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This file contains materials relating to the Council of State Governments, the Meals - on - Wheels program, Older Americans Month, the American Association of Retired Persons, the National Retired Teachers Association, Grady Means, and Decker Anstrom.
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Aging - General (4)
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Aging - General (4)
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This file contains materials relating to the Council of State Governments, the Meals - on - Wheels program, Older Americans Month, the American Association of Retired Persons, the National Retired Teachers Association, Grady Means, and Decker Anstrom.
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Sarah C. Massengale Files (Ford Administration)
Sarah Massengale's Health, Social Security and Welfare Files
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1976
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The original documents are located in Box 2, folder "Aging - General (4)" of the Sarah C.
Massengale Files at the Gerald R. Ford Presidential Library.
Copyright Notice
The copyright law of the United States (Title 17, United States Code) governs the making of
photocopies or other reproductions of copyrighted material. Gerald R. Ford donated to the
United States of America her copyrights in all of her husband's unpublished writings in National
Archives collections. Works prepared by U.S. Government employees as part of their official
duties are in the public domain. The copyrights to materials written by other individuals or
organizations are presumed to remain with them. If you think any of the information displayed
in the PDF is subject to a valid copyright claim, please contact the Gerald R. Ford Presidential
Library.
Some items in this folder were not digitized because it contains copyrighted
materials. Please contact the Gerald R. Ford Presidential Library for access to
these materials.
October 23, 1975
Dear Ms. White:
Thank you for your letter of September 18 to the President,
expressing concern over his remarks in transmitting the
Annual Report of the Federal Council on the Aging to the
Congress.
Please be assured that the President and this Administration
are depply concerned over the impact of the current economic
situation on older Americans. We are aware of the financial
difficulties faced by many elderly persons living on fixed
incomes.
The President asserted in his response to the Federal Council's
report that inflation is one of the "cruelest and most per-
vasive problems facing older Americans," and that reducing
its burden on them demands that overall government spending
be limited.
To help ease the burdens of inflation upon the elderly,
social security and supplemental security income (SSI)
payments were increased in June, with the raise reflected
in the July checks. Under the law, these payments will now
increase automatically whenever the Consumer Price Index
rises more than three percent a year (measured from the
first quarter of the year to the first quarter of the
following year).
Last spring, the President signed a $22.8 billion anti-
recession taxcut bill that carried a number of provisions
favorable to the elderly, including payment of $50 each to
some 34 million individuals receiving social security,
railroad retirement, and SSI benefits. Extension of un-
employment compensation payments, tax rebates for 1974, and
tax reductions for 1975 are features of the bill that benefit
many older Aersons. Also, rules concerning tax deductions
for expenses of caring for an elderly relative were liberalized,
GERALO, FORD LIBRARY
- 2 -
The President feels that high standards of safety and
care in nursing homes must be maintained. Enforcement
by the Department of Health, Education, and Welfare of
such standards in nursing homes participating in the
Medicare and Medicaid programs is a matter of highest
priority.
In responding to the Council's report, the President
noted that he is looking forward to receiving from the
Council two other Congressionally mandated studies, one
on the interrelationships of benefit programs for the
elderly and the other dealing with the combined impact
of all taxes on the elderly. The results of these studies
will be utilized by the Administration and the Congress in
evaluating existing programs and services, proposing
necessary reforms, and utilizing resources more effectively
to benefit older Americans.
I appreciate your taking the time to share your views
on this important matter.
Sincerely,
Sarah C. Massengale
Assistant Director
Domestic Council
Ms. Jeanette White
Council on Aging for
Southeastern Vermont
FORD LIBRARY is GERALD
139 Main Street
Brattleboro, Vermont 05301
THE WHITE HOUSE
WASHINGTON
September 17, 1975
Dear Mr. Applin:
Thank you for your letter to President Ford commenting on the
proposed tax cuts for corporations and urging tax relief for the elderly.
As I am sure you realize, the economic well-being of all our citizens,
old as well as young, depends on the total output of the economy. If
capital available for investment by business becomes scarce or declines,
the end result is a smaller level of output available to be consumed.
Corporate profits are the main source of business investment, and profits
have been declining relative to the rest of the economy for a number of
years, so there is good cause for being concerned about the future growth
of productive investment. This is why Treasury Secretary Simon proposed
the tax reduction on corporate dividends cited in the enclosure to your
letter.
Please be assured that concern for capital investment does not indicate
a lack of concern for the problems of the elderly and retired. As you
probably know, social security payments are automatically adjusted
periodically to reflect increases in the cost of living. The enactment
of medicare and medicaid also has been an aid to the elderly. As for
Federal taxes and the elderly, social security payments are not included
in their taxable income, and most older people do not have enough other
income to have to pay Federal income tax. Their main tax problem, as
you indicated in your letter, appears to be the property tax. Since this
tax is a State and local levy, any adjustments to reflect the economic
status of the elderly are within the purview of the States and localities.
A great many of the States have instituted so-called "circuit-breaker"
provisions in recognition of this situation.
GERALD FORD LIBRARY
3
The Tax Reduction Act of 1975 (signed on March 29) is helpful to all
taxpayers. It provides a rebate on 1974 taxes and a $50 rebate to all
social security recipients, and it increases the low income allowance
to $1, 600 for single persons and $1,900 for married persons filing a
joint return. The Act increases the percentage standard deduction to
16 percent with a maximum of $2, 300 for single persons and $2, 600
for married persons filing a joint return. In addition, a personal
exemption tax credit of $30 for each taxpayer or dependent is included
in the Act.
Also of assistance to the elderly is the retirement income credit, which
is designed to approximate the tax savings from the exclusion of social
security or railroad retirement benefits by persons retired under those
systems. Under present law, the retirement income credit is 15 percent
of the first $1, 524 of retirement income including dividends, interest,
rents, pensions, and annuities received by single persons, and 15 percent
of $2, 286 for most married couples. The income eligible for the credit,
however, must be reduced by income from social security and railroad
retirement benefits and other tax-exempt pensions, and for those under
the age of 72 by earnings above a specified level.
In its work on tax reform in the last session of the 93rd Congress, the
House Committee on Ways and Means tentatively decided to restructure
the retirement income credit, including increasing the allowable deduction.
The bill was not reported to the House before the Congress adjourned. It
is expected that the matter will be given consideration again when the Com-
mittee takes up the subject of tax reform later this year.
We appreciate your concern about the tax treatment of the elderly, and
we hope these comments are helpful.
Sincerely,
Roland L. Elliott
Director of Correspondence
Mr. George B. Applin
362 Atlanta Drive
Pittsburgh, Pennsylvania 15228
GLEATO FORD LIBRARY
file
FEDERAL COUNCIL ON THE AGING
WASHINGTON, D.C. 20201
Sarah massangale
F.Y. .
Cleo L.
9/16/75
FORD :- LIBRARY 978839
15654
CONGRESSIONAL RECORD
September 10, 197,
indomitable and extraordinary individ-
Aging, charged with advising and assisting the
pared with 15 percent for younger couple
ual, whose lifetime of achievement
President and the Congress in evaluating
Many elderly who are able to work and woul
stands as a symbol of man's will to be
government policies and programs designed
like to work have been forced out of the labe
to serve older Americans, recommending
free.
market completely. Many have ceased eve
needed changes and serving as a spokesman
to look for work and no longer are counte
on behalf of older citizens.
in unemployment statistics. Even those wh
NOTICE OF STAFF PARTICIPATION
In its first report to the President recently,
can find work are limited in what they CA
IN EDUCATIONAL EXCHANGE PRO-
the Council expressed its view that "the eco-
earn through the "retirement test" of th
nomic plight of the elderly is of crisis pro-
GRAM
Social Security system.
portions," requiring special attention by both
When the Council suggested that the Pret
Mr. HATFIELD. Mr. President, pur-
the executive and legislative branches of gov-
ident reassess his priorities in the war 0
suant to the guidelines set forth by the
ernment to offset the effects of recession
inflation, it surely had in mind his Cor
and inflation.
distinguished majority and minority
gressionally thwarted attempt to limit ir
"We continue to be distressed,' the Coun-
flation-bred Social Security benefit increase
leaders in their July 10, 1974, CONGRES-
cil said, "about the apparent lack of con-
to five percent, rather than the 8.7 percer
SIONAL RECORD joint statement, I wish to
sideration for the economic plight of the
called for through the automatic-escalat
advise that my legal counsel, Mr. Wal-
elderly as reflected in the Administration's
provisions of the law. After years of effor
ter H. Evans III will participate from
proposals for the 1976 Fiscal Year budget.
by our Association and others, that provisio
August to October 13 in the educa-
Cutbacks in federal monies for social services
was enacted to help older citizens cope wit
tional exchange program sponsored by
for the elderly and ceilings on benefit pro-
rampant inflation.
the European Community' visitors pro-
grams financed from social insurance trust
And it also had in mind his proposed IN
funds are particularly burdensome to this
ductions in other programs designed to seri
gram. I am advised that this program,
age group. Many of their financial assets are
the elderly. The President's budget propos
sponsored by the European Parliament
tied to fixed sources, while their needs are
for 1976 is actually more than $42 millio
and Commission of European Commu-
mobile. We recommend that the President
below appropriations for fiscal year 1975.
nities, closely parallels the leader grant
reconsider the serious effects of these fiscal
Congress is now in the process of approved
program operated by our Department of
proposals on the elderly of this nation with
ing the 1975 Amendments to the Older Ame:
State, and meets all criteria established
their urgent humanitarian needs."
icans Act, with provisions to strengthen pre
by the July 10 statement. Mr. Evans will
To its reasoned and reasonable recommen-
ent social services, nutrition, research an
be utilizing his regular vacation time
dations, the President responded: "The per-
training programs. They will place specif
spective and recommendations of this report
emphasis on other services needed to enab
during this period.
are limited to a particular area of interest
older Americans to remain in their OW
and advocacy. The report does not reflect
homes rather than enter nursing homes.
the Administration's policies, which must
Our Association believes that the change
A QUESTION OF PRIORITIES ON
reflect a broader range of responsibilities and
are highly desirable and urgently neede
AGING
priorities."
And we trust that the President will giv
Mr CHURCH. Mr. President, a few
Such harsh language and brusque treat-
the measure greater consideration than 1
ment of a report prepared by a bipartisan
did the first report of the Federal Counc
weeks ago President Ford issued a mes-
council composed of persons highly knowl-
on Aging. The measure will demand mo:
sage which tersely rejected major recom-
edgeable and experienced in the field of
than words of sympathy about the need
mendations made to him by the Federal
aging must be disheartening to the Council,
of older Americans. It will demand an a
Council on Aging.
and is surely disappointing to our Associa-
of approval.
As I said in a statement to the Sen-
tions.
ate on July 28, the President semed to
The Council is precisely charged with rep-
VIRGINIA COUNCIL ON HEALTH
take the attitude that the Council had
resenting a particular area of interest,
AND MEDICAL CARE
somehow spoken out of turn by suggest-
namely, the needs and concerns of the na-
ing that there are serious shortcomings
tion's growing older population. Its very
Mr. HARRY F. BYRD, JR. Mr. Pres
in present administration efforts on be-
purpose is to help the President and the
dent, the Senate may soon be calle
half of older Americans.
Congress comprehend the impact of broadly
upon to consider legislation relating 1
defined priorities on the narrowly defined
Furthermore, it seemed to me that the
the Federal programs of assistance
group of citizens who compose its constit-
President was needlessly abrasive in his
medical students.
uency. For the President to dismiss the
attitude to the Council, which came into
recommendations because they do not con-
One of the most important aspects (
being because of congressional insistence
form to his policies raises serious questions
the debate on this subject concerns dis
that a high-level unit be established to
about his concept of the Council's role and
tribution of health manpower through
assist and advise the President on mat-
his responsibility. Needed is a spirit of con-
out our country. They are, for exampl
ters related to aging.
sultation and cooperation, not an attitude
some areas where the physician-patier
of confrontation.
Mr. Bernard Nash executive director
ratio is far below the national averag
In rejecting the Council's recommenda-
of the National Retired Teachers As-
and below that needed for adequa
tions, the President said he was sympathetic
health care.
sociation-American Association of Re-
to its concerns, but was determined "to
The State of Virginia is fortunate 1
tired Persons in a member of that Fed-
reduce the burden of inflation on our older
citizens, and that effort demands that the
have an ambitious program aimed I
eral Council, along with 14 other persons
government spending be limited. Inflation
solving the problem of maldistributio:
with longstanding concern about public
is one of the cruelest and most pervasive
It is a program administered by the Via
issues related to aging.
problems facing older Americans, so many
ginia Council on Health and Medic
He has informed me that he deems it
of whom lived on fixed incomes. A reduction
Care, and it has achieved much in It
unfortunate that the first report of the
of inflation, therefore, is in the best interests
cent years.
Council should have been met with so
of all Americans and would be of particular
Fully 834 physicians have establishe
negative a response.
benefit to the aging."
practices in areas of need in the Stai
He has also provided an editorial
No member of the Council and no older
of Virginia. In fact, the Virginia pro
which is appearing in the September
Americans would likely disagree with that
AARP News Bulletin. I believe that this
statement. The issue is essentially one of
gram has been cited by the America
priorities. In defining policies and programs
Medical Association for outstandir
emphatic and compelling statement ad-
to control inflation, the Council is asking
achievement, and recently 17 othe
mirably expresses the concern caused by
the President to be more sensitive to the
States have contacted the Virginia Cour
the President's action. I ask unanimous
impact of his decisions on that segment
cil on Health and Medical Cafe for moi
consent to have it printed in the RECORD.
of the population most severely affected.
information on the program.
There being no objection, the editorial
While all Americans are burdened by ris-
I am familiar with the council an
was ordered to be printed in the RECORD,
ing costs of food, rent, clothing, medical care
the great work that they continue to d
as follows:
and transportation, such essentials take a
I know the director of the council, M
larger proportion of the near-fixed income
A QUESTION OF PRIORITIES
of the elderly than of the generally higher
Edgar J. Fisher, Jr., and I commend th
About 15 months ago, 15 distinguished
incomes of younger people in the work force.
council and Mr. Fisher for his great serv
Americans were sworn in as members of the
Rent, for example, takes some 30 percent of
ice to that organization.
Congressionally created Federal Council on
the average elderly couple's income com-
Because of the relevance of this Via
Opinion
A Question of Priorities
About 15 months ago, 15 distinguished
ing be limited. Inflation is one of the cruelest
Americans were sworn in as members of the
and most pervasive problems facing older
Congressionally created Federal Council on
Americans, so many of whom lived on fixed
Aging, charged with advising and assisting the
incomes. A reduction of inflation, therefore,
President and the Congress in evaluating gov-
is in the best interests of all Americans and
ernment policies and programs designed to
would be of particular benefit to the aging."
serve older Americans, recommending needed
changes and serving as a spokesman on behalf
No member of the Council and no older
FOR
GERALD
file
HEALTH.
EDUCATION SECURITY
DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
Aguig
U.S.A.
WASHINGTON, D.C. 20201
OFFICE OF THE SECRETARY
Office of Human Development
Administration on Aging
AUG 13 1975
MEMORANDUM FOR THE HONORABLE SARAH MASSENGALE
Attached is the Congressional Research Service
document that outlines and describes Federal programs
and benefits that assist older persons that we
discussed.
I will be sending you shortly a copy of all the Federal-
level interagency agreements that Commissioner
Flemming has signed.
It was a pleasure to meet you, and I look forward
to working with you.
If I can ever be of assistance please don't hesitate
to call.
Decker Make Anstrom
Assistant to the Commissioner
Attachment
GLRALD FORD LIBRARY
FEDERAL PROGRAMS AND BENEFITS ASSISTING THE ELDERLY
GERALD
FORD LIBRARY &
EVELYN TAGER
Education and Public Welfare Division
April 18, 1975
TABLE OF CONTENTS
Page
Introduction
1
Employment and Volunteer Programs
2
Foster Grandparent Program
2
Older Americans Community Service Employment Program
3
National Older Workers Program - (Operation Mainstream)
4
Retired Senior Volunteer Program
5
Service Corps of Retired Executives
6
Volunteers in Service to America
7
Health-Care Facilities and Health-Care Programs
8
Construction of Health-Care Facilities (Hill-Burton Program)
8
Construction of Nursing Homes and Intermediate-Care Facilities
9
Grants to States for Medical Assistance Programs (Medicaid)
10
Program of Health Insurance for the Aged and Disabled (Medicare)
11
Veterans Domiciliary Care Facilities and Domiciliary Care Program
14
Veterans State Nursing-Home Care Facilities and
Nursing-Home Care Program
15
Housing Programs
16
Housing for the Elderly (Section 202)
16
Low and Moderate Income Housing (Section 8)
17
Low Rent Public Housing
18
Mortgage Insurance on Rental Housing for the Elderly (Section 231)
19
Rental and Cooperative Housing for Lower and Moderate
Income Families (Section 236)
20
Income Maintenance Programs
22
Civil Service Retirement System
22
Old Age, Survivors Insurance Program (Social Security)
23
Railroad Retirement System
24
Supplemental Security Income Program for the Aged,
Blind and Disabled
26
Veterans Pension Program
27
(cont'd)
11
TABLE OF CONTENTS (cont'd)
Page
Social Service Programs and Related Programs
28
Education Programs for Non-English-Speaking Elderly
28
Education Programs to Resolve Problems of the Elderly
29
Food Stamp Program
30
Legal Services Corporation
31
Library Materials for the Blind and Physically Disabled
32
Model Projects to Provide for Social Services
33
Multipurpose Senior Citizens
34
Nutrition Program for tne Elderly
35
Older Reader Services
36
Revenue Sharing
37
Senior Opportunities and Services
38
Social Services for Public Assistance Recipients
and Low Income Individuals
39
State and Community Programs to Provide for Social Services
40
Transportation Assistance
42
Training and Research Programs
43
Multi-Disciplinary Centers of Gerontology
43
Nursing Home Care, Training and Research Programs
44
Personnel Training Program in the Field of Aging
45
Research and Demonstration Projects in the Field of Aging
46
Research on the Aging Process and Health Problems of the Elderly
47
INTRODUCTION
This report describes Federal programs and benefits either designed
solely for the elderly or which assist a significant number of elderly indi-
viduals. It covers employment and volunteer programs, health care pro-
grams, housing programs, income maintenance programs, nursing home con-
struction and health care programs, social service programs, and training and
research programs in the field of aging.
This report does not describe most general purpose programs designed
for all age groups even though some of these programs serve elderly individ-
uals. For instance, under income maintenance programs, we have not in-
cluded the military and foreign service retirement systems which pay benefits
to older people but are designed partially to encourage individuals to move
out of the military and foreign service in their middle years. In the area of
housing, the Department of Agriculture's housing loan programs for the re-
habilitation and construction of rural housing are omitted since only an esti-
mated three percent of the loans made available in recent years have gone
to elderly individuals. Most manpower and development training programs
also are omitted for similar reasons.
This report provides information for each program as follows:
1. Legal authority;
2. Brief description;
3. Statistical and financial data which represent the latest
information available on the program;
4. Administering agency.
CRS-2
EMPLOYMENT AND VOLUNTEER PROGRAMS
FOSTER GRANDPARENT PROGRAM
Authorizing Legislation:
Domestic Volunteer Service Act of 1973 (42 U.S.C. 5022 et seq. )
Summary:
The Foster Grandparent Program provides part-time volunteer service
opportunties for low-income persons age sixty or over who wish to render sup-
portive service to children receiving care in institutions, hospitals, or in other
health, education, welfare and related settings. Volunteers also serve as senior
health aides for older persons receiving home-health care and nursing care,
and as senior companions to persons with developmental disabilities.
Foster grandparent projects are established on the local level through
Federal grants made available to public and nonprofit private agencies or or-
ganizations. The Federal share of each local Foster Grandparent Program
may be up to 100 percent of the costs of developing and operating the project.
Participants work an average of 20 hours per week and receive a stipend equal
to at least the Federal minimum wage.
Statistical and Financial Data:
As of January 1975, there were 156 foster grandparent projects and
12, 833 individuals serving as volunteers.
The appropriation for fiscal year 1975 was $30.840 million.
CRS-3
Administering Agency:
ACTION
806 Connecticut Avenue N.W.
Washington, D.C. 20520
OLDER AMERICANS COMMUNITY SERVICE EMPLOYMENT PROGRAM
Authorizing Legislation:
The Older Americans Community Service Employment Act; (42 U.S.C.
3062 et seq. )
Summary:
The Older Americans Community Service Employment Program provides
part-time work opportunities in community service activities for unemployed
low-income persons who are fifty-five years of age or older and who have
poor employment prospects.
The Secretary of Labor is authorized to enter into agreements with
public or private nonprofit agencies or organizations to pay up to 90 I Crcent
of the costs of establishing and operating a project for the employment of older
persons. Up to 100 percent of the costs may be paid for a project located
in an emergency or disaster area or in an economically depressed area.
Community service activities may include social, health, welfare, edu-
cational, library, recreational, and other similar services; conservation, main-
tenance, or restoration of natural resources; community betterment or beauti-
fication; anti-pollution and environmental quality efforts; economic develop-
ment; and other services which are essential and necessary to the community.
Older persons participating in a community service employment pro-
ject are to be paid a rate equal to at least the Federal minimum wage.
CRS-4
Statistical and Financial Data:
The appropriation for fiscal year 1975 was $12 million. There are
3, 400 volunteer positions established under this program.
Administering Agency:
Manpower Administration
U.S. Department of Labor
Washington, D.C. 20201
NATIONAL OLDER WORKERS PROGRAM - (OPERATION MAINSTREAM)
Authorizing Legislation:
Comprehensive Employment and Training Act of -1973,title III (29
U.S.C. 801)
Summary:
Under the National Older Workers Program, commonly known as
Operation Mainstream, Federal grants are awarded to public and private
nonprofit agencies or organizations to pay up to 90 percent of the cost to
develop work and training projects, primarily in rural areas, for low-
income unemployed individuals age 55 and over. Jobs may entail planting
trees and shrubbery near highways, cleaning lakes, restoring historical
sites, and improving public parks and recreation areas. They also may
involve social service activities where participants work as aides inlibrar-
ies, schools, nutrition programs, day care centers and other community
service activities.
Statistical and Financial Data:
There are 8,900 volunteers age 55 and over participating in the
National Older Workers Program at an annual Federal operating cost of
$11,055,000.
CRS-5
Administering Agency:
Manpower Administration
U.S. Department of Labor
Washington, D.C. 20210
RETIRED SENIOR VOLUNTEER PROGRAM
Authorizing Legislation:
Domestic Volunteer Service Act of 1973 (42 U.S.C. 5022)
Summary:
Under the Retired Senior Volunteer Program grants are awarded to
private nonprofit organizations. or public agencies to pay all or part of the
cost of establishing or expanding volunteer service activities for the elderly.
Volunteers serve in many capacities such as tutoring children in school set-
tings, assisting day care centers, providing services to disabled persons,
counseling juvenile delinquents, and assisting local planning commissions in the
resolution of problems concerning the environment. Participants are compen-
sated for out-of-pocket expenses incidental to their volunteer services such as
transportation and meals.
Statistical and Financial Data:
As of January 1975, there were 662 grant recipients for retired senior
volunteer projects, and 120,319 individuals participating in volunteer service
projects.
The fiscal year 1975 appropriation was $15.980 million.
Administering Agency:
ACTION
806 Connecticut Avenue, N.W.
Washington, D.C. 20520
CRS-6
SERVICE CORPS OF RETIRED EXECUTIVES
Authorizing Legislation:
Domestic Volunteer Service Act of 1973 (42 U.S.C. 5033)
Summary:
The Service Corps of Retired Executives (SCORE) is a volunteer pro-
gram through which retired professionals and business people assist the own-
ers and managers of small businesses with operating, management, and other
related problems. Volunteers participating in this program join local SCORE
chapters organized through the field offices of the Small Business Adminis-
tration.
SCORE volunteers provide assistance primarily to retailers and owners
of service businesses such as shoe repair shops, dry cleaners, auto body shops,
and a wide variety of small manufacturers. They also help retired military
personnel and other individuals who request assistance in starting their own
business. Volunteers are reimbursed for out-of-pocket expenses.
Statistical and Financial Data:
There are 265 SCORE chapters throughout the country and 5, 220 SCORE
volunteers. The fiscal year 1975 appropriation was $400, 000.
Administering Agency:
ACTION
806 Connecticut Avenue, N. W.
Washington, D. C. 20520
CRS-7
VOLUNTEERS IN SERVICE TO AMERICA
Authorizing Legislation:
Domestic Volunteer Service Act of 1973 (42 U.S.C. 4951 et seq.)
Summary:
Through the Volunteers in Service to America Program (VISTA), in-
dividuals age 18 and over volunteer to serve in urban and rural poverty areas,
on Indian reservations, with migrant families, and in Federally assisted in-
stitutions for the mentally ill and retarded to help reduce poverty. Volun-
teers participate in varied activities including remedial education activities,
employment counseling, economic development, housing and community plan-
ning, the delivery of health care, and other needed services.
Full time volunteers serve for at least one year and usually live with-
in the community where they serve. Part-time volunteers may commute to
their project site. All volunteers receive a monthly living allowance to cover
the cost of food, travel and other incidentals. Older workers in the VISTA
Program are primarily part-time volunteers.
Statistical and Financial Data:
As of January 1, 1975, there were 467 sponsors of VISTA projects and
4, 747 VISTA volunteers ages 18 and over of whom 380 were age 60 and older.
This report does not contain financial data on the VISTA program as
most volunteers are not elderly.
Administering Agency:
ACTION
806 Connecticut Avenue, N.W.
Washington, D.C. 20520
CRS-8
HEALTH-CARE FACILITIES AND HEALTH-CARE PROGRAMS
CONSTRUCTION OF HEALTH-CARE FACILITIES (HILL-BURTON PROGRAM)
Authorizing Legislation:
Public Health Service Act, as amended, title XVI; (42 U.S.C. 291)
Summary:
Title XVI of the Public Health Service Act, commonly referred to as
the Hill-Burton Program, authorizes formula grants or loans to private non-
profit organizations, State governments, and other public agencies for the con-
struction, expansion, or modernization of health-care facilities. Facilities
funded under this program include long-term care facilities such as nursing
homes, chronic disease facilities, and long-term care units in hospitals as
well as other health-care facilities provided they meet a community need as
determined by the Hill-Burton State agency.
The Federal share of a project varies in each State and is based on a
State plan developed by the Hill-Burton State agency. Generally, it ranges
from one-third to two-thirds of the total cost of the construction or remodel-
ing. Loans are made available for a maximum of 40 years at low interest
rates.
Statistical and Financial Data:
As of February 1975, the Hill-Burton program has provided assistance
for 102, 300 long-term care beds in nursing homes, chronic disease hospitals
and long-term care units of general hospitals.
The Federal share in fiscal year 1975 was $10 million.
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Administering Agency:
Health Services Administration
U.S. Department of Health, Education, and Welfare.
Rockville, Maryland 20852
CONSTRUCTION OF NURSING HOMES AND INTERMEDIATE-CARE FACILITIES
Authorizing Legislation:
The National Housing Act, as amended in 1959, section 232; (12 U.S. C.
1715 z-1)
Summary:
The Section 232 Program authorizes the Federal government to insure
lenders against the loss of mortgages acquired by eligible sponsors to finance
the construction or rehabilitation and equipment of certified nursing homes or
intermediate-care facilities accommodating 20 or more patients. Nursing homes
insured under this program must provide skilled nursing-home care and speci-
fied related medical services. Intermediate-care facilities must offer con-
tinuous but minimum health-care services by licensed or specially trained
health care personnel. Nursing home services and intermediate-care services
may be combined in the same facility covered by an insured mortgage or may
be in separate facilities.
Sponsors, who may be private nonprofit corporations or associations or
individuals, are eligible for insured mortgages with terms of up to 40 years.
Statistical and Financial Data:
During the past 14 years, the Federal government has insured the mort-
gages for about 1, 000 long-term care facilities consisting of 100, 000 beds. The
total amount of insurance writted for these projects was approximately $1 billion.
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Administering Agency:
The Section 232 program is administered by the regional offices of the
U.S. Department of Housing and Urban Development, and the national office
whose address is:
Federal Housing Administration
U.S. Department of Housing and Urban Development
Washington, D.C. 20410
GRANTS TO STATES FOR MEDICAL ASSISTANCE PROGRAMS (MEDICAID)
Authorizing Legislation:
Social Security Act, as amended, title XIX; (42 U.S.C. 1396 et seq. )
Summary:
The medical assistance program, commonly known as medicaid, pro-
vides grants to States to design and administer a State program of medical
assistance for certain low-income persons who are aged, blind and disabled,
recipients of public assistance programs, and, at the State's option, persons
who are medically indigent. Eligibility for medical assistance is related to
a number of factors, but particularly to the income and other economic re-
sources of the applicants.
