Gerontology: A Fragile Field

By Binstock, Robert H. | Aging Today, March/April 2008 | Go to article overview

Gerontology: A Fragile Field


Binstock, Robert H., Aging Today


Although gerontology is currently thriving and will flourish further as the boomer generation ages, the field has reached its current state through substantial struggles. In truth, the field's remarkable gains remain somewhat fragile.

In the early 1960s, community services for elders were so rare in the United States that the Ford Foundation decided to stimulate the development of local programs on aging by launching a nationwide set of demonstration programs involving public and nonprofit agencies. However, these three-year demonstrations were not notably successful.

By the 1971 White House Conference on Aging, not much had changed despite the passage of the Older Americans Act (OAA) in 1965. After the conference, however, Arthur S. Flemming was" named commissioner of the Administration on Aging. A former secretary of Health, Education and Welfare, Flemming persuaded Congress to establish a nationwide, federally funded aging-services network consisting of state units on aging, area agencies on aging and other service providers.

Today, although older Americans benefit from OAA-funded programs, the aging-services network is meagerly funded in relation to society's current and growing needs. Since 1980, federal funds appropriated for OAA services, as measured by inflation-adjusted dollars, have substantially declined.

In the medical arena, despite the founding of the American Geriatrics Society (AGS) by 29 physicians in 1942, established leaders of American medicine staunchly opposed the notion of a geriatric specialty for decades. For instance, at a 1976 U.S. Senate hearing about medicine and aging, the dean of Yale Medical School and a leader of the American Association of Medical Colleges derided the notion of a specialty in geriatrics.

Not until 1988, under continuing pressure from geriatricians, did the American Boards of Internal Medicine and Family Medicine develop the first certification exams in geriatric medicine, assisted by AGS leaders. Furthermore, it took until 2006 for geriatrics to be formally recognized as a subspecialty of internal medicine. Even with these recognitions, however, a considerable shortage of geriatricians continues-and the shortage is expected to grow, according to a new report from the Institute of Medicine (see article on page 2). Filling this gap will be difficult. Geriatric practice has low compensation, is not glamorous and appeals to few medical students.

GERIATRIC SPECIALIZATIONS

Since the early 1980s, the maturation of geriatrics has led to the development and recognition of geriatric specializations in such other health professions as psychiatry, nursing, rehabilitation and social work. Meanwhile, specialists in aging have developed in other professional and business pursuits, such as architecture, law, journalism, personal finance and marketing, that previously paid little attention to older adults.

For most of the 20th century, societal consciousness of older people was largely manifest in broad negative images: poor, frail, dependent social problems. Today, aging individuals are more often seen as patients, clients and consumers.

However, changes in the public-policy arena have not been very favorable for elders. When I told people in the early 1970s that much of my work focused on public policy and aging, they'd frequently respond, "What does public policy have to do with aging?" Hardly anyone would ask that question today. Federal benefits for older adults now approach 40% of the federal budget.

From the New Deal in the 1930s through the 1970s, older people were stereotyped as deserving of government help. But in the past 25 years, the stereotypes have reversed as politicians, pundits, think tanks and public academics have publicized the current and projected costs of Social security and Medicare. "The elderly"-and increasingly "aging boomers"-have been portrayed as "greedy geezers," who will be an enormous fiscal burden for their children and grandchildren.

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