Aging, from one who knows

By Saul Freedman | Special to Newsday

10:42 AM EDT, March 21, 2008

Slight, soft-spoken and white-haired, Dr. Robert Neil Butler has the looks and demeanor of a classic family practitioner who came to your bedside when you got sick. But he is much more: the doctor who practically invented the specialty of geriatric medicine, treating and caring about people of age.

Indeed, I think it can be safely said that Bob Butler knows more than anyone about the triumphs and challenges of aging, its problems and processes, its science and politics.

A graduate of Columbia College, Butler says he was appalled by the dismissive and uncaring attitude toward older patients among his teachers in medical school. It helped drive him toward geriatrics as a specialty, and it helped him coin the term "ageism" in 1968, which has been his battleground ever since.

In 1975, Butler became the founding director of the National Institute on Aging as part of the National Institutes of Health, outside of Washington, D.C., where he identified Alzheimer's disease as a national research priority. In 1976, he wrote a breakthrough book, "Why Survive? Being Old in America," which won a Pulitzer Prize for nonfiction.

In 1990, Butler established one of the nation's premier think tanks on aging, the International Longevity Center in Manhattan, as part of the Mount Sinai Medical Center, where he still teaches. Last year the International Longevity Center-USA became an independent affiliate of the school.

Butler has written many books and hundreds of papers and articles. Now, at 81, he has packed just about everything he has learned into his new book, "The Longevity Revolution," which seeks to answer the question he raised in 1976. The book is subtitled, "The Benefits and Challenges of Living a Long Life." Earlier this month, I had a chance to sit and talk with him.

Q: Americans are supposed to be celebrating longevity, celebrating the fact we're living longer. Why, then, has it turned into a crisis?

A: There are some ... who think that Social Security and Medicare are not sustainable. There are those in medicine who fear it would be a large increase in Alzheimer's disease because there are more older people. ... .I call this [the] paradox of longevity. On the one hand, we should be celebrating, but on the other hand, the fear of too many old people is a fear that some people have, not all people but some people.

Q: Is there some fear that in this society, which is geared to the profit motive, we might err on the side of dispensing with people who are too old and not productive?

A: That's a very real possibility, and there are those in many countries that actually worry about this. The man who created "Shoah," which is the great film about the Holocaust, he worries that this could happen. Japan worries that this could happen. There is fear that there could be a kind of not maybe directly intended ... elimination of older people through not providing health care, not providing services, so they can go away and not be an expense to society.

Q: Do you think there's some evidence in this society yet?

A: I do worry that only one of 10 nursing homes in the U.S., which contain 1.5 million people ... actually pass basic federal standards with respect to personnel. That's pretty terrible.

Q: Somebody has called this fear the gray peril.

A: An example in my mind is the health insurance industry, which takes no pains to be helpful. ... We in our country spend 20 percent of our GDP on health. Europe spends 10 percent, on average. I don't see any redeeming advantage to the private health insurance industry.

Q: Is it because we're stingy as a society toward spending money on health, spending money on older, less- productive people?

A: There has been some of that, but I have to say there's been some ... change, too. Because of efforts to end mandatory retirement, I am still teaching. There are some greater opportunities now for older people. They're not only living longer but living more healthily. So there's been a decline in the rates of disabilities. That also speaks to the fact that older people can remain in the workforce longer. ... So I think we may see more of a productive use of older people.

Q: I agree with you, but talking about the baby boomers, AARP a few years ago did polling on the differences between generations, and they found among the younger people less inclination toward intergenerational caring. I wonder if what's happening in the U.S. is also a clash of generations.

A: I don't think we're really there yet. I don't mean there isn't some evidence, but most of the polls show that most young people want older people to get Social Security, Medicare, for example. They may be fearful that by the time they reach that age, they won't get it, but they don't seem to be that negative toward older people.

Q: Why does a magazine [The New Republic] come out with a cartoon depicting older people as "Greedy Geezers"?

A: That specific individual in that particular case was an English writer in America who wrote that very tough ... story. I'm not saying there aren't those that are ... negative toward old people. But I was responding in the more general sense of society.