The Federal law provides a comprehensive list of services that States
may include as part of their medicaid program. From this list there is a
minimum number of services that are required such as inpatient hospital
services, outpatient hospital services, laboratory and X-ray services, skilled
nursing facility services, and physicians services. Other services on the list
include home-health services, private duty nursing services, prescribed drugs,
and intermediate-care facility services.
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The Federal government helps finance a State's medical assistance pro-
gram by means of variable matching formulas. As a minimum, the Federal
government will pay 50 percent of the medical assistance costs incurred by a
State in providing health care under a medicaid program. In poor States, the
Federal share of medical assistance payments may increase up to 83 percent.
All States but Arizona have medicaid programs.
Statistical and Financial Data:
An estimated 4, 327, 000 persons age 65 or over will receive assistance
through the medicaid program during fiscal year 1976.
The medicaid program is an "open-end" program. Except for the
limitation on payments for the medically needy, there is no limit to the
amount of money the Federal government will pay to match the States' con-
tribution.
Administering Agency:
The medicaid program is administered at the State level by a desig-
nated State agency. At the national level the program is administered by:
Social and Rehabilitation Service
U.S. Department of Health, Education, and Welfare
Washington, D.C. 20201
PROGRAM OF HEALTH INSURANCE FOR THE AGED AND DISABLED (MEDICARE)
Authorizing Legislation:
The Social Security Act, as amended, title XVIII; (42 U.S.C. 1395 et seq. )
GERALD FORD VIBRARY
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Summary:
The health insurance program, commonly known as medicare, provides
benefits to most people age 65 and over. Health insurance protection under
this program is available to eligible persons without regard to their incomes
or assets.
Medicare consists of two parts; the Hospital Insurance program (HI),
and the Supplementary Medical Insurance program (SMI). The Hospital Insur-
ance program provides payments on behalf of most persons age 65 or over,
and other eligible persons subject to certain deductibles and coinsurance re-
quirements for the costs of specified services. These services include speci-
fied hospital services, post-hospital home-health services, and post-hospital
extended care services. For the most part, the Hospital Insurance program
is financed by means of a special hospital insurance payroll tax levied on em-
ployees, their employers, and self-employed individuals covered by the social
security program. Costs of providing hospital insurance benefits to eligible
individuals not entitled to cash benefits under this program are financed
through Federal funds.
The Supplementary Medical Insurance program is a voluntary program
in which almost everyone age 65 or over may enroll. Enrollees pay a month-
ly premium and the aggregate of these premiums is matched by the Federal
government through appropriations from general funds. Coverage under this
program includes services of medical doctors, osteopaths, chiropractors, 100
days of home-health care in addition to home-health care services provided
for in the Hospital Insurance program; certain diagnostic services, x-ray ser-
vices, and outpatient and laboratory services.
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During any calendar year, Supplementary Medical Insurance (with cer-
tain exceptions) pays 80, percent of the reasonable charges for all covered
services, after the insured pays the first $60.00 toward the costs of such
services.
Statistical and Financial Data:
The estimated number of persons who are to receive assistance through
the medicare program during fiscal year 1976 is 18, 965, 000. Of this number
an estimated 5, 675, 000 are to receive assistance under the Hospital Insurance
program and an estimated 13, 278, 000 are to receive assistance under the Sup-
plementary Medical Insurance program.
Payments to vendors of medical care for fiscal year 1976 are esti-
mated to total $11,380,000,000 under the Hospital Insurance program and
$4,145,000, 000 under the Supplementary Medical Insurance program.
Administering Agency:
Information concerning medicare may be obtained at offices of the
Social Security Administration located in numerous cities throughout the
country. At the national level, the medicare program is administered by:
Social Security Administration
U.S. Department of Health, Education, and Welfare
Baltimore, Maryland 21235
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VETERANS DOMICILIARY CARE FACILITIES AND
DOMICILIARY CARE PROGRAM
Authorizing Legislation:
(38 U.S.C. 5001-5002) (38 U.S.C. 641-643)
Summary:
The Veterans Administration is authorized to provide funds for the con-
struction dr repair of facilities providing domiciliary care services to veter-
ans. The domiciliary care program provides medical and personal care in a
residential-type setting to aged and disabled veterans who do not require hos
pitalization or skilled nursing home services.
The Veterans Administration also makes payments to State homes pro-
viding domiciliary care services to veterans. The per diem rate is $3.50 for
each veteran.
Statistical and Financial Data:
As of January 1975, there were 18 domiciliary facilities. An estimated
9, 198 veterans of whom 34 percent were age 65 and older received care daily.
75 percent of the veterans receiving care in State domiciliary homes were age
65 and older.
The estimated Federal fiscal year 1975 expenditures are $48,904,000
for the construction or remodeling of veteran domiciliary facilities.
Administering Agency:
Extended Care Facilities
Veterans Administration
Washington, D.C. 20420
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VETERANS STATE NURSING-HOME CARE FACILITIES AND
NURSING HOME CARE PROGRAM
Authorizing Legislation:,
(38 U.S.C. 5031-5037) (38 U.S.C. 641-643)
Summary:
The Veterans Administration is authorized to assist the States in the
construction of State homes for veterans where nursing home care is provided.
The Federal government may pay up to 50 percent of the cost of each construc-
tion project. To receive care in a home constructed through this program,
veterans must meet State admission criteria--including residency in the State
for a specified period of time. The per diem rate of payment from the
Veterans Administration to a State nursing home for each veteran is $5.00.
Statistical and Financial Data:
As of January 1975, there were 31 State nursing home care facilities.
An estimated 6, 500 veterans of whom 75 percent were. age 65 and older re-
ceived care daily in these facilities.
The estimated fiscal year 1975 expenditures for grants to assist States
in constructing State nursing homes are $11, 300, 000.
Administering Agency:
Extended Care Facilities
Veterans Administration
Washington, D.C. 20420
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HOUSING PROGRAMS
HOUSING FOR THE ELDERLY (SECTION 202)
Authorizing Legislation:
The Housing Act of 1959, as amended, section 202; (12 U.S.C. 1715 z-1)
Summary:
The Section 202 program is designed to increase the housing supply for
low and moderate-income elderly and handicapped individuals with incomes too
high to qualify for public housing units but too low to obtain housing on the
private market. The program is a direct loan program under which the
Federal government makes loans to private nonprofit corporations, public
agencies, and limited-profit partners for constructing or rehabilitating multi-
family rental housing for elderly and handicapped individuals. Sponsors re-
ceiving these loans, which can be up to 100 percent of the mortgage, repay
the government over a 50-year period at the market interest rates. LOW in-
come tenants do not have to pay more than 25 percent of their net income
for rent.
This program was phased out by the Administration in 1969, but reacti-
vated under the Housing and Community Development Act of 1974.
Statistical and Financial Data:
As of January 1975, there were commitments to finance 1, 700 Section
202 units at a cost of $34 million. In fiscal year 1976, there will be commit-
ments for an estimated 8, 750 units at a cost of $175 million.
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Administering Agency:
Federal Housing Administration
U.S. Department of Housing and Urban Development
Washington, D.C. 20410
LOW AND MODERATE INCOME HOUSING (SECTION 8)
Authorizing Legislation:
The Housing Act of 1937, as amended (42 U.S.C. 1437 f)
Summary:
Under this program, developers build and rehabilitate housing after
entering into agreements with local housing authorities to lease their units to
low and moderate income persons and families. The Federal government may
subsidize the rent of low income tenants down to 15-25 percent of the tenant's
income.
Preference for funding projects under this program is given to projects
with less than 20 percent of the units subsidized. Projects for the elderly may
have the same preference with 100 percent of the units subsidized.
The fiscal year 1976 budget states that the Section 8 program will be
used as the primary vehicle for providing housing assistance to lower income
families in 1975 and 1976.
Statistical and Financial Data:
As of January 1975, there were commitments to finance 200, 000 Sec-
tion 8 units. In fiscal year 1976, there will be commitments for an estimated
400,000 units. Information is unavailable as to the number of units occupied
by elderly individuals.
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Administering Agency:
Federal Housing Administration
U.S. Department of Housing and Urban Development
Washington, D.C. 20410
LOW-RENT PUBLIC HOUSING
Authorizing Legislation:
U.S. Housing Act of 1973, as amended; (42 U.S.C. 1401-1435)
Summary:
Through the Public Housing program, Federal loans are granted to local
housing authorities, which in turn use these loans (along with funds acquired
from the sale of bonds and notes) to purchase, rehabilitate, lease, or con-
struct public housing projects. Units within public housing projects are rented
to low-income families, elderly individuals age 62 or over, and handicapped
individuals, who meet the income limitation and need requirements established
locally. The rental charge is determined after taking into account the tenant's
ability to pay and the financial solvency of the housing project. By law, rents
in these projects may not exceed 25 percent of a family's income.
Public housing projects are designed for all age groups. In addition,
the law authorizes loans for projects specifically designed for the elderly.
Communal dining rooms and other shared facilities also may be developed in
projects where a significant number of elderly people live.
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Statistical and Financial Data:
As of January 1975, there were commitments to finance 38,000 units
under the low-rent public housing program. In fiscal year 1976, there will
be commitments on an estimated 6,000 units. Information is unavailable as
to the number of units occupied by elderly individuals.
Administering Agency:
The Low-Rent Public Housing program is administered locally by the
designated local housing authority. At the national level it is administered by:
U.S. Department of Housing and Urban Development
Washington, D.C. 20410
MORTGAGE INSURANCE ON RENTAL HOUSING FOR THE ELDERLY
(SECTION 231)
Authorizing Legislation:
National Housing Act, as amended in 1959, Section 231; (12 U.S.C. 1715V)
Summary:
Section 231 authorizes a mortgage insurance program under which the
Federal government insures lenders against the loss of mortgages used to
finance the construction or rehabilitation of multifamily, rental housing de-
signed for occupancy by the elderly or handicapped individuals. Tenants liv-
ing in Section 231 projects generally have a higher income than those individ-
uals residing in Federal housing for moderate-income families.
The Federal Government insures mortgages up to 40 years at market
interest rates. Profit-motivated sponsors may obtain mortgage insurance
FORD LIBRARY is
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amounting to 90 percent of the mortgage, while nonprofit sponsors may obtain
mortgage insurance amounting to 100 percent of the mortgage. A Section 231
project must contain at least 8 dwelling units.
Statistical and Financial Data:
This program has not been funded in recent years.
Administering Agency:
Federal Housing Administration
U.S. Department of Housing and Urban Development
Washington, D.C. 20410
RENTAL AND COOPERATIVE HOUSING FOR LOWER
AND MODERATE INCOME FAMILIES (SECTION 236)
Authorizing Legislation:
The Housing and Urban Development Act of 1968, Section 236; (12 U.S. C.
1715z-1)
Summary:
The Section 236 program is an interest subsidy program under which
private enterprise develops rental and cooperative housing for lower to mode-
rate income families, handicapped individuals and elderly individuals. Develop-
ers of Section 236 projects borrow money from the private money market at
going interest rates, and the Federal government then repays the lender of
the mortgage down to one percent of the interest on the mortgage. Since spon-
sors pay reduced interest rates, they are able to reduce the rental charge on
subsidized units for eligible tenants.
To qualify for occupancy in a subsidized unit, a tenant must meet the
income limitation requirement. These income limits are established locally
and on a case-by-case basis. Generally, tenants must have an income which
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is 35 percent more than the income limitation requirement set for initial occu-
pancy in public housing in the area. Tenants are required to pay at least 25
percent of their income for rent, but no more than the fair market rent.
Families with higher incomes may occupy apartments in a Section 236 project,
but may not benefit from the interest subsidy payments.
In addition to Section 236 projects designed for all age groups, the
law authorizes interest subsidies for Section 236 projects specifically de-
signed for the elderly. It also authorizes interest subsidies for special facil-
ities such as community kitchens, common dining areas, and other shared
facilities in projects designed for the elderly.
Statistical and Financial Data:
Projects under this program will be approved in 1975 and 1976 on a
limited basis and only where bona fide commitments cannot be met under the
lower income housing assistance program Section 8.
Administering Agency:
The Section 236 program is administered by regional offices of the U.S.
Department of Housing and Urban Development and the national office whose
address is:
Federal Housing Administration
U.S. Department of Health, Education and Welfare
Washington, D. C. 20410
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INCOME MAINTENANCE PROGRAMS
CIVIL SERVICE RETIREMENT SYSTEM
Authorizing Legislation:
The Civil Service Retirement Act, as amended; (5 U.S.C. 8331 et seq. )
Summary:
Under the Federal Civil Service Retirement system, the principal re-
tirement system for Federal civilian employees, monthly annuities are paid
to eligible retired workers, to the widows and minor children of employees
who die, and, in certain circumstances, to other designated survivors of an-
nuitants. An individual's entitlement to benefits and the level of these benefits
are based on past earnings and length of service. Generally, the amount of
one's annuity is based on the annual salary received during the three consec-
utive years which afford the highest dollar average.
Individuals are eligible for retirement benefits at age 62 after 5 years
of service, at age 60 after 20 years of service, or at age 55 after 30 years
of service. Retirement is compulsory at age 70 with 15 years of service.
Upon retirement, an employee may accept a reduced annuity in order to pro-
vide a survivor's benefit to his spouse upon death.
A widow's benefit is 55 percent of the amount which would have been
paid to her deceased husband if alive.
The Civil Service Retirement system is financed primarily through con-
tributions paid by the employee and matched by the employing agency. Employ-
ees contribute 7 percent of their basic salary with no ceiling. The Federal
CRS-23
government through Congressional appropriation is responsible for the balance
of the cost of the program.
Statistical and Financial Data:
During fiscal year 1976, there are to be an estimated 1, 464, 504 civil
service annuitants receiving a total of $8,536,000,000 in benefit payments.
Administering Agency:
U.S. Civil Service Commission
Washington, D.C. 20415
OLD-AGE, SURVIVORS INSURANCE PROGRAM (SOCIAL SECURITY)
Authorizing Legislation:
The Social Security Act, as amended, title II; (42 U.S.C. 401 et seq.)
Summary:
The Old-Age and Survivors Insurance program, commonly known as
social security, provides monthly cash benefit payments to retired workers,
their dependents, and to survivors of deceased workers. An individual's en-
titlement to benefits and the level of these benefits are based on past earn-
ings in employment covered by the program.
Insured persons are eligible for retirement benefits at age 65 and
permanently reduced benefits as early as age 62. Widows or widowers of
insured workers at age 65 are paid 100 percent of the amount which would
have been paid to their deceased spouse if alive; or at age 60 they may
elect to receive permanently reduced benefits.
The social security program is financed through a payroll tax paid by
employees, their employers and self-employed individuals.
CRS-24
Statistical and Financial Data:
As of December 1974, there were 20,026,000 social security benefi-
ciaries age 65 and older, of whom 14, 331, 000 were retired workers, 4, 417, 000
were survivors and dependents and 278, 000 were receiving special age 72 bene-
fits.
The average monthly benefit payment for retired workers for December
1974 was $188.21, and $177.29 for aged widows and widowers.
Administering Agency:
Information on the social security program may be obtained from social
security offices located in numerous cities throughout the country. At the
national level the program is administered by:
Social Security Administration
U.S. Department of Health, Education, and Welfare
Baltimore, Maryland 21235
RAILROAD RETIREMENT SYSTEM
Authorizing Legislation:
The Railroad Retirement Act of 1935, as amended; (45 U.S.C. 351-367)
Summary:
The Railroad Retirement system provides monthly cash benefit payments
to eligible retired and disabled workers, their wives and survivors. To qual-
ify for these benefits, an individual must have worked in covered railroad em-
ployment for at least 120 months (10 years) and, in most cases, must have
worked for a railroad for at least 12 out of the last 30 months before his re-
tirement or death. A worker is credited with railroad work each month he
CRS-25
does some compensated work for a covered employer. Covered employers in-
clude railroads engaged in interstate commerce, the REA Express, railroad
associations, and national railway labor organizations.
The amount of the retirement annuity depends on the employee's years
of service and average monthly railroad compensation.
Employees are eligible for retirement benefits at age 65 or actuarially
reduced benefits as early as age 62. Employees with 30 years of service may
receive full benefits as early as age 60. Widows at age 60 are paid the same
amount which would have been paid to their deceased spouses, provided a
widow has not remarried.
Individuals who work less than 10 years in employment covered by the
Railroad Retirement system have their coverage transferred to the social se-
curity system.
The Railroad Retirement system is financed primarily through contri-
butions in the form of a payroll tax paid equally by employees and employers.
Statistical and Financial Data:
In January 1975, there were 1, 134, 000 Railroad Retirement annuitants
receiving $250, 844, 000 in benefit payments.
Administering Agency:
Railroad Retirement Board
844 North Rush Street
Chicago, Illinois 60611
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SUPPLEMENTAL SECURITY INCOME PROGRAM FOR THE AGED,
BLIND AND DISABLED
Authorizing Legislation:
Social Security Act, as amended; title XVI; (42 U.S.C. 1381 et seq.)
Summary:
The Supplemental Security Income program is a Federal cash assist-
ance program through which aged, blind and disabled individuals with no other
income are guaranteed a monthly Federal payment of $146.00 and couples with
no other income are guaranteed $219.00 per month.
In addition, recipients who receive any other income, including social
security benefits, will be assured that the first $20.00 of this income will not
cause any reduction in their Supplemental Security Income payment. Also,
$65.00 a month of earned income plus one-half of any remaining earnings will
not cause any reduction in monthly payments.
This program also provides that the States may, and in some cases
must, supplement Federal payments. The law requires that the State must
supplement the Federal payment of people who are beneficiaries under the
present Federal-State welfare program in December of 1973. This will as-
sure that these recipients receive the same total monthly payment under the
Federal Supplemental Security Income program as they did under the State
program. States are not required to supplement Federal payments of 'recip-
ients who become eligible for Supplemental Security Income payments after
December 1973.
To qualify for Supplemental Security Income payments, an aged, blind
or disabled person must meet certain eligibility requirements as defined in
the Federal law. An aged person must be at least 65 years of age with
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assets of less than $1, 500. An elderly couple cannot have assets that exceed
$2, 250, In determining assets for the purpose of this program, the value of
a home, household goods, certain personal effects and property needed for
self support, if found to be reasonable, are to be excluded.
Statistical and Financial Data:
An estimated 2, 415, 000 aged individuals will be receiving Supplemental
Security Income payments in fiscal year 1976.
Administering Agency:
Social Security Administration
U.S. Department of Health, Education, and Welfare
Baltimore, Maryland 21235
VETERANS PENSION PROGRAM
Authorizing Legislation:
(30 U.S. C. 15 et seq. )
Summary:
Through the Veterans Pension program monthly cash benefits may be
paid to persons age 65 or over. Generally, to qualify for these benefits an
individual must have had 90 or more days of military service, including at
least 1 day of wartime service, and meet specified income limitation require-
ments. Monthly benefits also are paid to widows of eligible annuitants.
Veterans who served in World War I or after are subject to income
limitations for pension eligibility, while veterans who served in the Spanish-
American War are paid pensions on the basis of service without regard to
need.
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The amount of pension paid to veterans of World War I and after varies
according to the veteran's annual income.
Statistical and Financial Data:
During fiscal year 1976, an estimated 1, 563, 000 veterans and an esti-
mated 1, 155, 000 survivors are to receive a pension under this program. The
average payment per case is projected at $1,580 a year for veterans and $942
for survivors.
Administering Agency:
Veterans Administration
Washington, D.C. 20420
SOCIAL SERVICE PROGRAMS AND RELATED PROGRAMS
EDUCATION PROGRAMS FOR NON-ENGLISH-SPEAKING ELDERLY
Authorizing Legislation:
Adult Education Act, as amended in 1973, section 310 (20 U.S. C.
1201 et seq. )
Summary:
The 1973 Comprehensive Older Americans Services Amendments broad-
ened the Adult Education Act to provide for special education programs.
Through this Act, Federal grants can be made to State and local educational
agencies or other public or private nonprofit agencies for education programs
designed to serve elderly persons whose ability to speak and read the English
language is limited and who live in an area with a culture different than their
own. Programs must help participants deal with practical problems encountered
GERALD R.FORD LIBRARY:
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in everyday life, including the making of consumer purchases, meeting their
housing and transportation needs, and complying with governmental require-
ments such as those for obtaining citizenship, public assistance and social secu-
rity benefits.
Statistical and Financial Data:
The program has never been funded.
Administering Agency:
Office of Education
U.S. Department of Health, Education, and Welfare
Washington, D.C. 20201
EDUCATION PROGRAMS TO RESOLVE PROBLEMS OF THE ELDERLY
Authorizing Legislation:
The Higher Education Act of 1965, as amended, in 1973; title I;
(20 U.S. C. 1001 et seq. )
Summary:
The Older Americans Comprehensive Services Amendments of 1973
amended the Higher Education Act of 1965 to authorize assistance for the
elderly through certain educational institutions. The Federal government is
authorized to award grants to institutions of higher education to assist these
institutions in planning, developing, and carrying out programs specifically
designed to apply the resources of higher education to the problems of the
elderly. Special consideration is given to sponsors who develop programs to
meet the transportation and housing needs of elderly persons living in rural
and isolated areas.
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Statistical and Financial Data:
The program has never been funded.
Administering Agency:
Office of Education
U.S. Department of Health, Education, and Welfare
Washington, D.C. 20201
FOOD STAMP PROGRAM
Authorizing Legislation:
The Food Stamp Act of 1964, as amended; (7 U.S.C. 2016-2025)
Summary:
Through the Food Stamp program, the Federal government makes food
stamps available to local public welfare or other designated agencies for sale
to low-income families. The coupons are then used by the participants for
purchasing food in retail stores worth more than the amount paid or the
coupons. Persons age 60 or over who are homebound, physically handicapped,
or otherwise unable to adequately prepare all their meals are able to exchange
food stamps or coupons for meals prepared and served by certain nonprofit
sponsors.
To qualify for food stamps, an elderly family must meet the income
limitation requirements as determined locally and usually on a case-by-case
basis. Eligible families pay up to 30 percent of their income for the food
stamps.
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Statistical and Financial Data:
An estimated 15. 8 million individuals will participate in the food stamp
program during fiscal year 1975 and fiscal year 1976. Approximately 14 per-
cent of the participants are age 60 and over, and about 10 percent are age 65
and older. Expenditures in fiscal year 1975 will be approximately $3.9 bil-
lion, and approximately $4. 5 billion in fiscal year 1976.
Administering Agency:
The county welfare department usually administers the Food Stamp pro-
gram at the local level. At the national level the program is administered by:
Food and Nutrition Service
U.S. Department of Agriculture
Washington, D.C. 20250
LEGAL SERVICES CORPORATION
Authorizing Legislation:
Legal Services Corporation Act (42 U.S.C. 2996)
Summary:
An ll-member board of directors, appointed by the President and
approved by the Senate governs the legal Services Corporation. Through
this Corporation funds are made available to persons or projects providing
legal assistance to individuals of all ages who cannot afford legal assistance
on their own. The Corporation also may undertake research, training, and
serve as a clearinghouse for information in the area of legal services.
Statistical and Financial Data:
The Legal Services Corporation was established through legislation en-
acted in July 1974. The legislation has not been implemented to date.
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Administering Agency:
Community Services Administration
Washington, D. C. 20406
LIBRARY MATERIALS FOR THE BLIND AND PHYSICALLY DISABLED
Authorizing Legislation:
The Pratt-Smoot Act of 1931, as amended; (2 U.S.C. 135 a-b)
Summary:
The Library of Congress Division for the Blind and Physically Handi-
capped administers a program that provides library materials and other ser-
vices to persons who are unable to read conventional printed materials because
of a visual or physical limitation. Library materials, including talking book
machines, braille books, braille magazines, cassette players and cassettes,
and special music materials, are made available to eligible participants free
of charge through a system of cooperating regional and subregional libraries
located throughout the country.
To qualify for participation in this program, an individual must send a
statement to a cooperating library describing the visual or physical limitation
which prevents him from reading conventional reading material. The state-
ment must be signed by a physician, registered nurse, social worker, or an
individual certified by the Library of Congress. Nursing homes, hospitals,
institutions, and schools also may borrow materials from a cooperating li-
brary.
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Statistical and Financial Data:
There are approximately 435,000 individuals participating in the read-
ing program. Approximately 50 percent of these individuals are age 60 or
over.
The appropriation for fiscal year 1975 was $11,472,000.
Administering Agency:
Library materials may be obtained from 51 regional libraries and more
than 70 subregional cooperating libraries. The program is administered by:
'Division for the Blind and Physically Handicapped
Library of Congress
Washington, D.C. 20540
MODEL PROJECTS TO PROVIDE FOR SOCIAL SERVICES
Authorizing Legislation:
The Older Americans Act, as amended, title III; (42 U.S.C. 3021
et seq.)
Summary:
Under title III of the Older Americans Act, Federal grants are
awarded to or contracts are made with public or nonprofit private agencies or
organizations for paying part or all of the cost of developing and operating
statewide, regional, metropolitan, county, city or community model projects.
Model projects are designed to demonstrate new or improved methods of pro-
viding needed services to older people.
CRS-34
The 1973 amendments to the Older Americans Act revised this pro-
gram so that special consideration is given to sponsors who develop projects
in one of five areas--housing, transportation, education, pre-retirement coun-
seling, and special services for older handicapped individuals.
Prior to the 1973 amendments, model projects focused on alternatives
to institutionalization, outreach activities to identify elderly individuals living
in isolated areas, and needed services for elderly individuals living in disas-
ter areas.
Statistical and Financial Data:
During 1974, $16 million were earmarked to State agencies to conduct
areawide model projects. During fiscal year 1975, $7 million were appro-
priated to support model projects.
Administering Agency:
Administration on Aging
U.S. Department of Health, Education and Welfare
Washington, D.C. 20201
MULTIPURPOSE SENIOR CITIZENS
Authorizing Legislation:
The Older Americans Act as amended in 1973; title V; (42 U.S. C.
3021 et seq. )
Summary:
Title V of the Older Americans Act authorizes the Federal government
to award grants to or enter into contracts with public and nonprofit private
agencies to pay up to 75 percent of the cost of purchasing, leasing, repair-
ing, or altering a facility to serve as a multipurpose senior center. A sponsor
CRS-35
ust develop the center in an area that is in close proximity to the majority
individuals eligible to use the facility and within walking distance where
ssible.
In addition, title V authorizes the Federal government to insure mort-
ges for the acquisition, alteration, or renovation of such facilities. The
ortgage insurance is to be financed through a Multipurpose Senior Center
urance Fund created by the Secretary of Health, Education, and Welfare
a revolving fund for carrying out the insurance program.
Title V also authorizes funds for professional and technical staffing
uired for the initial operation of a multipurpose senior center. The
ernment may award initial staffing grants for three year periods of up
15 percent for the first year, 66 and 2/3 percent for the second year and
percent for the third year.
istical and Financial Data:
The program has never been funded.
inistering Agency:
Administration on Aging
U.S. Department of Health, Education, and Welfare
Washington, D.C. 20201
NUTRITION PROGRAM FOR THE ELDERLY
orizing Legislation:
Older Americans Act of 1965, as amended, title VII; (P.L. 92-258);
I.S.C. 3051)
CRS-36
Summary:
Title VII of the Older Americans Act provides formula grants to the
States to pay part of the cost of establishing and operating programs which
will deliver low-cost meal programs to older people. The programs must be
located in community settings such as schools, senior citizen centers and
churches accessible to the majority of elderly people for whom they are in-
tended. The programs are to provide one hot meal per day on at least five
days a week along with services which would introduce the participants to the
other social resources in the communities. They also are to provide home-
delivered meals to older persons in the community who are unable to leave
their homes.
Statistical and Financial Data:
The fiscal year 1975 appropriation was $125 million. There are 665
projects and 220, 000 participants on each of 5 days a week.
