STATEMENT OF EDWARD L. BORTZ, M.D., PRESIDENT-ELECT, AMERICAN GERIATRICS SOCIETY

Senator MCNAMARA. The American Geriatrics Society, Dr. Edward Bortz, president-elect.

We are glad to have you here, Doctor. I see you have a prepared statement. Would you like to present the statement for the record and summarize it or what is your pleasure?

Dr. BORTZ. Mr. Chairman, I would like to present this statement for the record and also comment on a few of the issues as I proceed.

Senator MCNAMARA. All right, sir. The statement will be printed in full in the record at this point.

(The statement of Dr. Bortz follows:)

PREPARED STATEMENT BY EDWARD L. BORTZ, M.D., PRESIDENT-ELECT, AMERICAN GERIATRICS SOCIETY

Mr. Chairman and members of the committee, in response to your invitation to present a statement concerning our interest in problems of aging, I wish to record the following information.

I am chief of one of the medical services of the Lankenau Hospital in Philadelphia. For some 25 years our principal professional interest has been in the fascinating problems bearing on the health and well-being of older individuals. Due to the substantial increase in medical knowledge in the last quarter century, more individuals are reaching the later period of life. The efficiency with which ordinary diseases and deterioration of the human body are being treated is making it more difficult to die. With the rapid increase in older citizens due to the control of the diseases which destroy life in the early years, there has been a shift in the type of illness which is making it necessary for individuals to seek medical services today.

The foremost common medical problems of older individuals are those involving the blood vessels and heart (over 2 million deaths in 1958); cancer (267,000 deaths in 1958): arthritis and rheumatism; nervous and mental disturbances (over 50 percent of the hospital beds in the Nation are taken by these cases). Intensified medical research today is utilizing highly efficient new techniques in search of the underlying causes which take such a toll in human life. These four maladies within the next quarter century will be much more clearly understood. Science will find ways to curb their depradations. Then there will be a further substantial addition to the human life span.

The shift in age groups with marked increase in individuals approaching the century milestone makes this phenomenon the great population challenge of the middle 20th century. As Senator McNamara has so forcefully emphasized, as a nation we are not utilizing the productivity of our older citizens. The health, well-being, and happiness of older citizens certainly represents a great problem facing every community in the Nation.

Medical science has been aware of the rapid changes taking place in the practice of medicine. The American Geriatrics Society, a comparatively young organization less than 20 years in existence, last year received over 2,000 applications for membership from doctors all over the world. Dr. Richard J. Kraemer and his staff are continually receiving requests for information concerning recent advances in theory and knowledge bearing on the health of older individuals. This society, through its publications and yearly meetings, is extending its efforts to further a higher standard of medical service to older individuals. It should be stated that knowledge is far ahead of application of health practices; that, if instituted this would result in healthy, older people. To be specific, the intimate relationship between diet, exercise, and the control of physical and nerve exhaustion is little known. Experimental evidence indicates that deterioration of the blood vessels and heart muscle is accelerated by overeating and underexercise. There is convincing experimental evidence that the lives of animals may be greatly extended by planned diet and exercise.

There are four basic tissues in the human body which, when kept in gooà functioning order by appropriate diet, activity, and regular rest periods, tend to prolong the period of useful existence. These tissues are the bones, muscles, blood vessels, and nerve cells. Research teams in various medical centers are busily engaged in study the stamina of these four body tissues under various conditions of stress and strain. As more knowledge accrues relating to healthy function of these four body tissues, it can with confidence be predicted that the body will be able to withstand more of the ordinary shocks which constitute the daily experience of living. Biologically, the human body can be modified. If can be altered for better or worse, depending upon the environmental influences (external and also internal). A healthy, stronger, more responsive body can be developed.

While there is much that is not known, certainly much valuable information exists bearing on physical fitness and mental health.

In the rapidly changing world today, man himself is changing. He is increasing his years of life but he also has the opportunity to enrich, to increase the quality of living in the later years. Permit me to explain. Man is not only living longer, he is staying young longer; that is, he is retaining the buoyancy and the responsiveness of his organs and tissues. We tend to ignore the tremendously important fact that, within each human body there is the amazing automatic mechanism for regeneration and repair.

A curious paradox faces society today. At the most promising period in the history of man there is the promise of healthy added years. Medical science is waging an exciting campaign. People are living longer. At the same time, outmoded practices on the part of industry, labor, Government; in fact, the attitude of society concerning retirement are forcing large groups of men and women out of useful occupations. This now takes place at a time when through years of practice, study, additional knowledge and experience, an individual is capable of the best performance of his entire life. Yet, because he arrives at an arbitrary year in life's journey, at the time when he needs work and needs to be kept in the stream of useful activity, he is relegated to the sideline by retirement. When a man retires out of life, life retires out of him. This is one of the major curses of our modern culture that needs prompt reevaluation. A half-century ago there was some basis for moving the trusted employee aside so that the younger individual could move on: today with automation, the muscleman is not so important. The man with know-how and experience increases in value in his position with passing time. This is indeed one of the major challenges facing all groups of society.

