this with a lawyer as the person directing the project and we believe that this is going to result in some interesting new proposals for a kind of an imaginative breakthrough in the way of handling this particular situation.

Now, I would like to state briefly what I think our Mr. Hobbs would like to say. It is not that we are not concerned with the humanitarian aspect of aging because we very obviously are. But Mr. Hobbs is a banker, and he often likes to describe himself as a Wall Street banker concerned with the problems of aging, he is concerned not only from the humanitarian aspect but from the economic aspect, and he believes that it is the work of our committee, and I believe I could say your committee and the White House Conference on Aging and whatever groups are at work, to help make the business community understand that it is important to the business life, the economic life of the country and community to maintain a higher level of buying power in the population over 65. I was just reading a report from the community in which they are trying to find out how the older people reduce their spending and it begins first of all in food and then goes into clothing; and, when it gets down to durable steel goods, it drops practically to nothing, and so on.

The other thing related to this, I think, is that we feel from where we sit in the committee that we see a lot of activity going on around the country in very many fields. There are experiments in housing, experiments in social services, like friendly visiting and meals on wheels, and a number of all kinds of visiting services, and so on. We see experiments in employment, some experimentation with trying to provide community programs to provide employment, and so on. But we see this as having been very spotty and experimental, out of which we have learned a good deal about what older people need if they are going to remain independent and active. But so far nobody has taken very seriously the need to consider that the total range of programs for older people nor what it would mean in terms of providing these services to all the people who need them.

Mr. Hobbs, I know, believes as your committee proceeds and as the White House Conference makes its recommendations that unless there is some concept of the price tag on these things, what housing for instance, adequate housing, would really cost, and what some of the other of the social services would cost, what good standards of institutional care would cost, that a lot of the talk will end in frustration. rather than in real progress.

He likes to point out that old age is big business, whether it is in the field of potential productivity of older workers, of which we think there is a good deal, old-age and survivors benefits and private pension plans, health programs, and care of the chronically ill, housing or social services. And therefore for this, as well as for humanitarian reasons, the National Committee on the Aging is grateful to know of this study which is being undertaken by your committee and its staff. Senator MCNAMARA. Thanks very much.

Do your studies indicate that people are retiring earlier or are they staying in the labor force to an older age? Testimony earlier revealed that some industries were encouraging people, in some cases compelling them, to retire at 60. Have you had any experience on that? Mrs. MATHIASEN. We have had some experience with this. This is true in some cases. Again this is a very spotty thing. I believe the

best thing we can say about this is that a number of companies are now reconsidering their policies in this direction. Some of them are actually lowering the age. This is particularly true in the oil industry. But there is also some evidence, on the other hand, that there is a good deal of experimentation also in extending the retirement age, particularly either in a completely flexible way or at least experimenting with extending it by 3 years, for example, or maybe 5 years. Senator MCNAMARA. Thanks very much.

Your testimony is very helpful and your statement will be published, including the notes at the end, if you have a copy for the reporter.

STATEMENT OF DR. FREDERICK C. SWARTZ, CHAIRMAN; ACCOMPANIED BY JOHN GUY MILLER, STAFF ASSOCIATE, COMMITTEE ON AGING, AMERICAN MEDICAL ASSOCIATION

Senator MCNAMARA. Next is Dr. Swartz, the chairman of the Committee on Aging of the American Medical Association. Glad to see you again.

I see you have one of your associates.

Dr. SWARTZ. This is Mr. John Guy Miller, who is staff associate on the Committee on Aging of the American Medical Association. Senator MCNAMARA. Glad to have you here, sir.

I take it you want to have your prepared statement published in its entirety in the record at this point.

Dr. SWARTZ. If it would please the committee; yes, sir.

Senator MCNAMARA. You may proceed in your manner, Doctor. Dr. SWARTZ. I am Frederick C. Swartz, chairman of the Committee on Aging of the American Medical Association. Before I begin my remarks, I would like to pay very high tribute to the two speakers, and their associations, who preceded me. We have had a great deal of contact with Dr. Andrus and her group. We are studying the proposal that she has made on our committee on insurance, and we certainly commend them for the dramatic way that they have demonstrated to the Nation the people of the retired group are capable of taking care of themselves and planning their future.

