Those persons who are presently the aged and aging have been productive workers and contributors to the wealth of this Nation during their working years. They have become accustomed to the finest medical care in the world. We are convinced that under no conditions should they become second class citizens. Furthermore we are convinced that there can be in these United States no "second class" medical care. Professional services must be made available in quantity and more particularly in quality, free from undue restrictions or administrative controls. Projected medical services should allow for the traditional doctor-patient relationship in which the patient's needs are paramount and where he may choose his own physician. Mass medicine or "bargain basement" care will not be tolerated by this older age group and will be violently opposed by the medical profession. The creation of Government controlled hospitals and clinics will not provide the essentials of quality and dignity so peculiarly needed by this group. Professional medical care will be best rendered at lesser cost in the physician's office and in the hospitals of the patient's community.

The problems of the aged with respect to medical, economic, and social needs will vary from one area of the country to another. Thus the problems arising in the great cities will be entirely different from those in the small towns, rural areas and the great western plains. It is essential that these local needs of the community be recognized. One single mass program at a national level will not take these factors into consideration. We, therefore, heartily approve of the regional hearings which your subcommittee has scheduled and we request that we be called upon to provide the names of appropriate officers of our component societies who desire to be heard at those hearings to present area problems and suggested solutions to improve the medical care of the aged.

Finally, we believe that the attitude of our Nation toward this group should be entirely different from the views of other nations. The enormous productivity and wealth of the United States provide financial resources to purchase first class medical care for the aged. Any attempt to equate our wealthy capitalistic system, its capabilities and respect for individual rights with the feeble resources and totalitarian techniques of many other nations is obviously impossible.

To summarize, we place the problems of the aged in the following order of

concern:

1. We recommend a reappraisal of the present compulsory retirement customs and laws of our States and Nation.

2. We respectfully suggest that you carefully analyze all proposals which may be submitted to you, so that the dignity of the aged person will be preserved and his rights and usefulness to society as a producer will be maintained rather than be classified as a "worn out second class citizen."

3. We recommend that any program including the medical care of the aged should envision the fact that within the foreseeable future possible one-half of all professional services rendered by specialists in internal medicine will be given to the group under study. Therefore, any program or recommendations should insure that the present high quality of medical care now available shall continue. Any program must have an economic base upon which medical schools may continue to increase the quality of their instruction as well as attract intellectually gifted young men and women into the medical profession.

4. We recommend continued study and long-range planning by yours and similar committees in recognition of the fact that medical break throughs or discoveries may alter completely the problem as we see it today.

5. We recommend that the committee dismiss from its consideration any rigid programs formulated on the basis of the experiences in other nations. These should not be used as a model for the United States of America.

AMERICAN PSYCHOLOGICAL ASSOCIATION,
Washington, D.C., August 4, 1959.

Hon. PAT MCNAMARA,

U.S. Senate Subcommittee on Problems of the Aged and Aging, Washington, D.C.

DEAR SENATOR MCNAMARA: On behalf of the American Psychological Association I wish to express appreciation for your invitation to submit to your subcommittee a statement dealing with the interests and activities of the association in the field of aging.

We strongly endorse your recent statement that "the time has long passed for the country to be able to ignore this great domestic challenge of the midcentury." As you will see from our statement, the American Psychological Association has, for a considerable period of time, been interested and active in the psychology of aging. During this period the activities of individual psychologists working in the field have markedly increased. At this very time senior psychologists most highly competent in the psychology of aging are participating in an intensive "workshop" at the University of California.

We hope that the attached statement will provide the kind of information requested in your letter of July 17, 1959: that it adequately presents the history of our interest in the field; some of the specific issues of research, services, and manpower which we believe need attention now; and our wish to be as helpful as possible in the development of knowledge and skill in this important area. Sincerely yours,

ROGER W. RUSSELL,
Executive Secretary.