Administering Agency:
The nutrition program is generally administered at the State level by
the designated State agency on Aging. At the national level the program is
administered by:
Administration on Aging
U.S. Department of Health, Education, and Welfare
Washington, D. C. 20201
OLDER READER SERVICES
Authorizing Legislation:
Library Services and Construction Act, as amended in 1973, title VIII;
(20 U.S. C. 351 et seq. )
CRS-37
Summary:
The 1973 Comprehensive Older Americans Services Amendments author-
ize Federal grants to State governments to develop and establish special li-
brary services for the elderly. Services may involve the training of librar-
ians to work with older people; developing special library programs for the
elderly; purchasing special library materials for use by the elderly; employing
elderly persons as assistants in programs for the elderly; home visits by li-
brary personnel; transportation services to and from the library; and outreach
programs to notify the elderly of available library services.
Statistical and Financial Data:
The program has never been funded.
Administering Agency:
Office of Education
U.S. Department of Health, Education, and Welfare
Washington, D.C. 20201
REVENUE SHARING
Authorizing Legislation:
State and Local Fiscal Assistance Act of 1972; (31 U.S.C. 1221 et seq. )
Summary:
The revenue sharing legislation provides funds to States and local units
of government. The State government receives one-third of the total amount
allocated to a State and the remaining two-thirds of the State's allocation is
divided among units of local government.
FORD LIBRARY 2 9ERALD
States may use funds for any legal expenditure except to match Fede-
ral grants. Local governments such as cities, counties, and townships may
expend these. funds to provide eight categories of services, one of which is
social services for the poor or elderly.
Each unit of government receives its share of Federal funds based on
several factors including the State-local tax effort, population, and the amount
of poverty present in the State's population. Funds are allocated on a quar-
terly basis.
Statistical and Financial Data:
Reports indicate that less than four percent of the fiscal year 1974
expenditures of $6.1 billion was used to fund social services for the poor or
elderly.
Administering Agency:
Office of Revenue Sharing
U.S. Department of the Treasury
Washington, D.C. 20226
SENIOR OPPORTUNITIES AND SERVICES
Authorizing Legislation:
Economic Opportunity Act of 1964, as amended, title II, section
222(a)(8); (42 U.S.C. 2809 et seq.)
Summary:
The Senior Opportunities and Services program was established in order
to identify and meet the special economic, health, employment, welfare and
other needs of poor persons above the age of 60 that were not being met ade-
quately by more general programs designed for all age groups. Through this
CRS-39
program, funds are made available, primarily to local community action agen-
cies which, in turn award grants to public and private nonprofit agencies, for
developing and operating projects providing services and activities for elderly
individuals. Projects may involve employment and volunteer opportunities,
referral services, neighborhood outreach programs, home day-care services,
recreation programs and other activities necessary to meet the needs of older
people.
Statistical and Financial Data:
There are 200 senior opportunity and services projects serving approx-
imately 1 million elderly individuals.
The Senior Opportunity and Services program is operating on a continu-
ing resolution. For fiscal year 1975, $7.5 million have been allocated for the
continuation of existing projects. The fiscal year 1976 proposed budget con-
tained requests to phase out this program in anticipation that similar programs
would be funded under the Older Americans Act.
Administering Agency:
Senior Opportunities and Services
Office of Economic Opportunity
Washington, D.C. 20406
SOCIAL SERVICES FOR PUBLIC ASSISTANCE RECIPIENTS
AND LOW INCOME INDIVIDUALS
Authorizing Legislation:
Social Security Act, as amended, title VI and title XX (42 U.S.C. 301-
306; 42 U.S.C. 1361-1371); (P.L. 93-647 places social services under title XX
of the Social Security Act effective October 1, 1975.)
CRS-40
Summary:
The Federal government makes formula grants available to State welfare
agencies which in turn use these grants to establish and operate social service
programs for public assistance recipients and other needy individuals who meet
the income limitation requirements established by the State. Services for elder-
ly individuals may include information and referral services, home-health care
services, housing improvement services, home-delivered meals, employment
services, education activities and other supportservices. The Federal govern-
ment will pay 75 percent of the cost of a State's social service program.
Statistical and Financial Data:
During fiscal year 1976, an estimated 2.7 million adults including sen-
ior citizens will receive one or more services under the States' social service
programs. Federal expenditures will be an estimated $608 million.
Administering Agency:
The program is administered on the State level through the designated
State welfare agency and locally through public welfare agencies. At the na-
tional level the program is administered by:
Social and Rehabilitation Service
U.S. Department of Health, Education, and Welfare
Washington, D.C. 20201
STATE AND COMMUNITY PROGRAMS TO PROVIDE FOR SOCIAL SERVICES
Authorizing Legislation:
The Older Americans Act of 1965, as amended, title III; (42 U.S. C.
3021-3025)
CRS-41
Summary:
The 1973 amendments to the Older Americans Act broadened the title
III program to authorize a more comprehensive social service delivery system
for the elderly. Through title III, formula grants are awarded to the States
to pay part of the cost of planning, developing, and operating a comprehen-
sive, social service delivery system in the community. In order to obtain
funding, the designated State agency on aging must divide the State into plan-
ning and service areas. The State agency also may elect to designate a local
area agency on aging which in turn would be responsible for planning, develop-
ing and operating a social service delivery system for elderly individuals re-
siding in the designated area.
In developing a social service delivery system for the elderly, the State
agency has overall responsibility for coordinating and utilizing existing social
services available on the local level. Also, the State agency may award grants
to public and private nonprofit agencies and organizations for providi : ser-
vices to older people which otherwise would be unavailable.
Projects funded under title III in the past have provided for various
social services on the local level such as information and referral services,
home-health care services, home repair services, meal programs, trans-
portation services, and recreation and educational activities.
Statistical and Financial Data:
As of January 1975, State Agencies on Aging identified 600 planning and
service areas and established 412 Area Agencies on Aging.
The appropriation for fiscal year 1975 was $100 million.
CRS-42
Administering Agency:
State and community programs are administered at the State level by the
designated State Agency on Aging. At the national level the program is adminis-
tered by:
Administration on Aging
U.S. Department of Health, Education and Welfare
Washington, D.C. 20201
TRANSPORTATION ASSISTANCE
Authorizing Legislation:
The Urban Mass Transportation Assistance Act of 1964 as amended
in 1974
Summary:
The Urban Mass Transportaion Administration provides funds to transit
companies to help cover operating costs and the costs of capital improvements.
Recipients of Federal funds are required to reduce fares (not to excecu one-
half of the rates during peak hours) to elderly and handicapped persons during
nonpeak hours.
Statistical and Financial Data:
The Department of Transportation held public hearings in April 1975
on regulations designed to implement the Federal law requiring Federally
subsidized transit systems to offer half fares to the elderly and handicapped
individuals during nonpeak hours. There is $3.975 billion available to appli-
cants for mass transportation planning and operating expenses over a six year
period.
FORD LIBRARY & GERALD
CRS-43
Administering Agency:
Department of Transportation
Urban Mass Transportation Administration
Washington, D.C. 20201
TRAINING AND RESEARCH PROGRAMS
MULTI-DISCIPLINARY CENTERS OF GERONTOLOGY
Authorizing Legislation:
Older Americans Act of 1965, as amended in 1973, title IV; (P.L. 93-29)
Summary:
The 1973 amendments to the Older Americans Act authorized a program
of grants to public and private nonprofit agencies, organizations, and institu-
tions to establish or support multi-disciplinary centers of gerontology. These
centers will provide for a wide range of activities such as the recrui.ing and
training of personnel to work in the field of aging. Activities also will in-
clude research and demonstration projects with respect to the social, econo-
mic and psychological needs of older people. In addition, consultation ser-
vices will be provided to public and voluntary organizations with respect to the
needs of older people.
Statistical and Financial Data:
This program has never been funded.
Administering Agency:
Administration on Aging
U.S. Department of Health, Education, and Welfare
Washington, D.C. 20201
CRS-44
NURSING-HOME CARE, TRAINING AND RESEARCH PROGRAMS
Authorization:
(Presidential Directive; August 6, 1971)
Summary:
The Office of Nursing Home Affairs is responsible for the training of
nursing home inspectors and the inspection and certification of skilled nurs-
ing facilities participating in the medicaid and medicare programs.
The Office also enters into contracts with nonprofit organizations and
associations and public agencies to provide short-term training for employees
of long-term care facilities. The training programs are directed at improv-
ing the general performance on the part of the employees in giving care to
patients in nursing homes.
In addition, the Office of Nursing Home Affairs is responsible for sup-
porting studies relating to long-term care such as the quality of care provided
in nursing homes, the costs of long-term care, and alternatives to institu-
tional care.
Statistical and Financial Data:
The Office of Nursing Homes Affairs is financed through general funds
appropriated to the Office of the Secretary of the U.S. Department of Health,
Education, and Welfare. An estimated $7.2 million will be expended in fiscal
year 1976 to assure that approximately 17, 400 nursing homes which receive
Federal payments comply with medicare and medicaid regulations.
CRS-45
Administering Agency:
Office of Nursing Home Affairs
U.S. Department of Health, Education, and Welfare
Washington, D.C. 20201
PERSONNEL TRAINING PROGRAM IN THE FIELD OF AGING
Authorizing Legislation:
Older Americans Act of 1965, as amended, title IV-A; (42 U.S.C. 3041-
3042)
Summary:
Title IV of the Older Americans Act authorizes grants to public and
private nonprofit agencies, organizations and institutions for training persons
employed or preparing for employment in the field of aging. Grants also
are awarded to public and private agencies and organizations to publicize
available career opportunities in the field of aging and encourage qualified
persons to enter or re-enter the field of aging.
Statistical and Financial Data:
During fiscal year 1975, 47 career training programs were sponsored
under title IV-A. Also, a number of short term training programs are being
supported.
$8 million was appropriated during fiscal year 1975 for the training
programs.
Administering Agency:
Administration on Aging
U.S. Department of Health, Education, and Welfare
Washington, D.C. 20201
CRS-46
RESEARCH AND DEMONSTRATION PROJECTS IN THE FIELD OF AGING
Authorizing Legislation:
Older Americans Act of 1965, as amended, title IV; (42 U.S.C. 3031-
3032)
Summary:
Title IV of the Older Americans Act authorizes grants to public and
private nonprofit organizations, agencies and to individuals for establishing
research and demonstration programs in the field of aging. Research and
demonstration projects may involve the study of current living patterns and
conditions of older persons; methods to improve the standard of living and
way of life for older people; and means for improving the coordination of
community services designed for older people.
The 1973 amendments to the Older Americans Act authorize the
Secretary of Transportation, the Secretary of Housing and Urban Development,
and the Commissioner on Aging to conduct a comprehensive study and survey
of the transportation problems of the elderly. In connection with this study,
Federal grants may be awarded to public and private nonprofit agencies and
organizations to assist in identifying and meeting the transportation problems
of older people. A preliminary study was submitted to Congress in January
1975.
Statistical and Financial Data:
During fiscal year 1974, 119 new and continuing research and demon-
stration projects were supported.
A total of $7 million was appropriated for these projects.
Administering Agency:
Administration on Aging
Office of Human Development
U.S. Department of Health, Education, and Welfare
Washington, D.C. 20201
RESEARCH ON THE AGING PROCESS AND HEALTH PROBLEMS
OF THE ELDERLY
Authorizing Legislation:
Public Health Service Act, as amended, title IE; (42 U.S.C. 298-d,
et seq. )
Summary:
The National Institute on Aging is responsible for conducting and sup-
porting research relating to the biological, bahavioral, and sociological as-
pects of the aging process and the special health problems of the elderly.
Research also is conducted through the Institute's Gerontology Research Center
in Baltimore, Maryland. Research is supported through grants awarded to
universities, hospitals, other public and nonprofit institutions and to individ-
uals. In addition, grants are awarded to public and nonprofit institutions for
training individuals in research relating to the aging process and health prob-
lems of the elderly.
Statistical and Financial Data:
The National Institute on Aging was established through legislation en-
acted in 1974. Research in prior years on the aging process had been con-
ducted by the Adult Branch of the new National Institute on Child and Human
Development. The fiscal year 1975 appropriation for the new National Insti-
tute on Aging was $16,190,000
CRS-48
Administering Agency:
National Institute of Child Health and Human Development
U.S. Department of Health, Education, and Welfare
Bethesda, Maryland 20014
10 L]] USA AMERICA
DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE
OFFICE OF THE SECRETARY
WASHINGTON, D.C. 20201
AUG 4 1975
MEMORANDUM FOR THE HONORABLE PAMELA G. NEEDHAM
As requested in your communication of June 24, I am
enclosing a suggested draft reply to the letter addressed
to the President from Mr. Boone Robinson.
/s/ DavidH. Lissy
David H. Lissy
Executive Secretary
to the Department
Enclosure
FORD is LIBRARY GERALD
Mr. Boone Robinson, Executive Secretary
DRAFT
State of California
Commission on Aging
926 "J" Street, Suite 914
P. 0. Box 350
Sacramento, California 95802
Dear Mr. Robinson:
Your letter of June 19 to the President regarding the direction of the
Administration on matters affecting the elderly has been referred to
me for response. The President is always pleased to have comments and
suggestions on matters of public policy.
You may be assured that the President and this Administration are
deeply concerned over the financial difficulties faced by many older
Americans today. The President is making every effort to combat
recession, inflation, and the energy crisis, which affect all Americans,
while at the same time seeing to it that the elderly, who generally
have fewer resources to draw upon than do younger adults, are helped
to meet these added burdens.
You are aware, I am sure, that the President did not propose to re-
duce or freeze social security benefits, but to hold the annual
social security benefits increase to 5% as a means of combating in-
flation. The actual increase was 8% effective in June and was reflected
in checks received July 3. This spring, the President signed a $22.8
billion anti-recession tax-cut bill that carried a number of provisions
DRAFT
Page 2 - Mr. Boone Robinson
favorable to the elderly, including payment of $50 each to some 34 million
individuals receiving Social Security, Railroad Retirement, and Supplemental
Security Income benefits. Extension of unemployment compensation benefits,
tax rebates for 1974, and tax reduction for 1975 are features of the bill
that benefit many older persons. Also, rules concerning tax deductions for
expenses of caring for an elderly relative were liberalized.
Since 1971, social security benefits have been increased several times
for 120 million recipients, and the Supplemental Security Income (SSI)
program has been established to maintain a minimum income level for
the elderly poor.
Attention has been given to private-sector income maintenance plans.
also. On Labor Day 1974, the President signed into law the Employee
Retirement Income Security Act, which will offer the approximately
35 million persons covered by private employee benefit plans and their
beneficiaries new protections and guarantees. ERISA encourages the
growth of private pension and welfare plans, insures that participants
do not lose benefits because of unduly restrictive eligibility provisions
or because the plan did not accumulate and retain sufficient funds to
meet its obligations, and provides greater equity in tax treatment of
private savings for retirement.
Page 3 - Mr. Boone Robinson
DRAFT
In vetoing two bills recently passed by Congress in the areas of
employment and housing, the President stressed the importance of
holding down the federal deficit and avoiding exacerbation of
budgetary and economic pressures. He has been particularly con-
cerned about over-stimulating the economy and setting off an-
other round of inflation that would be seriously harmful to
elderly persons on fixed incomes as well as to nearly every
other segment of society.
Last year, the President signed a historic housing bill having a
number of provisions with considerable potential for older
Americans--the Housing and Community Development Act of 1974.
For example, Section 8 of the Act provides for subsidized housing
for low-income renters, while the newly revised Section 202
authorizes direct, low-interest federal loans for construction of
housing for the elderly, among others. This expanded, more
flexible housing program, when fully operational, can go far to-
ward relieving critical housing problems for many older persons.
In the critical area of health care for older persons, the
Administration is working on a number of proposals and projects
that should contribute to better use of present and potential
resources for delivery of services to the elderly with a goal of
improving health and quality of life. The newly established
National Institute on Aging will not only conduct and support
DRAFT
Page 4 - Mr. Boone Robinson
research on the biological aspects of aging, but will examine the
social and physical environment for its effect on the aging process.
Mindful of wide-spread criticism of long-term care facilities for
the elderly, the Department of Health, Education and Welfare
is collecting data on conditions in nursing homes nationally so as
to be able to recommend sound policies and programs to improve long-
term care for the elderly. Also, a national rating system for
nursing homes receiving Medicaid and Medicare funds is currently
being developed.
Last year, the President submitted a Comprehensive Health Insurance
Plan to Congress, but it was not enacted. The plan has not been
resubmitted this year because of the President's desire not to in-
crease the federal budget deficit, but it will be given highest
priority next year.
Housing and health services are two of a number of areas in which
the Administration on Aging (AOA), within the Department of Health,
Education and Welfare, is undertaking cooperative efforts with other
federal agencies. A0A which is charged with serving as an advocate for
the elderly, is working with the Public Health Service and the Department
of Housing and Urban Development respectively toward the better use of
present and potential resources for delivery of services to older Americans.
Page 5 - Mr. Boone Robinson
DRAFT
There are currently several programs aimed at helping older Americans
who wish to work find employment. Title IX of the Older Americans
Comprehensive Services Amendments provides for establishment of part-
time employment opportunities in community service activities for
persons 55 years or older who have limited incomes. Under this are
specialized employment programs such as Senior Community Service
Projects, Senior Community Aides, Green Thumb, and Operation
Mainstream. There will be at least 12,400 job slots funded in Fiscal
Year 1976. Also certain ACTION programs pay a stipend to elderly
volunteers who participate in Foster Grandparents and similar pro-
jects.
There are other areas in which federal activities on behalf of the
elderly have increased recently. The Older Americans Act of 1965,
which marks its 10th anniversary this month, is making a major con-
tribution to the well-being of a growing number of elderly persons
in the Nation. Your agency is but one of the designated agencies
on aging now functioning in every State and in 412 communities, for
the purpose of coordinating existing and potential resources, and
providing information and referral services. The national Nutrition
Program for the Elderly now serves 228,000 meals a day, five days a
week. The recent action placing the annual operating level for this
program at $150 million (an increase of $50.4 million over the
previous year) will mean more elderly persons served at existing meal
sites and new sites to be opened in communities not previously served.
Page 6 - Mr. Boone Robinson
DRAFT
Under the new Title XX of the Social Security Act, funds will be
available to the States that can be used for development of coordi-
nated, comprehensive social service programs for low-income older
people. The law requires that services provided be coordinated
with plans for such programs as those set up under the Older Americans
Act.
The Administration has repeatedly urged State and local officals on
aging to make full use of federal revenue-sharing funds on behalf of
the elderly. The philosophy behind the New Federalism, supported by
the Ford Administration, has been to direct greater accountability to
elected officials in States and localities, believing that they can
best determine and solve local problems. To date, studies indicate
that the States have used revenue sharing for older persons only to
a limited extent. Nevertheless, health services and housing are
among the areas in which some towns and counties have sucessfully
utilized revenue sharing to benefit older residents.
It was good of you to write and share the views of the California
Commission on Aging with the President. I can assure you that he
gives careful consideration to such opinions in the formulation of
policy affecting older Americans.
Sincerely yours,
FOR IMMEDIATE RELEASE
July 24, 1975
Office of the White House Press Secretary
THE WHITE HOUSE
TO THE CONGRESS OF THE UNITED STATES:
I am transmitting herewith the Annual Report of the
Federal Council on Aging, together with my comments and
recommendations.
The Federal Council on the Aging was established by
the 1973 amendments to the Older Americans Act of 1965 to
advise and assist the President on matters relating to
the special needs of older Americans, and for other pur-
poses specified in the enabling legislation. Members of
the Federal Council on the Aging were confirmed by the
Senate on June 5, 1974.
As the annual report indicates, the Federal Council
on the Aging has undertaken a number of advocacy activities
pursuant to its legislated mandate. The report, as sub-
mitted to me by the Secretary of Health, Education, and
Welfare for transmittal, does not include supporting data
or analysis which would provide the basis for a detailed
review of policy positions and recommendations.
Since the Council was only recently formed, the
Administration, on behalf of the Federal Council on the
Aging, has requested that the Congress authorize an
extension until January 1, 1976, of the date for submission
to the Congress of the two legislatively mandated studies.
One study calls for a review of the interrelationships
of all benefit programs -- Federal, State, local -- serving
the elderly. Such information could be useful to the
Executive Branch and the Congress to identify duplicative
and overlapping programs and to propose the necessary re-
forms so that our resources may be more effectively applied
to help those most in need.
A second study, dealing with the combined impact of
all taxes on the elderly, could also be helpful in deter-
mining the burdens and benefits of government actions as
they affect the Nation's elderly.
I look forward to the study reports to help us provide
an effective and economical delivery of services to our
elderly citizens.
The Council specifically recommends "legislative action
to develop high standards of safety and care in nursing
homes." The Department of Health, Education, and Welfare
has set high standards of nursing home care and safety that
must be met by nursing homes participating in the Medicare
and Medicaid programs. The enforcement of these standards
is one of my Administration's highest priorities. Federal
funds pay 100 percent of the costs of inspection to monitor
compliance with these standards. The Federal Government
pays its share of the costs of meeting nursing home standards
more
FORD
SEVALD
LIBRARY
2
through health care financing programs, primarily Medicare
and Medicaid. Financial assistance is also made available
by the Department of Housing and Urban Development to assist
nursing homes in meeting selected fire safety standards.
The Council also expressed its concern about the level
of funding for programs to assist the elderly. I sympathize
with this concern, but I am determined to reduce the burden
of inflation on our older citizens, and that effort demands
that government spending be limited. Inflation is one of
the cruelest and most pervasive problems facing older Americans,
so many of whom live on fixed incomes. A reduction of inflation,
therefore, is in the best interests of all Americans and would
be of particular benefit to the aging.
The perspective and recommendations of this report
are limited to a particular area of interest and advocacy.
The report does not reflect the Administration's policies,
which must reflect a broader range of responsibilities and
priorities.
GERALD R. FORD
THE WHITE HOUSE,
July 24, 1975
# # # #
THE WHITE HOUSE
ACTION MEMORANDUM
WASHINGTON
LOG NO.:
Date: May 1, 1975
Time: 11:30am
Pam Needham
FOR ACTION:
CC (for information):
Max Friedersdorf
Warren Hendriks
Ken Lazarus
Jim Cavanaugh
Paul Theis
Jack Marsh
FROM THE STAFF SECRETARY
DUE: Date: Monday, May 5
Time: 11:30am
SUBJECT:
Administration on Aging Annual Report
ACTION REQUESTED:
For Necessary Action
X For Your Recommendations
Prepare Agenda and Briet
Dratt Keply
X
For Your Comments
Draft Remarks
REMARKS:
Please return to Judy Johnston, Ground Floor West Wing
OR-PN
FORD LIBRARY & GENALD
red. 5/1/75
PLEASE ATTACH THIS COPY TO MATERIAL SUBMITTED.
If you have any questions or if you anticipate a
delay in submitting the required material, please
telephone the Staff Secretary Immediately.
EXECUTIVE OFFICE OF THE PRESIDENT
OFFICE OF MANAGEMENT AND BUDGET
WASHINGTON, D.C. 20503
MAR 25 1975
MEMORANDUM FOR MR. WARREN HENDRIKS
Subject: AoA 1974 Annual Report
This is in response to your request for our comments on the
AoA 1974 Annual Report.
Background
FY 1974 was a year of transition for the Older Americans Act
(OAA) --making the first full operational year after enactment
of the 1973 Amendments. Prior to 1973, the OAA provided sup-
port for discrete services designed to respond to particular
needs of older persons in local communities. The 1973
Amendments were designed to develop a national initiative
directed toward providing comprehensive systems of services
which would coordinate, at the intrastate level, available
and potential services and resources on behalf of older
persons. Priority was to be given those planning and
service areas and Area Agencies on Aging having signifcant
concentrations or proportions of low-income and minority
older persons. Necessary services, including nutrition,
would be made available via this planning and service area
network.
Summary of Annual Report
The report provides detailed information relating to major
program initiatives, awards, and activities carried out
in FY 1974 as authorized by the Older Americans Act, as
amended. Major emphasis and detail are focused on Federal
Coordination Activities, R&D, Training, the National
Clearinghouse on Aging, the Federal Council on Aging, and
Special Projects.
Comments
(1) Although the Title III (State and Community) and
Title VII (Nutrition) programs account for over
90 percent of the Federal cost of the OAA, less
2
than 10 percent of the report's narrative is devoted
to what these programs are doing and assessments of
how well they are doing it.
The major portion of the report is focused on the
Training, Research, and Data Collection activities
of AoA. Note: The Administration has never requested
funds for Training, and these other functions could be
considered subordinate and/or marginal vis-a-vis the
high cost of Title III and Title VII functions,
(2) Minor editing is suggested in a number of instances
(as highlighted in red). There are several areas
where suggestive language should be modified since
this is a factual report and not a proposal (see
page 17). In addition, it would appear that all
references to FY 1975 should be removed for the
same reason (see page 19).
Recommendation
The lack of substantive information and objective assessment
of Title III (State and Community) and Title VII (Nutrition)
programs is unfortunate. It is the primary reason for the
Administration's attempt to hold down growth of these pro-
grams. Nevertheless, while the report is deficient in this
area, we see no reason to object to transmittal of the report
to Congress, following completion of the minor revisions
suggested above.
Paul H. O'Neill
Deputy Director
THE SECRETARY OF HEALTH EDUCATION, AND WELFARE
WASHINGTON, D.C. 20201
MAR 11 1975
The President
RL.
The White House
Washington, D.C. 20500
Dear Mr. President:
Section 208 of the 1973 Amendments to the Older Americans Act
(Public Law 89-73) provides that the Commissioner on Aging shall
prepare and submit to the President for transmittal to the Congress
a full and complete report on the activities carried out under this
Act, not later than one hundred and twenty days after the close of
each fiscal year.
Enclosed herein is the Annual Report of the Administration on Aging
for the fiscal year 1974. Data reflecting services and activities
provided individuals under the authority of the Older Americans
Act, during the preceding fiscal year are included in this document.
I am also enclosing the appropriate letters of transmittal to the
Congress for your convenience.
Enclosures
FORD & LIBRARY GERALD
Honorable Nelson A. Rockefeller
"DRAFT"
President of the Senate
Washington, D.C. 20510
Dear Mr. President:
Section 208 of the 1973 Amendments to the Older Americans Act
(Public Law 89-73) provides that the Commissioner on Aging shall
prepare and submit to the President for transmittal to the Congress
a full and complete report on the activities carried out under this
Act, not later than one hundred and twenty days after the close of
each fiscal year.
Secretary Weinberger has forwarded the Annual Report of the
Administration on Aging for the fiscal year 1974 to me, and I am
pleased to transmit this document to the Congress.
Sincerely yours,
Enclosures
Honorable Carl Albert
"DRAFT"
Speaker of the House of Representatives
Washington, D.C. 20515
Dear Mr. Speaker:
Section 208 of the 1973 Amendments to the Older Americans Act
(Public Law 89-73) provides that the Commissioner on Aging shall
prepare and submit to the President for transmittal to the Congress
a full and complete report on the activities carried out under this
Act, not later than one hundred and twenty days after the close of
each fiscal year.
Secretary Weinberger has forwarded the Annual Report of the
Administration on Aging for the fiscal year 1974 to me, and I am
pleased to transmit this document to the Congress.
Sincerely yours,
Enclosure
GERALD B: FORD CIBRARY
THE WHITE HOUSE
ACTION MEMORANDUM
WASHINGTOS
LOG NO.:
Date: April 24, 1975
Time: 230pm
FOR ACTION: Pam Needham
CC (for information): Warren Hendriks
Max Friedersdorf
Jim Cavanaugh
Ken Lazarus
Jack Marsh
Paul Theis Ron Kienlen
FROM THE STAFF SECRETARY
DUE: Date: April 25, 1975
Time: noon
SUBJECT:
Revised Proclamation: Older Americans Month
read. 4/25/75
ACTION REQUESTED:
For Necessary Action
X For Your Recommendations
Prepare Agenda and Brief
Draft Reply
X For Your Comments
Draft Remarks
REMARKS:
Please return to Judy Johnston, Ground Floor West Wing
This proclamation was redrafted by HEW. You have
previously cleared one routed earlier this month.
See charges
GN
FORD is LIBRARY OFRALD
PLEASE ATTACH THIS COPY TO MATERIAL SUBMITTED.
If you have any questions or if you anticipate a
delay in submitting the required material, please
OLDER AMERICANS MONTH, 1975
BY THE PRESIDENT OF THE UNITED STATES OF AMERICA
A PROCLAMATION
It is gratifying to note that, throughout the Nation, there
is increasing awareness of the growing national resource represented
by our older citizens. Wisely focused, their collective knowledge,
experience, and energy can contribute significantly to raising the
quality of life for all of us in all our communities throughout the
land.
