Aging in Minnesota

AGING IN MINNESOTA

A R E P O R T OF THE MINNESOTA PLANNING COMMITTEE FOR THE

White House Conference on Aging GOVERNOR'S CITIZENS COUNCIL ON AGING

Aging IN MINNESOTA

EDITED BY

Arnold M. Rose

UNIVERSITY OF MINNESOTA PRESS Minneapolis

Copyright 1963 by the University of Minnesota. All rights reserved Printed in the United States of America at the Jones Press, Inc., Minneapolis

Library of Congress Catalog Card Number: 63-1388^

PUBLISHED IN GREAT BRITAIN, INDIA, AND PAKISTAN BY THE OXFORD UNIVERSITY PRESS, LONDON, BOMBAY, AND KARACHI, AND IN CANADA BY THOMAS ALLEN, LTD., TORONTO

Foreword ARNOLD M. ROSE

THE problems of aging in American society are created by certain large-scale social forces interacting with the biological process of growing old. The latter is a constant, but the social forces are continually changing and hence create new problems and new variations in old problems. Today's major problems of older people have been significantly emerging only in the past forty or fifty years and even more recently; hence there has been little time for the culture to catch up with people's needs. Within the past ten years, we have witnessed the usual first stage of a culture catching up with changing human needs — the formation of a social movement attracting the attention and energies of a large number of citizens and the proposal of statutes to correct some aspects of the problem. It would be more correct historically to recognize that the movement began with Dr. Francis Townsend in 1932, and with the legislative efforts culminating in the passage of the Social Security Act in 1935. But these efforts did not create widespread "respectable" awareness of the nature of the problem; this has come about only since 1950. This volume is one manifestation of the fact that it is now respectable to study the problems of the aging and to present the findings to the interested public. This book grew out of Minnesota's preparation for the 1961 White House Conference on Aging. In August 1958, Congress passed the Fogarty Act (Public Law 85-908) which encouraged the separate states to make studies, hold conferences, and prepare recommendations with a view toward a national conference to advise on public v

Aging in Minnesota policy for the aging. Only some seventeen states — including Minnesota — had previously had some kind of official state program designed to promote the interests and welfare of their aging citizens. (Minnesota's program was under the guidance of the Governor's Citizens Council on Aging.) The remaining states were stimulated by the Fogarty Act to set up such a program, and the seventeen states with a head start were allowed to use the funds provided by the Fogarty Act (up to $15,000 per state was belatedly appropriated by Congress in June 1959) to advance their programs in new directions. Minnesota apparently was the first state in the country to organize a planning committee and a new set of activities in preparation for the White House Conference, and thus got an early beginning on the extensive program which is reported in the second chapter of this volume. The factual studies, the demonstrations, the formal recommendations produced by the Minnesota Planning Committee for the White House Conference, as well as the public interest generated by the entire Minnesota program, have laid the groundwork for a national policy to solve many aspects of the problem of the state's aging citizens. Some of the social programs envisioned can best be undertaken by private organizations; others require action by the federal, state, or local governments. Such division of labor is suggested in the final chapter of this volume. It is the factual studies, however, which are the meat of this book. A small number of the findings of these studies have been presented previously, notably in the pamphlet for public distribution entitled A State Report on Developments and Activities in Aging, but this book contains the reports of the studies themselves. The studies, prepared under the direction of Isaac Hoffman, research director for the Wilder Foundation, and Marvin Taves, associate professor of sociology at the University of Minnesota, provide all kinds of factual information for the national planning of future programs of action for the aging. They have already informed the preparation of the Recommendations for Action of the Governor's Citizens Council on Aging. They provide general knowledge about older people which is of value to sociologists, psychologists, economists, and social workers. Just as the Minnesota survey has already been a model, in whole or in part, for similar studies in twenty-two other states, we hope that the community organization demonstration project (reported in the vi

Foreword third chapter of this volume) will be a model for future programs of action in rural and small-town areas throughout the country. The Recommendations for Action, along with parallel compilations of recommendations from all the other states, have been considered as a basic for national policy at the White House Conference. They will also, of course, serve as recommendations to Minnesota governmental and private organizations. The regional and state conferences on aging have served to alert many state citizens to the problems of aging and to provide them with some knowledge as to what to do. Thus has the work of the Minnesota Planning Committee and the Council on Aging taken its place in the national effort to solve the problems of the aging. The authors of the separate chapters of this volume having to do with the White House Conference were the directors of their respective portions of the work of the Minnesota Planning Committee, and the editor — who served as chairman of the committee — can only call to the attention of the reader the notable contributions they have made to the state of Minnesota and to the movement to deal with aging. He would be remiss, however, if he did not call special attention to the service of Bernard E. Nash as staff to the committee and to the stimulus and understanding provided by former Governor Orville L. Freeman to all the work of the committee.

vii

This page intentionally left blank

Contributors

Gerald A. Bloedow, GROUP WORKER, MINNESOTA COMMUNITY ORGANIZATION DEMONSTRATION PROJECT

Gary D. Hansen, M.A., DIRECTOR, THE COMMISSION ON AGING, STATE OF MICHIGAN

Isaac L. Hoffman, M.A., DIRECTOR OF RESEARCH, AMHERST H. WILDER FOUNDATION, ST. PAUL

Ethel McClure, RETIRED FORMER MINNESOTA CIVIL SERVANT, FULL-TIME VOLUNTEER WORKER IN MINNESOTA'S AGING PROGRAM

Bernard E. Nash, M.S.W., SPECIAL CONSULTANT ON AGING, MINNESOTA DEPARTMENT OF PUBLIC WELFARE

Arnold M. Hose, Ph.D., PROFESSOR, DEPARTMENT OF SOCIOLOGY, UNIVERSITY OF MINNESOTA

Marvin J. Taves, Ph.D., PROFESSOR, DEPARTMENT OF RURAL SOCIOLOGY, MEMBER OF THE SPECIAL STAFF ON AGING, DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE

Aldena C. Thomason, M.A., AUTHOR OF POETRY, NOVELS, PLAYS

This page intentionally left blank

Table of Contents

AGING IN RETROSPECT by Bernard E. Nash and Ethel McClure

1

ACTIVITIES IN PREPARATION FOR THE WHITE HOUSE CONFERENCE by

Arnold M. Rose

12

THE FIVE-COUNTY DEMONSTRATION PROJECT by Bernard E. Nash and Gerald A. Bloedow

21

AN INVENTORY OF OUR OLDER RESIDENTS by Isaac L. Hoffman

34

SEVENTEEN HUNDRED ELDERLY CITIZENS by Marvin J. Taves and Gary D. Hansen

73

WE WHO ARE ELDERLY by Aldena Carlson Thomason

182

AGING IN THE FUTURE by Arnold M. Rose and Bernard E. Nash

299

APPENDIX

313

INDEX

317

This page intentionally left blank

AGING IN MINNESOTA

This page intentionally left blank

Aging in Retrospect B E R N A R D E. N A S H AND ETHEL MC CLURE

The government of Minnesota took official note of the special needs and prob~ lems of its older citizens as early as 186£. The history of state activities since that date is recorded in this introductory chapter as background for the presentations of studies and other activities which form the bulk of this volume. It is a history of progress at first slow, but achieving rapid growth in the 1950's.

MINNESOTA cannot lay claim to having awakened our nation to the challenges facing seventeen million older citizens, but it is justifiably proud of the sparks it has added to the fire of concern and activity presently growing throughout our land. Obviously, the "aging movement" and the social problems of today are not unique products of this generation. Today's efforts are built upon the foundations laid by earlier generations. Informed leaders predict that the decade of the sixties will be an era of action on behalf of the aging. Most of us agree that government alone cannot legislate programs which will assure every citizen happiness, security, and protection from adversity. As a society we hold that it is the sovereign and revered prerogative of each person to enjoy these guarantees. But who is responsible when opportunities are not available to the individual? Can society regard its less fortunate members as failures, and consign them to the limbo of unhappiness, insecurity, and certain adversity? Is collective action in problem-solving diametrically opposed to the theory of individual initiative? The White House Conference on Aging of 1961 brought into focus these issues and suggested methods that will lead to unity of purpose and action. 1

Aging in Minnesota What have we in Minnesota contributed to the solution of this problem? The next chapter gives a picture of our activity in preparation for the White House Conference. Here we shall outline some significant past events contributing to Minnesota's progress today. Minnesota did not become a state until 1858, but during its nine years as a territory the legislature created Boards of County Commissioners which, in 1864, were required to provide poorhouses for the indigent and aged. In this early period, all welfare was the direct responsibility of the local units of government. But in 1883 the legislature recognized the need for coordinating and supervising the services provided by the county boards and assigned this function to the newly created State Board of Corrections and Charities (which in 1901 was superseded by the State Board of Control). These were the forerunners of the social conscience and societal responsibility which are today invested in the county welfare boards (created in 1937) and the State Department of Public Welfare (created in 1939 as the Divisions of Social Welfare and Public Institutions). Minnesota, preceded only by Massachusetts and California, created a State Board of Health in 1872. Always leaders in medical and hospital-care programs, Minnesota's citizens early recognized this responsibility by supporting the establishment, in 1854, of the first hospital in Minnesota, St. Joseph's in St. Paul. By 1884 there were at least thirteen general hospitals in the state. During these years, most of the homeless and infirm aged were cared for in the county poorhouses referred to above. In 1867, the first benevolent home for the aged, the Home for the Friendless (now the Protestant Home in St. Paul) was established, and by 1900 at least nine homes for the aged had been opened under non-profit auspices. The first specific mention of a proprietary "rest home" is dated 1900, but there are earlier references to homes receiving "paupers on bid" from the counties. As early as 1907 it became obvious that sufficient numbers of private hospitals and related institutions were operating to justify the appointment of a state agent to "investigate" their ownership and management. But little legal "persuasive" authority was given him to assure a high caliber of service in these facilities. Until the early 1930's the social concern for the aging citizen was no more, perhaps less, than the concern shown for the social needs of oth2

Aging in Retrospect er age groups. In 1935, the first signs of a national movement began to appear. In Duluth, a group of administrators of homes for the aged and a few civic leaders gathered to discuss the need for organized social activities and eventually formed a committee which arranged to show free motion pictures in the homes. Some of these foresighted thinkers are still active in the Plus 65 Committee, which sponsors annually a picnic, a hobby show, and a Christmas party in Duluth. In 1935, Congress passed the Social Security Act and in 1936, the state legislature met in special session to pass legislation which enabled Minnesota to take advantage of the provisions of the Act, including the old-age assistance program. In 1937, the legislature created welfare boards in each county to administer the programs. Thus oldsters devastated by the depression were assured a basic income for preserving an adequate standard of decency and health. The development of rest homes was so markedly accelerated by the passage of the Social Security Act that it is sometimes assumed that the Old Age Assistance program was responsible for the creation of these homes. Social security, of course, was only one influence. The aging of the population, the greater incidence of chronic illness, and the effects of the depression all influenced the development of these homes. It is interesting to note that by 1935 at least thirty-six proprietary rest homes had opened in Minneapolis alone, and, according to the State Board of Control Report for 1935-1936, a large number had been opened throughout the state. One significant effect of the Social Security Act was the closing of the county poorhouses. Because the 1935 law did not permit payment of grants to persons in public institutions, many residents left the poorhouses to receive their "pensions" and flocked to commercial facilities that were not equipped to give them the kind of care they needed. The State Medical and Hospital Associations, alarmed by this situation, formed a committee to write a licensing law, which was passed by the legislature in 1941. This, the first comprehensive licensing law in the nation, provided controls over rest homes and sanitariums as well as hospitals and was in 1943 extended to cover public institutions. In 1944, the State Board of Health adopted standards for these institutions which were hailed nationally as the best available at the time. The 1945 legislature gave authority to welfare boards to make payments higher than the established maximum maintenance 3

