醫(yī)療保健和整個(gè)社會(huì)存在明顯的年齡歧視，并且醫(yī)學(xué)生認(rèn)為老年醫(yī)學(xué)的聲望和收入潛力較低 [3]，老年病學(xué)家一致報(bào)告對(duì)他們的工作高度滿意 [4]。
可能涉及幾個(gè)因素：老年醫(yī)學(xué)具有高效的方法[5]，它在許多未充分探索的研究領(lǐng)域具有智力刺激，涉及團(tuán)隊(duì)合作，尤其是在最豐富和最有趣的階段參與生活[6] . 晚年生活的豐富，以及長(zhǎng)壽紅利的諸多好處[7]，也許是老年醫(yī)學(xué)專(zhuān)業(yè)話語(yǔ)最為貧乏的領(lǐng)域。這樣做的后果很重要，因?yàn)樗鼈儾粌H可能阻礙我們對(duì)衰老的認(rèn)同和理解，阻礙我們對(duì)作為長(zhǎng)壽紅利守護(hù)者的職業(yè)使命重要性的認(rèn)識(shí)，還會(huì)阻礙我們對(duì)老年人和其他人的宣傳工作社會(huì)部門(mén)[8]。雖然在本科和研究生培訓(xùn)期間接觸老年學(xué)的其他分支（社會(huì)、心理和生物學(xué)）可以在一定程度上了解更廣泛的衰老背景 [1]，但很明顯，老年學(xué)的這些要素也越來(lái)越受挫他們的方法可能會(huì)掩蓋晚年生活的更廣泛意義 [9]。
同樣值得注意的是，老年病學(xué)家很少探索衰老在他們自己生活中的意義，并且可能在他們的研究范式中表達(dá)了對(duì)衰老的矛盾心理 [8]。一個(gè)有用的新方法是將醫(yī)學(xué)人文學(xué)科——其主要目的是促進(jìn)更好地理解人類(lèi)、健康、疾病以及通過(guò)人文和藝術(shù)領(lǐng)域體驗(yàn)醫(yī)療保健系統(tǒng) [10]——與不斷發(fā)展的文化老年學(xué)領(lǐng)域，在北美也被描述為人文和老齡化 [11]。正如該領(lǐng)域的一位領(lǐng)導(dǎo)者所描述的那樣 [9]，文化老年學(xué)可以被描述為一種趨勢(shì)或領(lǐng)域，其核心關(guān)注意義，渴望超越舊范式，并為晚年帶來(lái)更全面、更豐富的描述與迄今為止在老年學(xué)和老年醫(yī)學(xué)中的表現(xiàn)相比。鑒于醫(yī)學(xué)是人文學(xué)科之一的有爭(zhēng)議的案例 [10]，醫(yī)學(xué)的人文學(xué)科已經(jīng)被觀察了數(shù)千年，并且醫(yī)學(xué)人文學(xué)科的話語(yǔ)已經(jīng)在 50 多年來(lái)日益正規(guī)化，這是由佩萊格里諾的開(kāi)創(chuàng)性工作推動(dòng)的[12]，醫(yī)學(xué)人文學(xué)科和文化老年學(xué)之間的協(xié)同作用可能是文化老年學(xué)技術(shù)和方法學(xué)發(fā)展的良好起點(diǎn)。
在文化老年學(xué)的兩本重點(diǎn)教科書(shū)中，一本沒(méi)有提到醫(yī)學(xué)老年學(xué)[13]，另一本貢獻(xiàn)非常有限[11]。一般醫(yī)學(xué)期刊，偶爾也有老年醫(yī)學(xué)期刊，將衰老作為醫(yī)學(xué)人文學(xué)科的重點(diǎn)，允許通過(guò)藝術(shù)、文學(xué) [14]、戲劇 [15] 的晚年創(chuàng)造力反思衰老的豐富現(xiàn)象學(xué)]、電影 [16]、音樂(lè) [17] 和詩(shī)歌 [18]。文化老年學(xué)還有助于了解疾中存在的重要沖動(dòng) 期刊將衰老作為其醫(yī)學(xué)人文學(xué)科的重點(diǎn)，允許通過(guò)藝術(shù)、文學(xué) [14]、戲劇 [15]、電影 [16]、音樂(lè) [17] 的晚年創(chuàng)造力反思衰老的豐富現(xiàn)象學(xué)] 和詩(shī)歌 [18]。文化老年學(xué)還有助于了解疾病和 * D. O'Neill doneill@tcd.ie 中存在的重要沖動(dòng)
Geriatric medical humanities: fresh insights into ageing and geriatric medicine
Geriatricians differ from the broader grouping of gerontologists in that they are the discipline most likely to be in daily contact with older people [1]. This is simultaneously a strength and a weakness: a strength in that they are in constant contact with the reality of being an older person, and a weakness in that this is largely confined to those with usually complex healthcare needs. The healthcare paradigm means that our discourse may consciously or unconsciously reflect a failure model of ageing [2], and we may be less aware of the broader experience of ageing in increasingly healthy and growing populations of older people. However, despite prominent ageism within healthcare and society at large, and perceptions of lower prestige and earning potential of geriatric medicine by medical students within such systems [3], geriatricians consistently report high levels of satisfaction with their work [4]. There may be several factors involved: geriatric medicine has highly effective methodologies [5], it is intellectually stimulating with many under-explored areas of research, involves team working, and in particular engages with life at the richest and most intriguing stage [6]. The richness of later life, and the many benefits of the longevity dividend [7], are perhaps the areas where the professional discourse of geriatric medicine is most impoverished. The consequences of this are important, as they may hinder not only our own identification with, and understanding of, ageing, our appreciation of the importance of our professional mission as guardians of the longevity dividend, and hamper our advocacy efforts with older people and other sections of society [8]. While some degree of insight into the broader context of ageing can be gained from exposure to the other branches of gerontology (social, psychological and biological) during undergraduate and postgraduate training [1], it is clear that these elements of gerontology are also increasingly frustrated by how their methodologies may obscure the wider meanings of later life [9]. It is also notable that geriatricians rarely explore the meaning of ageing in their own lives and may express ambivalence about ageing in their research paradigms [8]. A helpful new approach is to blend medical humanities— whose key aim is to foster a better understanding of what it is to be human, well, ill and to experience the healthcare system through the fields of humanities and the arts [10]—with the evolving field of cultural gerontology, also described as humanities and ageing in North America [11]. As described by a leader in the field [9], cultural gerontology can be described as a tendency, or a field, with a central focus on meaning, a desire to transcend old paradigms, and to bring a fuller, richer account of later years than heretofore presented in gerontology and geriatric medicine. Given the arguable case that medicine is one of the humanities [10], that the humanities aspect of medicine has been observed for millennia, and that the discourse of the medical humanities has been increasingly formalized over 50 years, prompted by the pioneering work of Pellegrino [12], it might be expected that a synergy between the medical humanities and cultural gerontology might be a good starting point for development of techniques and methodology in cultural gerontology. Surprisingly, of the two key textbooks in cultural gerontology, one makes no reference to medical gerontology [13], and the other includes a very modest contribution [11]. The general medical, and very occasionally geriatric medical, journals have made space for ageing as a focus in their medical humanities rubrics, allowing for reflection on the rich phenomenology of ageing through late-life creativity in art, literature [14], theatre [15], film [16], music [17] and poetry [18]. Cultural gerontology also facilitates an appreciation of the vital impulses present in diseases and * D. O’Neill doneill@tcd.ie
更新日期：2019-04-10