I believe it is important, as we approach our national
Bicentennial, that we take special note of our nation's older citizens.
Today's older persons have made and are making significant contributions
to the strengthening of our nation. It is fitting, therefore, that we
not lose sight of these contributions, the continuing contributions
this generation can make, and the commitment we have as a society to
insure their needs are met.
Next year
The Ricentennial will mark fifteen years since the first White
House Conference on Aging produced a Senior Citizens Charter of Rights
and Obligations, and five years since the 1971 White House Conference on
on the spirit of the Bicentennial,
Aging. In the spirit of the Bieentennials it is time to reconsider the
charter, update it in the light of changing circumstances, newly defined
needs and programs, and growing knowledge about the older population,
and develop it as a Declaration of Rights and Obligations for Older
Persons. ster Come attorned that new declaration byopeople of all ages
-2-
should begin now
so that
suggestions for changes and additions can be considered prior to
in
a
Provide
Proelemation
at
the
egiming
of
the Bicentennial Year.
NOW, THEREFORE, I, Gerald R. Ford, President of the United
States of America, do hereby designate the month of May 1975 as Older
Americans Month. Furthermore, I urge that there be wide participation
in observance of this month, that special emphasis be placed in these
observances on the possible content of a new Declaration of Rights and
Obligations for Older Persons which can become a rallying point for
during the Bis untennial Year of 1976 and guide to
additional actions during the years ahead.
IN WITNESS WHEREOF, I have hereunto set my hand this
day of
,
in the year of our Lord nineteen hundred seventy-five,
and of the Independence of the United States of America the one hundred
and ninety-ninth.
Aging
proposal Killed
March 14, 1975
Dr. Theodore C. Marrs
Special Assistant to the
President
The White House
Washington, D.C. 20500
Dear Ted:
Attached is a Memorandum from Bernie Nash to you in
response to your request for our ideas concerning the
April 22nd, Tuesday morning White House meeting on aging
problems. We feel that such a meeting is important since
it will afford an opportunity for interested persons to
contribute their views directly to the White House and top
government officials on steps toward solving problems faced
by older Americans. I hope the attached recommendations will
be helpful to you in planning for this meeting.
If Bernie or I can be of any further assistance in
this regard, please call on us.
Sincerely,
Cyril F. Brickfield
FORD & LIBRARY GERALD
Counsel
Enclosure
MEMORANDUM
TO:
Dr. Theodore Marrs
FROM:
Bernard E. Nash
DATE:
March 14, 1975
SUBJECT: April 22nd White House Meeting on Aging Issues
I am pleased to submit the following information in
regard to the April 22nd White House Meeting on Aging Issues
which you requested from Cy Brickfield and John Martin at your
meeting on Friday, February 28, 1975.
We agree that a more extensive discussion of issues
relating to the elderly would be extremely helpful and we are
most pleased that you have obtained approval for an April 22nd
meeting at the White House in order that interested parties
may have an opportunity to air their views in regard to these
issues.
Our recommendations as to the format of the meeting
and a suggested list of invitees follow:
I. Invitees
A. Representatives of the principal organizations
concerned with aging:
GERALD LIBRARY GERALD R FORD
1. American Association of Homes for the Aged
(Msgr. Fahey or Constance Beaumont)
2. Ammrican Association of Retired Persons,
National Retired Teachers Association
(Bernard E. Nash, John Martin, James Hacking)
3. American Hospital Association
4. American Health Care Association (Dr. Tom Bell)
5. American Public Welfare Association
(Edward Weaver)
6. Black Caucus for the Aged (Hobart Jackson)
7. B'nai B'rith (Seymour Cohen)
MEMORANDUM
--- 2 -
March 14, 1975
8. Center for Voluntary Action (George Romney)
9. Common Cause (John Gardner)
10. Community Nutrition Institute (Rodney Leonard)
11. Consumer Federation of America (Carol Tucker
Forman)
12. Council of State Governments (Brevard Chihfield)
13. Democratic National Committee (Rbbert Strauss)
14. Duke Center for Study of Aging
15. Fleet Reserve Association (Nolan)
16. Michigan Institute of Gerontology
17. National Association of Counties (Bernard
Hillenbrand)
18. National Association of Retired Federal
Employees (John McClelland)
19. National Association of State Units on Aging
(Harry Walker)
20. National Conference of Catholic Charities
(Msgr. Lawrence Cochrane)
21. National Council of Senior Citizens (Nelson
Cruikshank)
22. National Council on the Aging (Jack Ossofsky)
23. National Gerontological Society (Ed Kaskowitz)
24. National Senior Citizens Law Center (Daul
Nathanson)
25. National Urban Elderly Coalition (Alice Brophy)
26. Republican National Committee (Mary Louise Smith)
27. Retired Officers Association (Col. Donald Foster)
28. U.S. Conference of Mayors (Alan Pritchard, Jr.)
29. U.S.C. Andrus Center (Dr. James Birren)
B. Congressional Representatives:
1. William Oriol, David Affeldt and John Guy Miller, /
(Senate Special Committee on Aging)
2. Jack Duncan, Charles Radcliffe (Select Education
Subcommittee of House Education & Labor Committee)
3. James Murphy (Subcommittee on Aging of Senate
Labor & Public Welfare Committee)
4. A representative of the new House Select Committee
on Aging
C. GovernmentaRepresentatives:
1. Dr. Arthur Flemming - Panel Chairman
FORD LIBRARY & GERALD
2. Paul O'Neill (Office of Management and Budget)
3. Caspar Weinberger & representatives (Veterans
Administration)
4. Representatives from ACTION, HIH (NIA), OEO,
Federal Council on Aging (Bertha Adkins), and
FEA (Special Impact Office)
MEMORANDUM
- 3 -
March 14, 1975
D. Others with Special Interests in Aging Issues:
1. Dr. Robert Butler, Psychiatrist & Gerontologist
2. Sylvia Porter, Syndicated Columnist, Phblishers-
Hall Syndicate
3. Peter Weaver, Weaver Communications, Inc.
4. Wendell Colton, Syndicated Columnist, Medicare
Mailbox, Boston Herald American
II. Areas of Discussion
A. State of the economy
B. Energy problems
C. Health care
D. Nursing Homes
E. Age Discrimination
F. Home health care
G. Social Security - - response to Social Security Advisory
Council's Recommendations - see discrimination
I. Housing
J. Transportation
K. Employment
file
Testimony on Physical Fitness
for
Older Persons
From Selected Hearings before the Sub-
committee on Aging of the Committee on
Labor and Public Welfare, U.S. Senate,
Ninety-fourth Congress, April 23, 1975
FORD is LIBRARY GERALD
NATIONAL ASSOCIATION FOR HUMAN DEVELOPMENT
1750 Penna. Ave., N.W., Washington, D.C. 20006
TABLE OF CONTENTS
Fox, Samuel III, M.D., Cardiology Exercise Laboratory,
Georgetown University
1
deVries, Herbert A., Ph.D., Director, Exercise
Physiology Laboratory, University of
Southern California,
What Research Tells us Regarding the Contribution
of Exercise to the Health of Older People
-
3
Swartz, Frederick C., M.D., Chairman, Committee on
Aging, Council on Medical Services, AMA
7
Radd, Anne, Project Director, National Association
for Human Development
10
Elrick, Harold, M.D., Specializing in Metabolic
Diseases and the Problems of the Aging,
Exercise and the Aging Process
-
15
Klumpp, Theodore G., M.D., Chairman (Emeritus)
Winthrop Laboratories; Chairman, National
Association for Human Development, Physical
Activity and Older Americans
20
Lamb, Lawrence E., M.D., Cardiologist,
Stay Youthful and Fit
36
Ryan, Allan, M.D., Professor of Rehabilitation
Medicine, University of Wisconsin,
Importance of Physical Activity for the Elderly -
-
59
Stiles, Merritt H., M.D., Cardiologist,
Physical Activity and Aging
- 64
Butler, Robert N., M.D., Research Psychiatrist
and Gerontologist, the Washington School
of Psychiatry, Psychological Importance of
Physical Fitness
67
Harris, Raymond, M.D., President, Center for the
Study of Aging, Value of Regular Exercise
Programs for Senior Citizens
71
Kraus, Hans, M.D., Orthopedic Physician, Associate
Professor of Physical Medicine and Rehabilitation,
New York University
-
-
79
Reprinted by the National Association for
Conrad, C. Carson, Executive Director, President's
Human Development as a reference source in
Council on Physical Fitness and Sports,
-
connection with the Model Health Education
Physical Fitness for the Elderly
82
and Fitness Program for Senior Citizens,
Fitness Program for Senior Citizens
developed in association with the President's
By the National Association for Human Development:
Quotes from various leaders of physical fitness
93
Council on Physical Fitness and Sports, under
a grant from the Administration on Aging, DHEW.
Senator BEALL. Our next witnesses are a panel on physical fitness
and the elderly.
The chairman of the panel is Dr. Samuel Fox III, Cardiology Exer-
cise Laboratory, Georgetown University. He is accompanied by Dr.
Herbert deVries, Exercise Physiology Laboratory, South Laguna,
Calif.; Mrs. Ann Radd, National Association for Human Develop-
ment; Dr. Frederick C. Swartz, chairman of the Committee on Aging
of the Council on Medical Service of the American Medical Associa-
tion; and Dr. Robert M. Butler, of Washington, D.C.
STATEMENT OF DR. SAMUEL FOX III, CARDIOLOGY EXERCISE
LABORATORY, GEORGETOWN UNIVERSITY, ACCOMPANIED BY
DR. HERBERT de VRIES, PH. D., EXERCISE PHYSIOLOGY LABORA-
TORY, SOUTH LAGUNA, CALIF.; MRS. ANN RADD, NATIONAL AS-
SOCIATION FOR HUMAN DEVELOPMENT; AND DR. FREDERICK
C. SWARTZ, CHAIRMAN, COMMITTEE ON AGING, COUNCIL ON
MEDICAL SERVICES, AMERICAN MEDICAL ASSOCIATION
Dr. Fox. I must report that Dr. Butler is otherwise engaged with
pressing professional commitments and sent his regrets. We regret
he is not able to be with us today.
Senator BEALL. You may proceed as you wish.
Dr. Fox. Thank you, Mr. Chairman, and members of the subcom-
mittee.
It is indeed a pleasure for us to be here and a privilege to speak on
behalf of this very important aspect of trying to maintain the fitness
and to enhance the health and performance of our elderly citizens, and
indeed all Americans SO when they reach later years, they will not
serve as a burden on themselves and the rest of society.
There is much that suggests very strongly that through a program
of increased physical activity, we can retain their flexibility, agility,
capability of getting around and being self-sufficient, and having self-
respect, which we wish them to have.
We have a panel here of experts who will speak directly to this. In
addition, there are some other renowned individuals whose work is
well known to many, who have written statements that support their
interest and understanding and concern for this problem. We wish to
submit those.
They include Harold Elrick, M.D.; Theodore Klumpp, M.D.; Law-
rence Lamb, M.D.; Allan J. Ryan, M.D., and Merritt H. Stiles, M.D.,
a gentleman who took up skiing at the age of 55 and ended up being
the chairman of the U.S. Ski Committee. His statement at age 75 is
on the rewards that he personally has found with the active life.
Senator BEALL. Their statements will certainly be included in the
record at the conclusion of your testimony.
Dr. Fox. My statement is very brief.
It is a privilege to appear before you as a private citizen, a resident
of Bethesda, Md., although I work chiefly in the District of Columbia.
I am privileged to serve as a member of the President's Council
on Physical Fitness and Sports. Previously, I have served as a cardi-
ologist in the Naval Medical Corps and with the U.S. Public Health
Service in laboratory research and later as Assistant Director of the
National Heart Institute of the National Institutes of Health.
1
Senator BEALL. I think it might be better if we have all the testi-
Subsequently, I was chief of the heart disease and stroke control
money and then go into questions.
program of the U.S. Public Health Service, and, in 1970, returned to
Dr. Fox. Thank you.
academic medicine where now I serve as professor of medicine at
I regret I did not follow my notes, because I have not introduced
Georgetown Medical Center and also have an appointment as clinical
my colleagues.
professor of medicine at George Washintgon University.
On my left is Mrs. Ann Radd, of the National Association for
In 1972 and 1973, I served as president of the American College of
Human Development, who will be the last of our group to testify. On
Cardiology, headquartered in Bethesda, Md.
my immediate right is Dr. Frederick S. Swartz of Lansing, Mich.; I
In the area of heart disease, I believe we are all impressed with the
would like to call on Dr. Herbert deVries of South Laguna, Calif.,
overwhelming importance of the preventive approach to avoiding the
director of the exercise physiology laboratory on the faculty of the
physical disability, mental distress, and drain on resources that re-
University of Southern California.
sult from circulatory diseases which clearly appear to be responsive
Dr. deVries.
to preventive action. There is a large-and increasing-body of knowl-
Dr. DE VRIES. Thank you, Mr. Chairman and members of the sub-
edge strongly persuasive of the important place of an increase in habit-
committee.
ual physical activity in attempts to delay or prevent the manifesta-
As we grow older, there appear to be losses in functional capacity at
tions of atherosclerosis-the clogging of arteries by fatty material-
the cellular level, at the tissue level, the organ level, and the system
which prevents an adequate blood supply reaching the heart muscle-
level of organization. However, as pointed out by Dr. Nathan Shock,
resulting in heart attack-or the brain-resulting in a stroke.
of Baltimore, the decrements in physiological functions that take
Each year, we lose two-thirds of a million Americans from heart at-
place with increasing age become most readily apparent in the re-
tacks-many of them with good years of health otherwise available
sponse of the whole organism to stress.
to them-and there is another two-thirds of a million survivors who
The exercise physiologist's interest lies in the measurement of the
need encouragement and guidance to return to self-sufficiency and to
human organism's responses to the most physiological of stressors,
avoid dependence on others for their shopping, housekeeping, and
physical activity. We are most concerned with the various functional
other services. There are over 4 million living Americans with estab-
capacities of the human individual and how they may be lost through
lished coronary disease.
aging or other processes, and how they may be improved through such
Over 200,000 deaths from cerebal vascular accidents occur each year
modalities as physical conditioning, improved nutrition, and better
in the United States and there are over 2 million survivors of strokes-
relaxation.
many cast aside and requiring assistance where, with adequate re-
Thus, before reviewing the evidence for the potential contributions
training programs, they could return to a rewarding level of self-
of physical exercise to the health of older people, it is necessary to
sufficiency and self-respect.
discuss some of the physiological changes which have been reported as
It is my personal conviction from over 25 years of medical practice,
accompanying the aging process and which collectively result in gross
research and teaching, that the maintenance of a vigorous lifestyle,
losses of functional capacity which the aging individual experiences
including participation in such activities as country dancing, bicy-
as a creeping loss of "vigor."
cling, moderately strenuous lifetime sports such as tennis, badminton,
There is a large and rapidly growing body of literature which deals
canoeing, skiing, and swimming, and useful yard work and gardening
with the physiology of aging. The discussion of that literature here
will do as much for the enhancement of general health and the im-
need only be cursory, since excellent reviews are available.
provement of the quality of life as they may for the prevention of the
As we grow older, the ability of the heart to function as a pump at
dread diseases.
rest declines approximately 1 percent per year, probably due to a
We need to exert leadership at the Federal level to develop programs
lessening strength of the heart muscle. A similar loss is seen at maxi-
to help maintain the interest and involvement of our senior citizens
mal exercise. Along with this loss, the arterial blood pressure ordi-
in such activities. I believe we will be able to promptly document fi-
narily increases and the coronary arteries gradually become plugged
nancial savings, above the costs of such programs, not to speak of the
up, and the circulation in general slows down.
psychological and physiologic benefits that will be derived by in-
Along with these changes in the cardiovascular system, the respira-
dividuals and society through having appropriate physical activity
tory system also loses some of its youthful capacity. The vital capac-
programs available and attractively continued so as to motivate per-
ity decreases and the ability to move large volumes of air during
sons to retain their flexibility, agility, strength, and enthusiasm.
heavy exercise declines. In general, the chest wall seems to become
It is therefore with deep personal conviction that I appear before
stiffer and breathing requires more muscular effort.
you in support of the renewal of the Older American's Act with a
Our skeletal muscles decrease gradually in strength and in their
strong request that it include specific authority for projects and pro-
ability to persevere with heavy workloads-endurance. Indeed, we
grams to maintain the physical vigor and activity of our elders in
probably lose about 3 to 5 percent of our active protoplasm-largely
their later years. I will be glad to try to answer any questions and I
muscle-each decade after maturity. In spite of this loss of active tis-
thank you for the privilege of appearing before you.
sue, however, we usually allow ourselves to gain weight as we grow
As you wish, sir. I will be glad to answer questions now or call on
older. This is worthy of note that even if we maintained the weight
my colleagues to give their testimony.
of our early maturity, we would still be getting fatter, since the re-
placement of the active tissue lost is very largely adipose tissue.
2
3
While many other, sometimes more obvious, changes occur also,
a 13-percent increase in cardiac output, and some suggestion of de-
such as drying and wrinkling of the skin, and graying of the hair, the
creased numbers of EKG abnormalities. However, it is difficult to
foregoing changes noted are most important in determining the func-
consider even the upper end of this age bracket as old although the
tional capacity of the individual; that is to say his level of vigor, best
investigators did refer to their subjects as "middle-aged and older"
measured as his capacity for oxygen consumption, sometimes referred
men.
to as aerobic capacity. By age 75, men have on the average lost about
Other investigations dealing with middle-aged men have shown that
50 percent of their maximal oxygen consumption and the data for
vigorous exercise can reduce cardiac abnormalities and serum trigly-
women follow roughly a parallel course.
ceride levels and it is in general feasible for middle-aged men and pro-
But most interestingly, many of these changes, particularly the loss
duces changes in functional capacity and body composition that run
of aerobic capacity or vigor, can be brought about in young, well-con-
counter to the downhill trend usually seen with aging. Highly signifi-
ditioned men by the simple expedient of enforced bed rest-in as little
cant reductions in the blood pressure of hypertensive middle-aged
as 3 weeks. For example, in one of the better studies in this area, it
men have also been brought about in a 6-month period of physical
was found that in 3 weeks of bed rest, the maximal cardiac output
conditioning.
decreased 26 percent; the maximal exercise stroke volume of the heart
Since very little experimental evidence existed regarding the phys-
by 30 percent; and the maximal ventilatory capacity by 30 percent;
ical conditioning effects upon older men and women-defined as 50
and oxygen consumption by 30 percent; and even the amount of active
and over-it was decided to develop a mobile exercise physiology
tissue declined by 1.5 percent.
laboratory at the Andrus Gerontology Center which could be taken to a
Thus, we see that inactivity can produce losses in function entirely
retirement community for further study. This work was supported by
similar to those brought about more slowly in the average individual
the Administration on Aging.
when he grows more sedentary as he grows older. These observations
In the first experiment, 112 older males, aged 52 to 87-mean age
lead us to question how much of the observed agewise losses in func-
equals 69.5-volunteered for participation in a vigorous exercise train-
tion are truly necessary age changes and how much may be brought
ing regimen. They exercised under our supervision at calisthenics,
about by the long-term deconditioning of the increasingly sedentary
jogging, and stretching at each workout for approximately 1 hour,
three times per week.
life we lead as we grow older.
On the basis of the evidence presented, it may be hypothesized that
The subjects were pretested and retested at 6, 18, and 42 weeks. The
the functional losses which have been observed and reported as age-
most significant findings were related to oxygen transport capacity.
wise changes in the medical literature must be considered to be the
Oxygen pulse and lung ventilation at near maximal workloads im-
resultant of at least three component factors: (1) true aging processes;
proved by 29.4 and 35.2 percent respectively. Vital capacity improved
(2) unrecognized disease processes; and (3) deconditioning resulting
by 19.6 percent. Significant improvement was also found in percentage
from our increasingly sedentary lifestyle as we grow older. Of these
body fat, physical work capacity and both systolic and diastolic blood
three factors, only the third is headily modified by methods presently
pressure. Controls did not improve on any of the above measures.
available.
A group of seven men was placed in a modified exercise program
because of various cardiovascular problems. This group exercised in
POTENTIAL FOR IMPROVEMENT OF HEALTH AND PHYSICAL FITNESS
the same manner, except that they substituted a progressive walking
program for the jogging and were restricted to a maximum heart
IN OLD AGE
rate of 120 instead of 145, which obtained with the normal group. This
Only a few years ago, the trainability of older people was still in
group was exercised for 6 weeks, at which time their improvement
question. In Germany, it had been concluded that commencement of
showed a similar pattern to that of the harder working normal subjects
physical training in a person unaccustomed to sport causes slight
at 6 weeks.
effects of adaptation after 40, while after 60 there is practically no
Life history of physical activity was evaluated in a subgroup of 53.
observable effect. An article from Japan also stated that marked im-
Neither the mean of high and low years of activity nor the peak
provement of physical ability by training cannot be expected in older
level of activity engaged in for a period of 6 weeks or more correlated
people.
positively with physiological improvement found.
On the other hand, Czechoslovakian physiologists had reported bet-
In a subsequent study, 17 older women, ages 52 to 79, from the same
ter physical performance and functional capacities in a sample of
community, participated in a vigorous 3-month exercise program
physically active older men than in a comparable sample of sedentary
and again physical fitness was significantly improved although the
older men.
women did not show the large improvement in the respiratory system
Two other investigators had shown significant improvement in phys-
shown by the men.
ical working capacity and cardiac function by conditioning older peo-
On the basis of a series of studies with this older subject population
ple although the sample size was very small in both, 8 in one, and 13
over a period of 5 years, during which not a single untoward incident
in the other. An excellent series of investigations from Stockholm
occurred, we concluded that (1) the exercise regimen as developed
clearly demonstrated the trainability of men in the 34 to 50 age bracket.
was both safe and effective for normal older men and women; (2)
This work demonstrated a 14-percent improvement in aerobic capacity;
the trainability of older men and women with respect to physical
work capacity is not significantly different from that in youth in a
4
5
Under his direction, in cooperation with local cardiologists, grass
relative sense, that is, the percentage gains are similar; and (3) the
roots leadership could be trained among both lay and physical educa-
training gains do not seem to depend upon having trained vigorously
tion personnel. Centers for the training of the key leadership at the
in youth.
top could conceivably be easily established at those universities already
Other health benefits which have been reported to accrue as the
having both a commitment to gerontology and interested and com-
result of physical conditioning of the older organism include: im-
petent physical education personnel such as exist at USC, Michigan
proved muscle strength and increased joint mobility, with respect to
State, and Duke. With appropriate Government-agency funding, such
the muscle-skeletal system; increased total blood volume and a re-
programs could be implemented in a very short time. The research pro-
gression of EKG abnormalities with respect to the cardiovascular
duced by faculty and graduate students involved in such a training
system. Also reported is a retarding effect on the typical agewise
program would constitute an additional spinoff of value to gerontology.
regression of lung function and aerobic capacity.
Thank you very much.
It is of interest that a general feeling of "well being" is often
Senator BEALL. Thank you, Doctor.
reported as one of the results of physical conditioning in older people.
Dr. Fox. If we may have Dr. Swartz's statement.
Unfortunately, this is not easily subject to scientific inquiry. How-
Dr. SWARTZ. Mr. Chairman and members of the committee, I am Dr.
ever, in comparing the tranquilizer effects of a light workout-brisk
Frederick C. Swartz of Lansing, Mich., in the active practice of
15-minute simulated walk-against a commonly-prescribed tran-
internal medicine in that town, and I also happen to be chairman of the
quilizer, meprobamate-Miltown-it was found that the workout
Committee on Aging of the Council on Medical Service of the Ameri-
brought about a highly significant reduction of 20 to 23 percent in
can Medical Association. The Committee on Aging of the American
nervous tension in older men and women; whereas, the meprobamate
Medical Association has from the beginning considered all people in
had no immediate effect. It is possible that this tranquilizer effect of
the later years to be the field of their concern.
exercise is the basis for the reported euphoria.
This takes us back to the earliest concept of medicine as a profession.
In summary, it must be pointed out that most of the data cited
At the time of the establishment of the earliest university, the area
in support of the health benefits from physical conditioning are as
of medicine was deemed to be man's relationship to nature. Using this
yet not firmly enough grounded on repeated and corroborated experi-
as our platform. it can be readily understood that our interest involved
ments from independently directed laboratory investigations to con-
every aspect of living of the oldster.
stitute irrefutable scientific evidence.
Our problem then became how could medicine be helpful in every
It must also be recognized that the data do not allow any conclu-
phase of living. We have come up with many answers but this paper
sions to be drawn with respect to the effect of the physiological bene-
deals only with physical fitness.
hts reported upon either morbidity or mortality statistics.
A survey of those, at present, in the later years, both the well and
However, the weight of the available evidence at the present time
the afflicted, reveals a far too great number who already present the
does suggest that the intelligent choice of life style would include a
"shaky hand and tottery gait" syndrome, or a tendency to go in that
suitably vigorous physical fitness regimen.
direction. It seems like a plague of feebleness, fragileness that seems
It is the writer's strong belief that physical fitness for old age
to take possession of the individual. For some reason or other the
should ideally have begun in the "earlier years" in order that maximum
spring is gone from the step. The free swinging gait is gone. Maybe
benefits may accrue to each individual. However, when this has not
from the fear of falling there is a tendency to take smaller steps and
occurred for one reason or another, data are now available to support
walk almost in such a crouch so that the body won't have so far to
the concept of trainability even in old age. Ideally, physical fitness is a
fall should that occur. It has been said that one is old because he stoops,
condition which should be achieved in youth, pursued to middle age,
not that one stoops because he is old.
and never relinquished insofar as that is humanly possible.
Sometimes this picture is related to medical pathology which ex-
Mr. Chairman, that concludes the main body of my testimony. If
plains the symptoms, but most often there is no pathological lesion
time permits, I would like to make a short addendum with respect to
demonstrable. In either case, the answer is the same but to a different
the training of personnel.
degree.
Senator BEALL. Thank you, Doctor.
Dr. DE VRIES. In view of the many benefits likely to result from the
This syndrome of shaky hand and tottery gait is responsible in a
large degree for much of the dependency of the present aged group.
improvement of physical fitness in the elderly, it seems desirable to
The treatment of this condition, varying only in degree of intensity
begin the implementation of programs in (1) exercise; (2) nutrition;
of application, is physical exercise program. This is not a 15-minute-a-
and (3) stress reduction, or relaxation procedures.
day deal, but a total change of lifestyle even at this late date.
However, training of older people in these areas requires instructors
Quoting from "Physiology of Medical Practice" by Guild, Fuisz, and
with highly specialized preparation and skills. At the present time, it
Botar, "Many people rank physical fitness alongside motherhood and
is the resource which is lacking.
It would appear that the highest priority should be given to the
liberty. Without motherhood, they say, there is extinction; without
training of such leadership. Ideally, every senior center, YMCA,
liberty, slavery; and without physical fitness, death." Of course they
YWCA, and public school adult education center should have available
stretch the point-but it is a fact that physical fitness does add a dy-
the services of, or at least consultation with, an exercise physiologist
namic bonus to daily living.
with special training in geriatric physical fitness.
7
6
Physical fitness really implies more than the ability to do a day's
or TV. Most people who get about this far along with the program.
work without running out of gas, or surviving the emergency snow
think they have done it all, but as we mentioned, this constitutes a
shoveling or grass cutting. It is also a state of physical well-being that
complete change in lifestyle SO there is more.
breeds confidence, poise, posture, physical ability, and an exhilerating
One of the most important items that contributes to good body
feeling of buoyancy.
function is good posture. We insist on oldsters sitting up straight in
Most people confuse physical fitness with the absence of disease and
their chair, feet on the floor, and walking tall, which leads to a sucking
most people confuse activity with meaningful exercise. Most people
up of the gut at all times.
think themselves healthy and fit when asymptomatic, without one
All activities of living should be converted into exercise. Ambulating
thought about the upkeep for reconditioning of the castle God gives
around the house, without lifting the heels off the floor, can be called
them in which to live.
activity, but hardly exercise. The heels should be lifted. There should
The media makes much of the great strides in heart surgery of all
be a spring in the step and at least at first the walker should be con-
kinds without ever suggesting the fact that this effort involves so
scious of the hardening and tensing of the calf muscles. This is such
small a section of our people-and their contribution casts a very
an important concept in the improvement in circulation that we recom-
small ripple on the sea of morbidity and mortality.
mend extension and flexion exercises of the foot maximally 500 times
There are others that maintain, and with more reason, that the
daily to all bed patients and those unable to walk or those taking a
greatest health problem at the moment is in the area of chronic disease.
long automobile trip.