Aging in Minnesota grant for old-age assistance recipients who are living in licensed rest homes. After World War II the pressures of mobility, shifts of population, and inflation began to be felt. In 1947 the First Methodist Church Council organized the West End Senior Citizens Club in Duluth, and in St. Paul a Committee for Older Persons was organized. In 1948, the Minneapolis Council of Jewish Women organized the first Minneapolis senior citizens' club. That year also saw the formation of the Minnesota Association of Nursing Homes. In 1948, the University of Minnesota School of Social Work assigned Jerome Kaplan, a student, to the Hennepin County Welfare Board on a special project to determine the effect of a recreation and leisure-time program on medical costs in public-assistance cases. This assignment proved sufficiently beneficial to warrant the Hennepin County Welfare Board's employing Mr. Kaplan after graduation. His assignment, the first such in a public welfare agency, was to organize service programs in churches and settlement houses and to provide leadership for other professional and civic organizations in developing a variety of programs. Activity went into high gear in 1949. In a series of weekly radio talks, Dr. Robert N. Barr of the state Health Department focused public interest on the plight of older persons in our society. In 1949 the mayor of Minneapolis appointed a citizens' committee to study the rest homes in that city. Also in Minneapolis, the Family and Children's Service Agency undertook an extensive evaluation of the referrals it was receiving regarding older persons. The Minneapolis Council of Church Women organized a program of visiting residents of rest homes. The University of Minnesota Center for Continuation Study offered the first annual institute for the Minnesota Association of Administrators of Homes for the Aged. Five senior citizens' clubs were formed in Duluth. The tempo of interest increased in 1950. In Minneapolis, a committee on Planning for Older People was appointed by the Hennepin County Community Chest and Council. Since the Family and Children's Service agency study report had shown a need for leisure-time programs, homemakers, and housekeeping services, the agency was granted $3,600 by the National Institute of Mental Health to expand its volunteer services. A visitation program was organized in boarding 4

Aging in Retrospect homes by the Family and Children's Service, and public agencies were encouraged to evaluate their referrals concerning older persons. Two settlement houses offered programs for senior citizens. The Jewish Community Center and the Salvation Army offered camping periods for older persons. When the Downtown Foundation and the Gethsemane Episcopal Church conducted a twenty-eight-block house-tohouse survey to determine the needs and desires of the older persons living on the fringe of the Minneapolis loop, they found that 73 per cent of those interviewed wanted a club program with emphasis on card-playing, dancing, and trips. At the first meeting sponsored by these two organizations, only five persons took part; but this club grew to be one of the biggest in the city. The Minneapolis Volunteer Service Bureau conducted an institute for volunteers willing to work with the aging. The Variety Club of Minneapolis sponsored entertainment for oldsters and five theaters offered them free passes. The county welfare board published Jerome Kaplan's brochure, Creative Activity for the Senior Age. In Minneapolis, a total of ten clubs were formed in churches and settlement houses. The movement was now taking hold. Geriatrics magazine registered its interest by establishing a social service section in the publication. The Minnesota Welfare Conference offered a panel presentation on recreation for the elderly. The director of library services in the state Department of Education expressed interest in expanding libraries' services to older persons. The University of Minnesota Hospitals conducted five classes in patient care and rehabilitation nursing for nursing-home personnel. The State Health Department surveyed facilities for the care of the infirm aged in nursing homes, homes for the aged, and county homes. In Duluth, the first hobby show for senior citizens was held, and in December 1950, a Christmas party was held in that city with more than six hundred persons in attendance. A large contingent of Minnesotans attended the first National Conference on Aging in Washington, D.C. in 1950. The 1951 legislature created a legislative interim commission of twenty-five members, including fifteen lay leaders, to study the health, housing, recreation, employment, and welfare needs of Minnesota's aging citizens. It also amended the hospital licensing law to cover boarding-care homes for older persons, as well as nursing homes. Counties were authorized to operate nursing homes. The legislature also passed 5

Aging in Minnesota the first "Mayhood law," which permitted operation in Minneapolis of state-licensed nursing homes without regard to local ordinances. In 1951, the University Center for Continuation Study organized the first of its annual institutes for staffs of nursing homes. The state Department of Health conducted classes for nursing home personnel in rural areas. The combined Protestant churches of Minneapolis conducted a series of six classes on the older adult. Vocational High School offered a course in preparing food on a limited budget. The Hennepin County Committee for Older People was expanded to include lay leaders, and the first annual hobby show was conducted in that community. Minneapolis had twenty-one senior citizens' clubs by the end of 1951, and two hundred elderly persons took advantage of the six summer camping sessions available that year. The following year was a period of study and evaluation. The first flurry of activity had greatly exceeded expectations and there was need to assess its value. The Legislative Interim Commission was compiling data on resources and unmet needs. In Duluth, the Community Chest and Council accepted the Plus 65 Committee into the Council. In Minneapolis, the Council of Jewish Women, satisfied with the growth of its senior citizens' club, opened the Council House for Senior Citizens, a day center for all older persons in the Minneapolis area. Two writers for a Minneapolis newspaper were given national awards for their series on the older citizen. Jerome Kaplan received the Survey magazine award for "imaginative and constructive social work" on behalf of the aging. Volunteers were now providing weekly visits to thirteen nursing homes and fifty homebound oldsters. Two thousand elderly people were members of the thirty senior citizens' clubs in Minneapolis. The following year, 1953, was a period of renewed vigor and action. The rural areas were beginning to stir, and a few clubs were organized there. Sibley County conducted the first rural hobby show for persons over sixty. Some of the old poor farms and tuberculosis sanatoriums were converted into county homes for the aged, and their licensure was transferred to the Department of Public Welfare. The St. Louis County Welfare Board hired a coordinator of volunteer services. A cooperative relation was established with the Social Security offices for the distribution of literature of interest and value to older persons. A series of meetings was held with twenty-five leading industrial firms 6

Aging in Retrospect to discuss the employment of older workers. The interim commission on aging issued its report and was granted a two-year extension for further study. The state Division of Social Welfare and the Division of Public Institutions were consolidated into the Department of Public Welfare. Authority was granted for payment for the care of old-age assistance recipients in licensed boarding-care homes, thereby providing a new resource for elderly persons unable to maintain their own homes and yet not requiring nursing-home care. The recommendations of the legislative interim commission noted that in spite of progress in some areas, there was a great and apparently growing need for additional facilities and services. Thus, in 1954, Minnesota again went through a period of study, in preparation for renewed action. Under the auspices of the Commission on Chronic Illness, the state Health Department conducted a comprehensive survey of the care of patients in nursing homes, homes for the aged, and boarding-care homes. The Hennepin County Council formed a committee to study and organize services to the residents of Minneapolis's "skid row," most of whom were elderly pensioners. By 1955, ten clubs had been organized in Duluth and fifty in Minneapolis, with some six thousand elderly people taking part. A church camp set aside a session for its older people, with about sixty attending. The Department of Public Welfare incorporated into its manual a philosophy about the needs of older persons. The Commissioner of Public Welfare was directed to establish a maximum-fee schedule for patients in nursing homes. The legislature authorized county public health nursing services to collect fees for home care and also allowed counties to hire licensed practical nurses to help public health nurses with home care. Minnesota was being hailed as a leader in the field of aging. In January 1956, Governor Orville L. Freeman appointed a temporary Citizens Commission on the Aging, charging it to present a program of action based on the recommendations contained in the reports of the 1951 and the 1953 legislative interim commissions. He wanted to provide the public with machinery that would harness the creative energies of citizens and organizations throughout the state. In June 1956, the Commission presented its plan of action: it called for the appointment of an assistant on aging to the governor and a permanent Citizens Advisory Council. The governor immediately hired Jerome Kap7

Aging in Minnesota Ian as assistant on aging, and appointed a Citizens Council as well as an Interdepartmental Committee on the Aging. Within three months the special assistant and the Citizens Council had organized and conducted fifty-three county town meetings throughout the state to discuss local problems and stimulate local activity. In November 1956, the first Governor's Conference on Aging was held, with seven hundred persons present. This Conference on Aging reviewed the findings of the earlier commissions, the recommendations of the town meetings, and the results achieved by ongoing programs for the elderly. The participants formulated an impressive list of resolutions, which were then submitted to the 1957 legislature. At the same time, the Industrial Relations Center at the university was conducting a survey of attitudes and practices regarding the employment of older workers by Twin City firms, a study that later became the pilot project for the seven city surveys conducted by the United States Department of Labor. During 1957 the Citizens League of Minneapolis and Hennepin County was conducting a comprehensive survey of the care of the chronically ill and indigent aged in Hennepin County. And, in Wright County, professional organizations were joining with citizens in a county-wide survey of the number and the needs of chronically ill persons being cared for at home. The 1957 legislature was responsive to all this activity: it provided funds for the appointment of a consultant on aging in the Department of Public Welfare, for the hiring of a specialist on older workers in the Department of Employment Security, for the employment of a specialist in adult education in the Department of Education, and for sending bookmobiles into more rural areas. Activities for and services to the elderly were increasing in the departments of state government. The Health Department had always been a leader in the development of services for the chronically ill and aged, and it now intensified its training programs in rehabilitation nursing. The Department of Employment Security embarked upon a series of programs to train its employees to serve the older worker, with the gratifying result of a marked increase in the placement of older workers. The Consultant on Aging in the Welfare Department focused his energies on the creation of county committees throughout the state composed of local leaders who would stimulate interest in and activity for the needs of older citizens at the community level. 8

Aging in Retrospect The 1957 legislature also provided for the expansion of the Governor's Citizens Council on Aging to include rural representatives. The first action of the Citizens Council was to draft a list of all earlier recommendations that remained unresolved. A priority was assigned each recommendation, and the Council proceeded in an orderly way to study each problem area through hearings, research, and surveys. The Governor's Citizens Council felt that the major issue facing the aging in society is society's negative attitude toward old age. This attitude, which considers the elderly as a group of dependent, almost handicapped persons, had created a wave of popular recommendations frequently based on emotion rather than fact. Consequently, desirable action was often blocked in favor of programs that treated symptoms rather than causes. The Council agreed that the solution to most problems of the elderly was to assure them equal opportunities for meaningful participation in the functions and decisions of society. This was the theme of the 1958 Second Governor's Conference on Aging and the basis for the activity of the twelve committees formed that year. And this solution was the germ of the campaign undertaken by the Citizens Council to spread facts, organize a variety of projects, encourage the development of appropriate concepts in college courses, and intensify efforts to enlist the support of churches and other institutions in shaping a positive attitude toward and image of the older person in our society. In 1958, Minnesota celebrated her hundredth year of statehood. During this year, Centennial Pioneer Certificates were awarded to the twenty-five hundred persons ninety or older in our state. These 1958 efforts were directed at balancing the opportunities afforded youth and age respectively — remedying an imbalance that had been caused by neglect, indifference, and ignorance. Minnesota has reaped important benefits from these efforts. In 1959, six colleges sponsored courses and institutes on aging. Nineteen counties had formed committees on aging. The university radio station had prepared a series of twelve fifteen-minute broadcasts on various aspects of the subject. The state offered a retirement preparation series for its older employees. The university's Extension Division and the county home agents added sessions in family life and homemaking for older persons in several counties. A program for training practical nurses was inaugurated at one state hospital, these graduates to work with geriatric patients in nursing homes throughout the state. Two 9

Aging in Minnesota large public housing units were opened in the Twin Cities. Church groups have shown a remarkable upsurge of interest in developing programs for senior members. Nursing homes, homes for the aged, and housing for older persons were built at an almost astounding rate. During 1959, the Citizens Council appointed a Health Committee which divided itself into sub-committees on financing medical care, rehabilitation, home care, and classification of congregate care facilities. The 1959 legislature enacted a number of laws which benefited older persons, directly or indirectly. The old-age assistance grant was increased, and the amount that might be paid for congregate care was raised. Another law required investigations prior to the commitment of patients to state mental hospitals. An enabling act made it possible for communities to issue bonds for the construction of congregate care facilities for older persons. Social programs and legislation are increasingly geared to the use of the older adults' abilities, thereby gaining for them status and partnership in contributing to the strength of our state. Though one cannot but be pleased when he reviews the history and development of activity in the field of aging in Minnesota, there remains much to be accomplished. On the positive side, there were by the fall of 1960 at least a hundred and forty-two senior citizens' clubs formed, six day-care centers were open at least two days a week, and three home-care programs were available on a limited basis. Twentythree county committees on aging had been formed. One of the most productive and valuable tools for planning bodies was a statistical report covering population trends, income limitations, and resources for each county of the state. This gives local planning bodies specific information on which to plan and conduct programs. Another achievement of great importance was the completion of a survey, including seventeen hundred interviews, of fourteen communities. A grant from the Ford Foundation to the state made possible a two-year demonstration project in organizing community services for older persons. The superintendents of state hospitals have formed a committee on aging to explore means for better care of patients and the increased movement of geriatric cases back to the community. A guide for elderly people meeting legal problems, prepared by the attorney general, and a directory of community resources, published by the Governor's Citizens Council and the Department of Public Welfare, have been widely 10

Aging in Retrospect distributed and have filled an expressed need for this kind of information. The Minneapolis City Council recently approved the construction of 1,056 public housing units for elderly residents. Yet we know we have just begun. Many solutions have been tried, and out of this trial and effort have come a recognition of basic issues, responsibility for coordination, and a blueprint for sound action. These require the intensive concern and inner conviction of each member of society, so that archaic attitudes and practices can be replaced with modern, positive, intelligent attitudes which respect the dignity and the privileges of old age.