This National Committee on Aging, too, has physicians represented and we participate in their ideas and ideals to the same extent. We would like to point out in the prepared material that has been submitted to the committee that there is an error on the division which has to do with the examples of individual and community initiative in the field of aging. On page 1 in the middle of the page it says "New York City Home for Aged and Informed Hebrews."

This should be "Infirm" but it should also be informed because we feel that the aged group are really more informed than given credit for.

Senator MCNAMARA. Thank you. We will see that that correction is made in the record.

Dr. SWARTZ. I would like to begin by saying that the medical profession applauds the Senate's concern with the aged and aging, and the way in which this subcommittee is going about its work. It is commendable that you have set out to gather all available facts before seeing any conclusions.

Moreover, your approach to this complex problem is similar to our own. For we, too, have been after the facts since the formation

of the committee in 1955. When the committee was first formed it was charged with the responsibility of studying the diseases of the aged, and we found very quickly that there were no diseases of the aged as such. The aged became sick, it is true, but there were no diseases that were particularly truly diseases of the aged. In the 1954 death statistics of the United States there were 98 children listed as having died with arterosclerotic heart disease including coronary disease below the age of 5. We feel conclusively there are no diseases of the aged. The geriatrics committee renamed itself the committee on aging. Since that time every aspect of living which bears directly or indirectly on health of our older people has been under our intensive study.

Good health is far more than the mere absence of disease or infirmity. This is only the negative side. Health also has a positive side, a physical, mental, and social well-being. There are certainly degrees of health. And any factor which detracts from that well-being detracts from the individual's total health.

Loneliness, rejection, lack of useful things to do, these emphatically affect the overall health of the aged. For hardening of the arteries is certainly no worse than softening of the will to live. This applies to every human being. It applies particularly to the aged.

The older person wants just about the same things out of life the rest of us do, to be part and parcel of his environment, to be loved, to belong, to feel that his skills and talents have value and that they will be used and appreciated.

Let us talk about health in its broader sense for a moment. All of us, no matter who we are or what we do or where we live, have definite responsibilities in regard to our elder citizens. Let me cite a few examples.

We believe it is society's responsibility to stimulate in older people that intangible quality called the will to live. I have seen people with this quality survive illnesses against which they seemed to have little chance. I have seen people without this quality die long before they should.

The will to live is the difference between fighting on and giving up; the difference between staying in the mainstream of life, active and interested, or becoming segregated and remote from life, a passive spectator who no longer cares.

It is a plain fact that people who feel rejected, shunted to the sidelines by society, all too often lose the will to live. Medical and hospital care, important as they are, can never compensate for rejection.

To stay alive and make their later years full and rewarding, old people must care. But they will not care unless we make it plain that we want them to care because we care about them, that we value their wisdom and experience and are anxious to use it.

We believe it is society's responsibility to encourage our elders in their desire to be self-reliant, to maintain faith and pride in themselves. It has been my experience that the overwhelming majority of these people don't want to be the wards of anyone. They want a helping hand if needed, yes; but a handout, no. For anything that undermines the self-respect of a man or woman undermines health, and saps the will to live.

Let me give you an example, typical, I suspect, of situations in many homes. I know of an elderly woman, plagued with all sorts of physical

problems, who repeatedly urged the son with whom she lived to accept part of her own limited income for household expenses. The son neither wanted nor needed the money, but finally agreed. It was not at all important to him. But it was important to her. She felt she had regained her self-respect. Her health improved accordingly.

We believe it is society's responsibility to assist older people in their desire to be treated as individuals, each with different physical chemistry, different hopes, different needs. For the 15 million persons we are talking about are alike in only one way; they are all 65 years of age or older. They are not a homogeneous group. They have no uniform list of wants that can be met by some convenient all-encompassing master plan. They are individuals and we must always remember it.

