he was still in good health, years older than the age at death of these male relatives. What did he begin to do at that earlier age which his ancestors and he himself had not done? It was this: I asked him when he was 34 to make every effort to carry out three recommendations which I now make to nearly every teenager, even though my patient whom I have just mentioned was already 15 or 20 years older:

(1) Do not gain a pound of weight after the age of 22 or if already overweight, get down to a hard weight. As for diet, limit calories to avoid obesity and reduce the intake of saturated (mostly animal) fat to a minimum.

(2) Exercise hard all through life until really old and then continue to exercise but not so strenuously. Walking is probably best because it is simple and possible in very old age and it involves the biggest muscles in the body which, utilizing nature's installation of valves in our veins, pump blood upwards, relieving the heart of some of its labor. My patient had walked religiously 5 or 6 miles a day in all those years.

(3) Don't smoke at all.

Sometimes of late years I have added a fourth directive in nervously hypersensitize persons to reduce emotional stress. Some individuals have a tendency, usually inherited, to be spasmophilic (subject to spasm of smooth muscle in artery walls, in the gastro-intestinal tract, and elsewhere, even I believe involving the coronary circulation). A rare patient of mine has had angina pectoris and even a minor heart attack despite the finding of a normal coronary angiogram. For such a person reduction of emotional stress but not of physical exercise, plus the use of tranquilizers when needed, seems to be the best program rather than, though sometimes added to, the nitrites. Much more study of this disorder which I call spasmophilia is in order. It is not the same as, although it may complicate, neurocirculatory asthenia, with its multiplicity of symptoms (sighing dyspnea, “heartache,” palpitation, tendency to faint, and morning fatigue).

Because cardiovascular disease has been my specialty and because of lack of time to cover other important hazards to life and to health, such as cancer, accidents, arthritis, mental afflictions, blindness, and deafness I shall limit my concluding remarks to some thoughts and advice to the aged in general.

In the first place I heartily agree with the advice of many others not to initiate or to maintian efforts to keep the heart beating and artificial respiration going after the brain has died, as determined by electroencephalography and other tests adequately applied.

Secondly, "euthanasia" in the popular sense cannot yet be legally condoned by the medical profession depsite the obvious arguments in its favor, but the apparently hopeluessly ill and suffering patient can be kept comfortable by drugs that are available. Also an important consideration, although usually unlikely but remotely possible, is that a cure or source of great alleviation may be just around the corner, about to be discovered or at least available to be applied.

Next, a word to the families of the deceased aged man or woman. Post-mortem examination is still important even in advanced old age. We need more knowledge of the pathology of sensecence. Autopsy findings can be a great help for the family which needs to find out any clues for future protection of the descendants. Important surprises are common and should become a part of the family's archives, too little supplied with such information.

To return to rehabilitation. I myself recall some of the survivors of many years and of many ills, rehabilitated by my father before the term was invented and when it had much more to do with infectious disease and accidents than with damaged hearts. Some of us who happened to pioneer in Cardiology, a pure accident so far as I was concerned, rather suddenly discovered in the late 1920s that most patients with either angina pectoris or coronary thrombosis did not die within three years but were still in good health after five or more. This led to a much more optimistic attitude in the 1930s but was accompanied by the finding that it didn't pay to live a gay life simply because it was to be a short one. We found that total disregard of simple rules of health did favor a shorter life and so we began to advise our coronary and hypertensive patients and others too that it was unwise to smoke, to get fat from a surplus of rich food, and to cease using the leg muscles. This rehabilitation led us on to the more important idea of prevention and finally to recommend control of the now familiar risk factors, especially in the young candidates for early coronary heart disease. Individuals vary so much, however, that I believe that those with an ancestry with little tendency to atherosclerosis need far less protection than those who are not so lucky. But we have not gone so far yet as to put all the

prime candidates on anticoagulants or intestinal resection in their youth. And of course some fat men and physically inactive men and heavy smokers do reach my age but they are certainly very few in number.

May I end with a plea for our use of nature's methods to support and extend longevity and the use of as few drugs and other potential poisons as possible. I should add that the value of vitamins of all kinds as additives to the diet in old age is still a matter of careful investigation but it seems reasonable meanwhile to supply those that are safe and seem to help.