11

Activities in Preparation for the White House Conference ARNOLD M. ROSE

The studies and other activities reported in this volume are the outgrowth of the preparation for the 1960 White House Conference on Aging. The organization and philosophy of the Minnesota committee charged with planning these activities are summarized in the following chapter.

ALMOST immediately after the passage of the Fogarty Act (Public Law 85-908) by Congress in August 1958, and before Congress had appropriated funds to implement the act or the United States Department of Health, Education, and Welfare had set up specifications for participation under the act, some members of the Minnesota Governor's Citizens Council on Aging started to plan for Minnesota's participation. Drawing upon previous experience with Council activities, they realized that the preparations for the White House Conference would have more long-range implications for Minnesota's aging population than the conference itself. The conference would simply provide the stimulus to develop the basic knowledge for a long-range program, and to disseminate that knowledge so that the people would be more prepared to undertake a long-range program. The situation called for as extensive a program of preparation as possible under the funds likely to be allotted. The program developed was guided by the following principles: 1. The acquisition of factual knowledge about the conditions, problems, and attitudes of the aging would provide an essential element in planning a long-range program for their benefit. 2. Effective action would involve the government, private groups, 12

Preparation for the White House Conference and individuals. Individual citizens needed to be informed about the problems of the aging, so that they would support organized programs. Voluntary associations needed to be stimulated to initiate and carry out local programs on behalf of the aging. Government — at the federal, state, and local levels — needed to be encouraged to undertake those large-scale activities which only government has the means to sponsor. 3. Recommendations for long-range activities should emanate from citizens throughout the state and not only from the Council on Aging. The Council could, however, encourage the citizenry to formulate recommendations by providing information, occasions for discussion, and opportunities for acquiring experience with the problems of the aging. 4. Whereas programs of action for the benefit of the aging were making progress in urban areas, including those in Minnesota, little had been started in rural areas. There was a need to ascertain how effective programs could be conducted in rural areas. Based on these principles, and recognizing that Minnesota already had a continuing program under the Special Consultant on Aging and the other departments of the state government, the following program was formulated in preparation for the White House Conference on Aging: 1. An analysis of all the statistical information available concerning the aging. Some of this was already compiled; the rest required compilation from untabulated records kept by the various state departments. The analysis was to be made for the state as a whole, and also in the separate counties, where the information was both available and useful. 2. The preparation of a directory of resources available to older citizens throughout the state. 3. A survey of the characteristics, status, and attitudes of persons over 65 through direct interviewing. This was to be done on an areasampling basis in the three large cities, eleven of the smaller cities, and three of the rural counties of the state. Partly because the expense of carrying on this task by trained personnel was beyond the resources of the Council, and partly because it was deemed highly desirable to enlist local citizens in this fact-gathering, so they might acquire firsthand acquaintance with the problems of the aging, the survey was 13

Aging in Minnesota planned as a self-survey conducted by local groups under the general direction of a research scientist. 4- A one-year community-organization demonstration project in five contiguous rural counties. This was to be conducted by a community organizer working with the existing and the newly formed local organizations in these counties. 5. An invitation to contribute recommendations for action programs, which would be the basis of Minnesota's recommendations to the White House Conjere-nce. These invitations were to be sent to all state voluntary associations known to be interested in the problems of the aging, to state legislators, to heads of state government departments, to county welfare commissioners, and to the county committees on aging (twenty-two of the eighty-seven counties had such volunteer committees). Using the recommendations sent in, the Council on Aging would formulate a comprehensive set of recommendations for action which would be taken to the White House Conference. The recommendations would be directed to federal, state, and local governments, and to relevant voluntary associations in the state. 6. Six regional conferences on aging, conducted in conjunction with local colleges and open to the public. These conferences were designed to bring together information from experts and to stimulate the interest of citizens throughout the state. They were to culminate in a state conference, the third such biennial conference to be conducted by the Council on Aging, lasting for two days and offering more comprehensive presentations and discussions. Where possible, there would also be presentations on aging at regular meetings of interested state organizations, such as the medical society and the state welfare conference. The regional conference conducted by Gustavus Adolphus College was so successful that the college decided to make it an annual affair, with funds provided by the Lutheran Brotherhood Insurance Company. The second conference was planned as a White House Conference in miniature, with participation by invitation only to organizations and individuals active in the field of aging. This conference had two purposes: (a) to test specific aspects of the format of the White House Conference, for the benefit of those planning the national conference (evaluations made by participants and special observers were forwarded to Washington); (b) to utilize the broad range of experience represented by the participants to formulate additional action recom14

Preparation for the White House Conference mendations that could be used by the Council on Aging in the preparation of the final Recommendations for Action. Upon approval by the Council on Aging in December 1958, the above program was submitted informally to the Special Staff on Aging, United States Department of Health, Education, and Welfare, as Minnesota's planned preparation for the White House Conference. It was apparently the first state program submitted, and was used to illustrate to a congressional committee what a state would do with the funds that Congress was considering allocating to the states. The following month (January 1959), Governor Orville L. Freeman — acting on the recommendation of the Council on Aging — appointed Dr. Arnold M. Rose, professor of sociology at the University of Minnesota, as Designee for Planning Minnesota's preparations for the White House Conference on Aging. Dr. Rose had been serving in the Council on Aging and had taken the lead in formulating the plans for the White House Conference. During the following months, a full planning committee and the sub-committees responsible for each aspect of the program were set up.* When Congress passed the appropriation act for the White House Conference, in June 1959, Minnesota was already beginning to put its program into action. Minnesota received the maximum appropriation of $15,000 for its preparations for the White House Conference, but this would not come near paying for the planned program. Fortunately, the services of Bernard E. Nash, Special Consultant on Aging of the Minnesota Department of Public Welfare, were made available by Commissioner Morris Hursh. (Nash took on these duties in addition to his work for his department and for the Council on Aging.) In response to a request by Governor Freeman, the heads of the various departments of the state government provided considerable clerical help and also made *The general Minnesota Planning Committee for the White House Conference consisted of Arnold M. Rose (chairman), Ted Arens, Mrs. Althea Atwater, Dr. Betty Bond, J. Earl Coughlin, Clint Hess, Isaac Hoffman, Frank M. Rang, Jr., Dr. Marvin Taves, Mrs. Walter W. Walker, with the following staff members: Bernard E. Nash, Miss Ethel McClure, Gerald Bloedow. The Statistical Subcommittee consisted of Isaac Hoffman (chairman), Dr. Betty Bond, Dr. Dean Fleming, Miss Ethel McClure, Richard Neuman (Virginia Dustin gave editorial assistance to this subcommittee). The Survey Subcommittee consisted of Marvin Taves (chairman), Miss Eddice Barber, Dr. Roy Francis, Mrs. Hugh Gower, Gary Hansen, John McGoffin, Mrs. Opal Tews. The Community Organization Sub-committee consisted of Frank M. Rang, Jr. (chairman), Mrs. Pauline Bamford, Mrs. Nathan Berman, Clint Hess, Dr. Etta Saloshin, Mrs. L. L. Stenback.

15

Aging in Minnesota available compilations of statistical data for the first project. Still, much more was needed, and a systematic effort was made to obtain volunteer workers and contributed services. The response was overwhelming. Over a thousand persons aided in the work without compensation, and at least four thousand others took part in the programs in some other way. If the monetary value of all the volunteer work and contributions in kind were counted, Minnesota's preparations for the White House Conference would have cost at least ten times the $15,000 made available by the federal government. The Council on Aging, under the chairmanship first of Mrs. Althea Atwater and then of Mrs. Walter W. Walker, devoted an increasing part of its time to considering reports of the Planning Committee and its sub-committees, and it set up a special sub-committee to nominate the Minnesota delegates to the White House Conference. Following the second Gustavus Adolphus conference on June 14-15, 1960, the Council took full charge of integrating action recommendations into the state plan. The Minnesota Division of the American Association of University Women, under the direction of Mrs. E. R. Komarek and Miss Eddice Barber, made a notable contribution by recruiting the volunteer interviewers for the survey. The coding of the data collected in the survey was largely done by the Retired Teachers Association, the Minneapolis Volunteer Service Bureau, and University of Minnesota students. The St. Paul Fire and Marine Insurance Company did IBM-card punching, and tabulation was undertaken by the Minnesota Mutual Insurance Company of St. Paul. The colleges (Gustavus Adolphus, Moorhead State, Bemidji State, and the University of Minnesota, Duluth), the St. Cloud Veterans Hospital, and the Winona branch of the AAUW sponsored the regional meetings. Recognition must be given to the work of Dr. Wendell Swenson, who chaired and helped plan the two conferences at Gustavus Adolphus College. The sub-committees not only led in planning the individual projects but also did much of the analysis and guidance on those projects. The achievements of these projects, some of which will be reported in detail in this volume, are summarized here: 1. The Statistical Information project was chaired and directed by Isaac Hoffman of the Wilder Foundation, with the assistance of Betty Bond and Richard Neuman. Using published statistics on the characteristics of the elderly and the compiled records in the various depart16

Preparation for the White House Conference ments of the state government, a factbook entitled A County by County Statistical Report was prepared. It contains a statistical description of the characteristics of the elderly, by counties, with a comment by each of the county welfare directors, a list of the local agencies serving the elderly in each county, and a summary description of the state which permits a comparison of each county with all the others. This factbook was distributed to county committees on the aging and to county welfare boards, with the hope that it might be useful in developing local programs. A comprehensive presentation of the state statistics is made available for the first time in this volume. The previously unpublished statistics were made available by the heads of various departments of the state department, acting under the advice of Governor Freeman to provide as much information and service as possible to the committee. The bulk of the information was provided by the departments of health, public welfare, taxation, and employment security. 2. A directory of resources available to older citizens throughout the state was prepared by Miss Ethel McClure, a full-time volunteer. County groups are listed in the County by County Statistical Report; state-wide resources and facilities are listed in a separate publication, Keep on Living! A Guidebook to Community Resources for the Senior Citizens in Minnesota. 3. The Survey Committee was chaired and directed by Dr. Marvin Taves, professor of sociology at the University of Minnesota, with the assistance of Gary Hansen. The main report of the survey forms a later section of this volume. Data drawn from the survey were presented by Dr. Taves at the Gustavus Adolphus and the state conferences. An open forum was held in each of the fourteen participating cities to share the survey results with local citizens. Selected findings have been used in drawing up the Minnesota Recommendations to the White House Conference on Aging. 4. The Community Organization Demonstration Project was chaired by Frank Rarig, Jr., director of the Wilder Foundation. The committee employed a project director, Gerald Bloedow, who worked full time for one year in the counties of Aitkin, Benton, Morrison, Sherburne, and Stearns to stimulate the development of a wide range of services and opportunities for the aging. A summary of the project is included in this volume. Mr. Bloedow always worked through local citizens' 17

