He's the Expert on Geriatrics
Recognized as a world expert on aging, neuropsychiatrist Robert Neil Butler, M.D., helped lead the drive to make "geriatrics" a formal medical discipline.
Dr. Butler began to specialize in the problems of the elderly soon after earning his medical degree in 1949 at Columbia University. At the National Institutes of Health (NIH) in the 1950s, he focused attention on the psychological and physical processes that go with aging. He was a co-founder of the National Institute on Aging, and director from 1975 to 1982.
After winning the Pulitzer Prize for his 1975 study of the elderly (Why Survive? Being Old in America), Dr. Butler founded the nation's first department of geriatrics, at Mount Sinai Medical Center in New York City. In 1990, he launched the International Longevity Center.
Dr. Butler says he was made aware of the "problems and also the opportunities" that accompany old age while being raised by his grandparents on a New Jersey chicken farm. He coined the term "ageism" during the 1960s to describe the "bigotry against the elderly" he often observed in that era.
But attitudes toward older people are changing rapidly, he says. For one thing, Americans are living longer, healthier lives than ever. With 75 million baby boomers (born between 1946 and 1964) becoming older Americans, he says, it's time to pay more attention to the needs of the elderly—and their "enormous gifts of experience."
Defining 'old age'
Q. How would you define "old age"?
Dr. Butler: Well, happily, there have been dramatic drops in the rates of disability in recent years, despite aging. So, more and more, we in medicine are thinking of old age as starting at 80, even 85 and above. People in their 60s and 70s are looking mighty healthy these days! As a broad generalization, the functional capabilities of people are now quite good until 80 and above.
Little support
Q. And yet the NIH spends only about $60 million a year right now to study the biology of aging-out of a total budget of nearly $13 billion. Why this lack of interest in the elderly?
Dr. Butler: I think people are often in denial when it comes to aging. Getting old always happens to somebody else—not to you and not to me.... But I also think that, scientifically, people don't want to devote resources to something that may not pay off. So I think the field of gerontology had to prove itself. And I think it now has.
Diseases of old age
Q. What does the latest research tell us about older people and the diseases that affect them most today?
Dr. Butler: Well, we now know that there are several "diseases of old age," such as Alzheimer's, which affects about 15 percent of those 65 and older. Alzheimer's has been getting a lot of attention lately, but there are many other disorders that loom as threats to the elderly. Heart disease still accounts for about half of the deaths in this population, with strokes and cancer as the two other major illnesses of old age. Diabetes is also a significant health threat. There's also the widespread problem of depression among the elderly, but somehow it seems to get little attention. Depression can lead to several forms of dementia, which is one of the most dreaded disorders of old age. And that's why depression needs a lot more study—and a lot more research dollars—than it's been getting lately.
Problems of the elderly
Q. You've often pointed out that many older people suffer terribly in this society. Many older women, for example, have the same poverty rates that afflict minority children. What are some of the other problems of the elderly?
Dr. Butler: Living alone, which makes you more vulnerable to institutionalization, to hospitalization, to poverty. And since 40 percent of older people live alone, and 80 percent of those who live alone are women, it's particularly women who are disadvantaged. It's fascinating to me that despite all the discussion these days about cutting back Social Security and Medicare, there's been very little discussion about the impact on women. Because it's women who will be most affected by cutbacks in either Social Security or Medicare.
Personal approach
Q. You've written that we all must learn how to confront the two most difficult processes of aging: becoming frail and dying. How do you plan to handle them yourself?
Dr. Butler: Well, one never knows exactly how one will deal with something, until one's confronted with it. My hope is that I'll deal with it very realistically, confront it head-on. But I hope, also—blessed as I am with a good family—that I'll have plenty of good support.
Message for others
Q. Do you have a message for America's 75 million baby boomers on the subject of aging?
Dr. Butler: Yes. You know, the Boomers are the largest generation in American history. They're about one-third of our population today. And my word to them is, "Wake up. Confront reality and deal with it." I think the country needs to start paying much more attention to the problems of the elderly, starting now, because so many of our citizens will soon be elderly themselves.