Moreover, we believe it is society's responsibility to encourage our elder citizens in their desire to be useful. Actually, this is more than a desire; it is a right. The right to be useful should be just as inalienable as the right to dissent or any other right.

Somewhere, someone, sometime once decided that 65 was old. It was as unsound a judgment as it was arbitrary. But once uttered, it was the first step to the conclusion that 65 was too old; and the idea spread. Today it is widespread. As ridiculous as it seems, numberless Americans now believe that 65 candles on the birthday cake disqualify a man for anything better than babysitting, whittling, or sleeping in the sun.

This is shockingly evident in the field of employment, where a man's right to be useful is frequently abridged by compulsory retirement policies. Many of the same firms that hire so carefully, taking into account the individual's training, skills, attitudes, and potentials, find nothing inconsistent in the retirement of a valuable employee by a chronological rule of thumb.

This is a case were nobody wins, neither the employer nor the worker compelled to retire. For most of our older people want to work and need to work. And good employees are not that easy to find.

Personnel policies should be flexible enough to take this into account and use the yardstick of ability instead of the yardstick of age. Again, it may not seem that the matter of compulsory retirement has much to do with health. But I can assure you, as a physician, that it does. I have seen this happen time and time again:

A man who has spent a quarter of his life learning to become independent, and a half of his life being independent, is suddenly cut off from his work. Suddenly he has been denied the right to be useful.

Unprepared for the sudden change in status, he finds himself at loose ends, burdened by a leisure he has not learned how to use. All at once he notices a subtle change in the attitude of his family, of his friends, of his community. For he is no longer the breadwinner. He has become overnight a man who no longer works for his living, a man whose time hangs heavily on his hands, a man whose stature has mysteriously diminished.

To compensate for that which he has lost he often develops aches and pains. And whether some of them are imaginary or not he suffers just the same. We must, therefore, think of the medical challenge as only a segment of the total challenge.

While the physician practices preventive medicine and seeks to forestall the disabling illness which can cripple an older person, society can also take the necessary steps to meet other existing needs that are just as important. Society must, through education, prepare people for retirement and old age. It must think in terms of the older person's many other requirements, whether they bein housing, recreation, or community understanding. Until society recognizes this fact, we will be taking a piecemeal, hit-or-miss approach to a problem that demands a broad-spectrum solution.

Let me point out that in much of the world there is no challenge posed by a large number of old people. In much of the world they just do not get old. They die young,

Thank God we in America have the "problem" of 15 million Americans who constitute one of our greatest assets. And thank God an increasing number of persons and groups have accepted the challenge and are beginning to meet it.

The medical profession and many others who work in the field of health is proud of having increased the life span of the average American. This increase in years has been accompanied by a rise in health levels for all ages, including those over 65.

Clearly, it is the responsibility of all our citizens to work together to insure that the lives we have helped prolong are as satisfactory in their later years as they were in youth.

I promise you, gentlemen, that the American doctor will do his part and more. But the answers that must be found, the solutions that must be reached, involve every segment of our population; every profession, occupation, industry, labor organization, religious denomination, civic group, community, and most important of all, family unit.

All must share the common responsibility.

I am proud that the solutions are being found, that real progress is now being made through the cooperative efforts of private citizens. Working voluntarily, they are proving their ability to do the job in their own communities, and do it effectively and well. A few specifics from their record of accomplishment are appended to this testimony.

The medical profession has continued in its role of providing leadership and support to the overall voluntary effort.

At this time it is enough to say that retirement villages, new nursing homes, chronic disease care centers, home care programs, recreational facilities, and research projects are being set up from coast to coast in substantial number. Further, many, many more are on the way.

Our State and local medical associations have moved promptly to make the American Medical Association's six point program, which I discussed with this subcommittee in June, an effective and workable instrument.

The medical needs of the aged involve the chronic illnesses and the so-called degenerative diseases. In a large percentage of cases, the main need is not for an expensive hospital stay or a surgical operation, but for medical care at home or in the doctor's office. In other cases, the important requirement is nursing care in the patient's home, or the home of relatives. And in still others, custodial care in a nursing home or public facility may be the only answer.