I am still interested in man's artificial control of such risk factors as diabetes, hypercholesterolemia, hypertension, and causes of pollution, and the amelioration by surgical therapy of defects in the heart and blood vessels, but basic research and a long follow-up of the application of therapeutic test measures are more important and demand the first priority for the present at least.

We are a long way from control of the diseases that beset the aged and especially from the control of the aging process itself, but I believe that we are now well on the way.

Thank you for your interest and patience.

Senator EAGLETON. The committee is adjourned.

(Whereupon, at 11:40 a.m., the hearing was recessed, to reconvene Wednesday, June 2, 1971, at 9:30 a.m.)

RESEARCH IN AGING AND NUTRITION PROGRAMS

FOR THE ELDERLY, 1971

WEDNESDAY, JUNE 2, 1971

U.S. SENATE,

SUBCOMMITTEE ON AGING OF THE

COMMITTEE ON LABOR AND PUBLIC WELFARE,

Washington, D.C.

The subcommittee met at 9:15 a.m., pursuant to call, in room 4232, New Senate Office Building, Senator Thomas F. Eagleton (chairman of the subcommittee) presiding.

Present: Senators Eagleton (presiding), Kennedy, Stevenson, and Taft.

Committee staff members present: James J. Murphy, counsel to the subcommittee; and Michael S. Gordon, minority counsel to the subcommittee.

Senator EAGLETON. The committee will come to order.

This morning, ladies and gentlemen, we have some scheduling and time problems so I am going to convene these hearings a bit early and maybe call a witness or two out of turn.

I have an opening statement which I will place in the record at this time.

OPENING STATEMENT OF HON. THOMAS F. EAGLETON, A U.S. SENATOR FROM THE STATE OF MISSOURI

This morning we will hear testimony on S. 1163, the bill introduced by Senator Kennedy to establish a nutrition program for the elderly under the Older Americans Act.

Hunger and malnutrition among our people result generally from an inadequate income and/or a lack of nutritional knowledge. Among the aged, 25 to 30 percent of whom live in poverty, these factors are important contributors to malnutrition.

But the aged also face other problems. Lack of physical mobility or of transportation may impair their ability to shop for food. Those who live in rented rooms may not have cooking and refrigeration facilities. And there are important social and psychological considerations. Those elderly people who live alone and are isolated from family and friends simply may lack the motivation to prepare adequate meals for themselves.

Congress recognized the special nutritional problems of the elderly in 1968 when it earmarked funds, under title IV of the Older Americans Act, for a special research and demonstration program to im prove nutritional services for the elderly.

Experience with the resulting demonstration projects has clearly shown-and I quote from the Administration on Aging's preliminary evaluation of these projects-that "the provision of meals in a group setting is a highly desirable approach because it fosters social interaction, facilitates the delivery of other services, and meets emotional needs of the aged while improving their nutrition."

The success of these demonstration projects has been reflected in recommendations for the establishment of a permanent program. The Panel on Aging of the 1969 White House Conference on Food, Nutrition, and Health recommended that the Administration on Aging and the Department of Agriculture undertake a permanent funding program of daily meal delivery service for the aged in group settings. Similarly, the President's Task Force on the Aging, in its April 1970 report, recommended the development of a program of technical and financial assistance to local groups to provide daily meals to older people.

S. 1163 would carry out these recommendations.

During hearings last year on a similar bill introduced in the House of Representatives by Congressman Claude Pepper, the administration expressed its opposition to a "categorical grant program" in favor of the intergration of "nutrition services into a system of comprehensively delivered social services." To date no administration proposal to achieve this goal has been forthcoming.

The Department of Health, Education, and Welfare, which was originally scheduled to testify on S. 1163 today, has asked that they be permitted to present their views at a later time, as have representatives of the Department of Agriculture.

In his message of May 1969, President Nixon stated that "the time has now come to put an end to hunger in America itself for all time." Federal funding for the remaining 18 nutrition demonstration projects is now expiring. To meet the goal set by the President, I believe the Congress should proceed without undue delay to establish a nutrition program especially tailored to the needs of the elderly. To this end, I am hopeful that we can have the constructive comments and recommendations of the administration in the near future.

At this point, I will ask that the text of S. 1163 and the recommendations of the White House Conference on Food, Nutrition, and Health and the President's Task Force on the Aging, to which I have referred, be printed in the hearing record.

(A copy of S. 1163 follows:)

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