Aging in Minnesota groups, to assure that the activity would continue after he left the area. Programs were developed in scores of communities, ranging in population from 175 to 33,000 (St. Cloud). The project's success is shown in the number of activities organized, by spontaneous comments made to members of the Minnesota Planning Committee, and by efforts of local groups to raise funds to employ county community organizers after Mr. Bloedow left. The achievement has been recognized by the Ford Foundation, which provided an additional $22,000 to extend it (for six months in the same five counties, and for a year and a half in six other counties, in southern Minnesota). This is the first Ford grant to an agency of any state government. 5. Of the six hundred letters sent to voluntary associations, legislators, government officials and county committees, asking for recommendations for future programs for the aging, only seventy were answered. The hundred and thirty-nine specific recommendations they contained were classified by Mrs. Althea Atwater, a retired social worker and former chairman of the Council on Aging. These recommendations, along with those emanating from the second Gustavus Adolphus Conference, were evaluated and integrated by the Council on Aging in preparing recommendations to the White House Conference on Aging. The recommendations provided the basis of detailed presentations and discussions at the third biennial state Conference on Aging, held at Minneapolis, August 25-26, 1960. Following final revision by the Council on Aging, it was separately published as Recommendations jor Action for wide distribution throughout the state. These recommendations, along with those of the other states, were considered by the White House Conference on Aging. 6. The six regional conferences on aging were planned by Bernard E. Nash with local committees. Attendance ranged from one hundred to three hundred. They were designed to stimulate local interest in undertaking programs for the aging, and to provide information as to how local activities might best be organized. One of the conferences was systematically evaluated by its participants. Other evidences of the conferences' success are three town meetings organized by persons who attended the conferences to discuss needs of local elderly people; the adoption of the conference as an annual affair by the Gustavus Adolphus College; and the organization of several new programs in local communities by participants. The third biennial state Confer18

Preparation /or the White House Conference ence on Aging was planned and activated by a committee headed by Mrs. Walter W. Walker, chairman of the Council on Aging. 7. The attorney general of the state of Minnesota, Walter F. Mondale, at the request of the Minnesota Planning Committee, directed his staff to prepare a short, readable summary of the laws that might be of interest to elderly people. This publication, The Law and Your Rights, has been widely distributed and has attracted a good deal of favorable attention. Various aspects of Minnesota's preparations for the White House Conference have received national attention. Mention has already been made of the interest of the Special Staff on Aging of the United States Department of Health, Education, and Welfare in the testing of various aspects of the format for the White House Conference at the second Gustavus Adolphus conference. They were particularly interested in the possible combining of sections, effective methods of organizing exchange meetings, and the development of efficient voting procedure. Of special significance has been the survey, which has been copied in content and form in some degree by twelve states. After several preliminary meetings, social researchers in seven midwestern states formed a Midwest Council on Social Research in Aging, and made their first project the collation of findings from surveys of five of their states which had followed the Minnesota design of survey research. The Midwest Council, which contemplated an extensive program of research on aging, may be considered to have been stimulated by the Minnesota Planning Committee. In June 1959, Dr. Rose and Mr. Nash reported Minnesota's plans at a national institute called by the White House Conference staff at Ann Arbor and received many favorable reactions. The January 1960 issue of the national journal, Aging, contained a detailed description of Minnesota's preparations for the White House Conference. In October 1959, Esther Stamats of the White House Conference staff visited Minnesota and called this state's preparations "the most exhaustive and extensive" of any state. In February 1960, Clark Tibbitts of the White House Conference staff visited Minnesota at the invitation of the Minnesota Planning Committee and spent four days observing all phases of the Minnesota program. He made a detailed report on Minnesota's activities and evaluated them very highly. The various activi19

Aging in Minnesota ties of the Planning Committee received attention in newspaper reports throughout the state, and particularly in articles in the Minneapolis Tribune. Just as the activities in preparation for the White House Conference grew out of the earlier work of the Governor's Citizens Council on Aging, so it might be expected that future activities for the aging in Minnesota will grow out of the various reports and projects of the Minnesota Planning Committee. Some of the more permanently useful of their findings are summarized in the following chapters.

£0

The Five-County Demonstration Project BERNARD E. NASH AND GERALD BLOEDOW

Local programs to aid the aging have, all over the country, been practically confined to cities. Those in charge of preparing for Minnesota's part in the White House Conference used a good share of their federal funds for an experimental rural program, following principles and procedures developed in earlier community organization work and producing the experience recorded below. It is believed that this demonstration project will be useful in guiding future similar efforts elsewhere.

WHEN, in the summer of 1959, Minnesota — along with all the other states — received a grant from the federal government to prepare for the White House Conference on Aging, the Minnesota Planning Committee for the Conference decided to use a major part of this grant to establish a demonstration project on organizing community services for the aging. This project, limited to five predominantly rural counties, extended from September 1, 1959, to September 1, 1960. One staff member experienced in community organization was to develop volunteer programs, provide consultation to any group or agency upon request, and record the progress of the project. Background. Individual organizations and communities in Minnesota had developed or sponsored programs for older persons for many years but no state-wide stimulation for such activity existed until mid1956. Although some local organizations were trying to improve life for the aging, it became apparent that even dedicated volunteers needed professional help, and that most communities needed more stimulation. In 1957 the Minnesota legislature created the position of special consultant on aging, a position charged with the responsibility of "en21

Aging in Minnesota couraging cooperation among agencies, both public and private, including the department of state government, in providing services for the aging" and of "providing consultation to county welfare boards in developing local services for the aging, promoting volunteer service programs and stimulating public interest in the problems of the aging." The approach to aging in Minnesota is that the major problem is society's attitude toward aging. Attitudes must be improved in the local communities if the aging are to have equal opportunities to be useful, independent, and self-sustaining. During the period 1957-1959 the Special Consultant on Aging was able to organize twelve county committees composed of representatives from major civic, social, and professional organizations and from agencies serving older adults. These committees dedicated themselves to the development of local programs and services in their respective counties. As action progressed problems increased. More organizations requested help in initiating projects, thereby limiting the availability of the Special Consultant on Aging to those programs already going on. As a result, some programs failed and others bogged down and failed to expand in all the areas of need. It became obvious that one person could not continue to build and administer the program. This was the background for the demonstration project on aging which began in September 1959. Getting started. The first decisions to be made involved finances and the selection of the project area and the staff member to develop volunteer services. Seventy-five hundred dollars were set aside for salary and expenses. Since this amount was a bare minimum, each county agreed to provide clerical assistance when needed, the use of office equipment, and two hundred dollars for administrative expenses of the committees on aging. As it turned out, only one county spent more than a hundred dollars during the year. The criteria for the selection of the site, established by a small central-office advisory committee headed by the Consultant on Aging, included the following: (a) the five counties must be contiguous so that travel time and expenses could be kept down; (b) the site must be rural — socially, economically, and demographically; (c) at least one county in the area must have a medium-sized city (25,000-50,000) with one or more private social agencies; (d) existing facilities and programs for the aging must be limited or nonexistent; (e) the county 22

The Five-County Demonstration Project welfare boards must agree to appoint a citizens' committee on aging which would represent the geographic sections and organizations in the county — a committee with an advisory function, giving local direction to the project, its members serving without compensation. After the eighty-seven counties were screened, three potential sites were approved. At this stage, the first approach was made to the counties. A series of questions was asked of county welfare directors and welfare boards to determine their attitudes and interest in the aging and their use of citizens' committees and volunteers. On the basis of these responses, the Consultant on Aging got approval from the Governor's Citizens Council on Aging to establish the project in five counties in central Minnesota (see the accompanying tabulation), covering an area of 5,158 square miles with a total population of 148,367. The county welfare boards in the area selected were approached, and they agreed to be co-sponsors of the project. County and Population Aitkin, 11,979 Benton, 17,216 Morrison, 26,413 Sherburne, 12,708 Stearns, 80,051

Percentage of Population Over 65 13.4 9.0 10.6 10.3 8.2

Largest Community and Population Aitkin, 2,079 Foley, 1,089 Little Falls, 6,717 Elk River, 1,399 St. Cloud, 33,100

The selection of the project director was more difficult. The salary was not high enough to attract a person with considerable experience in the field of aging and in rural organization, and after several interviews the selection committee revised its criteria, deciding that the personality of the director would be more important than his educational background, and experience in organization work more important than knowledge of gerontology. This change in the qualifications desired proved a sound decision. A project director was employed who had three years' experience as a rural worker with aged persons and who had been active in college and church organization efforts. Reared in a rural area, he had taught in a one-room country school; but, more important, he was able to establish rapport and confidence in almost everyone he came in touch with. Structure. Figure 1, showing the project's structure, may help to clarify the discussions that follow. The project director was employed 23

MINNESOTA DEPARTMENT OF PUBLIC WELFARE

GOVERNOR'S CITIZENS COUNCIL ON AGING

CONSULTANT ON AGING

PROJECT DIRECTOR

THE FIVE COUNTY WELFARE BOARDS (EACH COUNTY FUNCTIONS INDEPENDENTLY: THEIR ONLY TIE IS SHARING THE PROJECT DIRECTOR AS A CONSULTANT AND COORDINATOR)

APPOINTS

THE CITIZENS' COMMITTEE ON AGING IN EACH OF THE FIVE COUNTIES (THESE COMMITTEES VARY FROM 17 TO 28 MEMBERS; THEY STUDY NEEDS OF OLDER PERSONS IN HEALTH, HOUSING, EMPLOYMENT, ADULT EDUCATION, AND LEISURE-TIME OPPORTUNITIES)

THROUGH THE PROJECT DIRECTOR ADVISES AND ASSISTS IN THE DEVELOPMENT OF PROGRAMS AND SERVICES OF

CHURCHES, AGENCIES, VILLAGES, ORGANIZATIONS, ETC. (WHICH SPONSOR SPECIFIC PROGRAMS FOR OLDER PERSONS)

Figure 1. The project's structure

24

The Five-County Demonstration Project through the state Department of Public Welfare and was supervised by the Consultant on Aging. He lived in the project area and reported to the county welfare directors regarding activities and programs in then- counties. His assignments for developing desired projects were given by the county committees on aging. His assignments in the research and demonstration aspects of the project came from the Minnesota Planning Committee. Observing principles. The principles of community organization are no different in rural areas or in programs for the aging than they are anywhere else. But since the needs of older persons are a relatively recent concern of society, the method of applying known principles is necessarily new. Because Minnesota's program was dedicated to the use of volunteers it was apparent that these people would need training in the basic principles of community organization after they were sufficiently exposed to needs and motivated to action. The first step was to get the best talent available for the county committees. The most efficient way to do this was to leave the selection to the local leaders — the elected officials on the County Welfare Board, who, in Minnesota, are also the County Commissioners. These officials did not necessarily share a common conviction about the right or responsibility of a governmental agency to provide service to those who are not voicing a need, so it became necessary not only to approach the commissioners as a group but also individually to explore and discuss their questions and reservations. The next step was to get in touch with each of the nominees for membership on the county committee to explain the project's purpose, the committee's responsibility, the degree of involvement required, and the expected contribution of each member. Every opportunity was sought to acquaint the public with the project— through speeches, newspaper articles, radio interviews; and by individual contacts with organization presidents, the clergy, professionals (public health nurse, superintendent of schools, farm extension agent, veterans' service officer, hospital administrators, and so on), and leading citizens. The foregoing steps are a necessary antecedent to any community action, and were found especially important in rural areas, where new programs and the ideas of "outsiders" encounter cautiousness and uncertainty. But even creating the awareness that problems exist does not 25

