in the Appendix lists sources of information including congressional committees, Federal agencies, public interest organizations, and publications, as well as program aids for each chapter.

The chapter on economic security notes that many mayors have negotiated discounts, rebates, or free services for their older constituents. Among these are reductions for city services (transportation, water, garbage), recreational facilities, building or vehicle permits, rent, utility or property taxes, pet or hunting licenses, eyeglasses, or hearing aids. Some cities offering senior discount programs include Chicago, Ill.; Portland, Oreg.; Jersey City, N.J.; Seattle, Wash.; San Diego, Calif.; and New York City.

One program in Boston called the Mayor's Older Bostonians disseminates information about discounts available to seniors in the community. The MOB symbol is displayed in neighborhood stores and where services sponsored by Boston's Commission on Affairs of the Elderly are available. An MOB identification card and discount information booklet may be obtained by city residents age 60 or older at any of the 16 "Little City Halls" throughout the city.

Also discussed is the Older Worker Employment Program in Portland, Oreg., supervised by the Aging Services Division of the Human Resources Bureau. Through the program, seniors are being trained to work with other older persons, providing staff assistance to eight senior centers in the county which offer transportation, home repair, and outreach services. Seniors in CETA (Community Employment Training Act) programs, which the city also sponsors, work in nutrition, emergency repair, and homemaker projects.

A major goal of the Older Worker Employment Program is drawing seniors into the mainstream of the public and private job markets. The Aging Services Division has transitioned 60 CETA participants from subsidized to non-subsidized employment.

In Jersery City, N.J., Mayor Paul Jordan initiated an energy conservation program to help low-income elderly with energy costs. Operated by the Division of Senior Affairs in the city's Department of Human Resources, the program provides for home winterization to reduce heating costs and emergency cash assistance for seniors who cannot pay accumulated utility bills. The program also includes free, community-wide training on home repair techniques and an emergency energy service to help seniors with household budgeting.

According to the report, a new development in housing called "single room occupancy" has occurred with the migration of seniors to the cities. "SRO's" are renters living in single rooms in sub-standard

urban hotels, usually in the heart of the city. They subsist at or below the poverty level in an atmosphere frequently pervaded by fear and danger. The chapter on housing notes that a salient characteristic of the SRO syndrome is a fierce desire for independence by the older person-to the extent of isolation. Because of this isolation, they are often unaware of medical and nutritional programs available to them.

The section on housing examines efforts to bring services closer to the SRO population. A renovated hotel in downtown Seattle, Wash., now has a branch of the city welfare office on the second floor. In Portland, Oreg., a group from Portland State University has established a “transit bank" on the ground floor of an old hotel without any public funds. Since SRO residents seldom use regular banks, this is an alternative that keeps their money nearby in a well-protected area. A para-professional clinic offering basic testing and treatment is also located in the hotel.

The Northwest Pilot Project in Portland has also focused on meeting the needs of the single room occupant. When the city initiated stringent enforcement of the fire code which resulted in closing many SRO's, the NPP worked with a mayoral committee to relocate residents. It manages a housing service that matches vacancies with the elderly who are referred by a variety of social services agencies. One of the project's major activities, in cooperation with the Mayor and the city office of community development, has been the attempt to upgrade management in SRO hotels.

Regarding the role of the mayor in serving the elderly, the USCM Task Force on Aging summarizes: "Essentially, Mayors and other local officials must address the question of resource allocation. In light of city budget reductions and service personnel cutbacks, cities must find ways to meet the basic immediate and long-term needs of the elderly.

"In the final analysis, the Mayor, as chief executive, is the city's primary advocate and catalyst for services to seniors. It is unlikely that the many substantive programs geared to improving the lives of the urban elderly that are described in this handbook would have been realized without mayoral leadership. Significant gains have been made. Yet, the need to address the multiple and interwoven problems that seniors in cities face never has been more apparent."

Copies of the manual have been sent to mayors who are members of the Conference. A limited number of the manuals are available for $7 from the USCM Task Force on Aging, United States Conference of Mayors, 1620 Eye St., N.W., Washington, D.C. 20006.

ver 2,000 professionals in the aging field gathered for the Gerontological Society's 29th Annual Scientific Meeting held Oct. 13-17 at the New York Hilton.

Society President Dr. Robert Binstock presided over the opening symposium, which featured a U.S. Senate Special Committee on Aging Hearing, "Medicine and Aging: An Assessment of Opportunities and Neglect."

Illinois Senator Charles H. Percy chaired the hearing.

Among those testifying were Dr. Robert N. Butler, Pulitzer Prize winning author and Director of the National Institute on Aging; Robert W. Berliner, M.D., Dean of Yale University School of Medicine; John A. D. Cooper, M.D., President of the Association of American Medical Colleges, Washington, D.C.; and Leslie S. Libow, M.D., Medical Director of the Jewish Institute for Geriatric Care in New York, and Chief of Geriatric Medicine in the Long Island Jewish Hillside Medical Center.

