Senior Adventures in motion pictures: personal reflections on Geriatric Medicine and film

3306290895_7bdeeb5802_oKhalid Ali is a senior lecturer in Geriatrics, Brighton and Sussex Medical School, and Ageing Research Lead for the Kent, Surrey and Sussex Comprehensive Research Network

Back in the 70’s where I grew up in Khartoum, Sudan, the highlight of my week was Thursday movie-night, when my father took the family to watch Peter Seller’s “The party” or John Travolta’s Saturday Night Fever. In addition to pure sensory entertainment, I became aware of world politics; the Watergate Scandal in All The President’s Men, the Vietnam War in Coming Home, Apocalypse Now, and The Deer Hunter. Coming to the UK to pursue my postgraduate studies in medicine in 1999, I was lucky to be reminded of the magic and power of film to inspire, amaze and educate through world cinema on offer at the London Film Festival (LFF).

As a senior house officer in Geriatrics passing the time in a quiet on-call shift in the doctor’s mess at Hemel Hempstead General Hospital, I came across Guiseppe Tornatore’s 1988 master-piece Cinema Paradiso on TV . In that amazing film (winner of the 1989 Academy Award for best foreign language film), the wisdom of old age in Alfredo (the local cinema projectionist) guides a young man’s Salvatore hesitant steps into his first romantic experience, and life challenging trials and tribulations, all seen against a backdrop of a charming collage of classic Italian films. It was a definitive moment when I realized that films have a lot to offer to support the well-being of doctors as well as patients, by offering the viewer a three-dimensional account of human stories.

Hippocrates said “It is more important to know what sort of person has a disease than to know what sort of disease a person has” perhaps coining down the much-talked about importance of “patient stories”. Michael Balint, a Hungarian psychoanalyst, founded the concept of “Doctor-Patient relationships” and stressed its potential in achieving better patient satisfaction, adherence to treatment, better health outcomes, reduced anxiety, and ultimately well-being for both patients and healthcare professionals.

My first British Medical Journal (BMJ) film review “Demystifying doctors” analyzed those concepts in Stormy Weather and After Life, both of which screened at the LFF in 2003.

The world of Geriatric medicine dealing with people at times of frailty, vulnerability and co-morbidity when they succumb to dementia, stroke, or Parkinson’s disease provided a rich source for film-makers exploring illnesses such as dementia:

  • The evolving phases of dementia (denial, grief, acceptance, and eventual loss of identity): Still Alice, Cairo Time, and The Iron Lady
  • Role reversal of children acting as guardians to their elderly parents: Radiator, My Old Lady, Nebraska, Amour, and Black
  • Rewarding aspects of caring for old people: A Simple Life, and Robot & Frank
  • Potential for physical, verbal and financial abuse: A Separation, and Dark Blue, Almost Black
  • Placement issues: Away From Her, and The Savages

Daily ethical and moral dilemmas in deciding when to use a Naso-Gastric (NG) or a Percutaneous Endoscopic gastrostomy (PEG) tube, and similarly complicated decisions when to palliate and offer Tender, Loving Care (TLC) have been the focus of Volcano, and Amour. These films stimulated debate and discussion in international forums in film festival circuits, and highlighted universal health and social challenges such as dementia and controversial issues such as “Right to die”.

The Knowledge, Attitude, and Practice (KAP) theory in medical education advocates knowledge as the basis for delivering evidence-based high quality care for people of all ages. Arts, humanities and films can provide a holistic education to medical students about the diversity, complexity and resilience of growing old. Films such as The Best Exotic Marigold Hotel and its recent sequel, or documentary films such as Alive Inside provide another dimension of successful ageing, and the role of arts, and music in promoting well-being in old age. There are ongoing initiatives to bring films closer to UK hospitals such as Medicinema which is a charitable organization building cinemas inside hospitals

Over the years films have certainly enriched and widened my artistic and cultural horizons and enabled me to reflect on patients’ and carers’ challenging times in sickness. By using films as a medium, I strive to educate myself, students and hospital staff on how we can deliver compassionate, dignified care for older people. The annual London Film Festival is my eminent adventure into the world of senior citizens; this year, films such as The Lady In The Van, Youth, Chronic and Grandma all served to underline that understanding geriatric medicine is no long confined to lecture halls and hospital wards.

Image credit: Francesco Bleve via flickr.

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