Aging in Minnesota automatically guarantee that action will follow. It was important to find local "igniters" or "initiators" who could convey confidence in the project to the rest of the citizens. To assure this support, it was important that key leaders and groups in the community publicly sanction the project. Since our avowed purpose was to change attitudes toward the aging and stir the community's conscience to voluntary action, we decided to work through the churches, civic clubs, and social organizations. From them it could be determined whether the plans were acceptable and the goals achievable and what amount of support could be expected. Strict adherence to this principle of appealing to community groups prevented well-intentioned committees from imposing unwanted programs upon the community. At the same time, elected officials, agency directors, and other persons in positions of responsibility could not be overlooked. It would have been unwise to create a force of aroused citizens in favor of a project intended to effect a change in established agency operations without first discussing the project with the agency directors. It was essential that the committee on aging include members representing the major public and private agencies in the county, who not only "legitimized" the powers of the committee but gave its lay members a sense of direction. The next step was to help the new committees to succeed in a project which would prove that their efforts were needed and would in itself be of value to the community. The method successfully used in the project was to have at the first meeting a written expression of the needs which each committee member felt existed in his county. After these needs had been tallied and discussed, a priority project was undertaken — often a party for the older persons of the county. Each member was assigned to a planning committee. The success of this initial project bound the members into a group sharing the conviction that a need was there and that it was within their power to do something to meet it. From this point the committee moved on to study other needs and stimulate community groups to take part in solving the problems. It should be noted here that seldom did two communities proceed in the same way. The community's traditional manner of meeting problems, its knowledge of the problems, the depth of its convictions, the economic conditions of the area, other popular projects underway — these are but a few of the influences on procedures. But whether 26

The Five-County Demonstration Project a committee agreed on a formal survey, a series of educational meetings, subdividing into sub-committees, or some action project, the community had to be made aware of the committee's purpose and objectives. Once a specific project was agreed upon and cleared with the appropriate persons or groups, the principle of community involvement was applied. Committees often wanted to undertake the project themselves, and indeed sometimes did. But it was found easier to sustain a project and to originate new ones when the committee remained a stimulator, educator, initiator, and coordinator, rather than a sponsor of the desired programs. If a senior citizens' club were desired, the committee discovered that it was best to stimulate local organizations to sponsor and organize the club. By this method, the work was spread to many people, and the committee was left free to study and encourage other projects and to set new goals. Methods and techniques. The objectives assigned the committees by the appointing authority (in this case the welfare boards) were broad and unspecific. But though these objectives were general, they covered three specific areas: the education of the citizens to the needs of the older person; the education of the older people themselves; and the organization and surveying of the community for solutions to the problems. The approach was to have county welfare boards appoint leading citizens — persons interested in the problems of aging but not necessarily representatives of specific organizations — to county committees on aging. At first we assumed that these committees would serve as advisory and study bodies to survey areas and recommend solutions to the local problems they found; but since their organization, these committees have become more than this: some are now action-oriented. Action in the counties was carried out through the county committees, with the local community committees on aging and the community organizations cooperating, and the project director serving as adviser to the committees. He did not tell them what should be done, but how best to achieve their objective. In the early period the committees required, and willingly accepted, direction; but the project director soon became more consultant to than director of the committees. He also served as consultant to the actual sponsors of senior citizens' clubs and other programs stimulated by the committees. 27

Aging in Minnesota A program like this needs constant review. Committees and volunteers can be used and are important, but a staff person is required for sustained continuity and direction as the program progresses. The relation of the committee to the welfare board or appointing authority must be made clear from the beginning. The argument that the committees on aging will become pressure groups against the appointing authority, and that they could become a detriment to the agency instead of a help, has not proved valid in this project. The committees have been a real help to the agency. Once given knowledge of the agency's policies, programs, and limitations, the county committees have served as valuable public relations arms of the agency. In only one instance was a staff member of the welfare department an officer of the county committee. The county welfare directors and staff set their own degree of involvement. The directors were usually hesitant to become very closely associated with the committee and its work in the early stages. But as the work progressed, they grew closer to the work of the committee and in some counties became members. It was valuable to have a chairman of a county committee who was able to devote much time to the committee's work, and who had a deep conviction of the value of what was being done. It was also important that he have the desire and the ability to stimulate the other members to accept responsibility. Complete knowledge is still lacking as to what kinds of programs will be successful in rural areas. We do know that it has been difficult to arouse interest in certain programs, such as meals-on-wheels, formal adult education courses, and the creation of employment opportunities for older persons. It has proved valuable to develop communication between the counties in the project. This has been done through newsletters, conferences, and exchange meetings with committees, welfare boards, and agency staffs. It was necessary to involve many organizations. Usually the participation of just one organization in a program limited the scope of that program, as was illustrated by the sponsorship of a certain program on preretirement planning by one farm organization, which meant that other farm organizations would not take part in the program. A 28

The Five-County Demonstration Project similar difficulty arose when one church sponsored a program for older persons, causing members of other churches to resist joining. But when several churches co-sponsored a, project, the members of all freely took part. It was extremely important to get the support and the active participation of the churches and the cooperation of the clergy. If the clergy sanctioned the program being sponsored, it had a much better chance of succeeding. And it was important in dealing with older people to use words that would be accepted: "mature" rather than "old" and "challenges and opportunities" rather than "needs." When speaking to groups it was not only vital for them to be stimulated, but for their interest to be sustained and to result in action. Material concerning what might be done was given to those attending the meetings, which they could take with them, read later, and present to their group as a possible program (see the appendix, p. 313). There were many possible projects in which organizations could be involved; for this reason it was important to have an outline of a possible program. In rural communities, which have few voluntary organizations that devote time and effort to community projects, there was noticeable suspicion among citizens about the volunteers' motivation. Some suspected that the members of the committees on aging received pay or had ulterior motives. It was essential in news releases and talks to emphasize the dedication of the committees and the voluntary aspect of their work. The clergy helped in this by including this emphasis in their announcements and sermons, discussing the motives of the volunteers and thus doing away with gossip or preventing it. It was not enough to make the point once: the less accustomed an area was to volunteer services, the more need there was for repetition. Another issue that required sensitivity and awareness on the part of the county committee, welfare boards, and the project director was the political implication. Some local people believed that a certain political party was behind the program. It had been observed in other places that community leaders and others valuable to a certain project had refused to take part if one political group was over-active in supporting or sponsoring programs for the aging. Very few persons reacted in this way in the five-county project, so there was not a widespread problem. Probably a reason for this absence of a serious prob29

Aging in Minnesota lem was the attention given to it by the project director and welfare boards and the appointment of bipartisan committees. Results of the project. (1) The appointment of county committees on aging by county welfare boards is a satisfactory way of originating such committees. There is a prestige factor in such appointments. The committee also becomes a representative committee of the people and the areas of the county. (2) Personal contacts with appointed committee members by the project director and welfare board members have proved worthwhile in impressing the importance of the work upon the appointees. Several committee members have said that they would not have accepted the appointment if this method had not been used, that they hesitated to accept until after this visit. The visit offered an opportunity to explain and discuss the project and gave an idea of the work involved. (3) Individuals and organizations are enthusiastic in responding. Agencies and churches have moved more slowly. (4) Leisure-time activities can more easily be established in small communities than in large. Small communities identify more closely with the program, because the citizens know each other. One man explained it this way: "Why shouldn't we be concerned? These are our parents and relatives and friends we have known for many years." (5) A significantly higher percentage of older persons in rural areas takes part in group activities for their age group. In one community of 175 people the average attendance at the senior citizens' club meetings has been 30. The higher percentage of participation in rural communities is perhaps due to the small community's lack of other activities in which older people can engage. Perhaps one of the measures of the success of a program is in the response of the person for whom the program is intended. A few anecdotes from the past year or two leave little doubt that many volunteer workers should feel more than compensated for the cost and effort. A woman in her eighties returned from California to her home community when she learned that there would be programs organized for people of her age. Two men in Aitkin County who had gone to school together had a glorious reunion for the first time in fifty years at the first meeting of the Golden Age Club, even though they had lived within fifteen miles of each other all the time. A man in his nineties who walks with a cane and has difficulty in negotiating steps joined a senior citizens' dancing club and is considered one of its most active 30

The Five-County Demonstration Project dancers. He reports that he never has had so much fun in his life and that he spends the whole week looking forward to the next meeting. One community reported that the Golden Age program was the only project that had brought together all the community's organizations and churches. A leading citizen said that this was the finest example he had seen in years of the citizens' interest and concern in their community. A woman of eighty-seven, walking on a rural country road seven miles from town, was picked up by a motorist. She told him that she was heading for the Golden Age Club meeting she had read about in the paper. She reported that she had not been off her farm in five years because she thought most of her friends were gone, but that she wouldn't miss this meeting for anything. In a community of 105 people, the average attendance at senior citizens' meeting is 86; obviously, some 60 of these elderly people come from outside the community and even outside the county. A men's club in a community of less than a thousand donated twenty-five dollars to a newly formed senior citizens' club for its operation. After three meetings, the men's club asked if the senior group needed more financial assistance. The president of the senior club apologized for not having informed the men's club that they placed a cup next to their refreshments and had collected sufficient funds to maintain their own activity. He added that they had even collected enough in this way so that they had been able to donate seven dollars of the original twenty-five to the Christian Rural Overseas Program. These and many other similar incidents can be found in the record of the project, valid evidence of the interest engendered in the community programs for older citizens. As the activities mature, the kinds of program have been broadened to offer more recreation. Specialinterest groups have developed Great Books discussions and jewelrymaking, for example. Opportunities to be of service to others have arisen in several clubs. One adopted an orphanage and the women make clothes and dolls for the children. Another club conducts all the fund-raising campaigns in its area. A third spends one day a week wrapping cancer bandages. Several clubs do volunteer work at nearby mental hospitals. Another addition to these senior groups has been a definite interest in opportunities for education. Most groups now provide time for a speaker during the course of their meetings. Speakers include doctors, 31

Aging in Minnesota lawyers, home economists, nutritionists, police and fire officials, political leaders, and the like. The fourth element that has come into these clubs has been the opportunities for social interaction aside from the recreational program. Opportunities to make new friends, to reminisce, and to discuss the present and the future have been provided. If in no other way, the project has been successful when measured in terms of these human factors. Summary of one year's results. More than three thousand persons attended meetings at which the needs of the aging were presented by the director, resulting in a noticeable change in attitude toward aging. Senior citizens' clubs were organized in eight communities, ranging in size from 175 to 1,400 people, with at least six more clubs in the planning stages. Hobby shows were held in three communities. A county hobby show was held as part of the Sherburne County fair. A county-wide show was held for Aitkin County at the end of 1960. Two retirement-planning lecture-discussions were held in Morrison County: one on social security and the other on legal problems (deeds, wills, property transfer) and veterans' benefits. Six communities were hosts to the sessions, with 541 persons attending the first and 326 the second. A building was bought in Aitkin to be used as a day center for older people. In five months, over twenty-five hundred dollars was raised for this purpose. Buying the building became a community effort, with most of the townspeople and organizations taking part. Many churches paid more attention to their older members, one congregation giving a dinner honoring them. Many increased their friendly visits to persons in nursing homes as well as in private homes. More transportation was made available to those needing it. A picnic for the aged was held in Aitkin County; because of its success it was thereafter planned as an annual event. Christmas parties were held in several communities in Benton and Sherburne counties, resulting in the organization of clubs. The activities of the senior citizens' clubs have been varied: a birdhouse contest between the men and the women, planting a tree on Arbor Day in honor of the older people of the community but dedicated to the youth, picnics with several clubs uniting, Christmas caroling by the older people, safety-education programs, more visiting by older persons themselves, participation in community charity drives. A glaucoma clinic was planned for Stearns County. Articles on older 32

The Five-County Demonstration Project citizens were published in local newspapers, which gave excellent coverage to the activities of the project. Members who reached the age of ninety were given special recognition by the various clubs. Transportation was provided for older persons to visit graves on Memorial Day. A county-wide survey was planned in Morrison County, sponsored by the county committee on aging in cooperation with the county nursing board, to determine the present status and needs of their older citizens. Several counties worked on directories of services available, including pertinent information of particular interest to the older citizens. Seven local community committees were organized. Several organizations provided radios for old people in nursing homes. The Aitkin County committee had a float in the Fourth of July parade. Sherburne County emphasized "Senior Citizens at the Fair." In addition to the hobby show there was a horseshoe contest for those sixty and older. Several homes for the aged developed newspapers for their institutions. Minnesota's five-county demonstration project on aging has shown, in the short span of one year, that the public can be educated to the problems of aging and can meet these challenges in such a way that the later years of life can be healthier and happier.