STATEMENT OF ROGER RUSSELL, EXECUTIVE SECRETARY, AMERICAN PSYCHOLOGICAL ASSOCIATION

Mr. Chairman and members of the Senate subcommittee, the American Psychological Association very much appreciates the opportunity to submit testimony pertaining to problems of the aged and aging. These are problems of great importance to the welfare of an increasing segment of the Nation's citizens. Medical science now makes it possible for relatively greater numbers of people to live to a more advanced age; but, as this subcommittee knows, this happy fact nonetheless raises problems and poses new responsibilities for the Nation. We strongly endorse Senator McNamara's recent statement that "the time has long passed for the country to be able to ignore this great domestic challenge of the midcentury."

Psychologists, as citizens with certain special competences, constitute one of the scientific and professional groups which, for a number of years, have been interested in the field of aging and have actively studied its problems. This interest and activity has been supported by the American Psychological Association, the national organization of American psychologists.

The American Psychological Association, founded in 1892, has its headquarters in Washington, D.C., at 1333 16th Street NW. At present it has a membership of approximately 18,000, which constitutes the great majority of qualified psychologists in the country. The purpose of the American Psychological Association is to advance psychology as a science, as a profession, and as a means of promoting human welfare. The association attempts to further these objectives by encouraging the sound development of psychology in all its branches; by the promotion of research in psychology and the improvement of research methods and conditions; by the improvement of the qualifications and usefulness of psychologists through high standards of professional ethics, conduct, education, and achievement; and by the increase and diffusion of psychological knowledge through meetings, professional contacts, reports, papers, discussions, and publications. The association is organized into 19 divisions, each representing an area of major scientific or professional interest. Many of the divisions have members whose skills and interests bear upon problems of the aging and aged. A division on maturity and old age was organized in 1946 with a specific concern in this The purpose of the division is to further the study of psychological development and change during the adult years and old age, to discover and foster means for dealing with such changes, to collaborate with other groups or organizations interested in these problems, and to disseminate knowledge in this field. The division has conducted several surveys of psychological research, training, anad service to the aging; its individual members are engaged, some full time and some part time, in scientific and professional activities in the field.

area.

The testimony which follows is organized under two main headings: (a) history of the American Psychological Association's interest and concern with problems of the aged and aging, and (b) specific problems of aging. We submit with the present statement copies of the following documents, which review in detail those aspects of aging in which psychologists are particularly interested:

1. "Psychological Aspects of Aging": Proceedings of a conference on planning research. Edited by John E. Anderson.

1956.

2. "Psychological Aspects of Aging": James E. Birren (prepared for Annual Reviews of Psychology, 1960).

HISTORY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION'S CONCERN WITH PROBLEMS OF THE AGED AND AGING

From its very beginning the American Psychological Association was concerned with research on child development. Knowledge increased rapidly until, at the time of the early White House conferences on children, psychologists were able to offer consultation and advice on a matter of such wide national interest. It was only natural that this interest in the early years of life would spread to the recognition that psychological development is a process covering man's entire lifespan that from this recognition would grow interests and concerns with problems of older people. Psychologists who have been active during this transition period have commented upon the analogy between the present rising inter. ests and concerns with problems of older people and those centering upoù problems of childhood in the early 1920's.

Although the interests of psychologists in problems of aging have been growing most rapidly during recent years, it would not be accurate to say that no such interests existed earlier in the century. What is perhaps the first book published on the psychology of aging was by Dr. G. Stanley Hall in 1923 entitled "Senescence: The Last Half of Life." Dr. Hall, then president of Clark University, had previously been interested in the developmental psychology of childhood. He was a founder of the American Psychological Association; its president in 1892 and again in 1924, the year after the book on aging appeared. His personal interests during this latter period had significant influences upon the association and its members. At the time he wrote the book, there was very little psychological research in the field to be reviewed.

The first technical review of the literature bearing on aging was by Dr. Walter R. Miles in 1933 entitled “Age and Human Ability” and published in one of the association's journals, the "Psychological Review." Two years later, in 1935, he published a second comprehensive review of the existing literature on the psychological aspects of aging as a chapter in the "Handbook of Social Psychology" entitled "Age in Human Society." In 1941 the U.S. Public Health Service held, in Washington, D.C., a conference on "Mental Health in Later Maturity" to which were invited several distinguished members of the American Psychological Association: Drs. Leonard Carmichael, Carney Landis, Walter R. Miles, Edgar A. Doll, George Lawton, Otto Klineberg, David Shakow, and David Wechsler. In 1946, the association's division on maturity and old age was founded. In 1955 this division held a 3-day conference on "Research on Aging."

