How old is old?

A Conversation With Robert N. Butler
Focusing on the Issue of Aging, and Growing Into the Job
By CLAUDIA DREIFUS/NY Times

For a man about to turn 80, Dr. Robert N. Butler is an astonishingly frequent flier. When he is not dashing to India, he is off to a conference in Virginia, speaking out for human rights for the world’s elderly.

Long before he himself became what he terms “an older person,” Dr. Butler dedicated himself to the health of the aged.

In 1975, he served as the founding director of the National Institute on Aging. A year later, his meditation on aging, “Why Survive?” won a Pulitzer Prize . In the 1980s, Dr. Butler founded the department of geriatrics at the Mount Sinai School of Medicine in New York. His International Longevity Center, a research and policy organization he leads, remains an affiliate of Mount Sinai.

“We need to be thinking differently about aging,” Dr. Butler said over breakfast at his Manhattan offices. “People are living about 30 years longer than they used to. That means that society is going to have more older people, and we’re going to need different priorities and mindsets.”

Q. Earlier this year, your organization released a report, “Ageism in America.” What is the sum of your findings?

A. We did a literature review. According to a 2004 article in The Lancet ,between one and three million older Americans suffered some form of elder abuse from people they depended upon for their care. In the workplace, the General Social Survey studied over-65 workers between 1977 and 2002. Among them, perceived age discrimination rose from 11.6 percent to 16.9 percent. According to the government, 1.5 million older Americans live in nursing homes, 90 percent of which have inadequate staffing.

Older people also experience health care discrimination. Physicians are often less aggressive in treating their illnesses than they are with younger patients. Medical schools don’t teach much, if anything, about elder care. You almost never see a medical student in a nursing home. And you don’t see them taught much about death and dying, either. Moreover, Medicare doesn’t cover what a lot of what older people need — long-term care. The hospice coverage offered is minimal.

Medications? Forty percent of all prescriptions are written for older people, but many weren’t tested on older patients in clinical trials — this despite the fact that some drugs act differently in older bodies.

Q. Why aren’t they tested on older consumers?

A. The excuse is that it’s too complex to study older people because they tend to be taking a lot of different medications and they have diseases. But that’s why you should include them in trials. And there are ways to do it. You could study people in smaller clusters.

Q. In the 1960s, you coined the word “ageism.” Have you personally encountered any?

A. I’m fairly vigorous. I have financial resources. And I’m the boss here, which certainly protects me from ageism.

But there are two things I’ve noticed. One relates to the “R” word, “retired.” When I stepped down as the chair of geriatrics at Mount Sinai to build the Longevity Center, people began referring to me as “retired.” I quickly realized that “retired” was not a good word. If you are applying for grants from the N.I.H., you don’t want to be perceived as “retired,” which seems to be a synonym for “over the hill.”

The other thing relates to insensitivity about a disability. I have a hearing impairment. A third of all people over 65 have some hearing damage. I was recently at a conference in Washington, and the chairman wouldn’t turn on the sound system. So I asked him to do it. He said, “Aw, later.” You can only ask once about something like that.

Of course, none of this is as severe as being denied a job or health care, but one doesn’t like it.

Q. Your report mentions that the elderly are left out of most emergency planning. Why is this important?

A. Because most of the people who died in New Orleans were older. Following 9/11, my wife, Myrna Lewis, who was a social worker and who died in 2005, went to seek out the elderly in the neighborhoods around the World Trade Center. She found lots of older people who were really neglected in the emergency. They went without medications. Home health aides couldn’t get through to them. Some were living in feces.

Both events should get us thinking about what happens to older people in assisted care and nursing home facilities during emergencies — tornados, blackouts, hurricanes . Society is not sensitive to the fact that old people are not as able to survive under perilous circumstances. Homeland Security needs to be considering this.

Q. Much is made of the fact that the first cohort within the baby boomers are turning 60 this year. Will they transform aging as they’ve changed everything else?

A. I think they’re in for a hell of time, because society is not prepared for them. And I don’t think they’re a bit prepared for old age. They are often fat, unhealthy, and they haven’t been saving money — though a small percentage of them will receive inheritances. There aren’t enough nursing homes and elder care facilities to accommodate them.

Now, the boomers could become a strong public group by virtue of their size. They have political experience and they may use it to create change. If they are able to, it will mostly benefit Generations X and Y. The boomers are, quite frankly, a generation at risk.

Q. You will be 80 in January. As a child, did you wonder who you’d be when you got old?

A. I didn’t think about my own aging. In those days, the 1930s, you were lucky if you lived to 65. When Social Security first began, the life expectancy for men was 57.

I did feel a lot of sympathy for older people and poverty they experienced, particularly older women when they were widowed. You see, I was raised by grandparents. When I was 7, my grandfather suddenly died and we were homeless in the middle of the Depression. My grandmother went to work on a W.P.A. job, which was how we survived.

Some of what I saw then is still a problem today. The pundits like to say that we’ve solved elder poverty. But 25 percent of Americans over 65 live on less than $38 per day. A lot of these are in minority groups and most are women. The poorest sectors of our country today are black children and older women.

Q. Did you say earlier that your own wife had died?

A. She died last year. It was devastating. I haven’t recovered. One of the many ways Myrna’s death affects me is that we can’t reminisce together. But it’s worse than that; there is just this terrific loneliness. You keep going. Being left alone is one of the facts of aging. There’s data that suggests that people can actually die of a broken heart, become sick because of it.

Since her death, I’ve been very protective of myself, quite purposely. I go to bed earlier. I’ve been more thoughtful about my diet and activity levels. I pace myself. On weekends, I have this walking club. A whole group of us walk six miles through the city. I feel like I have to take care of myself. I still have work to do. And it’s important work!