SO oo

An Inventory of Our Older Residents ISAAC L. HOFFMAN

Every government collects records as a by-product of its functions. Some are tabulated in a form useful in providing information about the people living under that government, but probably most simply remain buried. The first step in getting data about the numbers, characteristics, and problems of Minnesota's elderly was to mine these records. The results for the whole state are reported below. The statistics are not only proving useful for planning programs for Minnesota, but can also serve to guide other states in mining their own official records.

As PART of the activity of this state in the 1961 White House Conference on Aging, the White House Conference Planning Committee prepared two factbooks, Minnesota's Aging Citizens, A County by County Statistical Report and Inter-County Comparison Statistical Supplement. These documents present selected statistical facts about the aging population of each of the eighty-seven counties of the state. This chapter is a summary of the material reported in the county factbooks and it also relates the county data to state averages, calling attention to the major variations among the counties. The data came from existing official sources rather than from special surveys and studies. In pursuing its task, the Factbook Sub-committee — which has prepared the statistical reports and this chapter* — decided to concentrate on a small number of significant factual items which were most directly related to planning for the aging, and to use the local geographic areas as the units for reporting the information it gathered. *The Factbook Sub-committee wishes to express its appreciation and gratitude to all departments of the state government who generously supplied data and assistance. It wishes to extend its special appreciation to the Department of Public Welfare and its research and statistics unit, to the state Department of Health, the state Department of Taxation and its research personnel, and the Department of Employment Security. 34

An Inventory of Our Older Residents The statistical information most easily obtainable is not always the most important for planning services. We therefore decided to concentrate on the information most meaningful for planning, which could be secured for each of the eighty-seven counties in the state, or which could be reliably estimated for each county from the basic facts that were available. For each of the eighty-seven counties in the state we have answered the following questions: How many elderly people were there in the county in 1958? What has been the trend in population change in the county? What is the distribution by age groups of the elderly in the county? What is the distribution by sex of the elderly in the county? Where were these aging persons living in 1958? How much income did they have and where did they get it? What were their living arrangements? What were their health-care costs? What follows is a summary of the findings for each item. In each instance comments are made on the facts for Minnesota and the major variations between the state figures and the variation among the counties. Numbers. The number of Minnesota residents sixty-five and over has continued to increase. As of April 1, 1960, the number was 354,351, 10.4 per cent of Minnesota's population. In the 1950 census, 269,130 persons sixty-five or over were counted and at that time made up 9 per cent of the population. This means that in the past ten years the aging in Minnesota have increased over twice as fast as the total population— 31.7 per cent in contrast with a total population increase of 14.5 per cent (see also the accompanying tabulation, which shows the average annual rate of increase over the years for the aging and for the total population). The big jump in the rate of increase of the aging of Age 65 and Over Total 1.7% 1900-1920 2.9% 1920-1930 4.8 0.7 1930-1940 3.0 0.9 1940-1950 2.7 0.7 1950-1960 3.2 1.5 this state came, as the tabulation shows, between 1920 and 1930. Since then the rate of increase has been more or less stable and of the same size as was the rate between 1900 and 1920; it should begin to drop within the next decade. Although the proportion of the number of the aging in the population will continue to increase, this increase will not be so spectacular in the future as it has been in the past. 35

Aging in Minnesota Today those over sixty-five make up 10.4 per cent of our state population and about 17.7 per cent of the adult population. We may expect that by 1970 the aging will make up approximately 11 per cent of the total and 20 per cent of the adult population. The likely development in the proportion of the aging to the total population of the state may be as shown in the accompanying tabulation, which shows the percentage of aging to total population under conditions of minimum and maximum growth. Thus by 1990 the aging may form as much as a Maximum Minimum Growth Growth 1970 11.00% 11.25% 1980 11.75 12.00 1990 12.50 13.00 2000 11.75 12.50 quarter of the adult population. But this should be the peak, for probably by that time the proportion of the population sixty-five and over will begin to decrease in relation to total population. By the turn of the century the aging will constitute between twenty-two and twentythree and a half per cent of the adult population. This ratio will decrease for several decades thereafter, but by the year 2020 the proportion of the aging will again increase, because children born during the population boom which began in the late 1940's will then in increasing numbers begin to join the ranks of those sixty-five years of age and over. It is clear that the elderly are becoming a larger part of both the total and adult population and will continue to do so for some time. Though this has been taken by some to mean that providing for the elderly will become an increasing burden on the productive portion of the population, that conclusion does not necessarily follow. Nationally the labor force which is the productive portion of the population has been increasing primarily because of the sharp increase in the number of married women entering the labor market. In the entire country, the ratio between those sixty-five and over and the productive force has decreased or remained fairly stable since 1900. For determining dependency ratios, the volume of Gross National Product and the relation of the number of non-productive consuming dependents of all ages is more important than the relation of the number of aged or children to the number in the "productive" age groups. For the nation as a whole it is plain that the production of goods and services has 86

An Inventory of Our Older Residents more than kept pace with the increase in the number of non-producers, and this is probably as true for Minnesota as it is for the entire country. There are, however, variations among states in this respect as in others. Even more important is the variation which undoubtedly exists among localities. We may assume that there are counties in Minnesota as there are in other states where the ratio of the dependent aged is greater than the economic capacity of that locality to meet the needs of their aged for goods and services. Minnesota is among the states with a significantly higher than average portion of aging residents, although it is not one of the very highest. The states with the highest proportions of the elderly form contiguous geographic areas. The first group consists of the midwest states of Iowa in first place, Missouri second, and Nebraska third. The second group is made up of the New England states of New Hampshire and Vermont which are tied with Florida for fourth, fifth, and sixth place; Massachusetts which is seventh; and Maine which is eighth. The southwestern states of Arkansas and Oklahoma are ninth and tenth respectively. South Dakota is eleventh and Minnesota, Rhode Island, and Oregon are tied for twelfth, thirteenth, and fourteenth rank. The figures which have been cited apply to the state's situation, but when individual counties are examined they range widely in the number and proportion of aging. The differences among counties within the state are, in fact, greater than the differences between Minnesota and the other states. The largest number of the aging live in the most populous counties. Hennepin, Ramsey, and St. Louis counties are first, second, and third in both total population and in the number of aging, while Red Lake, Lake of the Woods, and Cook counties are lowest in total population and in number of aged. But this relationship is not completely uniform. The counties differ from each other in the proportion of their aged quite apart from the numbers of their total or aging population. In 1960, the proportion of population sixty-five and over for the state as a whole was 10.4 per cent. Yet the counties ranged from a high of 16.1 per cent for Chisago County to a low of 4.3 per cent for Anoka County. Not quite half (42.1 per cent) of all the aging in Minnesota live in the metropolitan counties, a third (34.8 per cent) in the Twin Cities area and 7.3 per cent in the Duluth area. Even so, relative to total population, the Twin City metropolitan counties are in the lowest 37

Aging in Minnesota fourth of all state counties. Dakota (86) and Anoka (87) counties rank lowest. Washington and Ramsey counties rank 84 and 72, respectively, and Hennepin County ranks 73. The number of elderly residents in an area influences the amount and kind of services that must be provided there. In some respects, however, the relation of those over sixty-five to the total population of the county may be more important. A county with a small population and a small number of elderly, who nevertheless make up a proportionately large part of the total, may find it more burdensome to provide services than does a county with a much larger number of aging who constitute a small portion of the total population. Although there is a very high correlation among the counties between the total number of residents and those sixty-five and over, there is no relation between the rank of the counties in the number of elderly and the percentage of the total county population these aging residents constitute. Because of this there are groups of counties in which there is a significant pattern of unbalance in the age distribution of their population. One group of counties has a significantly higher than average (highest quarter) total population and residents sixty-five and over, yet the aged in these counties make up a significantly lower (lowest quarter) than average part of the total population. Eleven counties have this favorable relation of aging to total population. Arranged in order by the number of steps of difference between rank in number of aged and rank in percentage of population these aged constitute, these counties are shown in Table 1. A second group of counties also has a favorable relation of aging to total population in that both the number of aging residents in the county and the proportion of the total population they constitute is significantly lower than the state's average. There are seven counties with this pattern, shown in Table 2. Two groups of counties have, by contrast, unfavorable relations of aging to total population. These are the counties in which there is a sharp disparity between the number of aging and the proportion of the population these aging residents constitute and the counties which have a larger number of the aging who also constitute a greater portion of the population. In the group with low aging population, which, however, is a significantly greater than average part of the total popu38

Table 1. Eleven Counties with Favorable Relation of Aging to Total Population: High Total Population, Low Aging Population Rank Order Number* County

Population 65 and Over

Percentage

7 4 6 1 2 18 15 12 23 20 16

86 82 79 73 72 87 84 80 83 74 69

Dakota Stearns Olmsted Hennepin Ramsey Anoka Washington Mower Clay Itasca Freeborn

of Total

Population

* Based on ranks of 87 counties from 1 — highest county to 87 — lowest county. Table 2. Seven Counties with Favorable Relation of Aging to Total Population: Low Total Population, Low Aging Population Rank Order Number* County

Population 65 and Over

Percentage of Total Population

Lake Murray Rock Stevens Wilkin Cook Benton

62 71 73 76 81 87 64

85 75 68 67 71 77 76

* Based on ranks of 87 counties from 1 — highest county to 87 — lowest county. Table 3. Five Counties with Unfavorable Relation of Aging to Total Population: Low Total Population, High Aging Population Rank Order Number* County

Population 65 and

Percentage of Total .copulation

78 70 75 77 80

22 5 14 20 23

Clearwater Hubbard Grant Big Stone Kittson

* Based on ranks of 87 counties from 1 — highest county to 87 — lowest county.

39

Aging in Minnesota lation, are the five counties shown in Table 3. In these counties the situation is affected by the relatively higher than average proportion that the aging are of the total county population rather than the number of aging there are in these counties. In the last group are three counties — Ottertail, Kandiyohi, and Fillmore — which not only rank in the highest quarter of the counties with the largest number of aging residents (fifth, seventeenth, and twentyfirst respectively), but the ratio of their aging to their total population (sixth, sixteenth, and eleventh) also places them in the highest fourth of the counties; that is, these counties both have a much higher than average number of persons sixty-five and over and these persons are a significantly greater than average proportion of the total population. With three exceptions, the counties with the greatest unbalance in their patterns of distribution of aging population (that is, the 10 per cent of the counties with the highest ratio of aging to total population, relatively high ratios even though low numbers of aging, and both high ratios and large numbers of elderly) lie in a geographic belt which extends in a northwesterly diagonal line across the central part of the state. The counties with the more favorable patterns (low ratios of aging to total population, and lower numbers and population ratios of aging), again with the exception of three counties, are either in the Twin City metropolitan area elsewhere or in the southeastern part of the state. The two populations of the aging. The increase in the number of persons sixty-five and over has been well publicized. Another trend which is perhaps of even greater importance for planning services to the elderly has received less public attention. In the past two decades the numbers in the age groups from seventy on and especially between seventy-five and eighty-five have been increasing at a faster rate than the sixty-five through sixty-nine group. Between 1950 and 1959, the United States Bureau of the Census estimates that for the entire country persons sixty-five through sixty-nine decreased by 3.1 per cent; but persons seventy through seventy-four increased by 4.4 per cent, persons seventy-five through seventy-nine increased by 21.4 per cent, the eighty through eighty-four group increased by 12.5 per cent, and the eighty-five and over group increased 25 per cent. The trend in Minnesota has not been so spectacular as this national trend, but nevertheless there has been a marked difference in the rate of growth of the 40