At this point, we would like to suggest that our greatest health prob-
This concept of converting all activity to an exercise level applies
lem is in the physical fitness of the Nation. Here the answer is the
to all other forms of activity. Shaking the hairspray can, or the
simplest and the cheapest, has the greatest application, and its re-
cocktail shaker or the snow shovel or the lawnmower all should be done
flection on the reduction of morbidity and mortality rates would be
vigorously so each set of muscles involved gets a bit of a workout.
immediate and tremendous. It is entirely possible that a well-practiced
Waste not a minute of your waking hours but use each in the effort
physical fitness program begun early in life would increase the life
to keep the machine in as near perfect condition as possible. This is not
expectancy by 10 years, not to mention the improvement in the qual-
only aimed at muscle tone but also at agility and flexibility of the
ity of living in the later years.
respective appendages. A concert pianist who used to practice with
There are many exercise programs that could be employed. None of
finger motions his coming concert while riding on an airplane is a case
these meet the approval of all the experts. In the daily practice of a
in point.
primary physician, we are concerned with getting results. We have to
In our office, we follow the patient in and out of the consultation
instill the motivation and accept what we can that will not distract
room admonishing and exhorting him to stand up straight, walk tall,
from the already over-filled life of the patient.
stride out, don't watch your feet-you never used to-walk with a
We have the feeling in an anecdotal way-that is, without real
broader base by keeping the feet a little farther apart and turning on
scientific assay with controls, et cetera-that those who participate in
the outside foot like the soldier does. It is surprising how often and
these physical fitness programs have fewer illnesses, a greater chance
how well these requests can be complied with. Then our problem is to
of living longer, and certainly have a greater zest for living.
get cooperation of the relatives so that the program can be carried
Much fear is often expressed by the patient and his relatives of
on at home.
the possibility of injury or heart attack from an exercise program.
In the car or in the rocking chair at home mild isometric exercises are
We guard against this by beginning gently and adding new incre-
recommended not only for muscle tone but limberness and agility of the
ments of exercise only when enough progress has been made to indi-
parts. We realize the dangers of the Valsalva type of exertion and
cate that the addition is safe.
advise against this type effort in an exercise program or straining at
We sometimes have to point out that the only hazard-free area in
stool.
this world is the graveyard. If you want to play the game of life, you
We are convinced that participation in this type of program increases the con-
must accept some risk-the possibility of a broken leg may be a small
fidence and a feeling of well-being for the individual and staves off dependency
price for the chance to make a touchdown.
by preventing or softening the shaky hand and tottery gait syndrome.
After the daily formal exercise program has been mastered and
The haunting question which was there from the start-if all this
put into force, we proceed to institute a more strenuous program two
works to a degree in the later years, when should we really start the
or three times weekly. This may be typified by a walk for exercise
regime?
or bike riding on a stationary bike-stationary largely because weather
The obvious answer is at day one. This type of body care should be
ceases to be an excuse for nonparticipation and the room housing the
part of everyone's lifestyle for the simple reason that you feel better,
bike is usually safer than the street or highway. Improved speed, skill,
you do more, you enjoy life more and in the later years, you will be in-
strength, stamina, circulation, and range of motion should be the ob-
dependent because you have escaped the shaky hand and tottery gait
jective of all physical fitness programs.
syndrome.
To sugarcoat the exercise program one may keep occupied mentally
Mr. Chairman, this concludes my statement.
and educationally at these times with a cassette or record of music or
I would like to add one sentence that may add a degree of credibility
discussion of economics or drama or poetry or be entertained by radio
to what I just said; because this has been my lifestyle since World
War II.
8
9
I am on the job 12 or 14 hours, 7 days a week, and I just passed my
73d birthday.
Based on loss of motivation and interest, and to a large extent be-
Senator BEALL. Very good testimony.
cause of the fear psychosis against exercise and exertion, older persons
What is Valsalva exercise?
reduce their physical activities still further upon reaching age 60, and
Dr. SWARTZ. Take a big breath and bear down hard like this [indi-
with especially damaging results since atrophy of disuse accentuates
cating]. Do not do it.
their lessened capacity to react to stress and contributes as a factor in
Dr. Fox. We would like to call on Mrs. Radd.
the death of older persons subjected to accidents, shock, operations,
Mrs. RADD. I am Anne Radd, representing the National Association
deprivation, and prolonged illness. Unless older persons are motivated
for Human Development, with offices at 1750 Pennsylvania Avenue,
through health education concerning the importance of physical ac-
NE., in Washington, D.C.
tivity as a therapeutic measure, they are unlikely to experience any
The National Association for Human Development is a nonprofit
improvement in functional capability.
organization designed to assist the aged and other segments of our
Studies at Duke University Center for Studying of Aging, and
society toward the fulfillment of their social, physical, economic and
elsewhere, reveal that if aging persons maintain a meaningful social
intellectual needs. The principals of the National Association for
role, it keeps them physically active and intellectually stimulated-
Human Development include three prominent medical specialists
they are motivated to take care of themselves.
whose professional careers span lifetimes, devoted to health care
These studies indicate that physical activity was the predictive
through public and private service. We are concerned about the lack
factor, and that fewer illnesses and significantly fewer early deaths
of health education and information emphasizing the importance of
were noted among those who were on their feet and moving about.
physical activity for the elderly. This has been a serious impediment to
The studies concluded that moderate disabilities can be controlled and
improved health for this population and, in most instances, they are
reversed. They also emphasized that aging appeared to be more a
the population needing it the most.
product of sedentary lifestyles than it was of age.
We believe that there is a need for greater understanding of what
In accordance with National Association for Human Development
lifestyle factors contribute to sickness and death and for identifying
concepts which translate research findings into action-oriented pro-
courses of action which may be taken to improve health. The goal, of
grams, we suggest that physical activity projects for older persons
course, is to increase the number of disability-free days in the lives of
can be applied at the grassroots level by utilizing existing mechanisms
older Americans through health enhancement activities.
already available and serving the needs of older persons.
If we are to reduce the growing numbers of chronically ill and dis-
Specifically, we suggest that social service activities of the 400
abled older persons, it is critically important that we also raise the
planning service areas be broadened to encompass regular programs
awareness of those with responsibility for carrying out programs on
for physical activity. Similarly, the approximately 600 nutrition proj-
behalf of older persons to the role which health education can play in
ects could be enhanced by providing health education and a physical
upgrading health and in reversing the degenerative process for older
activity program on a regular basis.
persons.
We believe that through this approach the introduction of lifestyle
To do this, the aging population, along with the general public,
changes in older persons can be effected in an amazingly simple man-
must be made clearly aware of the profound difference between health
ner; and even more important to older persons, it can fit comfortably
information-disseminated facts-and health education-persuading
into the normal routine of their lives. Thus, a program of physical
people to change their lifestyles.
activity for older persons properly supervised can and should benefit
Most people tend to confuse health information with health educa-
both the individual and society as a whole.
tion. Health information is simply facts. And facts are widely avail-
We propose that the language of the Older Americans Act should
able. Health education is the process which bridges the gap between
emphasize the importance of physical activity in social service pro-
health information and health practices. Health education motivates
grams for the aging, and that such programs would include regularly
the person to take the information and do something with it-to keep
prescribed physical activity. We suggest that this might be accom-
himself healthier by avoiding actions which are harmful and by form-
plished by adding a subparagraph under title III, section 302(1) to
ing habits and lifestyles which are beneficial.
read "health education designed to encourage and assist older persons
Given their relative effectiveness in effecting change, health informa-
to attain physical and mental well-being through regular physical
tion has grown year by year in volume, while health education has
activity."
developed much more slowly. For older persons, and in particular
I thank you, Mr. Chairman, and members of the committee, for this
those who are suffering chronic ailments, the need is critical for a
opportunity to testify on this important subject.
nationwide effort to change personal attitudes toward health and
Senator BEALL. Thank you very much.
activity and to influence them to take more individual responsibility
I thank all of the members of the panel.
for the health of their minds and bodies by making important changes
Dr. Fox. Thank you, Mr. Chairman.
in their lifestvle factors. Unfortunately, the important and often
I would like to add one point that I think is quite important and
crucial role which regular physical activity can play in maintaining
well known to you. It is, we believe, important to indicate that only
health has rarely been clearly explained or adequately dramatized in
+ percent of the Federal expenditures for health care go into the
the past.
provision of preventive services, and we are speaking about preventive
services here. We believe sincerely that the expense of efforts of the
10
11
type that have been outlined would be returned to the country and
the citizens by more than the expenditures involved in their imple-
Senator BEALL. I am happy to hear that is done in Michigan. It
mentation.
has been my observation that most physicians confine themselves to
Dr. SWARTZ. May I add one thing, Senator?
providing traditional kinds of health services to the aged and do not
In the items in title III, we have transportation, nutrition, this sort
necessarily get into recommending these other means that might be
of thing. I think one has to put on a pair of glasses of physical fitness
used to improve longevity or improve the general well being.
on these particular problems; because it seems to me that in providing
I am wondering, is there any organized effort within the medical
too much transportation, we are also taking away a method of exer-
profession to see to it that the kind of advice and recommendations
cise. I will quote just briefly the sample of what happened to me.
you are making today get implemented?
A lady in a particular family lost her husband. She was sitting at
Dr. SWARTZ. Yes. I think literature in Geriatric magazine talked
home alone. She got meals on wheels offered to her. So a couple of
to this point quite frequently. The latest one has an article on the senior
weeks after that, I was called to the house to see her; and she had
olympics in California, which emphasizes the possibility of physical
swollen ankles clear to the knees. I could not find out why she had the
exertion on the part of older people, but this is an extreme case.
swollen ankles at home. She was complaining. Her daughters had to
Dr. EVRIES. I wonder if I may make another comment in that vein.
come from New York and Chicago. This was an added expense. They
I think it needs to be pointed out that heroic measures are not neces-
put her in the hospital. They found that physically she was intact.
sary, particularly for the older individual who is not in a very good
But by providing meals on wheels she stopped doing any activity.
state of fitness. The challenge for him need not be that great, and
She developed swelling of both ankles.
even such activities as walking have been well documented to bring
And I think that we should look at this type of thing with glasses
about available training effect.
because sometime we may be offering something that is doing them
Furthermore, I think it is important to point out that there are
harm. In physical fitness programs, it is extremely important in con-
other aspects of physical fitness which could be implemented almost
sidering older Americans that we use methods that emphasize con-
immediately after training in workshop-type situations for improving
tinued activity.
an individual's ability to relax that well, which again constitutes a
Senator BEALL. One of the things that concerns us as we legislate
part of the overall picture of physical fitness.
in this area, is the concern about whether we have the competence on
Mrs. RADD. Senator Beall, the National Association for Human
the area agency level to make sure that proper professional guidance
Development recently recommended to the President's Council, and
is being given to those who are going to be beneficiaries of this service.
they have been most receptive in establishing a series of workshops
I am wondering what kinds of safeguards do we need to make sure
at an areawide level that would bring these people up to speed on
that the senior citizens get the proper advice and are not asked to do
what kind of exercise would be appropriate for older persons; so
things they should not be doing? Do we have the manpower properly
there is movement in that direction now.
trained across the country to implement a program, at the area agency
Senator BEALL. Are medical schools involved in retraining pro-
level, that will enable us to have the proper safeguards?
grams?
Dr. Fox. I think Dr. deVries stated in his opinion, which I share,
Dr. Fox. They are, sir, but not at the level that many of us feel is
that we do not. I believe there is a large pool of interested young men
appropriate. But I am happy to report that there is a great deal of
and women who would find this to be a career of great interest to
enthusiasm, and I think you will see a burgeoning of interest and
them. We must set up the mechanisms for training programs, work-
good programs SO that in a short period of years, all physicians on
shops, and facilities, exercise evaluation, without going to the extreme
graduation will have an understanding of these principles and how
that we use for the qualification of aircraft pilots, for instance, in
to apply them.
commercial aviation; but appropriate exercise tests to be undertaken,
Senator BEALL. I notice that most physical education training pro-
made available, at reasonable prices, to reassure people that the pro-
grams are directed toward physical fitness for the young. Is there
grams being recommended are indeed of a very low probability of
any emphasis being given to redirecting the physical fitness training
hazard.
programs SO they are directed more toward the total population and
Dr. SWARTZ. I am on the commission for the Governor from the
particularly toward the elderly? Obviously if you start young, you
State of Michigan which has to do with services for the aging; and
can keep it as a lifestyle.
I think before we get trained people, we cannot wait for trained
Dr. Fox. These two gentlemen represent indeed very worthwhile
people; I think somewhere along the line we have to start very simply.
efforts in that regard.
We have been trying to do this with the American physician to get
Dr. DEVRIES. I would like to believe that we are coming to recog-
him interested in talking physical exercise to all patients he sees, well
nizing the need for the older population. Certainly there has been a
and sick, in his office. This will precede getting personnel to carry on
great deal more effort at the middle age level. I think to really imple-
the program. But I think we cannot wait. This is very important.
ment the philosophy that we have been talking about at the level of
the older individual, designated as 60 and over, is going to require
12
13
some agency support for the training of the competencies that are
needed to supervise this on the part of both physicians and physical
EXERCISE AND THE AGEING PROCESS
educators to do the job safely.
Senator BEALL. To change directions, has it been your observation
that those who now have responsibility for administering the area
SUBMITTED BY: Harold Elrick, M.D. to the Senate Sub-Committee
agencies and/or the other State programs of the elderly, have an inter-
on Aging
est in and willingness to cooperate with you in your efforts to develop
and implement physical activity programs for the elderly?
SUBMITTED TO: Senator Thomas F. Eagleton, Chairman, Senate
Mrs. RADD. I think the Administration on Aging is responding to
Sub-Committee on Aging, April 23, 1975
that need right now and the President's Council has been working
very closely with them. I would have to answer affirmatively.
Senator BEALL. I would like to thank you all very much. Your testi-
The following statement is based largely on research
mony has been most helpful.
[The following material was subsequently submitted for the record
done by members of the Foundation for Optimal Health and
as follows:]
Longevity carried out during the year 1970 to 1975.
As a person gets older, many changes take place in the
body and mind. In some the changes are great, in others they
are minimal. Thus, there are individuals who remain vigorous,
both mentally and physically, well into their 80's and 90's,
whereas many become progressively more feeble in mind and
body at a much younger age. Our Nursing Homes are filled
with people aged 60 to 90 years who have deteriorated mentally
and physically to the point of complete helplessness.
If we examine the changes that occur with advancing age,
we find a characteristic clinical picture beginning in early
middle age or earlier; progressive increase in body fat and
loss of muscle and bone mass, gradual loss of physical vigor,
increasing levels of blood cholesterol and triglycerides,
and high incidence of hypertension and cardiovascular diseases.
During the past 5 years the Foundation for Optimal
Health and Longevity has engaged in research on Exercise,
14
15
- 3
2. Their diet was in general much lower in calories,
- 2 -
animal (saturated) fats, cholesterol, and salt than the
Diet, and Longevity to determine why some individuals and
usual American diet.
population groups are able to maintain vigor of mind and
3. They were generally slender, well muscled, and had
body with advancing age, whereas the majority follow the
a vigorous, youthful appearance.
course of progressive deterioration cited above. These
4. Blood cholesterols (115-185 mg%) and triglycerides
studies were done in Ecuador, the Caucasus, Hunzaland, and
(50-100 mg%) done on the Ecuadorian group were much lower
California.
than that of the average American of similar age group.
Population groups in Ecuador, Hunza, and the Caucasus
5. High blood pressure and cardiovascular diseases
were chosen because they had the reputation of being ex-
were virtually absent.
ceptionally long-lived. In Hunzaland and the Caucasus
Our studies in the San Diego area were done on 2 groups
scientific documentation of the ages was lacking. Nonethe-
of individuals;
less, it seemed clear to us that there were large numbers
1. Highly conditioned men between the ages of 40 and 75.
of older individuals (over 75) who were exceptionally vigorous
These were long distance runners who were training and com-
in mind and body. In Vilcabamba, Ecuador, the documentation
peting regularly the year round at distances of 1 to 26 miles.
of age was considerably better because of existence of Bap-
2. A variety of unconditioned, but normal, individuals
tismal Records. Here we found 46 men and women over the age
and groups; school girls and boys aged 9-10, individual men
of 75 in a village with a population of 819. All of them
and women aged 17-69, and firemen and policemen aged 30-50
were unusually vigorous, both mentally and physically.
years. These groups were tested before and after 6-12 months
The long-lived people in the 3 population groups cited
of special exercise and dietary programs.
above had several characteristics in common:
Summary and Conclusions: The research studies cited
1. They engaged in many hours of vigorous physical
above have led me to the following tentative conclusions:
exertion daily; primarily farming, using hand tools, and
1. Daily, prolonged physical activity as a part of an
doing much up and down hill walking in the course of their
individual's life style is a major factor in the maintenance
work. In addition, they frequently carried heavy objects
for relatively long distances.
16
17
- 5 -
- 4 -
of physical and mental vigor many years beyond the usual
life style of the long-lived population groups. Such pro-
retirement age (65 or 70 years) in the long-lived population
grams combined with optimal diets (low in animal fat, cho-
lesterol, calories, and salt) have been used extensively
groups studied.
in unconditioned individuals aged 9-70 years by the Foun-
2. A diet substantially lower in animal fat, cholesterol,
dation during the past 5 years with success in achieving
calories, and salt than is present in the typical American
the physical and biochemical characteristics of long-lived
diet is an important factor in the prevention of atheroscle-
population groups. The application of such programs to
rosis (hardening of the arteries) and cardiovascular diseases,
individuals of all ages under the supervision of properly
and thereby favors increased life span.
qualified personnel is feasible, and wider use of the methods
3. The older distance runners studied by us exhibit
is recommended to increase the incidence of vigorous longevity,
physical and blood chemical characteristics similar to those
as well as decrease the incidence of cardiovascular diseases.
of the long-lived population groups; maintenance of high
physical and mental vigor, low incidence of hypertension and
Harold Elrick, M.D.
cardiovascular diseases, low blood cholesterol and trigly-
480 Fourth Avenue, Suite 207
cerides, and slender, well-muscled bodies.
Chula Vista, CA 92010
4. Mental and/or physical deterioration so commonly
seen in older individuals in the USA is not a part of the
normal process of ageing, and therefore not inevitable. It
is due to specific diseases or is a consequence of many years
*Dr. Elrick is a graduate of Harvard Medical School and
specializes in Metabolic Diseases and Problems of the Aging.
of insufficient use of mental and physical faculties. The
He has lectured at the universities of Uppsla and Lund in
Sweden; as a Research Fellow in Biochemistry at McGill
"Cardinal Law" of ageing is that any body function that is
University and Assistant Professor of Medicine at the
University of Colorado; Chief of Endocrine and Diabetics
not used continually will gradually be lost.
Clinicsat the UCSD Hospital. He has been an Associate of
Alexander Leaf, M.D., Professor of Medicine, Harvard Medical
5. Properly designed and supervised exercise programs
Schools in Studies of Older People in Ecuador, Caucasus,
Hunzaland and California.
based on endurance activities appear to be a practical sub-
stitute for the physical activities which are a part of the
18
19
There are some 50 million adult Americans who do not
STATEMENT ON
engage in physical activity for the purpose of exercise. That's
PHYSICAL ACTIVITY
equivalent to the entire population of France - and it was once
AND
said that 50 million Frenchmen can't be wrong. Can 50 million
OLDER AMERICANS
Americans be wrong? I think they are, and that's why we are here.
But the fact that there are as many heretics as the population of
all of France must inevitably have a powerful influence on us.
It means that we are not just playing games but dealing with a
matter that is fundamental to the health and well being of our
entire nation. It is only when one is in good health and has
a reasonable life expentancy that the problems of the world
PRESENTED TO:
acquire significance. Those older Americans who are sick or
THE SPECIAL SENATE COMMITTEE
about to die couldn't care less about the social, economic and
ON
political problems of mankind.
AGING
We also have a great responsibility to be sure that we
are right and to know why we think our position is correct.
When I first became interested in the subject of exercise
BY
and aging during the early 1930's, the physicians of this country
THEODORE KLUMPP, M.D.
were almost all promoting rest in bed as the panacea for every-
thing. Among the gains that you and I can record, and maybe
take a little pride in, is the conversion of the preponderance
of heart specialists to the idea that exercise is important in
APRIL 23, 1975
the prevention and treatment of heart disease. They were Johnny-
come-latelys, and some of them who can't see the woods for the
Theodore Klumpp, M.D., is Chairman (Emeritus), Winthrop
trees are still dragging their heels, but they are at long last
Laboratories; formerly president, National Fund for Medical
on our side privately and officially and moving in the right
Education. Past chairman of the Committee on Rehabilitation,
American Heart Association; and member, Governor's Council on
Rehabilitation, State of New York. Was for eight years, a
member of the American Medical Association's Committee on
Exercise and Physical Fitness. Fellow, American Medical
Association and New York Academy of Medicine. Has
published numerous articles on longevity, medical research
and the pharmaceutical industry. B.S., Princeton
University; M.D., Harvard University.
Dr. Klumpp is Chairman, National Association for Human
Development.
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direction. Along with this, it is gratifying to note that for
A century and a half ago, Horace Walpole wrote these lines:
the first time there appears to be a decline in the number of
"About the time I die, or a little later, the secret will be
fatal heart attacks in the United States. This decline was
found of how to live forever." Feeling that enough time had
recorded for the period from 1963 to 1971, coincident with the
passed to warrant a reply, Helen Bevington answered:
intensive public information programs of the President's Council
on Physical Fitness and Sports, and the American Medical Associa-
"Horace, be comforted to die.
One century has meandered by
tions's Committee on Exercise and Physical Fitness.
And half the next since, it was true,
The temporal state eluded you.
The pursuit of physical fitness for older Americans is not
Now as I read your pensive letter,
only to look better and feel better. After all, there are cultures
I wish myself that times were better
And I might boast how men contrive,
in which obesity is admired and sought. Our own Santa Claus is
As you foretold, to stay alive.
By now we should possess the key
a model to many of what a jolly, healthy, senior citizen should
To fleshly immortality
And, if we wanted to, endeavor
look like. And as for feeling good, there are millions of non-
To live forever and forever.
This, to my infinite regret,
exercisers who think they couldn't feel any better. If obesity
Is not a custom with us yet.
were merely a matter of cosmetics, we wouldn't have much of a
I write you, Horace, for good cheer
Life is about as usual here."
case. No we are primarily interested in the last analysis, in
Certainly a man as learned as Horace Walpole was not
avoiding the degenerative disease which shortens our lives and
entirely serious when he forecast that someday the secret
prematurely infirms our older citizens. Our focus must turn
of how to live forever would be found. This no doubt is
from health care of the aged to helping them to understand and
asking too much, and something that does not appear to fit
incorporate the health enhancement factions which result from
into the biological scheme of things. Only the simplest
appropriate levels of regular exercise. The pathological process
unit of life, the cell, goes on sometimes indefinitely by
of arteriosclerosis or atherosclerosis is the underlying cause of
division or budding. With this possible exception, all
the most common and serious of the degenerative diseases with
living things from century plants to elephants go through a
which we should be concerned.
cycle of growth, senescence and death.
In the remainder of my testimony, I propose to discuss the
Let us remember, the biblical three score and ten was
role of physical activity in relation to longevity, health.
written a long time ago, some 2500 years, before the dawn
enhancement and atherosclerosis.
of man's scientific awakening. In this, what seems to me
the greatest century of all time, we have suddenly burst the
GLRALD FORD LIBRARY
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bonds of darkness and ignorance that have tied men down as
lived the longest. This may be 117, or 146 for the Dane,
crawling creatures on the surface of the earth, and led them
Christen Jacobsen Bragenberg - or something even beyond that,
to early graves. We have learned to split the atom, regarded
as claimed by the Russians. From such an example, we can draw
for more than 2,000 years as indivisible. We were once earth-
the conclusion that man has the biological capacity of living
bound, and now even the earth and gravity are powerless to
at least that long. It has been done once; why can't it be
contain man's ingenuity and imagination. For all the gains
done again, and maybe again and again? That is the measure of
that have been made, do you suppose the last word has been
man's endurance today. It should not be too difficult a trick
said, and the last gain realized in man's fight against
ultimately for our scientists to reproduce similar external
disease, disability and death?
and internal conditions so that many more can be brought up
Right now, in laboratories throughout the country, man's
to such a ripe old age - in sound body and mind. I've heard
endurance and ability to stand adverse conditions are being
people dismiss the whole subject by saying it's heredity. Pick
tested. He is being subjected to oxygen deprivation, low
long lived parents. Heredity in this respect does nothing more
atmospheric pressures, excessive acceleration and deceleration,
than repeat internal physical or chemical patterns of action
wind blasts, prolonged confinement and darkness, and a host
or reaction, or living habits, conducive to or inimical to long-
of other labors of Hercules. The previous measure of man's
evity. These are also subject to modification without the
ability to endure adversity has been found to be false. In
necessity of invoking the Biblical injunction that "Ye shall
a similar way, what yardstick do we have to measure man's
be born again."
ultimately attainable life span? If man can't live forever,
But prevailing records of longevity do not necessarily
to what limit is it reasonable to expect that he might be
represent the limits of man's ultimately attainable life span.
able to survive? If anyone attempts to give a firm answer
The cells of the body, with the possible exception of nerve
to these questions, he might find himself in the position
cells, are being constantly replaced by new cells. The rate
of the Commissioner of Patents who stated in 1844, "We see
at which this occurs and its duration are determined by our
the arrival at that period where human improvement is at an
glands of internal secretion. Encouraging progress is being
end."
made in our understanding of the functioning of this critically
However, we can at least approach it in another way.
important control system of the body. There is at least a
Let us take the age of the person known with assurance to have
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speculative chance that it can be chemically so influenced,
by the fact that the investigator doesn't live any longer than
modified, or supplemented that the replacement of new cells
his subjects, and he doesn't have the advantage of observing
will continue for a more prolonged period at the rate it occurs
even a single generation from beginning to end. In this respect
in youth. At the same time, we have the problem of, in some
the science of living and aging is at a particular disadvantage
way, holding the cells of the central nervous system alive and
in comparison with other fields of medical endeavor. In order
active for a longer span. In the wondrously coordinated mechanisms
to save years and even generations of time, I believe we are
of the body, the most awesome phenomenon in all of nature, it is
justified in applying working hypotheses based on a reasonably
not unreasonable to speculate that the endocrine forces that
high order of probability. This entails the risk that we may
regulate the rate of cell division may also mediate the continued
sometimes be wrong, but I have no question in my mind that it
vitality of the cells of the nervous system, and that these
is far more desirable to give useful employment to knowledge as
controls go hand in hand, as a good engineer would have designed
early as possible, and run the risk of being wrong occasionally,
them to go. All this speculation has only one point, namely,
then to hold off until those distant millenia when everybody
to indicate to you that there is a basis for speculating that
agrees. It was once wisely said: Nothing will ever be attempted
man's life span, in good health, can be extended. Indeed,
if all possible objections must first be overcome. Let's
as one who has been a participant in basic research for most of
not forget that there are people who still believe that the
his life, I can tell you that people are working on facets of
earth is flat. When there is something we do not understand,
these very important problems. George Bernard Shaw may have been
the best thing we can do is to turn to basic biologic and
thinking of something like this when he said that modern man
physiologic principles for guidance. With all the conflicts
is not God's last creation.
of opinions and impressions, the history of medical science
While waiting for the arrival of the millenium, shall we
has demonstrated over and over again that those views in accord
sit by and do nothing, or shall we utilize and apply what we
with such basic principles will eventually turn out to have been
think we now know concerning the aging process. This is not
correct.
so simple as it may seem, because in the present state of our
With these considerations in mind, I would like to consider
knowledge, there are very few facts and observations that are
certain factors that appear to have a bearing on physical fitness
beyond dispute, and differences of opinion even among the experts.
and the aging process.