If one accepts the statement that it is now possible to improve the physical fitness and mental health of older individuals, the next question concerns the utilization of older citizens in meaningful activity. Personally, I am convinced that a vast amount of sickness today can be avoided. Healthy modes of living, we believe, should be a part of the instruction program in the schools of our Nation. Government, collaborating with the educational authorities, could contribute greatly to the modernization of our education curriculum. In fact, we believe, education should be regarded as a lifelong discipline. Emphasis should more and more be placed on health practices that would promote physical and mental well-being.

These suggestions are offered because there is a pressing need for a greater recognition of the fabulous potentials now quiescent in our growing aging population. The problem has suddenly assumed major importance. Unless useful careers can be evolved for individuals as they continue their life journey (and many are going to reach the century mark), their need for funds might well endanger the entire Nation. Obviously, the immediate indication is to encourage individuals to keep healthy as they grow older. Health in its broadest sense includes not only physical and mental well-being, but engagement in an activity of importance to society. Certainly the solvent older individual who does not need the support of his Government, who is a contributing rather than a noncontributing member of the community is an asset of first importance. Older individuals in a community may be divided into three groups. First, the large number of healthy, substantial, independent, productive persons capable of carrying on and increasing their contribution to the life of the community. As they grow older this large group has much to gain by utilizing known facts concerning personal health. The simple essentials of a well-balanced diet, generous exercise, adequate rest periods, the participation in community and national activities, the avoidance of nuisance maladies; in other words, wellbalanced living is of first importance as individuals enjoy the extended years, the dividends of modern science.

To reenforce this large group, a family insurance plan, broad and inclusive in type, should be established when the family unit is created. Long-range planning becomes more important as long-range life comes into view. Many experiments are now being carried on in the field of insurance for unexpected catastrophes that may fall upon any citizen. Life itself is a hazardous experience. The second large group of older individuals is those needing medical care. So much attention has been given to the economic aspects of long-term illness that insufficient consideration has been directed to measures leading to prevention.

In the Lankenau Hospital in Philadelphia, an interesting experiment has been carried on in the field of education for the past 5 years, a health_education program with a full-time staff and members of the medical staff and board of trustees. With the use of a health museum and various teaching techniques, classes are held for various groups of the community where instruction is given in the basic facts of life. This is a movement to keep people out of the hospital by keeping them healthy. This unique experiment has excited the curiosity and, indeed, the enthusiastic support of many individuals and organizations.

In association with this activity there is a new research unit with teams of investigators studying the stamina of human tissues under varying conditions of stress and strain. It can readily be proven that flabby individuals can increase the tonicity of a soft, overfed body by regular exercise and attention to diet, recreation, and rest. Our researchers have demonstrated the basic importance of a high specific motivation. It would appear that, the older an individual, the greater the need for an all absorbing interest. An aging individual by aimless living can accelerate his deterioration as he grows older. These facts are so self-evident as to appear almost trite. Nevertheless, they are of the greatest importance to the individual and of equal importance to society.

In addition to healthy normal individuals and, second, those in need of medical care, there is a third group. These are the aged and infirm. In many instances they may be designated as medicated survivors. In previous eras, nature eliminated individuals through infection, or other means of removal. In primitive cultures when the individual ceased to be a support to his clan or his tribe, he was eliminated. The aged, the infirm were no threat to the primitive. In modern times the spark of life is supported by marvelously effective techniques which keep the patient alive, even though self-sufficiency and independence is impossible. Through no fault of their own, numbers of our fellowmen reach an unhappy physical condition where they are unable to support and take care of themselves. These are the living dead. At the precemetery level they have one further step to complete the issue. Where the pathology, has become irreversible and science is powerless to reinstate the individual, science must give way to art. Tender loving care is all that is required. Elaborate expensive house and entertainment facilities are not appreciated by those who can't tell night from day.

The most practical approach to the solution of immediate problems facing those far advanced in the deterioration of aging is the creation of facilities at the local level whereby immediate needs will be adequately met. It is reasonable to expect the family to assume the responsibility for the care of an aged loved one just as the family assumes responsibility for a child. When, however, the facilities are not available then other measures must be provided. Here is where the nursing homes come in. The decision concerning the solution in any particular case rests with the family and the physician in charge. This is always an individual matter and production line techniques are not applicable. The extent of the need for such service can only be determined at the local community level.

The fascinating problems touching upon the health and well-being of the huge numbers of the aging citizens lend themselves to cooperative study on the part of many organizations within the community. As a physician it can readily be understood why we find the health and care for the medical needs of older individuals as our congenial concern. Experience has also shown that a great deal can be done for these older individuals.

The American Geriatrics Society will be most happy to cooperate in anyway with other organizations interested in the fascinating problems of our aging population.

Dr. BORTZ. I would like to take this opportunity to thank you for the privilege of being here because this problem of the health and wellbeing of our older citizens has been one of the principal interests of my entire professional career.