The proceedings of this conference reviewed the research conducted during the previous decades. It is interesting to note that the 1935 review by Dr. Walter R. Miles contained a total reference list of 139 articles, some of which were only remotely classifiable as psychological research. In the proceedings of the 1955 conference there were 380 references, although similarly some were not strictly classifiable as psychological research. During the 20 years between 1935 and 1955 there had been at least a doubling in the amount of phychological literature on problems of aging as compared with the amount of information available prior to 1935. A review of the psychological aspects of aging covering the years 1956 to 1959 has now been prepared by Dr. James E. Birren for publication in the 1960 volume of the "Annual Reviews of Psychology" (copy attached). This review shows that the acceleration in psychological research on aging which characterized the years just preceding 1955 has markedly increased; part of this increase may be ascribed to the stimulus of the association's conference in 1955.

The interest shown at the 1955 conference, and the very considerable amount of information by then available, suggested to two of the conference committee members that a handbook of technical information in the field was necessary. Earlier, manuals in child psychology had proven to be useful means of collating information from diverse sources in such a form as to make it available for further study, research, and application. This suggestion has come to fruition in a project developed as an interuniversity activity centered administratively at the University of Michigan. Dr. James E. Birren, one of the past presidents of the association's division on maturity and old age, is now completing the editorial work on a "Handbook of Aging in the Individual: Psychological and Biological Aspects" which is to be published by the University of Chicago Press in the late fall of 1959. This is a joint activity of over 24 scientists who summarize the available literature on the psychological well being of older persons.

The members of the association take pride in the history of their research on problems of aging and in the fact that several of the Association's publications not only pioneered but have continued to stimulate progress in the field. Psychologists are active in service organizations for older persons, and their services are being used as consultants by many State commissions, Federal agencies, and public service groups concerned with the aged and aging. Members are currently teaching courses on the psychology of aging.

Thus, what began as an interest in childhood development and spread to the entire lifespan has now become a major interest of the association as represented by a division of individual scientists specifically concerned with and working in the field of the psychological aspects of aging. And what began as an area of little knowledge and less application has become one in which a collation of information is now possible and services are available.

SPECIFIC PROBLEMS

When the Nation recognizes the existence of an important problem affecting the basic welfare of its citizens, actions typically proceed from support of a thorough investigation of the problem to the provision of services :

Research seeks to define problems more precisely, to study their various facets in detail, and to discover ways of solving them.

Services apply solutions, preferably under careful observation and evaluation.

The strategy of support for research and service requires wise and skillful timing. As the results of research become available, services become more prominent. When, however, an attack on such complex problems as those of the aged and aging is new, it is understandable that emphasis must first be placed upon the research. The overall strategy must also take into consideration the need for properly trained manpower to implement both research and services.

Research. The increase of interest and concern in problems of the aged and aging is shared by psychologists with members of a number of other scientific and professional groups. The acceleration of activities which this increase has motivated may suggest that sufficient knowledge is already, or soon will be available on which to base decisions concerning the roles of older people in our society and the services society should provide for them. Unfortunately, this would be an overoptimistic assumption: there are many problems in the field of aging for which there is still an impressive lack of fundamental information. Recent activities have served the important function of putting into an organized form what information we do possess; they have provided a point of departure for organizing a systematic program of research, training, and services which will lead to a fuller understanding of the aging process and to promoting the health and welfare of the Nation's citzens over a maximal life span. Research can serve the field of the aged and aging in the same way it serves such fields as medicine and agriculture. It can provide basic knowledge, it can establish principles which will sugget new procedures for applying this knowledge, it can test the effectiveness of old and new applications.

With age there is an increase in the incidence and severity of a number of aspects of human well-being which fall within the psychologist's area of special competence. The following are some of the major problem areas which merit detailed evaluation by psychologists because these are areas which may well need special emphasis in the public interest:

1. Personal and social adjustment and productivity of the healthy aged. 2. Personal adjustment of the handicapped and retired.