In the study of problems in this field, we are badly handicapped
Arteriosclerosis, or atherosclerosis, if you will, appears
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to be the most important present limiting factor in our life
consequence in getting at its fundamental nature. There is a
span. It is far more destructive than wars, famine, pestilence
physical or chemical change that is responsible for this
and the modern automobile. It appears to be the basic pathological
phenomenon, and this is what we are primarily interested in
process responsible for the preponderance of deaths due to coronary
identifying.
and cerebral thrombosis, cerebral hemorrhage and adult kidney
It is a strange circumstance that disability and death
disease. It causes over a million deaths annually and the
from atherosclerosis should be on the increase coincident with
evidence indicates that the toll is rising. If things don't
the phenomenal advances in our civilization and standard of living,
change, two of every three American males will die of athero-
a period marked by so many other gains in health, comfort and
sclerosis. While atherosclerosis appears and develops as man
human well-being. Some of this apparent increase is due to
ages, there are good reasons for believing that it is not in
more accurate diagnosis and the fact that other causes of death,
itself the basic aging process. It is merely a deathdealing
which have claimed young lives, have been reduced. Nevertheless,
hitch-hiker that goes along for the ride. It does not occur
most students of the subject are convinced that the increase is
at all in certain animals as they age. It appears not infrequently
real in both a relative and absolute sense. Some have ascribed
in children, particularly diabetics, and at times there is
this situation to the anxieties and tensions of the modern
remarkably little evidence of it found in older persons who have
world. Unfortunately, I cannot find this explanation convincing.
died of some other unrelated conditions. It appears most
Since the dawn of civilization, every age has had its tensions
pronouncedly in association with obesity, diabetes, severe
and anxieties which, I have no doubt, have always seemed the
hypothyroidism, xanthochromotosis, and other lipoid metabolic
worst ever to those living at the time. By what standard,
disturbances, and (we are now beginning to recognize) physical
by what instrument of precision, are we qualified to conclude
inactivity. I had a patient and a friend who was immobilized
that now has come the ultimate. I rather suspect that the
in bed for 25 years with a broken back. If anyone was protected
lurking dangers of the jungle, the savage terror of the
from stress and physical wear and tear, it was he. He died,
unknown, the looming threat of pestilence and famine were just
not of his broken back, but from atherosclerosis.
as real worries in times gone by as the atomic bomb, wars,
To throw up our hands and say that atherosclerosis is merely
inflation, Watergate and the energy crisis are today. But
something that is inherited is to say nothing. The mere
more important than national or international tensions as sources
observation that the same change may take place in related
of anxiety, are the personal everyday problems of the individual.
individuals is interesting, not at all surprising and of no
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His own individual disappointments, frustrations, losses and
a block for a newspaper, instead of walking, and for even this we
bereavements are the more potent, real and immediate sources of
no longer need use muscles to steer, apply the brakes or open
anxiety, and these have been present as long as man has enjoyed
the windows - and we are more tired than our fathers and father's
the mental and emotional attributes of a human being. The
fathers used to be when they ran, walked, chopped wood, shoveled
so-called swift tempo of modern living has significance only
snow, dug ditches, pitched hay, stoked the furnace, and did all
in how we adjust or react to it. One man can fly at 2,000
the physical chores so abhorrent to the last third of the
miles an hour and feel little if any emotional stress. Another
twentieth century.
rolls along with a horse and buggy and feels as if he were
A story illustrates my point: A father sent his son
flying. Indeed, were strain, tension and anxiety the critical
to the cellar for a screwdriver. Son: "I found the Vodka,
factors in the etiology of vascular accidents, I see no reason
but I didn't see any orange juice."
why they should not occur more commonly in young individuals,
Have you ever seen anyone take a single step on a moving
where these forces are often at their maximum intensity. On
escalator? If you have, it was probably some oddball like Hans
the other hand, there is good evidence that vascular accidents
Kraus of New York, or Ted Klumpp. Heart attacks are not the
are the result of atherosclerosis, and I have found no convincing
result of shoveling snow or running for a train, as popularly
explanation of the role of anxiety in the pathogenesis of this
believed. On the contrary, they are the product of a lifetime
process.
of not doing things like shoveling snow and running. It is true
But perhaps there are other factors in our civilization
that an attack may occur coincident with exertion, but more
and way of life that should be considered as possibly having
than 50% of heart attacks happen while the victim is asleep
a bearing on the increased incidence of arteriosclerotic heart
in bed. And if he isn't asleep, whatever he happens to be
and vascular disease. Perhaps not all the products of tech-
doing at the time or in the recent past gets the blame. We
nological gain have been beneficial to man. It would be sur-
are imbued with the idea, without the benefit of scientific
prising if they were. Our scientists and engineers have been
rationale that physical exertion, particularly in the older
and are increasingly on a mad rampage to develop not only labor-
American, is harmful. This has taken the form of a national
saving devices but every conceivable gadget to enable man to
psychosis that has swept the country like an ancient plague.
avoid effort, exertion and activity, whether it saves labor or not.
We are afraid to live for fear of dying.
We no longer tend the furnace or carry out the ashes; we drive
It was Theodore H. White who said that the history of
contemporary civilization is the story of the displacement of
food as the principal source of energy by coal, petroleum,
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water power, gas, and I may add atomic fission. But we go right
blood vessels, stones in the urinary tract, digestion is impared,
on stoking our human furnaces as we did when brawn and muscle
and the bowels and organs of excretion lose their functional
power made the wheels of the world go round. Does all of this
efficiency. I have not doubt that the endocrines, in their
carry with it a penalty in terms of the degenerative diseases,
delicately balanced interrelationship, suffer also. Immobili-
heart disease and arteriosclerosis? Fortunately, more and more
zation in bed and in space, and its effects, differ only in
of us are becoming convinced that it does. We have more labor-
degree from the immobilization resulting from our so-called labor-
saving devices in this country and the highest incidence of
saving devices and present day attitudes toward physical activity.
heart attacks. Is there any doubt that there is a connection
Based on loss of motivation and interest, and to a large
between the two?
extent because of the fear psychosis against exercise and exertion,
Two important fundamental biological principles appear
our older Americans reduced their physical activities still
to have application to what we are talking about. The first
further, to the same effect, and with what I believe is especially
is this: Tissues and functions that are not used, atrophy.
damaging, if not disastrous results.
There is no argument about the application of this principle to
In addition to the consequences previously noted, atrophy
muscle tissue. The functional capacity of the heart and blood
of disuse accentuates the lessened capacity of older persons
vessels is aerived from their muscular structure, and the
to react to stress. I have no doubt that such avoidable atrophy
manifestations of atrophy are clearly evident at all ages in the
is a contributing factor in the death of older persons subjected
shortness of breath and reduction in work capacity that results
to accidents, shock, operations, deprivation, stress and pro-
from disuse. To me one of the most striking demonstrations of
longed illnesses.
this is the astonishing rapidity and extend of the physical
Aside from its functional aspects, it is a depressing
and circulatory deterioration that takes place as the result of
thing to see what can happen to the human figure - a thing of
a short period of immobilization. To my way of thinking, this
most exquisite beauty until misshapen by fat, atrophy, bulges,
has been one of the most important scientific revelations of
swellings, protuberances, pendulosities and hernias. These
our space flights. We did not really realize before how quickly
are not necessary concomitants of the aging process, as the
this physical deterioration occurs. In addition to the manifest
fine physically active figures of many elderly ladies and gentle-
effects in terms of circulation and muscles, we know that the
men without corsets, girdles, belts and trusses bear witness.
bones lose their calcium, joints stiffen, clots form in the
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Unfortunately, nature does not appear to favor mind over
So much has been said and written about the harmful effects
matter, and the full utilization of only our mental capacities
of stress that I am afraid we have been left with an entirely
does not appear to be enough. I believe that we must do
lopsided view of its biological role. It has not been made
everything we can, as we grow older, to resist the inclination
entirely clear that extremes of stress, from the standpoint of
to slow down the tempo of our living. I am convinced that if
intensity or duration, are harmful. In this connection it is
you will just sit around and wait for infirmity or death to
safe to assume that extremes of any kind are harmful. Like
come along, you will not have to wait so long.
potent medicines, the proper dosage is beneficial and even
life-saving; too much is poison. In a similar way, I look upon
moderate or graded stress as necessary to the maintenance of
good health, vitality, and an adequate reserve against the
extremes of stress that in one way or another befall all of us.
Functional capacities of all systems of the body can only be
augmented through moderate stress. From this point of view,
exercise may be regarded as the most beneficial form of graded
stress. I have no doubt that it applies to the mind and emotions
as well as to the rest of the body. This principle has, I
believe, particular application to the aging process. After
the prime of life, the peak of which comes at different times
for the various functions of the body, a decline occurs. In
my opinion this decline will proceed more slowly if the bodily
functions are fully employed and, through moderate and unfortunately
descending stress, they are held to their maximum capacities.
Theodore Klumpp, M.D., is Chairman (Emeritus), Winthrop Laboratories;
What I consider to be one of the most important biological
formerly president, National Fund for Medical Education. Past
chairman of the Committee on Rehabilitation, American Heart Asso-
principles has a bearing on this subject, and it is this:
ciation; and member, Governor's Council on Rehabilitation, State
of New York. Was for eight years, a member of the American
"Nature tends to eliminate those who have relinquished their
Medical Association's Committee on Exercise and Physical Fitness.
Fellow, American Medical Association and New York Academy of
functional usefulness."
Medicine. Has published numerous articles on longevity, medical
research and the pharmaceutical industry. B.S., Princeton
University; M.D., Harvard University.
35
34
STAY YOUTHFUL AND FIT
2.
Presented by
LAWRENCE E. LAMB, M.D.*
disease and cancer. It is generally believed that if
To The
satisfactory solutions to these major medical problems
Senate Subcommittee on Aging
April 23, 1975
of modern society are found many individuals can live
in good health to the centenarian mark. One should em-
Despite the obvious capacity to live well past 100 years
phasize that the interest here is in increasing the
most individuals from industrial societies do not. At
active middle years of life--that is, delaying the onset
birth the life expectancy for a white woman in the United
of old age. Many individuals who die before their time
States is 74.9 years; for a white man it is only 67.5
really begin to have the things we associate with old age
years. For nonwhites the life expectancy is 67.5 years
sooner: heart attacks in their 40's and 50's, strokes,
for women and 60.1 years for men. The average life
loss of physical ability, impotence, and other manifesta-
expectancy of a man who has already reached 50 in the
tions of sexual decline accompanied by loss of physical
United States is 70, but on the island of Cyprus 50-year-
prowess.
old men have a life expectancy of 83; in Iceland, 79; and
Living with all of one's faculties, health, and vigor, with
in Sweden, 78. Since these are averages, many have longer
the full joy of living, is one thing, but to be disabled,
or shorter lives. In the United States in a population
isolated, unloved, and ill is another.
of 100,000 white males aged 40 to 44 years, 1877 die each
year of atherosclerotic heart disease, a complication of
There are social problems to be solved as well as medical
atherosclerotic blockage of the arteries. Atherosclerosis
and health problems, if one is to enjoy a long life. Even
is responsible for many changes often ascribed to old age.
so, it is not possible to deny the rewards of being able
to live longer in good health with full vigor and as a
For the vast majority of individuals, the first hurdle in
meaningful part of one's society and environment. Aside
lengthening life is doing away with heart and vascular
from dreams for the future, there are solid facts to support
Cardiologist and internist; author of numerous books on health and
fitness and syndicated medical columnist in over 400 newspapers
what the individual can do to help achieve this goal now:
throughout the country; formerly Professor of Medicine at Baylor
University. Was Chief of the Clinical Science Division of the USAF
specifically, understand the changes that occur with the
School of Aerospace Medicine for 11 years; received the meritorious
civilian service award, the highest the Air Force can give a civilian,
process of aging, and learn how to delay the adverse changes,
as well as the Department of Defense Distinguished Civilian Service
Award for his contributions to NASA-Defense planning programs.
and maintain youthfulness and energy. It is entirely possi-
B.S., M.D., University of Kansas.
ble for most people to add years of healthy vigorous living
FORD LIBRARY is GENALD
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37
3.
to their life span. Usually a change in some living
in older people occurs because something has gone wrong in
patterns is required, as well as the development of a
disciplined personality. But the person who loves life
the body, not because of time. It is true that increasing
and wants to live while he lives can do something about
age seems to decrease the body's ability to withstand these
it.
disease processes and other environmental challenges, but
even that observation isn't absolute. Doctors may examine
Acquired Versus Time-Dependent Aging
the heart of a 26-year-old man and note that it "is as
Many of the health problems, disability, and the deteri-
old as a 70-year-old man's," and what they mean is that
oration now associated with age are "acquired changes" rather
the changes in the arteries are as advanced as those often
than simply the result of the passage of time. A social
seen in older men; but in neither case are the changes
attitude has evolved that because of a person's age he is
caused by time. The occurrence of heart attacks and cancer
expected to have these changes; therefore, they can be
and even early osteoarthritis in young people reminds us
disregarded. The simple truth is that most older people
that we are dealing with "acquired changes."
in our society are not just old. They are sick and have as
much right to society's concern as infants or adolescents.
Because the end results of aging and of common diseases are
the same, no doubt there is an overlapping between the ef-
At age 70 a person may have reached only the halfway mark
of the possible life span if the 50 maximal cell doublings
fects of "acquired changes" and "time-dependent changes."
were achieved. Many disabilities of the 70-year-old person
Disuse Factor
are from acquired defects that we have not learned to prevent
Certainly many of the problems noted in older people which
or cure rather than from time-dependent aging. The first
we attribute to aging are the direct result of disuse.
step in managing these problems is recognizing that they
There is clear evidence of loss of muscle cells and decrease
are illnesses--not just the ravages of time.
in size of muscles if they are not used, just as there is
evidence that the amount of muscle mass can be increased
For example, fatty deposits may plug the arteries and inter-
fere with circulation, causing, in turn, heart attacks,
with appropriate exercise, as long as the blood supply for
the developing muscle is adequate. Disuse of bodily systems
strokes, and other diseases. The resulting dead heart cells,
brain cells, and cells of other organs are dead because of
not only affects skeletal muscles but can affect the heart
a disease process, not because of time. Death from cancer
38
39
6.
5.
muscle, decreasing the heart's capacity. It can affect
strength comes from using the body; chemical ability, from
the lung's capacity and almost every bodily system.
exercising the chemical system of the body. Loss of the
Nature seems to follow a simple principle: "If you don't
normal range of these functions is not genetic aging; it
use it, you lose it."
is the body's response to disuse. Perhaps lack of activity
in some way turns off some of the basic cellular mechanisms,
A good example of this principle is what happens in the
but this is theory. In any case disuse is an important
formation of red blood cells. Everyone destroys a certain
component in the weakening, loss of function, and loss of
number of red blood cells every day by normal physical
the full range of capacity of function seen so often with
activity. The simple mechanical process of circulating
increasing years. Most of these changes are within the
blood causes mechanical wear and tear on blood cells and
voluntary control of the individual.
brings about this destruction. The older cells apparently
are the weaker ones and are the ones usually destroyed.
Atherosclerosis
If an individual maintains a relatively constant level of
Atherosclerosis is the accumulation of fatty deposits in
activity, the bone marrow will form enough red blood cells
the arteries. This can occur anywhere in the body.
each day to replace those that are destroyed. In this way
If it affects the arteries to the heart muscle, it
the necessary balance of red blood cells is preserved within
causes heart disease; to the brain, it causes strokes;
narrow limits. If a person becomes inactive, the cells
to the legs, it interferes with walking; to the
are not destroyed so rapidly and the bone marrow stops
genitals, it can interfere with a man's capacity to have
producing as many. It literally becomes inactive and may
erections or affect his testicular function; to the kidneys,
take as long as three weeks to be fully reactivated when
it can alter their normal function. Because atherosclerosis
one resumes more vigorous physical activity.
leads to blockage of the arteries, it interferes with circu-
lation. Cells will then be deficient in oxygen and nutrients
There are countless examples, whether reference is to
and accumulate end products of metabolism like carbon dioxide.
chemical systems or more obvious mechanical systems like
These adverse effects on the cells limit their capacity to
bone and muscle, to show that the range of capacity of the
regenerate and hinder their growth and response to use, there-
human body's functions is dependent upon using it. Physical
by contributing to the disuse problem. In their extreme form
they can result in cell death.
40
41
8.
7.
Through causing heart attacks, strokes, and kidney disease
A System of Opposing Forces
and its multiple problems, atherosclerosis accounts for
One of the interesting things about the musculoskeletal
approximately half of the deaths in the United States. It
system is the arrangement of the muscles and their attach-
occasions untold numbers of cases of senility because of
ment to the skeleton. For the most part there are opposing
brain damage and a host of other medical problems. The
sets of muscles. This feature is very important in appre-
amount of fatty deposits in the arteries clearly increases
ciating what happens to the musculoskeletal system with
with age, and it was therefore once assumed that atheroscle-
advancing years. Examples of opposing muscles are every-
rosis was an aging phenomenon. This is obviously a false
where. The biceps in the upper arm contracts to bend the
assumption since atherosclerosis also occurs in young people,
elbow. The triceps muscle on the back of the arm contracts
particularly in the arteries to the heart in men as young
to straighten the elbow. The actions of these two muscle
as 22 years of age and in sufficient amounts to cause heart
groups oppose each other. Opposing muscles bend or straighten
attacks in these individuals. Nevertheless, because it
the joints in almost every region of the body, or rotate
increases with age, the changes it brings about are often
parts of the skeleton in opposite directions. Muscles along
considered as aging. They are, of course, acquired changes.
the back help us sit or stand upright. They are opposed by
muscles from the other side of the trunk which allow us to
The Musculoskeletal System
bend the spine forward. There are muscles which help us
We commonly think of youth as being associated with supple
rotate the spine to the right and other muscles which rotate
bodies with good muscles and strong bones capable of a wide
the spine to the left. Large muscles in the front of the
range of physical activity and endurance. We think of age,
neck let us rotate the head to the right or to the left.
by contrast, as being associated with loss of muscles, weak
Muscles between the shoulders help us keep our shoulders back
and brittle bones, and loss of body suppleness. Certainly
in a normal position. Muscles across the front of the chest
within our framework of living patterns these concepts are
contract in an opposite direction and tend to roll the shoul-
true. Yet in many parts of the world older individuals con-
ders forward, producing the rounded-shoulder effect. The
tinue to be physically vigorous with strong muscles, strong
state of contraction and general position of all these mus-
bones, and supple bodies. One need look no farther than
cles in relation to each other are responsible for optimal
the 70- and 80-year-old Africans who are tribal dancers.
posture and movement.
Many changes noted in the muscles and skeleton with age
can definitely be prevented.
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43
9.
10.
The commonly observed decrease in the size of muscles with
dimension is no longer around the chest but around the
increasing age is not all time related. The muscle mass
waist and buttocks.
can be influenced by the amount and type of physical activity.
A person with relatively small muscles can develop large
It is intriguing to observe the decrease with age of
muscles with a properly carried-out weight training program.
steroid hormones generated by the adrenal gland and the
Exercise which causes the muscles to have to contract firmly
sex glands that parallels the decrease in muscle mass.
or against force will gradually increase the size of the
The measurable amounts of these eliminated in the urine
muscles. Older individuals who have continued forms of
decrease with age, but correlation with muscle mass shows
physical activity that constantly work the muscles often
that the same amount of the hormones is formed per pound
have retained a larger muscle mass than much younger indi-
of muscle in both the young and the old. While there is
viduals who follow no physical fitness program. The range
probably some inherent decrease, the question is whether
of possibility of development of muscle mass is so great
or not the decrease in the hormones is associated with
that there is a very obvious overlap between the physically
age or lack of physical activity. Since muscle size can
active older person and the inactive young person. Not that
be increased with exercise at almost any age, there remains
the very old person by physical activity alone can retain
the possibility that physical activity which increases
the maximum amount of muscular development that the human
size and function of the muscular system can in turn influence
body is able to achieve. But physical activity is a major
the master genes of the body that control the time sequence
factor in maintaining muscle mass, and its absence is a
of the various cells and in so doing be a youth factor.
major factor in failure to develop or maintain muscle mass.
The War with Gravity
Because physical activity progressively declines in individu-
The commonly observed loss of muscle mass in advancing
als with increasing years or sometimes with material success,
years affects some muscle groups more than others. Muscle
there is a tendency toward a gradual change in body composi-
tissue is typically lost between the bones in the hand,
tion so that a large portion of the muscle mass is replaced
leading to the development of the "bony hand" of older indi-
with fat tissue. This is a main reason for the change in
viduals. By appropriate hand exercises these muscle groups
body configuration attributed to aging. It is often said
can be at least partially maintained. Similarly, the muscle
that as a person gets older his chest falls. The largest
44
45
12.
11.
Abdominal muscles that remain strong add support to the
fibers in the arms and legs tend to shrink, so that the
spine and reduce a great deal of the wear and tear of
size of the muscles in the extremities is decreased. The
weight on the spine and spinal muscles. Thus in this
loss in size and strength of the abdominal muscle results
in the relaxed abdomen which is a major factor in the
sense they work together.
familiar "bay window."
As the weak muscles between the shoulders lose their tone,
they remain stretched even in the resting state. The
The muscles along the entire spine are likely to weaken, as
muscles across the front of the chest (pectoral muscles)
are those between the shoulders. These and other changes
then contract or their fibers shorten, so that the shoul-
are responsible for the posture and physical appearance of
ders roll forward. The end result is a combination of
the body of older people. There is a constant battle against
muscles in the front of the chest which are contracted,
gravity to maintain upright posture. As the muscles weaken,
unable to stretch to their usual length, and muscles across
the battle is lost and the body begins to sag. Just as an
the back of the shoulders which are weakened and overstretched.
old tree gradually bends to the earth, the human body bends
Clearly, correction of this type of problem involves treat-
more and more; its muscles can no longer keep the skeleton
ment of both muscle groups, the relaxation and lengthening
in its optimal, upright position.
of those across the chest and the strengthening of those
As the muscles become less and less able to maintain the
between the shoulders to provide normal shoulder position.
constant state of semicontraction necessary for proper
In addition to the changes observed in the spine, the joints
alignment of the spine, the spine bends forward, decreasing
begin to bend at hip and knee just as if they were giving
the normal tension on the abdominal muscles. Visualize a
slightly under the constant load of carrying the weight of
bow and its string. The bow is the spine; the taut string,
the body. The flexed positions of the hips and knees
the abdominal muscles. If you seize the bow by both ends
contributes to the loss in height associated with increasing
and bend it or curl it, the tension on the string is released
years. Maintaining the optimal range of capacity of the
and the string becomes slack. So it is with the abdominal
muscles will go a long way toward maintaining proper posi-
muscles. As the spine inclines forward, it relieves the
tioning of the hips and knees for optimal body posture.
tension on these muscles and they become slack.
The tendons at the joints also shorten as the muscles remain
contracted. The Achilles tendon in the ankle, for example
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46
13.
14.
shortens, decreasing the mobility of the ankle. Regular
As skeletal changes occur, underlying medical problems
stretching of a joint helps retain normal tendon length.
often become more important. These include such things
The elbows and wrists also tend to be slightly bent, and
as having one leg shorter than the other (which causes the
keeping their full range of motion is likewise an important
pelvis to tilt and the entire spine to be canted out of
aspect of preserving youthful vigor. The body makes constant
position) and old injuries of any type which have affected
adjustments to maintain balance as it loses the battle against
the skeletal system. The loss of normal muscle strength
gravity. Factors which influence the legs and spine gradu-
alone is a major factor in the frequent occurrence of
ally reach up to affect the neck and head, since the head
backaches, and these of course are common even in young
must balance on top of the spinal column. The changes in
people, who also may have weak muscles. The overall pre-
the musculoskeletal system just described cause the head
ventive program for the musculoskeletal system is invalu-
and neck to thrust forward a little. The face itself
able even in the early years in preventing backache.
changes. If the muscles are not used frequently, the face
Exercise
may become impassive, and there is likely to be frequent
There is a lot of truth in the saying "If you don't use
blinking of the eyes.
it, you lose it." Exercise or physical activity is a means
The changes in body posture are not solely muscular.
of preventing disuse. Disuse is a major factor in causing
Degeneration of the spine, associated with the degeneration
many of the changes in the body we call aging. Physical
of the disks between vertebrae and actual dissolving of
activity is essential to maintain the strength and function
the bones, causes fractures of the spine, deformities of
of the musculoskeletal system, including bone and muscle
the vertebrae, and other derangements which magnify the
mass. Bones that are not used tend to decalcify. If a leg
problem. It cannot be emphasized too strongly that once
is put in a cast, the leg bone loses calcium, and, of
these changes have become extensive it is impossible to
course, the size of the muscle also decreases.
reverse them. Therefore a preventive program for the
As muscle mass shrinks, the amount of vital hormones declines.
musculoskeletal system must be established early in life.
The amount of steroid hormones from the adrenal gland and
Since the formation of bone--and, indeed, its destruction--
sex glands diminish with age, but in proportion to the decrease
is frequently a long-term process, such a program should
in muscle mass. It is not definitely known whether increasing
be initiated early and followed vigorously.
48
49
15.
16.
the muscle mass will increase the amount of hormones and
resulting in a chemical reorganization within the nerve
what the overall effect will be upon the body. It is
cells.
known, however, that the muscle mass can be increased in
Although there are many gaps in our knowledge of the
middle-aged, inactive people by appropriate exercises.
interrelated functions, it has been established that the
With an exercise program, there are many medical indicators
musculoskeletal system and its function are linked to the
of improved health and well-being. It is possible that
functions of both the nervous system and hormone production.
the level of physical activity is a significant factor in
The nervous system and endocrine system likewise influence
maintaining optimal functions of the endocrine glands to
each other. Thus, the musculoskeletal, nervous, and endo-
provide lifegiving hormones for continued youth and vigor.
crine systems are synchronized, and physical activity
Patterns of muscle movements are integrated with the
influences all three.
nervous system. The finely coordinated movements of the
Work for the Heart Muscle
concert pianist, for example, respond to a memory pattern
Exercise assists in maintaining optimal function and health
in the brain or to a visual stimulus which is processed
of the heart and circulation. It must be used properly.
through the brain. Or again, if a leg is removed, the
Physical activity requires that more oxygen be delivered
nerve cells related to its function undergo changes. There
to the working muscles. Transporting this greater amount
are numerous other examples to illustrate the interrelations
of oxygen is the job of the heart and circulation. It's
between the musculoskeletal system and the nervous system.
easy to understand, then, that physical activity makes the
It is well known that a stroke or damage to the central
heart pump more blood or work harder. The capacity of
nervous system can cause a leg or any portion of the muscu-
the heart to pump blood is increased by working it, just
loskeletal system to cease functioning properly. Conversely,
as the strength and size of any other muscle in the body
the functions of the musculoskeletal system affect the memory
are improved by using it. A distance runner needs to
organization and fundamental patterns of response, ultimately
develop not only the muscles in his legs but the strength
and capacity of the heart muscle to pump enough blood for
him to run. Individuals who undertake very little physical
activity do not allow the optimal capacity of their heart
FORD VIERANT
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51
18.
17.
Increase in Volume Capacity of the Heart
and circulation to be achieved.
Adequate amounts of proper exercise will also increase the
The Vital Artery Network
volume capacity of the heart. Remember that the heart is
Proper physical exercise increases the circulation to the
a muscular organ and acts as a reservoir for blood between
heart muscle by developing the network of small arteries
beats. If the heart has to pump more blood, it actually
between the two main arteries to the heart. This network
starts enlarging its chambers so that more blood can be
is important in providing adequate blood flow to the
stored for each beat. This is a normal healthy response.
individual muscle fibers. In the healthy physically fit
It is similar to the increase in volume of the lungs that
individual the network is extensive, and during vigorous
can be induced by breathing exercises. If a heart has a
physical activity it enables large amounts of blood to be
very small capacity, its ability to increase the amount of
circulated to the working heart muscle fibers. In the
blood it can pump is limited, and consequently the amount
absence of a well-developed network, the amount of blood
of oxygen that can be delivered and the amount of physical
siphoned to the heart muscle, and hence the work capacity
activity that one can do are limited too. Clearly, the
of the heart is limited. A well-developed network also
volume capacity of the heart is an important factor in a
helps to protect the heart from the effects of blockage
person's ability to perform strenuous or lengthy exercise.
in any one branch of the artery system by a buildup of
In individuals who are free of significant blockage in the
fatty deposits. In fact, if an artery is blocked in one
arteries to the heart muscle it is probably the single most
spot and the individual survives, the network to detour
important factor controlling the amount of physical work
blood around the blocked artery is further developed to
that can be done.
provide a new blood supply to this area of the heart muscle.
The heart does sometimes enlarge with disease, but this is
The increased circulation to the heart muscle brought about
a compensatory mechanism to try to overcome some mechanical
by exercise not only helps protect one from a heart attack
defect in the heart. For example, if a valve to the outlet
but also improves his chances of surviving a heart attack
of the heart is partially obstructed, the heart has to work
if it occurs. The greater vascularity of the heart muscle
harder to eject blood past the obstruction. In essence the
is comparable to that noted in the skeletal muscles. If
heart is worked and it enlarges accordingly. The normal
these are exercised and developed, the circulation to them
increase in size and capacity of the heart with physical
is increased.