An Inventory of Our Older Residents number of Minnesota residents past seventy-five and that of those sixty-five through seventy-four. Between 1930 and 1960 the rate of growth in the various age ranges of the aging population of the state of Minnesota has shown the following pattern: 65-69 90.1% 70-74 111.6 75 and over 162.1 Minnesota's residents past seventy-five have increased at a rate almost one and a half times faster than did those between sixty-five and seventy. Since 1900 the number of the elderly aged sixty-five through seventy-four compared with those seventy-five and over has been declining slowly. In 1960 the ratio was almost 2 to 1, as compared with a 7 to 3 ratio in 1900. The pattern of this change in age composition among the older residents of Minnesota is shown in the accompanying tabulation. The lack of decline in this ratio in the two decades between 1910 and 1930 probably reflects the decline in immigration because of the change in the United States' immigration policy during and after the First World War. Since Minnesota had received substantial numbers of younger aged immigrants prior to these decades, the loss of this source of population interrupted the otherwise slow but continuous increase in the proportion of elderly seventy-five and over. This change will continue, probably in an even more marked degree, in the next several decades. The modern advances which are enabling more persons to live beyond their sixty-fifth year are enabling an even greater proportion to live beyond their seventy-fifth. 65-74 75 and Over 1900 71.4% 28.6% 1910 67.8 32.2 1920 68.6 31.4 1930 71.8 28.2 1940 67.3 32.7 1950 66.5 33.5 1960 65.9 34.1 The effect of this trend has already been felt in the field of institutional care. In homes for the aged and nursing homes there are fewer and fewer persons in their late sixties and early seventies as compared with those in their eighties. The average age of residents in many, 41

Aging in Minnesota if not most, of the institutions is in the upper seventies and lower eighties. This differential rate of growth of the very oldest part of our population is of special importance. Though the age group sixty-five through seventy-four will always be a larger portion of the elderly as compared with those over seventy-five, the substantial increase in the numbers over seventy-five has created two populations or categories of aging, each with different needs and service requirements. In the larger population, the sixty-five through seventy-four group, most are relatively able-bodied, some working though most are retired. By contrast, the numerically smaller but growing number beyond the age of seventyfive are less able-bodied, probably require more health services of a more expensive nature, and come to this period of their lives after ten or more years of retirement, with less income and fewer income resources to meet the costs of their increasing medical needs. As the number in the upper years increases, there will be more persons who have lived longer on a retirement-level income. In the earlier years of retirement, most live in their own households with their spouses. Service for them must focus on better income maintenance opportunities, employment, more appropriate independent housing, and more socially meaningful and personally satisfying use of leisure time. As these citizens go into their later years in larger numbers, their needs change. Increasing disabilities after a longer period of lowered income may require more subsidized health services and institutional facilities. In this respect as in others there is wide variation among the counties. In 1960 the ratios of the aged sixty-five through seventy-four to those seventy-five and over ranged from the low county, Cook, with a 3:1 ratio (Table 4) to the high, Dodge, with a 3:2 ratio (Table 5). Sex distribution among the aged. The fact that American women outlive men is very well publicized, as is the fact that women over sixty-five are increasing in numbers and proportion in relation to the number and proportion of men. In 1900, nationally, men over sixtyfive outnumbered women over sixty-five 102.2 to 100; by 1960 this ratio had been reversed to 100 (women) to 82.9 (men). Minnesota, however, did not conform to this national pattern. As late as 1950, men in this age group still outnumbered women 100 to 99.3. During the past ten years Minnesota has come much closer to catching up with the national pattern. In the 1960 Minnesota census, women over 42

An Inventory of Our Older Residents Table 4. Nine Counties with the Lowest Ratio of Those 65-74 to Those 75 and Over* County Watonwan Blue Earth McLeod Le Sueur Olmsted Wabasha Goodhue Nicollet Dodge

Rank

65-74

75 and Over

79 80 81 82 83 84 85 86 87

62.1% 62.1 61.9 61.8 61.7 61.3 61.0 60.8 59.5

37.9% 37.9 38.1 38.2 38.3 38.7 39.0 39.2 40.5

*For Minnesota as a whole the ratio is 65.9:34.1. Table 5. Nine Counties with the Highest Ratio of Those 65-74 to Those 75 and Over* County Cook Marshall Mahnomen Aitkin Crow Wing Itasca Anoka Kittson Benton

Rank

65-74

75 and Over

1 2 3 4 5 6 7 8 9

74.9% 71.2 70.0 69.8 69.6 69.4 68.8 68.7 68.7

25.1% 27.8 30.0 30.2 30.4 30.6 31.2 31.3 31.3

*For Minnesota as a whole the ratio is 65.9:34.1.

65 outnumbered men, at a rate of 90.8 men for each 100 women. But for Minnesota this difference in favor of women is still significantly less than the national average. In this as in most other facts about their aging population, the counties show a marked variation from the state average. There is a very sharp contrast between Cook County, which has the most aged males in proportion to aged females, at one end of the range (Table 6) and Olmsted County, which has the fewest aged males in proportion to the aged females (Table 7). In Cook County there are practically twice as many men as women sixty-five and over. Olmsted County, on the other hand, has a fourth more aged women than men. Tables 6 and 7 give evidence of the wide spread among the counties in the ratio of males to females sixty-five and above. There is a moderately close correlation among the counties in their ranking for the ratio of males to females and age groups sixty-five through seventyfour to seventy-five and over. Thus the counties with the highest ratio 43

Aging in Minnesota Table 6. Nine Counties with the Most Aged Males in Proportion to Aged Females County Cook Lake of the Woods Koochiching Roseau Mahnomen Clearwater Marshall Aitkin Kittson

Rank

Number of Males Per 100 Females*

1 2 3 4 5 6 7 8 9

198.1 158.9 157.0 1376 135.7 1355 134.0 134.0 131.9

* For Minnesota as a whole, the number of aged males per 100 aged females is 90.8. Table 7. Nine Counties with the Fewest Aged Males in Proportion to Aged Females County Brown Nicollet Steele Rice Winona Blue Earth Hennepin Ramsey Olmsted

Rank

Number of Males Per 100 Females*

79 80 81 82 83 84 85 86 87

86.3 85.5 84.7 83.2 83.0 80.0 75.9 73.8 73.8

* For Minnesota as a whole, the number of aged males per 100 aged females is 90.8.

of males tend to be the counties with the higher percentage of population age sixty-five through seventy-four. They are in the northern part of the state, in contrast to the counties with the lowest ratio of men to women which are the Twin City metropolitan counties (Ramsey and Hennepin), or in the southern part of the state. The upper age groups, those beyond seventy-five years, show a marked predominance of women over men. As the proportion of the elderly in the ages beyond seventy-five increases throughout the state, we may expect an increasing disparity in the ratio of males to females. Even so, in the northern counties the excess of aged males over females should continue for some time to come. Urban-rural distribution of the aging population. The largest number of elderly live where the largest number of all age groups live, in 44

An Inventory of Our Older Residents urban centers. It was not always thus. Minnesota was largely a rural state until 1930 as the accompanying tabulation, of the percentage of population living in rural areas, shows. Total Population 65 and Over 1910 59.0% 66.2% 1920 55.9 59.1 1930 51.0 52.2 1940 50.2 50.2 1950 46.1 44.9 1960 39.0 38.7 The trend in the present century for the rural population to decrease is true of the aging no less than the other age groups. In fact, until 1930 the proportion of the aging in rural areas of the state dropped faster than the proportion of other age groups. The depression decade interrupted but did not halt this downward trend. Even in that decade the downward movement of the aging in rural areas was slightly greater than for the other age groups. Since 1940, however, the greater rate of decrease of the aging in rural areas has lessened. The rate of out-migration of the rural elderly has slowed down, whereas that of the younger segments of the population has increased. By 1960, 61.3 per cent of Minnesota's population age sixty-five and over was living in urban centers. The 38.7 per cent who were in rural areas were located principally in rural villages rather than on farms. In the years from 1930 to 1960 the elderly of Minnesota living in urban towns and cities increased one and a half times —154 per cent. The major change has been the decrease in the number of the aging living on farms. There has been a steady movement of the elderly from farms to the rural villages and urban towns. In 1920 almost a third (31.6 per cent) of the aging population of the state was living on farms. Since that time, this proportion has decreased steadily, the sharpest decline taking place between 1940 and 1950, when the percentage dropped 9 per cent. In 1950 the number of Minnesota residents living on farms made up 18.3 per cent of all the aging in the state. By 1960 only 12.6 per cent of the aged were living on farms. The increase in the number of aging in rural villages has almost kept pace with the increase of the elderly in the urban towns and cities. Between 1930 and 1960 the number of residents sixty-five and over living 45

Aging in Minnesota in rural villages increased by 139 per cent, as compared with a 154 per cent increase for the towns and cities, meaning that the proportion of Minnesota's aging living in rural villages has been relatively stable. In 1920, 27.5 per cent of Minnesota's elderly were in rural villages. By 1940 this figure had dropped to 22.9 per cent. Since then, the rate of increase has quickened so that by 1960 26.1 per cent of Minnesota's aging residents were in rural villages. The decrease in the number of the aging on farms has been offset by the increase in the urban towns and cities. At present, most of the aging in the state are living in the larger communities, those with more than 25,000. It may be, however, that the movement of the elderly has not been directly from the farm to the larger communities but rather to rural villages and smaller urban towns of under 25,000. There is evidence to suggest that some rural villages and smaller towns are becoming important centers of residence for older people. Among the counties we again find wide variation. Only sixty of the eighty-seven Minnesota counties had urban communities of 2,500 and more, and in twenty-seven counties there were no urban population centers. Obviously, no elderly residents were living in urban towns and cities in these counties. For the state as a whole, 61.3 per cent of the elderly were living in urban towns and cities. But the percentage varied among the sixty counties, from the urban metropolitan Ramsey and Hennepin counties, where 97 per cent and 90 per cent, respectively, of the aging were in urban centers, to Itasca County, where only 12.4 per cent were in urban centers. All eighty-seven counties had elderly residents living in rural villages. With a state average of 28.2 per cent, the range among the counties varied from Cook County with 93.2 per cent of its elderly citizens in rural villages to Hennepin, Ramsey, and Brown counties with 8.1, 2.9, and 0.7 per cent, respectively, of their elderly in rural villages. There is also as wide .a variation in the number of older persons living on farms. Compared with the estimated state average of 12.6 per cent, Kanabec County ranked highest with an estimated 51.7 per cent of its elderly on farms, and Hennepin and Ramsey counties lowest, with 0.9 and 0.1 per cent of their older residents on farms. Wide variations also appear among the counties in the rate at which the number of older residents in urban centers has been increasing or decreasing. In the sixty counties with urban centers, the fastest in46

An Inventory of Our Older Residents crease of population in them took place in Lake County. For the state as a whole, the increase was 154 per cent, but in Lake County the increase between 1930 and 1958 in the number of elderly in towns and cities was 339 per cent. The least change occurred in Wabasha County, which showed an increase of only 60 per cent. The trend in the number of older residents in rural villages was upward between 1930 and 1960, except in three counties, Big Stone, Wilkin, and Brown. Big Stone County had a 1 per cent decrease, Wilkin an 11 per cent decrease, and Brown a 93 per cent decrease. In the remaining eighty-four counties, the number of older persons in rural villages increased, ranging from Anoka County, which showed a 972 per cent jump, to Stevens County, where the elderly in rural villages increased by only 0.3 per cent. The movement of older citizens away from farms does not happen in all the counties in the state. The 1960 census shows that in twentyeight counties there was an increase rather than a decline in the percentage of older residents on farms between 1930 and 1960. In several counties the increase was very small, but several others show sizable growth; the increases ranged from a high of 74 per cent in Itasca County to a low of 1 per cent in Jackson County. In the fifty-eight counties where the percentage of elderly living on farms dropped during this period, the difference among the counties ranged from an 85.4 per cent decrease for Ramsey County to a 0.8 per cent decrease in Faribault County. These county data raise the question of whether the movement of the older people away from the farms may be related to the productivity and hence to the wealth of the farm areas. The counties with the most prosperous farm lands tend to show a higher rate of decrease in older residents on farms than do the counties with the less productive farm lands. Does this mean that in the less productive farm areas the older residents must remain on the farms because they are less able to leave? Does it also mean that in the more productive farm areas the older residents retire more readily as they grow older and leave their farms for rural villages and small towns because they have the means to do so? Income levels of the aging. Another well-known condition of the aging population is its relatively low income. Nationally, information on the income of the aging is available, but locally the information is less adequate. For our report, the state Department of Public Welfare 47