Due to the substantial increase in medical knowledge in the last quarter century, certainly more individuals are living longer. The efficiency with which ordinary diseases and deteriorations of the human body today are being treated, due to the advances of medical sciences, is making it more difficult to die. With the rapid increase in the number of older citizens due to the control of the diseases which destroy life in the early years, there has been a shift in the type of illness which is making it necessary for individuals to seek medical services today.

Now, the four most common diseases that afflict older people are, first, diseases of the heart and blood vessels that last year killed over 2 million Americans; second is cancer that destroyed over 267,000 lives; and then the great problem of arthritis and rheumatism, and, fourth, over 50 percent of the hospital beds of the Nation today are taken up by nervous and mental problem cases.

What I want to point out is this, that intensified medical research today is utilizing highly efficient new techniques that have just been developed in the last decade or two, in search of the underlying causes of these four maladies. I believe, it can with confidence be predicted that, within the next couple decades, science will find ways to control heart disease and hardening of the arteries, high blood pressure, strokes, coronary occlusion, and so on.

We are closer to the control of cancer, certainly much better control. The Secretary of the American Cancer Society last week stated, if we take advantage of the knowledge today to control the killing aspects of cancer we could reduce the fatality rate by 50 percent.

Now, the shift in age groups with marked increase in individuals approaching more and more the century milestone (and I think there is no doubt about it that within the next couple of decades more and more people are going to reach the round century of life, and they will not only be reaching that age quantitatively but they will be healthy much longer), and as you, sir, Senator McNamara, have so forcefully emphasized, as a nation we are not utilizing the productivity of our older citizens; and the health, the well-being and the happiness of older citizens represents a great problem facing every community in the Nation.

Medical science has been aware of the rapid changes taking place in the practice of medicine. The American Geriatrics Society, of which I have the honor to be president-elect, which is a young organization in the field of specialties, less than 20 years in existence, last year Dr. Kraemer, who is in the audience this morning, and his staff, received applications from over 2,000 doctors for membership in the American Geriatrics Society. It is an unheard of demand and a showing of interest. This society, through its publications and yearly meetings, is extending its efforts to provide a higher standard of medical service to older individuals. It should be stated that knowledge is far ahead of application of health practices today. If the knowledge that we have available today were utilized, if we had a broad educational program, if the philosophy of our Nation were concentrated on health practices, we could reduce a vast amount of useless suffering.

For example, we know today the intimate relationship between diet, exercise, and control of physical and nerve exhaustion. Science knows that. This is knowledge that we have. Yet it is little appre

ciated throughout the Nation at large. Experimental evidence shows that deterioration of the blood vessels and heart muscle is accelerated by overeating and under-exercise. There is convincing evidence, we have in our laboratories today, that you can take experimental animals and practically double their life span. Not only can you expand their lives, their period of life, but you will preserve their vitality and youthfulness, and buoyancy and sleekness of coat far into the period that a decade or two ago was thought impossible.

From the biological and scientific point of view, the four basic tissues in the human body which we should concentrate on are the bones, that is, the skeleton, the muscles, the blood vessels, and the nerve cells.

In various areas of the Nation research teams are busily engaged in studying the stamina of these four body tissues. As more knowledge accrues relating to the healthy function of these four tissues in the body, it can with confidence be predicted that the body will be able to withstand many of the ordinary shocks which constitute the daily experience of living. There is no doubt that, biologically, the human body can be modified. There is no doubt of that, depending on the control of environmental influences, that is, external environment and the internal environment within the body. We can do a great deal in controlling the equilibrium of the individual, whether he is a flabby individual or whether he is a strong and resilient individual with good muscle tone. In the rapidly changing world today, man himself is changing. He is increasing his years of life, but he also has the opportunity to enrich, to increase the quality of living in the later

years.

Let me explain. Not only is he living longer, but he is staying young longer, he is retaining the buoyancy and responsiveness of his organs and tissues. We tend to ignore this tremendously important fact that within each human body there is the amazing automatic mechanism for general recharging, for regeneration of injured tissues and repair of damaged tissues.

Today a curious paradox faces society. At the most promising period in the history of man there is a promise of healthy added years with added buoyancy and vitality of the tissues and mentality of the individual. We are waging an exciting campaign. People are living longer. But, at the same time, the outmoded practice on the part of society today-industry, labor, government, the professions-with reference to retirement is forcing large groups of men and women out of useful occupations. This takes place just at a time when, through years of practice, study, additional knowledge, and experience, an individual is capable of the best performance of his entire life. Yet, because he arrives at an arbitrary period in life's journey at the time when he needs work and should be kept in the stream of useful activity, he is relegated to the sideline by retirement. When a man retires out of life, life retires out of him. This is one of the major curses of our modern culture. A half century ago there was some basis for moving the trusted employee aside so that the younger man could move on. Today, with automation, which is rapidly changing our whole social fabric, the muscle man is not so important as he But the man with know-how and experience increases in value

was.

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