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52
19.
20.
exercise in healthy people is a healthy finding and shows
to where it is needed as opposed to sending it equally to
optimal heart function. An indicator of this is the heart
all parts of the body.
rate. The individual with a relatively rapid resting heart
Exercise and Atherosclerosis
rate is likely to have a small heart with limited capacity.
Of course exercise influences the heart and circulation
The healthy individual with a normally slow heart rate
indirectly through its metabolic effects. To the extent
probably has a heart with larger capacity and a greater
that exercise decreases obesity and lowers the amount of
range of function.
fat particles in the blood, it helps to prevent the build-
Circulatory Efficiency
up of atherosclerosis which causes blockage of the arteries.
It therefore improves the circulation all over the body--
Physical fitness increases circulatory efficiency. That is,
in the legs, the kidneys, the testicles, or wherever. Since
the heart and circulation of a person in good condition do
atherosclerosis can even affect the balance and hearing
less work for a given physical task than those of a person
mechanisms, to the degree that exercise prevents athero-
in poor condition doing the same task. Both may use about
sclerosis, it can help maintain optimal function of the
the same amount of oxygen if the task really requires the
ears. Whenever one loses body weight, he also finds it
same amount of energy, but to deliver that oxygen in the
easier to engage in a lot of normal physical activity without
unfit individual the heart has to pump a great deal more
overloading his heart. The excess fat that a person carries
blood; thus there must be an increased blood flow to the
around is truly an extra weight. Obviously the man who
heart muscle. The reasons are not entirely clear but are
walks a mile carrying 50 pounds of excess fat must work
undoubtedly related to the small arteries that channel
harder, and his heart must pump more blood and work harder
blood to the different parts of the body. In the well-
too. If the heart has a limited capacity because of disease
conditioned athlete a major portion of the blood pumped
or other factors, getting rid of the extra 50 pounds of fat
by the heart is sent directly to the working muscles and a
means the body has to work less during that mile walk and
smaller portion of it is sent to muscles that are not being
the heart has to work less. Even an individual with limited
used. In this way the maximum amount of oxygen can be
capacity of the heart can walk more after he has lost excess
withdrawn from the blood pumped by the heart. Many complex
fat than he could before and still not overload his heart.
mechanisms exist in the body that provide for transporting
the increased amount of blood pumped by the heart directly
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55
21.
22.
To the extent that exercise induces fat loss, it will
Blood Formation
improve exercise capacity whether or not the work capacity
The level of physical activity influences the body's
of the heart is increased.
capacity to form red blood cells. Each day a small number
Blood Pressure
of red blood cells are destroyed as they succumb to the
Exercise tends to affect the small arteries throughout the
wear and tear of being tumbled through miles of blood
body which are important in regulating blood pressure.
vessels. The greater the physical activity, the more
Either through the exercise activity itself or through
rapidly the blood circulates, and consequently the more
associated fat loss, changes occur in a number of individuals
red blood cells are destroyed each day. These are replaced
that result in a lowering of their blood pressure at resting
regularly by the bone marrow and blood-forming organs of
conditions. During exercise the blood pressure normally goes
the body. With regular levels of physical activity the
up. In individuals in poor physical condition it usually
blood-forming organs produce the same amount of red blood
goes up more rapidly than in those in optimal physical condi-
cells that the body destroys. Thus the number of red
tion. Thus, exercise is often a useful adjunct in treating
blood cells is kept in fairly constant balance.
people with elevated blood pressure.
During periods of long inactivity, red blood cell destruction
Breathing Capacity
decreases and the blood-forming organs cease to produce as
Just as exercise requires the heart to pump more blood, it
many red blood cells. They become relatively inactive and
also requires the lungs to provide more oxygen. Increased
sluggish compared to their state in a very active individual.
breathing exercises the lungs and helps maintain lung
I observed this effect in studying many healthy young men
capacity. Not only are the lung sacs themselves filled
placed at bed rest to evaluate the probable influence of
and emptied rapidly during moderate exercise, but the
weightlessness during space flight. When the men got out
muscles in the chest wall that are responsible for expanding
of bed and resumed normal physical activity, the old red
and contracting the chest cavity are also put to more vigor-
blood cells which had accumulated were suddenly destroyed.
ous use. There is a considerable body of evidence to suggest
The bone marrow had become accustomed to producing a small
that regular, adequate amounts of exercise help keep up the
number of red blood cells and was unable immediately to
functional capacity of the lungs.
replace the destroyed cells. As a result most of these
young men tended to develop a sudden anemia caused by
resuming normal physical activity. In the course
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57
23.
of three to four weeks of normal physical activity the
IMPORTANCE OF PHYSICAL ACTIVITY FOR THE ELDERLY
bone marrow would regain its level of productivity and
a new balance would be established. At this point the
SUBMITTED BY: *Allan Ryan, M.D. to the Senate Sub-Committee
on Aging
anemia would disappear.
SUBMITTED TO: Senator Thomas F. Eagleton, Chairman, Senate
Sub-Committee on Aging
In other studies--of dogs--the bone marrow was found to
be yellow, filled with fat, and inactive in caged dogs
Physical activity brings life and inactivity leads to
not allowed to exercise. Dogs exercised regularly
death. This is hardly a new concept, but one which we as
developed a rich, red marrow characteristic of active
a nation seem to have to be reminded of at least every 50
blood cell production. Exercise is apparently important
years. We talk about physical fitness as if it were some-
in maintaining optimal bone marrow function.
thing we invented rather than a quality that we had almost
Summary
lost sight of 20 years ago. Thanks to a series of sharp
reminders from the President's Council on Physical Fitness
I am pleased to have the opportunity to present this
statement because I am sure that the government can help
and Sports, and from the dedicated physicians and others
who have supported the Council's work, we have steered a
a large number of older people to see the values they can
sizable proportion of our people back on the track towards
gain for their health with a good fitness program. I am
keeping themselves more physical: y fit.
confident that if older Americans could be educated about
In the rush to get on the bandwagon, however, we have
the healthful aspects of exercise the demands for health
left a significant group of our people -- the great majority
services could be sharply reduced. We have a lot of
of our senior citizens -- somewhere behind. True, we have
smart older people, and they are capable of helping them-
"Masters" and "Seniors" programs going on now in a number
selves, if given the knowledge. If our society can learn
of sports, and we see some outstanding examples of men and
to live better and maintain fitness in its broadest sense,
women in their seventies and on up who are remaining active
people will not suffer from many of the medical problems
in vigorous and demanding physical activities. But these
we attribute to old age.
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58
- 2 -
- 3 -
are only a small portion of the millions of older persons
who could benefit from being involved in active physical
speak of a perfect state of health, since no one of us could
exercise but instead are languishing in apartments, rest
be said to enjoy it. Rather, he said, we should think in
homes and other dwellings where they seldom get any vigorous
terms of our ability to be active and to be useful to our-
activity at all.
selves and others as a measure of our state of health. Even
Why should it be important for older persons to exercise
the physically handicapped person need not be considered in
vigorously? Haven't they run their course, and don't they
poor health if he can participate actively in life. In fact,
deserve a rest? When a man or woman stops working, we say
there is no better way for him to improve his health.
that he or she is "retired," signifying a withdrawal from
Rather than encouraging the senior citizen to a life
occupation, but too often it means a withdrawal from life.
of vigorous activity, our society has tended to push them
Physicians know that the body functions decay when they are
out of the mainstream and into the backwaters where they
not called upon regularly. Herodicus, who preceded the great
drift in a desultory fashion, lapsing into a gradual decline
Hippocrates 2500 years ago, exercised his patients vigorously
which leads inevitably to a hospital, a convalescent home
to restore their health when they had been ill and advised
and eventually to a death which may be untimely. They pay
them to exercise regularly to keep from falling ill again.
the price with their lives, and society pays in hundreds of
It is easy to measure the decrease in the size of a muscle
millions of dollars for medical and ancillary care services.
when it is deliberately or accidentally immobilized. The
It is a mistake to assume, however, that the elderly
heart enlarges and strengthens itself when stimulated by
have an entirely free choice as to whether they will remain
vigorous exercise but shrinks and weakens in its force when
vigorously active or not. Besides these barriers of ignorance
its owner become inactive for too long.
and lack of motivation which they set for themselves, there
But shouldn't the elderly be more cautious against over-
are others even more formidable which many of them are in
exertion, since many have some chronic infirmity which might
no position to overcome. Lack of funds, an inhospitable
be aggravated by too vigorous exercise? Galen warned his
environment, lack of facilities, inadequate transportation,
fellow physicians 1800 years ago that it was meaningless to
and lack of trained supervision and leadership are the chief
of these. Localities and states, already heavily burdened
with costs for educating the young and providing welfare and
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- 5 -
medical assistance for people of all ages, have not met
that this could be so is already available but will not be
and perhaps cannot meet, the costs of surmounting these
cited here in the interests of brevity. Failure of the
barriers to greater physical activity for the elderly. Here
Government to act in this matter will only result in the
is where the Federal Government may play a role.
costs of care for the elderly continuing to mount steadily.
What is needed is to put to work the knowledge and
experience of those in the fields of health, physical educa-
tion and recreation. We must have sufficient funding to
make available to older persons the programs, leadership
and facilities which will enable them to become involved
on a year-around basis in physical activities which will
help to keep them healthy and mentally alert, thus increasing
their independence and perhaps even prolonging their lives.
Outdoor programs should be available throughout the
year, and in many cases this would not necessitate new
facilities. In the northern tier of states, however, there
would be a great need for large multi-purpose indoor facili-
ties whose use would be restricted to the older age group.
The Federal Government could forward these purposes by
making grants to localities, states and other public and private
*Dr. Ryan is professor of Rehabilitation Medicine, University
agencies who would agree to plan, staff and maintain such
of Wisconsin, Madison. Formerly practiced general surgery
in Meriden, Connecticut. Past chairman, American Medical
programs and facilities. Within a relatively few years, such
Association's Committee on Exercise and Physical Fitness;
Fellow, American College of Sports Medicine; member, Wisconsin
grants would more than pay for themselves by reducing the
Governor's Council on Physical Activity and Sports for Fitness.
Editor-in-Chief, "The Physician and Sportsmedicine"; parti-
heavy expenditures for medical and para-medical services for
cipates in symposia and seminars throughout the world on
athletic injuries and sports medicine. B.A., Yale College;
which the Government is now liable. The medical evidence
M.D., Columbia University.
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2
PHYSICAL ACTIVITY AND AGING
of Cologne University has recommended five minutes of daily exercise at from
seventy to seventy-five percent of capacity, a degree of exercise hardly to
by Merritt H. Stiles, M.D.*
be called "moderate." Dr. Thomas K. Cureton, of the University of Illinois,
believes the average adult should get from 300 to 500 calories worth of exer-
To The
cise a day, equivalent to from 30 to 50 minutes of jogging or skiing, again
Senate Subcommittee on Aging
hardly moderate.
April 23, 1975
What type of exercise is best? Suffice it to say, there is general agreement
that the most important forms of exercise are those which stress the heart
and lungs. To accomplish this, the body's largest muscle masses, the legs,
The relationship between physical activity and the aging process has long
must be used vigorously. Brisk walking, climbing stairs, hills, or mountains,
been recognized. Many physicians have noted that their healthier older
jogging, running, cycling, swimming, and skating, are all excellent, particu-
patients, particularly those in their late seventies, eighties and nineties,
larly if practiced vigorously and regularly. Even dancing, if practiced
are almost without exception, unenthusiastic persons who are still young in
with sufficient vigor and frequency, and for long enough periods, may be bene-
spirit. It is a moot question whether they are active because of their
ficial. Gardening, particularly if digging is involved, can be beneficial too.
enthusiasm, or enthusiastic and interested because of their activity. The two
characteristics unquestionably go hand in hand. It may be significant that
Sports such as tennis, squash, kayaking, sculling, horseback riding all pro-
if one of these healthy older individuals is compelled to remain inactive for
vide excellent exercise, and are enjoyable. Skiing qualifies as an unusually
a prolonged period, by accident or illness, deterioration will set in and a
desirable form of exercise. Being both vigorous and sustained, it is parti-
steady downhill course will ensue unless the individual can be stimulated to
cularly beneficial to the heart and circulation. Yet the effort required is
return to the greatest degree of activity possible.
usually only 25 to 40 percent of maximum, with frequent interruptions to view
the scenery, converse with a friend, rest one's legs, pick one's self up after
Studies have shown a gradual but progressive deterioration in physiologic
a fall, or ride a lift to the mountain top for another run. In addition, it
function associated with chronologic age. This applies to the maximum oxygen
is fun, so much fun that exercise becomes a pleasure and not a duty.
uptake, the maximum heart rate, the vital capacity, the metabolic rate, and
numerous other functions. Yet there is some question as to whether these
Since exercise on a lifelong basis seems essential if a person is to enjoy life
changes are the result of age alone. One study suggests that the decline in
to the fullest, it behooves him to pick out a sport or form of exercise which
maximum heart rate is related to the decline in metabolic rate, rather than
he enjoys, and then practice it regularly as long as he is able. Should his
of age itself. Other observations have suggested that if an active exercise
choice be a seasonal sport, like skiing, he will need to find substitute activ-
program is pursued, the maximum oxygen uptake does not decline, or declin
ities for other seasons. Resistance exercises weight lifting, and muscle
much more slowly.
building exercises in general, do little for the heart and lungs, however, they
do have a positive role in muscular development and in specific athletic skills.
Granted that exercise may be a factor in slowing the deteriorative changes
When used in corjunction with other training programs, they may serve a useful
of the aging process, how vigorous should exercise be? While we lack a defi-
purpose, such as in training for competitive skiing. When used unwisely, how-
nite answer, there is a growing feeling that the "moderation" which the
ever, by inadequately conditioned individuals, unfortunate consequences have
medical profession has preached so long, may not be the final word as far as
sometimes developed. It should also be stressed, however, that it is not advis-
exercise in the conditioned individual is concerned. Professor Wildor Hollman
able to go from a life of relative inactivity to any form of active exercise
without going through a gradual period of training during which the tempo and
*Internist, cardiologist - born Sep. 10, 1899. Attended Univ. of Wash.
vigor of exercise are gradually increased.
1916-17, 1919-20; M.D., Univ. of Penn. 1924. WW I, Sect. 570, U.S.A. Ambulance
In summary, it may be stated that, unfortunately, the average American of mature
Service, Italy, France; WW II, Chief of Medical Svc, Baxter Gen Hosp., Spokane;
years, male and female alike, has allowed himself or herself to deteriorate
Commanding Off., 118th Gen. Hosp., Leyte; 1st pres. of the Spokane Soc. of
Internal Medicine and the Wash. State Soc. of Internal Medicine; former presi-
into a state of physical unfitness. The young adult male often works under too
much stress, with prolonged hours, with too little recreation and with no exer-
dent and 1st Board Chmn., and lifetime trustee of Wash. State Heart Asso; former
Director and V. Pres. of American Heart Association; Pres. of U.S. Ski Asso.
cise, frequently associated with heavy cigarette smoking, too much alcohol, over-
eating and resultant overweight. Can such a person reverse this unfortunate
(1961-65); Director of U.S. Olympic Committee (1961-69); has published approx.
downward course? I believe it is possible, providing he has sufficient desire,
50 articles in various journals, coauthor of SKI AT ANY AGE; has received many
and providing he is willing to restore himself and devote as little as one
awards from the above organizations and in 1975 was elected to Ski Hall of Fame.
percent of his time to regular, healthful exercise.
64
65
3
The rewards to be gained by those willing to exercise vigorously and regularly
are great. Physical inactivity is a most important factor in the development
of what has been called the Twentieth Century Epidemic, coronary heart disease,
responsible for nearly 40 percent of all deaths in the United States. Physical
MEMORANDUM TO:
inactivity is also a primary factor in development of overweight and obesity,
Senate Sub-Committee on Aging
and to some of us, at least, it seems to be a primary factor in the premature onset
Senate Committee, Labor & Public Welfare
of the aging process. Cardiologists recommend a low fat diet, weight control,
abstinence from cigarettes, and control of high blood pressure, in addition to
FROM:
Robert N. Butler, M.D., Research Psychiatrist &
exercise as means of controlling coronary heart disease; many cardiologists feel
Gerontologist, The Washington School of Psychiatry
that active regular exercise is the single most important factor; and cardiolo-
Consultant: Health, Social Retirement, Research
gists in general are possibly the nation's most regular and dedicated exercisers.
Planning and Services.
It seems reasonable to believe that these same factors which help control coronary
heart disease, may also be important in delaying the onset of the unhappy conse-
SUBJECT:
The Psychological Importance of Phvsical Fitness
quences of the aging process.
To be truly effective, exercise must be most vigorous and sustained, and, once
the individual is in suitable condition, part of it perhaps should be close to
Seneca, the Roman philosopher, said, "Man does not die, he
the individual's maximum ability. It must also be regular, the more regular the
better. During building up and improvement phases, exercise should, if possible,
kills Mimself." There is no question but that much of our behavior
involve from thirty minutes to an hour daily. Once an optimum stage has been
reached, fitness can be maintained by a lower degree of activity, possibly as
over which we can exercise sone degree ct control is nfluential
little as sixty minutes a week. Any form of exercise or sport sufficiently
vigorous to fulfill the conditions outlined above should prove satisfactory. It
both in the quality and length of our lives. Yet we do not take
must be remembered, however, that a person who has gotten soft from inactivity,
or from illness, should not plunge immediately into a full blown exercise program.
personal responsibility either for ourselves individually or
If I may introduce a personal digression, with twenty years of active exercise
collectively as a society by shaping our lives into the kind of
behind me, I am, at seventy-five, in infinitely better health as well as fifty
pounds lighter than I was at fifty-five. During the winter months, if I can get
regimen that would enhance both the character and length of life.
in two or more days of skiing per week, I feel that no additional exercise is
necessary. During the spring, summer and fall, when skiing is out of the ques-
Poor diets, overeating, smoking, physical inactivity,
tion, I (og ":wo miles daily, three or more days each week. Kind friends occa-
sionally ask le if, at seventy-five, I am still skiing. My answer is, of course.
excessive drinking, the overuse and misuse of drugs, accidents,
I was late in getting started, and I have a lot of missing years to make up
for. Besides, I am trying to follow in the footsteps of Herman Smith-Johannsen,
stress and life-endangering life styles are all targets of preventive
better known as "Jackrabbit Johannsen." Jackrabbit is still an active cross-
country skier at the age of one-hundred, and I have another twenty-five years
medicine. One can see interrelations between these elements and
to go before I can equal his present records.
many physical conditions. A graphic example is found in the work
being done on the influence of personality and life styles on heart
attacks.
"Exercise is the closest thing to an anti-aging pill now
available. It acts like a miracle drug, and it's free for the
doing," writes researcher Josef P. Hrachovec. Yet about 45 per cent
of adult Americans -- 49 million of 109 million men and women are
sedentary, not engaging in physical exercise.
Substantial evidence supports the value of exercise in main-
taining health, improved circulation anc respiration, better sleep
and diminished stress. Exercise reduces the risk of heart attack
and enhances survival following an attack. Swimming, walking,
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67
The Psychological Importance of Physical Fitness
-2-
The Psychological Importance of Physical Fitness
-3-
running and bicycling are especially good and inexpensive forms
Exercise must be planned on a routine daily basis. One
of exercise, since they actively strengthen the circulatory and
simply must take time for it. In addition, advantage must be
respiratory systems.
taken of spontaneous opportunities for physical activities.
Age need not be an impediment to bicycling and other forms of
Emptying the trash, mowing the lawn and walking upstairs instead
exercise. Tolstoy learned to ride a bike at age sixty-seven. Paul
of taking the elevator should follow a redefinition of what is
Dudley White, President Eisenhower's physician, urged bicycling
called drudgery and what is exercise. So-called labor- and time-saving
as a preventive and curative exercise. Nineteen seventy-two baw
devices may reduce physical fitness. Gardening is a fine hobby as
the sale of 13 million bicycles in the United States, exceeding
well as an attraction that gives pleasure to others. It saves
the sale of American and foreign automobiles by some 2.4 million.
money to garden, cut the grass, pull weeds, do household chores.
It is estimated that about 18 million Americans now ride bicycles,
Purchase of a handyman guide for work around the house can lead
both as recreation and as a form of transportation. By 1973 there
to exercise and save repair costs too.
were at least five bills before Congress to appropriate money or
Dancing is an activity that combines social, inve.personal and
land or both to provide safe and separate bicycle paths, special
physical pleasure. Folk dancing, square dancing and ball room
lanes in traffic, shelters, parking facilities and traffic control
dancing should be part of the available repertoire. The rugged
devices. Bicycles with side wheels can be used by older people who
outdoor life -- hiking and trail blazing -- is also valuable for
worry about balancing but want the exercise. A basket on the back
older people.
makes it easy to carry packages, and the bicycle can be used for
Medical monitoring of exercise is important in later life.
going distances too long to walk.
Regular physical exams and discussions of appropriate exercise
Spectator sports hold a large place in American life, with
with a doctor can lessen the chance of overdoing or miscalculating
college and pofessional sports centering upon a few well-exercised
one's abilities. Treadmill electrocardiac surveillance (including
athletes.* The same money might better be spent on programs and
testing under stress) is very valuable. Education around common
facilities that encourage physical exercise for the population as a
dangers is another imperative. For example, in 1970 the Federal
whole. Health clubs and the VMCA and the YWCA could offer programs
Trade Commission warned the elderly and inform to be careful about
tailored to older people. The large amounts of public park space
sauna and steam baths because of adverse effects of rising body
presently gobbled up by golfers could be more equitably divided among
temperature, blood pressure and puls: rates. There is evidence also
hikers, swimmers and other sports enthusiasts.
to suggest that isometric, statis OT' overly sustained exercises may
*Tronically, athietes Lay have shorter life spans than average.
See, for example, "Longevity and Cause of Death among Harvard
elevate blood pressure to the point of provoking a heart attack.
College Athletes and Their Classmates,' Geriatrics, October,
1972.
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69
The Psychological Importance of Physical Fitness
THE VALUE OF REGULAR EXERCISE PROGRAMS
-4-
FOR SENIOR CITIZENS
Sexual activity is a useful form of exercise for the relief
Presented by
of tension, mild tuning-up of circulation and muscles and for
RAYMOND HARRIS, MD*
emotional well-being. Massage is another very helpful technique,
To The
especially crucial for the bedridden, but relaxing and stimulating
Senate Subcommittee on Aging
for all.
April 23, 1975
The Administration on Aging end the President's Council on
Physical Fitness have collaborated in an excellent booklet on
As a physician actively engaged in the treatment and
maintenance of physical fitness, "The Fitness Challange in the
care of medical problems of older Americans, I am firmly
Later Years" (1968); (Reprinted, 1973).
convinced that regular physical exercise can play a major
As a physician, psychiatrist and gerontologist, I urge continued
role in preventing the onset of premature aging. I find
federal efforts in this vital aspect of the health care of older
that more than half of the patients who consult me complain
Americans -- physical fitness. I regard this subject of such
of symptoms and other difficulties which they mistakenly
importance that I included its discussion in a chapter The Gift
of Life in my book Why Survive? Being Old in America (1975).
attribute to the aging process. However, as a geriatric
cardiologist researcher and physician, I find that the
Robert N
majority of their problems are the result of a chronic
Robert N. Butler, M.D.
state of muscular and cardiovascular unfitness. Hyper-
tension, hardening of the arteries and other circulatory
disturbances are evident in patients with a long-standing
history of physical inactivity and emotional stress and
*President of the Center for the Study of Aging; Clinical
Associate Professor of Medicine, Albany Medical College;
Chief of Cardiology, Sub-Department of Cardiovascular Medi-
cine, St. Peter's Hospital and former Vice President of the
Gerontological Society. Dr. Harris is the author of The
Management of Geriatric Cardiovascular Disease, a member of
the Physical Health and Education Committee of the National
Jewish Welfare Board, and President of the Albany Jewish
Community Center.
GERALD ? LIBRARY FORD
71
70
-3-
-2-
tensions that could have been relieved by regular physi-
the development of faulty feedback mechanisms between move-
cal activity.
ment and body image. Inactive older people develop in-
Properly taught and prescribed physical exercise pro-
creased internal tensions and pent-up aggressions.
grams are particularly valuable and practical for delaying
Physical activity is valuable in promoting the health
the changes of aging and the progression of organic musculo-
of older people. Regular physical activity increases the
skelotal and circulatory diseases. People who have become
outlets for the discharge of aggressive energy and neuro-
habitually sedentary in their living and thinking often
muscular tensions. Such activity aids mental health by im-
overeat, thereby laying the groundwork for conditions which
proving the older person's self-image and the relationship
stimulate the development of organic disease. I refer
of one's self with the environment. By improving muscular
specifically to complaints of aches and pains in joints
tone, circulation, energy, work performance, mental and
and muscles, low back strain and transient illnesses of the
physical work capacity, physical stamina and body weight,
cardiovascular system such as labile high blood pressure
physical fitness programs initiate a process of adaptive
and coronary spasms.
rejuvenation which can reverse much of the atrophy of
Impaired mobility in middle-aged and older people,
muscles, joints and other organs and tissues caused by dis-
often the result of poor physical fitness, leads to social
use. Such disuse atrophy probably causes some of the signs
isolation, personality and emotional deterioration and
of apparent early aging.
poor mental health. Physically inactive people past 50
Physical activity is particularly important in pre-
perceive their bodies to be broader and heavier then they
venting the effects of hypokinetic disease, often mistakenly
really are and they experience bodily activities as in-
attributed to aging rather than the true cause--lack of
creasingly strenuous. Kinesthetic pleasures which young
physical activity. As people age and become physically in-
people derive from motor action are steadily reduced in
active and unfit, their flexor muscles shorten and anti-
habitually sedentary elderly subjects who eventually become
gravity muscles supporting the body and straightening joints
reluctant to move at all. Muscular degeneration, distinct
weaken. Such weakness of the back and shoulder muscles
physiological changes and distortion of the body image re-
produces a humpbacked appearance which further limits the
sulting from restriction of physical exercise lead to
amount and type of physical activity which older people can
greater clumsiness, increased fear of physical activity and
perform.
72
73
-5-
-4-
Properly performed exercise can delay and retard a
Physical exercise and relaxation programs can do much
major portion of these changes in the musculoskeletal,
to improve the mental and physical health of older Americans
respiratory and cardiovascular systems. Exercise and train-
by increasing the flexibility of their thoughts as well as
ing programs started in youth and continued throughout adult-
their muscles. Being in better shape mentally and physi-
hood may delay or prevent these changes. However, even when
cally, the older individual will be able to better meet the
these changes have occurred, partial improvement in posture
stresses and strains of daily living and the socioeconomic
and organic function may be obtained by older people if
problems of old age. Exercises that increase the fitness of
supervised exercise routines are followed conscientiously
older Americans also increase their quality of life. There
for extended periods of time.
is no reason for our citizens to become physically debili-
Physical activity also opens up new challenging in-
tated and confined to wheelchairs and beds so early in life.
terests, goals, skills, experiences and abilities. It in-
In my practice as a physician and geriatrician, I have
creases the independence of older people. Physical activity
found it useful to demonstrate and describe various types
performed in groups also permits an experience which changes
of exercises to improve the functional conditions of aging
people's attitudes and behavior and improves their inter-
Americans. Of particular help are exercises to build up
personal relationships.
antigravity muscles and improve posture to prevent functional
Proper calisthenics and stretching exercises have been
deformities. Increasing numbers of studies attest to the
shown to improve vigor, vitality and zest in middle-aged
value of physical exercise in improving simple reaction
and older people when they are done under properly super-
and discrimination time and other slowed central nervous
vised and qualified instructors. Such types of exercise
system responses, many of which have been attributed to the
are valuable medically to improve the musculoskeletal system
aging process but which really represent the growing physi-
and eliminating the complaints so frequently found in elderly
cal unfitness of older Americans because of inactivity.
inactive people.
Elementary as it seems, too many older people have forgotten
Programs should also include jogging, walking and sports
what it is to walk properly and be aware of the feeling of
which improve the cardiovascular fitness of middle-aged and
good health. They have come to accept as inevitable the
older people and which have been shown to improve the cir-
feeling of tension, stiffness and pain as an accompaniment
culation to the brain, heart and other organs.