Over 400 speakers presented papers in scientific sessions, round table discussions, and discussion groups, which dealt with the latest informa

tion on research in the biological, behavioral, and social sciences, clinical medicine, and social research, planning, and practice.

Commissioner on Aging Arthur S. Flemming presided during the Donald S. Kent Memorial Lecture. Dr. Ollie A. Randall, 1975 Kent Award winner, discussed "Aging in America Today New Aspects in Aging." Winner of the 1975 Robert W. Kleemeier Award, Dr. Klaus Riegel, spoke on "Dialectics of Time and Aging."

In his opening statement for the Senate Special Committee on Aging Hearing at the meeting, Senator Charles Percy noted that pervasive negative cultural attitudes toward the elderly underlie their medical problems.

Quoting recent findings of the Long-Term Care Subcommittee, the Illinois Senator observed that many physicians avoid dealing with the elderly, especially nursing home patients. Doctors testified before the Subcommittee that they elect to take care of younger people who can return to the mainstream of society as productive members. According to

Senator Percy, the low Medicare and Medicaid fees and associated red tape also greatly deter physicians from caring for the elderly.

Another reason for lack of physician interest, the Senator commented, is the "Marcus Welby syndrome." He explained, "The psychological reinforcement that comes from seeing the sick 'cured' is not thought to be available in the context of the infirm elderly."

He said an informal survey of the Nation's 114 medical schools revealed that of 87 responding to a questionnaire, only three offered a specialty in geriatrics, 35 had programs where interns worked in nursing homes, and 47 had other programs serving the elderly.

He concluded:

"I know that today's failures to deal with the illnesses and frailties of aging will grow as the numbers of older Americans grow: 23 million today, about 31 million less than 21/2 decades from now, when the new century begins. Much of that growth will take place in the very highest age brackets, where the likelihood of longterm illness and incapacity is the

greatest.

"If we have problems now, we'll have super-problems later, unless we change a few attitudes and practices."

In his testimony during the hearing, Dr. Robert Butler also asserted that "a personal and institutionalized prejudice against older people is at the root of our failure to adequately provide for them." He added that the universal dread of aging true in all cultures is reinforced in our own and that when the medical student or doctor shares in this cultural attitude it is even more disturbing. Dr. Butler maintained that the introduction of geriatric instruction into medical schools would "significantly improve the quality of health care for the elderly in America."

Dr. Butler asserted that for a number of reasons, knowledge already accumulated on the special medical problems of aging must be incorporated into a unified teaching mechanism. Chief among these reasons is that the elderly do not respond like the young to disease and illness. Symtoms, he observed, appear differently in the older person and the untrained clinician often misses the diagnoses. Impact of Medicare

Ethel Shanas, Professor of Sociology at the University of Illinois in Chicago summarized findings from her research in the U.S. and abroad. She reported at the meeting that the enactment of Medicare legislation did not seem to have made any significant

Above: George Sacher (rt.) receives congratulations upon winning the 1976 R. W. Kleemeier Award for outstanding contributions to aging research. Dr. Sacher heads the aging program of the Argonne National Laboratory, Argonne, Ill.

Center: Dr. Wilma Donahue, holds the 1976 Donald P. Kent Award trophy given for high standards of professional leadership through teaching, service, or interpretation of aging to society. Clark Tibbitts of AoA who collaborated with her on many books and articles stands beside Dr. Donahue.

Below: Dr. Klaus Riegel receives his certificate of appreciation for his 1976 R. W. Kleemeier lecture, "Dialectics of Time and Aging," from last year's lecturer Dr. Leonard Hayflick. Dr. Riegel received the award for outstanding contributions

to aging research.

impact on the quality of health care available to the elderly. Nor, contrary to popular belief, did it seem to have taken elderly invalids out of their homes and put them into institutions to any great extent, she noted.

In a comparison based on surveys completed in 1962 and 1975, Dr. Shanas said she found:

• That four out of every 100 older persons were living in institutions in 1962 compared to five out of 100 in 1975. Because of the growth in the aged population, the increase in actual numbers was from 650,000 in 1962 to 1 million persons in 1975.

That 6% of the noninstitutionalized population over 65 was housebound in 1962, and 7% in 1975. This represents an increase, rather than a decrease, of 1%.

• That approximately a third of all older persons, 30% in 1962 and 33% in 1975, had seen a physician in the month before the survey was taken. But the proportion of older persons who had not seen a doctor in a year or more dropped from 35% in 1962 to 19% in 1975.

Clearly, Dr. Shanas concluded, her comparison indicates that Medicare has had no real effect on reducing the proportion of the elderly who are housebound. At the same time, she commented, there has been an increase in the use of physicians by elderly persons with serious functional

limitations.