3. Sensory handicaps-e.g., deafness and blindness-and retraining.

4. Senile mental disorders and psychosomatic disabilities.

5. Assessment of skills and capacities of individuals whose performance directly affects the public safety-e.g., driver licensing, aircraft pilots, and other transportation employees.

Scientific methods are available for studying specific problems within each of these general areas: the reviews and handbooks referred to earlier are based upon research already completed, and there is more work in progress.

As is typical of research strategies in the biological and behavioral sciences, much important basic research can, indeed in some instances must, be conducted using animal subjects rather than man. At present there is a serious shortage of suitable animal material for research on aging; there is a need for the creation and maintenance of colonies of older animals.

It is also necessary that longitudinal studies of aging in animals and in man be encouraged. Our knowledge of child development benefited greatly from

information which longitudinal studies provided; our knowledge of aging can similarly benefit from this approach. Longitudinal studies follow the aging process as it runs its course in particular individuals; the alternative approach, cross-sectional studies, examines aging in a given group at a specific stage of development. While providing useful information, the cross-sectional approach can mask some of the dynamic features of the aging process as it occurs over time in individuals. Aging is after all a process of continuous change. Obviously longitudinal studies are demanding of time, space, and facilities; they represent continuing commitments which cannot be undertaken without guarantees of long-term support.

The Nation is already aware of the very significant returns on its investments in research and development. Our investment in research on problems of the aged and aging should continue to keep abreast of the increasing efforts going into this research. Research funds should be free to follow research opportunity. To earmark funds for what at a given time are one or two promising areas is to attract investigators into them at the expense of other research areas whose promise has not yet been so clearly realized. Problems of the aged and aging can be attacked by the same scientific methods that advance us in other practical fields. Nature hides her secrets well, and we dare not turn all our search parties in one direction. The creative investigator must be set free and encouraged to choose his own path. This has always paid off, and it will pay off in meeting our responsibilities to the aged and aging.

We believe that it is important at this time to stimulate and facilitate the development of basic research on aging.

1. Since research on aging involves the special competences of several scientific disciplines, it could be useful to establish an integrated group of representatives of these disciplines, perhaps under the aegis of the National Science Foundation to make a detailed analysis of the factors and opportunities affecting basic research on aging.

2. A consideration could be given to the suggestion of an institute for research on aging or some other distinctive organizations, following the successful pattern of the National Institutes of Health.

3. Consideration should be given now to the establishment of an information center, perhaps within the Federal Government, which would gather and disseminate information about the status of older persons in the Nation and about research on the aged and aging. Such a center could be very helpful both in keeping Congress and the Nation up to date on what firm knowledge our research activities have provided and in facilitating the flow of such knowledge to those who may apply it in services for older persons.

Services. The ultimate goal of research in this field is improved human welfare; this requires the effective application of knowledge and skills. Application involves the services of competent practitioners who must be constantly informed of new developments.

In other areas of national concern, methods have been developed for applying knowledge to provide needed services. We believe that these methods could be used advantageously in establishing and evaluating services, both public and private, for older persons. The methods include support for demonstrations and evaluations of improved services. These demonstrations may themselves also be a form of applied research: they provide opportunities to observe the problems which arise in putting improved techniques to work, so that the technique may be as useful as possible when recommended for wide adoption. Grants to State and other local authorities enable the establishment of new types of services and the incorporation of new ideas and information in ongoing programs already supported by local funds.

We believe that it would be useful now to evaluate present and future needs for community centers providing services to older persons. It is to be expected that there will be an expansion of services for older persons as a consequence of current public interest in aging. Psychologists can contribute to these services in several ways, e.g., preretirement counseling; clinical diagnosis, counseling, and guidance; adult education; and psychological testing of abilities.

Manpower.-Progress in the attack on problems of the aged and aging depends upon manpower-and upon the training of that manpower. The work of the association's division on maturity and old age suggests that some balance is desirable: if all the present emphasis is on research, we will not increase the