74
75
-6-
-7-
of the aging process. Whereas, in reality, most of these
with a psychological stimulation of recovered movements,
changes are due to the shortening of muscles, fibrotic
tends to renew the body image and improve physical relations
changes and decreased function of joints and muscles as a
with the environment.
result of not being adoquately used or used incorrectly.
There is need, in my opinion, for the expenditure of
As a result, functional postural changes eventually produce
federal funds for non-profit programs in physical exercise
the false stereotype of the older person as a stooped, ky-
and activity to motivate normal middle-aged and older Ameri-
photic, shuffling, senile individual.
cans to begin programs which pay attention to their physical,
Physical exercise programs that encourage older Ameri-
emotional and social needs. Furthermore, funds are neces-
cans to be more active, independent and mobile, provide eco-
sary to provide continuing education for physical educators
nomic benefits by reducing medical problems and hospital
and other professionals concerned with exercise in aging
costs. Group exercise programs at all ages assist people to
Americans. They need to be more aware of the needs of normal
acquire new friends, new interests and lead to better mental
older Americans and how to conduct programs to keep aging
and physical health.
Americans in good physical fitness and normal mental health.
Physical activity and exercise furthermore provide a
There is also a need for the accumulation of scientific data
structured time relationship for older people that enables
from physical exercise programs to determine the best way
them better to cope with a potentially threatening environ-
of retarding the symptoms and signs of the aging process
ment. Physical fitness that improves their kinesthetic
and improving the quality of life and health of older Ameri-
sense, self-image and reduces psychologic tension is es-
cans.
sential for their good mental health. The rationale of
In summary, it is my position, as a physician concerned
exercise and activity programs in geriatric day care centers
with diagnosing and treating older people, that proper physi-
is based upon helping older people to rejoin society and
cal activity has a great deal to contribute to the health of
thereby to feel better mentally and physically. Ludotherapy
people. These programs afford great opportunities to reduce
(treatment by games) is useful to help the aged person who
the emotional tensions, lack of physical fitness and personal
exhibits a tendency to disengage from the world and society.
crises that afflict many older people after retirement. Physi-
Kinesitherapy, associating the mobilization of the muscles
cally fit elderly people can care better for themselves and
76
77
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April 23, 1975
remain more active in the community and stay out of in-
stitutions. Effective patterns of physical activity
MEMORANDUM
established during youth and middle-age and followed into
TC:
Senate Committee, Labor and Public Welfare
old age provide a structured time relationship for older
Sub-Committee on Aging
people. Physical activity and exercise programs leading to
FROM:
Hans Kraus, M.D.
465 Park Avenue
physical and cardiovascular fitness are useful preventive
New York, N.Y. 10022
measures that will keep aging people healthier and happier
It is an honor for me to have the opportunity to present
and reduce the ever-mounting costs of growing old.
a statement for your committee and I wish to commend
you for taking the time to consider the important topic
of physical activity for elderly people. There is no
more important aspect of life nor one which has been
more neglected than physical and mental vigor through
exercise.
Studies in the field of therapeutic exercises have con-
vinced us that many disabilities and neuromuscular tension
syndromes are due to underexercise.
The mechanized way of our lives has created the "substrength
individual" who, at the same time, becomes the "supertense
person.
The substrength individual compares to the well-exercised
one as follows: The physically active individual has
low neuromuscular tension, low absolute and relative
weight, low blood pressure, low pulse rate, greater adreno-
cortical reserve, greater vital breathing capacity.
The physically inactive individual shows signs of aging
earlier in life. He exists physiologically at a lower
potential and is less well equipped to maintain homeostasis
and to meet daily stresses. This low level of function,
combined with enforced suppression of the "fight and flight"
response, enhances the incidence of disease. If physical
activity drops below a certain minimum, weight increase be-
comes unavoidable unless caloric intake is stringently
restricted.
Dr. Kraus, an internationally recognized orthopedic
physician, from New York has been an Associate Professor
of Physical Medicine and Rehabilitation at New York Univer-
sity. He is the physician whose research on youth physical
fitness and report to President Eisenhower resulted in the
establishment of the original President's Council on Youth
Fitness
78
79
- 3. -
- 2
the vital need is the availability of programs iL
We are the victims of cur ecology. From the quiet of
which they can participate. These opportunities
the countryside where we had to use our bodies in hard
must be convenient for them and must be conducted by
work for our daily bread we have moved to overcrowded
exercise leaders with adequate training and with an
cities with persistent noise and irritations and mostly
understanding of the older citizen.
to an entirely sedentary way of living. Lack of exercise,
combined with over-irritation, are disease producing
factors. Not only do we get weak through lack of use of
our bodies, but we get tense and stiff by sitting and by
being unable to respond to the constant irritations by
bodily action. Our cardiovascular system and our lungs
deteriorate in the measure they are not used. It is
for this reason that the interest in physical fitness
has become of increasing importance. We are here referring
to the faculty of body and mind to meet the daily demands
of living and still have some reserve for possible
emergencies.
Good physical fitness work should actually start in child-
hood and should include daily exercise classes of at
least an hour in every elementary school. These should
continue throughout the whole school and academic life.
Business and industry should set aside time for exercise
breaks rather than for coffee breaks. Reconditioning
centers should be established as has been done abroad for
many years-where people who are getting "deconditioned"
and prone to one or more of the chronic degenerative
diseases have an opportunity to rest, get reconditioned,
and return with healthier bodies and a more placid frame
of mind.
Such reconditioning centers have shown excellent results.
In one study it was shown that morbidity two years after
one month of reconditioning was cut in half as compared
to two years before. In spite of this and a steadily
mounting proof of the value of systematic reconditioning
particularly for older citizens, not one such center has
been established by state or federal government in the
country. No pilot efforts to explore the effectiveness
of such programs.
This need is becoming more critical as an increasing
percentage of the population is in the over 60 age group.
There must be education for these citizens to understand
the need for regular physical activity in their lives
and motivation for them to want to be active. Ofcourse,
81
80
PHYSICAL FITNESS FOR THE ELDERLY
Regular exercise can significantly
delay the aging process by inhibiting the losses of
Statement by
vital capacity, muscular strength and joint flexibility
C. Carson Conrad
Executive Director
which are characteristic of the middle and later years.
President's Council on Physical Fitness and Sports
It is a fundamental law of physiology that the functional
efficiency of an organ or system improves with use and
regresses with disuse.
Regular exercise may deter the onset of degenerative diseases
which are among today's major killers, and it may improve the ability
to survive and recover from heart attack by promoting the development
of collateral circulation in the heart muscle. The growing conviction
that incidence of disease may be reduced among physically active persons
Submitted to
Subcommittee on Aging
is supported by the commonplace observation that enforced idleness
Committee on Labor and Public Welfare
often is the prelude to early incapacitation for the elderly.
United States Senate
A state of physical fitness enhances the quality
of life for the elderly by increasing their independence.
May 6, 1975
The ability to "go places and do things," without being
dependent on others, provides a strong psychological
lift which is conducive to good mental health.
Physical fitness programs approved on an individual basis by
physicians can and should play an important role in efforts to improve
preventive health care for the elderly. Many forms of exercise involve
82
83
2
3.
In terms of physical fitness, the elderly are
little, if any, expense for participants, and it would be a
a "needy" segment of our population. They grew up
relatively simple matter to improve the availability and
during a period when it was expected that one's work
accessibility of exercise facilities in most communities.
would provide all the exercise that was required, and
when there was no national emphasis on physical fitness.
The medical profession accepts a strong role in
Relatively few of the elderly have extensive experience
preventive medicine for physical fitness programs.
in physical education and/or sport, and fewer still
The recent transfer of the President's Council on
possess the skills to enjoy swimming, tennis, golf and
Physical Fitness and Sports to the administrative
other popular participatory activities. And they have
apparatus of the Public Health Service is in itself
little understanding of the human need for physical activity.
recognition of this fact. The PCPFS, the American
The problem is one which merits attention and we believe
Medical Association and the American Heart Association
we have an obligation to deal with it. Doing so will strengthen
conduct joint programs designed to inform physicians
both our nation and our national health care system.
and the public at large about the relationship between
There is authority at the present time for the
exercise and health.
Department of Health, Education and Welfare to encour-
The public's perception of physical fitness as
age and/or establish programs of physical activity for
an aspect of health, and changes in the Council's
perception of its role, also support a role in preventive
medicine for fitness programs. The Council was estab-
lished 19 years ago as an agency concerned exclusively
with youth fitness, but its major emphasis now is on
physical activity for middle-aged and older Americans.
This emphasis has had an effect. When questioned in a
recent national survey, more than one-half of those
adults who exercise said they do so for reasons of
health."
85
84
5.
4.
2. Section 308 - Model Projects
the elderly. Some emphasis has been directed to this
The purpose of this discretionary project
concern through the Administration on Aging and the
grant program is to enhance the scope
President's Council on Physical Fitness and Sports.
and quality of services provided to
I. What can be Done under Present Legislation
older persons, and in general to demon-
and Regulations
strate ways of promoting the well being
The authority to develop needed programs
of older people. The law provides that
in Physical Fitness for the Aging exists at
the program emphasize certain areas of
the present time under the following two agencies:
concern, including meeting the needs of
A. Title III of the Older Americans Act of 1965,
the physically and mentally impaired
as amended
elderly. Therefore, a model project
1. Title III is a Federal-State formula
designed to demonstrate how physical
grant program, which has as its overall
fitness programs could improve the well-
objective, the development or strengthen-
being of physically or mentally impaired
ing at the sub-state or area level, of
older persons could be funded under this
coordinated, comprehensive service
program.
programs for older persons. A wide
range of services are identified in the
B. The President's Council on Physical Fitness
and Sports (PCPFS). Executive Order 11562
law which may be provided or coordinated
established the Council and determined its
under this program, including the follow-
responsibilities under the Assistant Secretary
ing which could include physical fitness
for Health, Department of Health, Education
components:
and Welfare. The Council is charged with the
-health related services
-preventive services
promotion and improvement of the Physical
-recreational services
-any other services determined to
Fitness of all Americans by the following:
be necessary for the general welfare
of older persons.
1. Enlist the support and assistance
of non-governmental individuals
87
86
7
6.
II. What is Being Done at the Present Time
and groups in efforts to promote and
As noted, physical fitness programs can be
improve physical fitness and sports.
supported under Title III of the Older Americans
2. Stimulate, improve and strengthen
Act, but State and Area Agencies on Aging must
coordination of Federal services and
determine if such activities fall within the
programs relating to physical fitness
priorities established by the needs surveys that
and sports.
are required as part of State and Area Plans
3. Encourage state and local governments
on Aging. For example, West Virginia initiated
to enhance physical fitness and sports
a physical fitness project for the elderly under
participation.
Title III in Charleston in 1970, and the project
4. Seek to strengthen the physical fit-
was so successful that the program (which is now
ness of American children, youth
supported through a variety of sources), operated
and adults.
by the Laurence Frankel Foundation, has expanded
5. Develop cooperative programs with
until it is now offered Statewide, in Senior
medical, dental and other similar
Centers, Nursing Homes and State Hospitals.
societies to encourage and implement
sound physical fitness.
The PCPFS and Administration on Aging prepared
6. Stimulate and encourage research
the booklet, The Fitness Challenge
in the Later
in the areas of physical fitness
Years, which was published by the Administration
and sports performance.
on Aging. There has been a heavy demand for this
7. Assist aducational agencies in
booklet.
developing quality programs to
The PCPFS is charged to promote and improve
encourage innovation, improve
the physical fitness of all Americans. In carry-
teacher preparation and strengthen
ing out this mission, the PCPFS through its own
state and local leadership.
resources and with no relation to the Older
Americans Act has:
89
88
9.
8.
A. Included leadership training through work-
E. Co-sponsored each year with the Center for
shops in each of the six Regional Clinics
the Study of Aging, Albany, NY, the national
conference on "Fitness After Fifty."
on Physical Fitness and Sports conducted
by the Council each year. Such workshops
F. Provided articles on exercise programs for
will be conducted in Toledo, Ohio; Newark,
the aging for popular magazines and profes-
Delaware; San Juan, Puerto Rico; Las' Cruces,
sional journals.
New Mexico; Lexington, Kentucky; and Detroit,
Michigan during FY '76.
G. Conducted the Presidential Sports Award
program which is offered in 39 sports and
B.
Provided emphasis on exercise and physical
through, which adults, including older Ameri-
activity for older Americans as part of the
cans, are encouraged to participate regularly
on-going public information/advertising
in their favorite sport.
campaign. For example, Lowell Thomas was
recently featured on six radio spot ads which
SUMMARY
went to 4,000 radio stations.
The Department of Health, Education and Welfare
has a strong commitment to support the concept that the
C. Produced the film, Physical Fitness for Older
older people of America have a right to opportunities
Americans, in which the Council's Executive
and benefits similar to those available to other segments
Director interviewed Lowell Thomas on the
of society. Many of the concerns for the elderly are the
subject of the importance of exercise programs
same as for other groups. However, the elderly do have
for the aging. The film is available on free
unique characteristics, needs and interests which neces-
loan for use in training sessions for exercise
sitate different programs and emphasis. These facts are
leadership.
particularly prevalent when considering the health aspects
D. Provided State leadership training workshops
of physical activity.
on physical fitness for the aging.
The efforts described above have been well received
and have had some influence, but have only touched the
FORD LIBRARY is 9ERALD
90
91
10.
surface of the potential for improving the health and well
Fitness Program Senior Citylend
1
being of the elderly through physical activity. There are
(amodel project of National agre)
economic values in addition to the personal physical and
The Nat l assec by for Human Development
The Preside Council a
L. A. Pilot Demonstration
psychological value of improved health through improved
physical fitness. Any efforts by the federal government
"
approximately 49 million men and women do not
engage in physical activity for the purpose of exercise.
to lessen the cost of medical care .or other social services
These sedentary Americans tend to be older, less
educated, and less affluent than those who do exercise.
should be vigorously pursued and the Department will continue to
Due to the failure of these aging citizens to participate
in physical and mental impairments. In the opinion
of medical gerontologists, much of this impairment can
explore these avenues under existing authority.
be prevented by a schedule of exercise activities.'
treas Pregram
Opinion Research Corp.
smokel
President's Council on
The nat'l avere for Human Develgment
Physical Fitness
The Council physical Sports
"The only antidote for aging that I know (for a person)
is to continue to function mentally and physically in
every respect. Proper nutrition for older persons is
important. But it is not enough and of itself will not
acheive optimum health and wellbeing for the aged.
Equivalent in importance is the necessity of opposing
decline and atrophy at any age through mental and
physical activity and exercise. Atrophy of disuse is
the greatest enemy of the aged."
Dr. Theodore G. klumpp
(cardiologist and advisor
to The President's Council
on Physical Fitness and
Sports)
If a study of cardiovascular disease showed that there
are reductions of blood supply brought on by aging:
and more so, in those who are physically inactive.
Both exercise and dietary corrections are linked to
lessened cardiovascular system, it balances energy
cycles within the body and is a benefit to organ and
endocrine function in addition to the obvious conditioning
of the muscles and connective tissues. There is still
a myth that mental activity invariably decreases
rapidly throughout adult life, as a consequence of
aging.. I hold that this is not caused by aging
but by inactivity.
Dr. Hardin G. Jones
University of California
at Berkley
"The talk used to be all diet and exercise. Today it
2.111
is exercise and diet."
Dr. Frederick J. Stare
Harvard
"While the need and demand for improved health servises
have been using (the report states), health education
by either the public or private sector has been shock-
ingly neglected--- failure to heed the opportunity
92
93
2
3
to help themselves to have better health. The aging
population along with the general public must be
"Physical fitness can be defined as the ability of
made clearly aware of the profound difference between
the body to take strenuous exercise with a minimum
health information (disseminating facts) and health
change in body dynamics fromphe resting state.
education (persuading people to change their lifestyles).
The distinguished members of the President's Committee
"While performance capacity diminishes with advancing
Health Education strongly emphasized the need for a
age, these experiments show that training can improve
nationwide effort to change personal attitudé toward
performance in older bodies. The more a muscle is
health and physical activity.
kept alive, the better its ability to perform. These
Report of the President's
observations point to the advisability of aging people
Committee on Health Services
maintaining their muscular equipment in good tone.
Lack of exercise, it would appear, invites atrophy, a
Certification of Instructors for Geriatric Services
condition synonymous with decrepitude of old age.
"the only risks and/or discomforts (to participating
human subjects) will be those involved in physical
BUSINESS WEEK
exercise. We have not experienced any negative effects
"The New Rx For Better Health"
p.61
with regard to the subject's physical, psychological,
sociological wellbeing as a consequence of such
"Exercise strengthens the heart's collateral cir-
January 5,1974
activities in six years of project work along these
p.1
culation. And exercise has been proven to reduce
lines.
blood cholesterol levels. "
Dr. Warren Guild
exercise and testing programs we used
Harvard Medical School
resulted in a mean improvment in aerobic capacity
of 29% which was accompanied by other improvments
in health status such as lowered blood pressure and
"Four to six outings a week, of at least 30 minutes each,
p.62
better ability to relax as measured by resting muscle
is a reasonable level of activity to be attained and
action potential level. This improvfient in health
p.2
continued by an over-40 executive, the specialists
and viggr was accomplished without SO much as a
say. A gradual buildup, of course, is mandatory.
syncopal episode over the four years of our experience
in this area.
BEYOND DIET - EXERCISE YOUR WAY TO FITNESS AND HEART HEALTH
HEALTHY ADDED YEARS
LENORE R Zohman, M.D 1974
"Physical fitness, actually cardiovascular fitness, is
Edward L. Bortz. M.D.
an observable and predictaale benefit of exercise
(President, American Geriatric Society) 1961
training The fit individual has endurance or stamina,
Reprivted from the 1961 BRHANNICA Book of the YEAR_ conspage ARTIVE)
and he is able to supply more energy to his muscles so
11 medical science does know with a high degree of
p.6
that they can work harder and longer, and with less
certainty that these (cardiovascular) diseases are
effort, than when he was not physically fit. Thus,
susceptible to control through prevention and practice
when fit, the exerciser puts less strain on his car-
of proper diet and living habits and through regular
diovascusar system. He feels better, sleeps better
and thorough medical checkups.
and supposedly has improved digestion and disposition."
"It has been estimated that more than 12,000,000
" populations maintaining a customary high level of
persons in the United States, an overwhelming percentage
occupational and receeational physical activity and
of whom are in the over-45 age group, are striken with
avoiding excessive amounts of saturated fats, have
arthritis or rheumatism. Medical science had no cer-
low heart attack rates. Research in progress also
tain clues to the causes of these ailments, but again
documents mounting, although not yet conclusive,
researchers are convinced that to a large extent
P
evidence that an exercise training program can probably
they will prove finally susceptible to contrrol through
decrease your chances of sustaining a heart attack or
sensible health habits and precautions.
"
having another if you have already been stricken.
Furthermore, if you have a heart attack at all, it will
"The cellular activity of the skeleton is dependent
probably be milder if you are physically fit. The
on endocrine function, nutriment and osteoporosis as
American Heart Association has taken the position
the result of disuse has been widely observed.
that it is at least "prudent" to exercise.
Evidence now at hand indicates that the brittleness
of the aging skeleton can to a large measure be con-
trolled by diet, exercise and glandular supplements."
94
95
4
"Some risk factors are actually diminished by exercise
Prepared by the President a Injured these
5
training. For example, there may be a beneficial
lowering of both blood pressure and heart rate so
p.7
that the heart needs less oxygen. Exercise also
Published by she administrationan aging may 1968
end sports the administration on aging
changes the clotting power of the blood so that it is
THE FITNESS CHALLENGE IN LATER YEARS
less likely a clot will form on the If lipid plaques in the
coronary arteries (heart attack).
"Physically active individuals are less likely to experience
a heart attack or other forms of cardiovascular disease
" Despite the fact that exercise training does not
that sedentary people. And apparently an active person
p.7.
seem to stop hardening of the arteries, it does appear
to render the artherosclerotic process less apt to
p.2 who does suffer a coronary attack will probably have
a less severe form and will be more apt to survive
lead to a heart attack."
"
the experience.
"For many individuals, frequent involvment in some sort
WHY EXERCISE?
of physical activity helps to reduce mental fatigue,
theast Regunal Theodore Clinic Physical G. Klumpp M. Diforts, u. Sept.27.38,1974
p.2
tension, strain, or boredom produced by our highly
technical and sedentary way of life.
"
an attack (heart) may occur coincident with exertion,
p.19
but more than 50% of heart attacks happen while the
"Perhaps the greatest benefit of maintaining physical
victim is asleep in bed. "
P.2 fitness is the degree of independence it affords.
This is a quality to be most prized in the later years.
"Functional capacities of all systems of the body
can only be augmented through moderate stress. From
"Exercise of the joints also helps slow down the onset
this point of view, exercise may be regarded as the
or the development of arthritis, one of the most common
p.at
most beneficial form of graded stress. I have no doubt
p.3
and painful diseases assosciated with old age.
that it applies to the mind and emotions as well as to
the rest of the body. This principle has, I believe,
"Programs that promise "fitness" in a minute a day are
particular application to the aging process. In my
more than inadequate in their effect on circulation.
opinion this (physical end emotional) decline will proceed
p.4
So, too, are the traditionally recommedded activities
more slowly if the bodily functions are fully employed
for the elderly, such as puttering in the garden or
and, through moderate and unfortunately descending
taking a leisurely stroll.'
stress, they are held to their maximum capacities."
NEWSWEEK
CAN AGING BE CURED?
Newswerk, april 16, 1973
"Dr. Herbert A. DeVries of U.S.C. found that exercise
increased oxygen-carrying capacity--the best single measure
of vigor - reduced body fat and nervous tension and
improved heart and blood-vessel function as well as
p.63
arm strength. DeVries' exercise program includes
calisthentics, jogging and swimming. He insists
that the elderly begin exercising with caution and
that a physician should perscribe the appropriate
regimen with the same care and certainty that he uses
in choosing drugs for his patients.
96
97
suly
THE WHITE HOUSE
ageng
WASHINGTON
March 12, 1975
MEMORANDUM TO:
ANDRE BUCKLES
FROM:
PAM NEEDHAM
SUBJECT:
Orthodox Jews' Urban Problems
Following is my suggested response to Item 6 on the paper
presented by the Orthodox Jews.
#6 Aid to the Elderly Poor
The Administration shares the group's concerns about the
effects of categorical projects that serve to benefit some
areas but do not reach others. That is why we have supported
the elimination of categorical grants wherever possible, and
have not supported additional community action programs.
For the aging specifically, we strongly support the Area
Agencies on Aging established by the 1973 Amendments to the
Older Americans Act. Through establishing some 600 agencies
covering all areas of the United States, we would provide
nationwide coverage of comprehensive coordinated services for
the elderly. The major task of these agencies is to serve as
a focal point for the aging in its area. They determine the
need for social services for older people with an emphasis on
low-income requirements, develop programs for addressing those
needs, establish funding arrangements, and coordinate the
provision of services. We feel these area agencies are the
appropriate and most effective means of providing services to
the elderly and are much preferable to special projects.
FORD LIBRARY & GERALD
THE WHITE HOUSE
WASHINGTON
March 5, 1975
MEMORANDUM FOR
JAMES MITCHELL
MIKE DUVAL
PAM NEEDHAM
DICK PARSONS
ROGER SEMERAD
FROM
ANDRE BUCKLES A
Attached is a memorandum describing the concerns of American
Orthodox Jews regarding urban problems encountered by the Orthodox
Jewish Community. The memorandum was presented to the White
House Staff by Rabbi Leib Pinter who hopes to discuss these matters
in the near future with the President.
I would most appreciate your reviewing the attached memorandum
and preparing a statement of the Administration's position on the
matters discussed in the memorandum which fall in your area of
responsibility.
Your suggested response is requested by Noon Monday, March 10.
Thank you for your assistance in this regard.
FORD is LIBRARY GERALD
Pam-
this is a different memo
from the one we sent to HEW
on poverty guidelines
From:
GERALD FORD LIBRARY
To:
Re: URBAN PROBLEMS FACING THE AMERICAN ORTHODOX JEWISH COMMUNITY OF AMERICA
1. The American Orthodox Jew lives a double life. Like everyone else in this
great country of ours, he has his obligations and responsibilities as an
American citizen, which, in turn, entitles him to the services and benefits
enjoyed by all American citizens. In addition, however, he also bears the
obligations and responsibilities of his faith, as outlined in the
Scriptures (Torah) and elucidated by Rabbinic scholars over the past
3000 years. By the very nature of his most demanding religion (613
Biblical commandments alone, not counting thousands of Rabbinic ordinances,
decrees and customs), his life is constricted by the requirements of
Judaism. His work days and hours cannot conflict with certain holy days;
his food must be kosher (prepared in strict accordance to certain laws);
his place of residence is limited to areas where he can enjoy the services
of and be able to maintain economically a synagogue, a Jewish school,
Jewish stores carrying Jewish foods, etc., etc. In fact and in practice,
the vast majority of Orthodox Jews live in large population centers, in
the megalopolitan urban areas of this country, where the above conditions
can most easily be met. Consequently, while he does enjoy the necessities
his Jewishness requires, he is forced, perhaps more than any other
American minority group, to suffer the ills that plague our urban centers.
In Particular:
2. Mass transit. Orthodox Jews, as residents of large metropolitan areas,
are vitally interested in low cost mass transit. Even those who possess
cars prefer not to drive them into the clogged, smogged city centers where
they usually work. Any Federal policy which ignores the crying need for
-2-
MEMORANDUM #1
aid to urban mass transit deeply, and adversely, affects this portion of
our population.
3. Housing. As members, in large measure, of the lower middle-income group,
Orthodox Jews suffer - along with others in the same financial position -
from the rigid eligibility standards for Federally-subsidized housing.
Standards which have been established on a national level tend to be
unfair and discriminatory to those who live in higher-priced urban areas,
effectively denying them the opportunity to share in the benefits of
middle-income ($12 - $18,000) housing programs.
4. Race relations. Forced as they are by their religious needs to reside
and conduct their businesses in the inner cores of large cities,
Orthodox Jews are often the first to bear the brunt of changing neighbor-
hoods, The historically "wandering Jew" becomes a wandering Jew again -
in free America! -- as less desirable and often vandalizing minorities
encroach upon Jewish neighborhoods. Legitimate Jewish businessmen, who
cannot move their stores every few years, often feel the wrath of the under-
privileged who shoplift, rob, and loot and even set fire to the closest
"representatives" of the existing economic structure of this country. In
addition to Federal policies to ameliorate the economic plight of the
underprivileged, we recommend special programs of protection and compensa-
tion for the victimes of this unsettling and destructive national problem.
5. Affirmative action. While the Orthodox Jew is as liberal as the next man,
we feel that the recent approach to racial inequities called "affirmative
action" (or more realistically "reverse quotas") is highly unfair. Should
one group of people who have a culture inclination toward scholastic
pursuits or sociological ambition toward certain professions now be
-j-
MEMORANDUM #1
penalized because some other minority group exhibited no such inclination
or ambition? An analogy might be in order: Jews and Italians emigrated
to this country in large numbers at about the same time. Jews tended to
enter certain businesses and professions, Italians certain others. Must
we today redress the balance and insist that Italians be entitled to a
specific percentage of openings or jobs in medicine or law, for example?
In this land of equal opportunity, every citizen should be free to follow
his natural inclinations with regard to choice of occupations, particularly
when to do otherwise would deprive other citizens of their opportunities
to pursue their legitimate desires. "Quotas" and "equal opportunity" are
contradictory terms; "merit" should be the keystone of our national policy.
6. Aid to the elderly poor. For the vast majority of Americans, old age
represents poverty; retiring millionaires are relatively scarce, pension
plans are still not as widespread or as effective as they should be,
Social Security payments hover around the poverty level. The Federal
governments antipoverty programs, while highly commendable, are also
occasionally inequitable. These programs select geographic target areas
(in New York, for example, these would be Harlem, East New York, Brownsville,
Bedford Stuyvesant, etc.) and funnel their funds through community corpo-
rations or organizational groups. If a poor person (and this applies
particularly to Orthodox Jews) does not live in such a target area, or does
not belong to such an organizational group, there is little chance that he
would benefit from such programs. We would suggest that Federal anti-
poverty projects be awarded to city-wide or area-wide blanket organiza-
tions which could ferret out the scattered poor and direct the funds to
the intended needy wherever they might be.
FORD LIBRARY & 93839