One explanation, according to the sociologist, is that the family is still considered the first line of recourse for the seriously ill older person. She remarked, "Older wives and husbands take care of each other in illness; adult children look after parents; brothers, sisters, other relatives, neighbors and friends of old people help provide needed home care. Both old people and their families still see long-term care facilities, whether correctly or not, as 'dumping grounds' and 'places to die'." Such facilities, according to the social scientist, however well managed or equipped, are still seen as a residential choice of last resort.

Because Medicare does not provide adequate reimbursement for home care, the social scientist said, it has been of only nominal benefit to those who do not require institutional care or who prefer to remain at home.

Medicare, Dr. Shanas emphasized, is a payment scheme, not a panacea. She concluded:

"The legislation assumes that payment schemes meet health-care needs but that is not true. The elderly need other things that they can't get paid for or cannot get at all. Our healthcare system is posited on the theory that the need for treatment is temporary, but health care for the aged is chronic in most cases.

"In devising a total health-care scheme for the elderly, what is need is the recognition that their problems are special, that there is a need for an interdisciplinary approach to their needs that will provide social and supportive services as well as medical care, and that health care for the elderly cannot-as it is presently— remain cure-oriented." Elderly Must Band Together

Dr. Ollie A. Randall, recipient of the 1975 Donald S. Kent Award, presented the Memorial Lecture, "Aging in America Today-New Aspects in Aging."

Dr. Randall stressed that older Americans are now faced with new challenges and opportunities which have not been present in the past. She noted that the growing number of older people no longer makes them a "minority" in the adult population. "We must use our new found strength and realize that with our numbers we have not only the right but the responsibility to exercise the privilege of voting in our best interests as well as that of the common good.

"We hear much today," she continued, "of the new generation of the elderly. This implies that we are a group, which we are not. We are perhaps the most individualistic people alive today. We are no longer conformists as we were apt to be when we were younger. We are only as we

are compelled to be by circumstances beyond our control."

Dr. Randall noted that there are several generations among the socalled elderly ranging from the "young old" to the "old old" whose educational backgrounds and lifestyles as well as present needs in the areas of health care and services differ substantially.

In order to improve conditions for the "elderly", she urged older Americans to become actively involved in

those service systems which have been created to assist the aging, and to make their needs known to local, State, and national representatives. "Now that we have numbers, these people will listen as they never have before," she said.

Dr. Randall also noted that the increase in volunteer programs has benefited both the elderly and society and has been "among the healthiest social developments of this half century."

In concluding, Dr. Randall said, "The easiest way of meeting life's needs is the provision of the dollars essential to make it worthwhile. Yet 'poverty of the spirit' is much more corrosive of our morals than poverty of the purse will ever be, and it is much more difficult to alleviate. So here we would suggest that we must turn to the spiritual leaders in our midst and appeal to them to attempt to do more for their elderly than some of them are now doing."

Over 500 institutions in the U.S. are providing courses or services for older persons, according to a survey by the Academy for Educational Development. A significant factor in developing college programs for the elderly was funding from the Administration on Aging, the Academy reports.

The Academy survey indicates that public community colleges are taking the lead in creating programs for the elderly. It terms this trend logical "because community colleges are by mandate most closely tied to the need of their localities and are usually very flexible."

As the Academy observes in its report, "We do a great deal to help prepare young people to enter the labor force, but comparatively little to assist them through the trauma of leaving it at ages 55 to 65."

In addition to its Center for Continuing Education, Georgia Southern College at Statesboro also presents seminars for older persons in association with the State Extension Service. Practical lectures on proper nutrition, physical fitness, care of house plants, and consumer problems are presented by college faculty

members and extension service personnel.

In Bellingham, Wash., an innovative experiment involving the elderly and multi-generational living is underway at Fairhaven College. The program brings together on one campus groups ranging in age from two to 82. The groups include preschool day care children, young college students, middle-aged persons taking courses or pursuing degrees, and older persons who can chose their courses and interests.

Older students, including at least 20 members of the American Association of Retired Persons, live in their own apartment-style dormitories and attend college classes, share cafeteria meals, and join informal discussions with students of other age groups. Since the program's inception two years ago, a number of older students have received high school and college credits. Two great grandmothers recently earned high school equivalency diplomas.

At Syracuse University in New York, the survey reports, 400 residents of a public housing project on the campus share full use of the university facilities. In Florida, Miami

Dade Community College offers courses directly to older persons in community centers, large housing complexes, churches, schools, and nursing homes.

Ohio Bell Offers
Discounts on Phone
Calls for the Elderly

Ohio Bell Telephone Company is offering a new service for its clients who are elderly and living on fixed incomes.

The corporation is providing the option of measured service involving 30 outgoing calls a month at a reduced cost, with a nine cent charge for each additional call. The service is recommended for those making fewer than 65 calls monthly.

A special service is also being offered to the blind or those with a disability which prevents them from using the telephone directly. They may get an exemption from Ohio Bell's new charge of 20¢ per call for over three directory assistance calls per month. Exemption certificates are available from local telephone business offices and social service agencies.