European Geriatric Medicine ( IF 3.8 ) Pub Date : 2019-04-10 , DOI: 10.1007/s41999-019-00187-z

老年病学家不同于更广泛的老年病学家群体，因为他们是最有可能与老年人日常接触的学科[1]。这既是优势又是劣势：优势在于他们不断接触老年人的现实，而劣势在于这主要限于那些通常具有复杂医疗保健需求的人。医疗保健范式意味着我们的话语可能有意识或无意识地反映了衰老的失败模型 [2]，而且我们可能不太了解越来越健康和不断增长的老年人口中更广泛的老龄化经历。然而，尽管医疗保健和整个社会存在明显的年龄歧视，并且医学生认为老年医学的声望和收入潜力较低 [3]，老年病学家一致报告对他们的工作高度满意 [4]。

可能涉及几个因素：老年医学具有高效的方法[5]，它在许多未充分探索的研究领域具有智力刺激，涉及团队合作，尤其是在最丰富和最有趣的阶段参与生活[6] . 晚年生活的丰富，以及长寿红利的诸多好处[7]，也许是老年医学专业话语最为贫乏的领域。这样做的后果很重要，因为它们不仅可能阻碍我们对衰老的认同和理解，阻碍我们对作为长寿红利守护者的职业使命重要性的认识，还会阻碍我们对老年人和其他人的宣传工作社会部门[8]。虽然在本科和研究生培训期间接触老年学的其他分支（社会、心理和生物学）可以在一定程度上了解更广泛的衰老背景 [1]，但很明显，老年学的这些要素也越来越受挫他们的方法可能会掩盖晚年生活的更广泛意义 [9]。

同样值得注意的是，老年病学家很少探索衰老在他们自己生活中的意义，并且可能在他们的研究范式中表达了对衰老的矛盾心理 [8]。一个有用的新方法是将医学人文学科——其主要目的是促进更好地理解人类、健康、疾病以及通过人文和艺术领域体验医疗保健系统 [10]——与不断发展的文化老年学领域，在北美也被描述为人文和老龄化 [11]。正如该领域的一位领导者所描述的那样 [9]，文化老年学可以被描述为一种趋势或领域，其核心关注意义，渴望超越旧范式，并为晚年带来更全面、更丰富的描述与迄今为止在老年学和老年医学中的表现相比。鉴于医学是人文学科之一的有争议的案例 [10]，医学的人文学科已经被观察了数千年，并且医学人文学科的话语已经在 50 多年来日益正规化，这是由佩莱格里诺的开创性工作推动的[12]，医学人文学科和文化老年学之间的协同作用可能是文化老年学技术和方法学发展的良好起点。

在文化老年学的两本重点教科书中，一本没有提到医学老年学[13]，另一本贡献非常有限[11]。一般医学期刊，偶尔也有老年医学期刊，将衰老作为医学人文学科的重点，允许通过艺术、文学 [14]、戏剧 [15] 的晚年创造力反思衰老的丰富现象学]、电影 [16]、音乐 [17] 和诗歌 [18]。文化老年学还有助于了解疾中存在的重要冲动 期刊将衰老作为其医学人文学科的重点，允许通过艺术、文学 [14]、戏剧 [15]、电影 [16]、音乐 [17] 的晚年创造力反思衰老的丰富现象学] 和诗歌 [18]。文化老年学还有助于了解疾病和 * D. O'Neill doneill@tcd.ie 中存在的重要冲动

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