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My Mother's Hip
Margolies. Review by Kay Paggi
    Margolies is a professional writer, anthropologist, experienced observer and researcher; all of her professional abilities are used in this masterfully crafted book. What makes this book remarkable is Margolies’ exhaustive research into the American medical system, as it concerns patients in later life. The picture she draws is of a system that is out of control and probably unfixable.
     Margolies became an active caregiver when her mother broke both hips; she also assumed care for her father, who had a severe heart condition and declining cognitive function. The book alternates between narrative chapters describing events chronologically and chapters detailing statistics describing the chaotic system of elderly patient treatment common in the United States today.    
    Hip fractures are labeled as the “silent killer”; 27% of older adults who fracture a hip die within one year. The mortality risk rises after the acute hospital stay.  Only 25% of elders who have hip-fractures in the U.S. will return to the level of independence they had before the fracture. In contrast to this figure, in Northern Europe 76% of hip fracture patients regain their prior level of independence. The difference appears to be due to American medical emphasis on the initial acute phase with less importance given to rehabilitation. Co-coordinated services based on the individual patient’s needs, both during and after hospitalization have been proven to improve the likelihood of complete recovery.
     Statistics on osteoporosis and Hormone Replacement Therapy (HRT) are disturbing. Every 10 years, we get a new set of bones, as old bone is reabsorbed and new bone built. Most women take estrogen replacement therapy for a few years following menopause to prevent post-menopausal bone loss. What is less well known is that as soon as a woman stops hormone therapy, her chances of hip fracture are the same as if she had never taken it. Estrogen withdrawal is followed by accelerated bone loss. To maintain strong bones, women must continue lifelong hormone replacement therapy. Unfortunately, estrogen is a known carcinogen, and those who take HRT also are at higher risk for heart attacks and strokes. Each additional year of use increases these risks. 
     Margolies’ chapter on the psychological impact of chronic conditions is insightful, and should be required reading for all caregivers. Seven of ten care-receivers have a chronic condition that is progressive and incurable. People who have a chronic disability are not sick, but they are not well, either. These permanent conditions affect every aspect of their lives, where they go, how they get there, what they do, and how they interact with others. Paradoxically, medical technology has extended life span without developing cures or treatments for chronic maladies that accompany old age. 
     The majority of caregivers are women who provide care an average of 3 hours every day, and have been fulfilling this task for more than 5 years. Most caregivers still view nursing home placement as a failure on their part. Daughters tend to view caregiving not as a discrete set of tasks, but as an unending responsibility that grows out of their feelings of “connectedness”.  They are more likely than their brothers to go along with the fiction that ‘everything is fine’ as a way of preserving parental dignity. Daughters view the continuing decline of a parent as somehow their fault, and suffer intense guilt. Those who have been close to their mothers are particularly affected, and tend to view their parent’s aging as a foreshadow of their own. Margolis points out that a parent’s ongoing decline is not due to any failure of the caregiver but rather a failure of the medical system. 
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