Aging in Minnesota prepared a county-by-county analysis of the 1958 number of persons getting Old Age Assistance and the number getting Old Age and Survivors' Insurance. Also the state Department of Taxation made a county-by-county analysis of the state income tax returns of Minnesota residents sixty-five and over. From these several sources it has been possible to make county estimates of the income levels of the elderly in each county in our state. The income estimates are based on the personal money income of persons sixty-five and over. A more adequate analysis of the income resources of the elderly would relate their incomes to the family or household units of which they were members. Unfortunately this is not possible. We do not have adequate data on income in terms of the number and types of units within which the elderly receive and use their income, but we have some indirect evidence which may be helpful. The estimates of the living arrangements of the elderly derived from Census Bureau data show that between 28 and 32 per cent of the elderly in Minnesota were living alone or were apparently responsible only for their own maintenance. The remaining 68 (perhaps less) to 72 per cent were economically responsible for or lived with others. An analysis of the state income tax returns of Minnesota's aging shows that 27.9 per cent of those filing claimed no dependents; 64.9 per cent claimed one; 5.5 per cent claimed two dependents; and 1.7 per cent claimed three or more. It would appear that a substantial number of the aging live in consuming units of more than one person, but it is not known whether the numbers over sixty-five or others are the income-suppliers in these units. A fourth (24.9 per cent) of Minnesota's aging filed state income tax returns in 1958. Of these 82,814 elderly citizens, 27.9 per cent had annual gross incomes of at least $1,000. The remaining 72.1 per cent reported gross incomes of $2,000 or more. Only half (52.1 per cent) of those over sixty-five who filed had sufficient net income to require payment of an income tax. Thus, 43,120 or 13 per cent of Minnesota's residents sixty-five and over paid income tax in that year. The aging make up about 18.5 per cent of the adult population of the state, but the income tax returns they filed were only 8.2 per cent of all returns. This is, of course, a clue to the lower level of income of the aging as compared with the general public. From the sources mentioned, the Factbook Sub-committee devel48

An Inventory of Our Older Residents oped the following estimate of the number of persons sixty-five and over in Minnesota in 1958 with personal incomes at the levels shown in Table 8. Because of the nature of the data from which these estimates were derived, a broader grouping of income levels is probably more reliable. In 1958, 66.3 per cent of Minnesota's residents sixty-five and over had personal incomes under $2,000; 28.9 per cent between $2,000 and $5,000; and 4.8 per cent $5,000 or more. A comparison of the income distributions of Minnesota's aging population with the national average for the aging as reported by the Census Bureau shows that the incomes of Minnesota's elderly citizens are somewhat higher than the national average (Table 9). While the proportion of the aged with actual income under $2,000 is approximately the same for Minnesota and the entire country, there is a significant difference in the proportion of the aging with no cash income. The sizable difference between Minnesota and the United States average in this category may result in part from a statistical estimating error. But the probabilities are that even if there is some statistical error in the Minnesota estimate, a significant real difference exists between Minnesota Table 8. Number and Percentage of Elderly Persons Sixty-five and Over at Various Income Levels Cash Income Level

Number

Percentage

None Under $1,000 $1,000-$1,999 $2,000-$2,999 $3,000-$3,999 $4,000-$4,999 $5,000 and over

8,427 73,449 188,439 50,570 35,060 10,431 15,874

2.5% 22.1 41.7 15.2 10.6 3.1 4.8

Table 9. Percentage of Elderly Persons at Various Income Levels, Minnesota and U.S. Compared Cash Income Level None Under $2,000 . . . $2,000-$3,999 . . . $4,000-$4,999 . . . $5,000 and over .

United States

Minnesota Percentage

2.5% 63.8 25.8 3.1 4.8

Cumulative Percentage 66.3% 92.1 95.2 100.0

49

Percentage 16.8% 63.0 12.9 3.1 4.2

Cumulative Percentage 79.8% 92.7 95.8 100.0

Aging in Minnesota and the entire country in the number of elderly with no cash income. Minnesota also has considerably more older citizens with incomes between $2,000 and $4,000 than does the country as a whole. The proportion of Minnesota income tax returns filed by residents over sixty-five also casts light on the income status of the aging population. The aging represent 18.5 per cent of the adult population of the state. If their income was proportionately the same as the income of the general adult population, we would expect about 18.5 per cent of the returns at each income level would be filed by persons over sixtyfive. But the returns of such persons reporting gross incomes up to $3,000 represented only from 11 to 11.75 per cent of all returns in this income category. For incomes between $3,000 and $10,000 the proportion of the over sixty-five group varied from 4 to 7.5 per cent. For incomes between $10,000 and $40,000, the proportion supplied by this group ranged from 7 to 9.5 per cent. In the $40,000 to $100,000 income bracket, the group's part was 12.5 to 14 per cent. Only for incomes of $100,000 and more did the proportion of returns filed by those over sixty-five exceed 18.5 per cent. In this income bracket 25 per cent of the returns were filed by persons age sixty-five and over. In all income categories other than the $100,000 one the aging are significantly under-represented; they are most under-represented in the categories from $3,000 to $10,000 and slightly less, but still considerably under-represented in the $10,000 to $40,000 categories. They are least under-represented in the income categories under $3,000 and between $40,000 to $100,000. Only in the very high income category of $100,000 or more do the aging show any sizable over-representation. In 1958, 200 persons over sixty-five reported gross incomes for tax purposes of over $50,000, another 1,152 reported incomes between $15,000 and $50,000, and 1,698 reported incomes of $10,000 to $15,000. Thus 3,410, or 1.1 per cent of Minnesota's aging population, had what may be considered high personal incomes. In the $5,000-$10,000 bracket, a medium-high income level, there were 12,465, or 3.7 per cent of the elderly. The remaining 95.2 per cent had low-average or very low personal incomes. This wide variation among the counties of the state in the income levels of their older residents is even more important than the variation in other characteristics. There are two methods of ranking the counties by income level of the elderly: the rank order of counties with 50

An Inventory of Our Older Residents the highest percentage of their aging residents having individual incomes of $5,000 a year or more; or the rank order of the counties according to the percentage of the aging with annual incomes under $2,000. The two methods will put the counties in different order because of the variation among counties in the proportion of their elderly with incomes between $2,000 and $5,000: the counties with the highest percentage of their aging with incomes over $5,000 are not consistently the counties with the lowest percentage of their aging with incomes under $2,000. Table 10. The Highest and Lowest Counties as Determined by Each Method County

$5,000 and Over %

High Brown Low Cook Kanabec

Rank

Under $2,000 %

Rank

$2,000-$4,999

.0

1

52.0

87

40.0

0.0 0.7

87 78

83.0 96.7

25 1

17.0 2.6

The effect of using each method of determining the county with the highest and lowest incomes among its aging residents may be noted in Table 10. By both methods Brown County is in the most favorable position, but the county with the lowest income level is different, depending on which method is used. On the basis of incomes $5,000 or more, Cook County is at the bottom; on the basis of the percentage with incomes under $2,000, however, Kanabec County has the highest percentage — that is, it is at the bottom of the list. The analyses which follow rank counties as favorable on the basis of incomes of $5,000 or more and unfavorable on the basis of incomes under $2,000. The counties that rank highest in income of the general population do not consistently rank highest in income of the aging population, though there is a substantial correlation between the two. The counties whose general population has the lowest income are also not consistently lowest in income for the aging. The rank order of counties according to the income of the general population on the basis of average tax liability per income tax return for the nine counties in the highest 10 per cent of all Minnesota's counties and the rank order of counties by income of the aging population on the basis of the per51

Aging in Minnesota Table 11. Rank Order of Income Level of Population 65 and Over in Nine Counties with Highest Income Level of General Population Rank Order of Income Level Countv

General Population

Population 65 and Over

1 2 3 4 5 6 7 8 9

5 2 8 22 11 7 32 9 19

Hennepin Mower Ramsey Olmsted St. Louis Freeborn Washington Itasca Winona

Table 12. Rank Order of Income Level of Population 65 and Over in Nine Counties with Lowest Income Level of the General Population Rank Order of Income Level County

General Population

Population 65 and Over

87 86 85 84 83 82 81 80 79

82 85 58 86 46 81 47 63 76

Red Lake Pine Todd Hubbard Mahnomen Aitkin Grant Roseau Mille Lacs

centage with income of $5,000 or more were as shown in Table 11. Of these nine counties, seven also rank in the upper group for income of the aging. The other two counties, Olmsted and Washington, show a significant difference between the income of their general population and that of their elderly, who have relatively smaller incomes. At the other end of the scale, the 10 per cent of the counties with the lowest income for general population and the income of their aging population as measured by the percentage of the aging with incomes of $5,000 or more are shown in Table 12. Here, of the nine counties with the relatively lowest general population income, five also are in this category for income of the aging. In four counties the aging were in a much better position in terms of the proportion having income of 52

An Inventory of Our Older Residents Table 13. Nine Counties with Aging in Lower Income Position Relative to the General Population Rank Order of Income Level County Cook Polk Carlton Clay Nobles Cottonwood TCanabeo Steams Washington

Aging Population

General Population

Difference between Ranks

87

32 15 29 18 43 37 51 22 7

55 44 39 32 29 28 27 27 25

59

68

50

72 65 78 49 32

$5,000 or more a year than was the general population in terms of their average income. Throughout the range of counties there are some in which the aging are either in a much lower relative income position in relation to the general population of the county (Table 13) or in a much higher position (Table 14). In twenty-two of the eighty-seven counties there is enough difference between the rank order of income of the aging and of the general population to indicate a meaningful lack of balance in the relative income position of the two groups. In thirteen counties the relative income position of the aging is more favorable than that of Table 14. Thirteen Counties with Aging in Higher Income Position Relative to the General Population Rank Order of Income Level County Lincoln Chisago Lac qui Parle Chippewa Dodge Mahnomen Grant Brown Redwood Clearwater Todd Norman Swift

Aging Population

General Population

Difference between Ranks

6 IS 27 31 21 46 47 1 12 45 58 37 38

78 76 77 72 62 83 81 31 42 74 85 64 63

72 63 50 41 41 37 84 80 SO 29 27 27 25

53

Aging in Minnesota the general population of these counties, and among these thirteen, the top seven show a very marked and significant better relative position of the aging. In the lower six the difference is notable, but not so marked. In nine counties the position of the aging is less favorable than that of the general population. In the top four of these this discrepancy is very marked and significant, but in the bottom five it is notable but less marked. Table 15. Nine Counties with the Highest Percentage of the Aging Population with Incomes of $5,000 or More County

Percentage

Brown Mower Koochiching Wilkin Hennepin Lincoln Freeborn Ramsey Itasca

8.0 6.6 6.0 6.0 5.8 5.8 5.2 5.0 5.0

Rank 1 2 3 4 5 6 7 8 9

Table 16. Nine Counties with the Lowest Percentage of the Aging Population with Incomes of $5,000 or More County

Percentage

Rank

0.0 0.1 0.1 0.2 0.2 0.4 0.4 0.4 0.6

87 86 85 84 83 82 81 80 79

Cook Hubbard Pine Isanti Lake of the Woods Red Lake Aitkin Wadena Douglas

In the foregoing discussion the criterion of higher income for the aging has been the proportion of the aging with income of $5,000 or more a year; the percentage of the aging in this category is, however, very small, as is clear from Tables 15 and 16. If we use as our criterion of the income level of the aging the more meaningful statistic of the percentage with incomes under $2,000, we find that the counties which arrange themselves in highest and lowest relative order, or in which the aging are in a better or worse relative position for income level with respect to the general population, include some counties not included when we used the income criterion of 54

An Inventory of Our Older Residents aging with incomes of $5,000 or more. The nine counties with the highest percentage of aging with incomes under $2,000 are shown in Table 17, the nine counties with the lowest in Table 18. The rank order numbers in these two tables is the reverse of those used for the criterion "percentage of aging with incomes of $5,000 or more"; the lower the rank number of the county the greater the percentage of aging with Table 17. Nine Counties with the Highest Percentage of Their Aging Having Incomes Under $2,000 Rank and County 1. Kanabec 2. Cass 3. Mille Lacs 4. Wadena 5. Hubbard 6. Sherburne 7. Clearwater 8. Todd 9. Carlton .

Incomes of the Elderl; Under $2,000

$2,000-$4,999

96.7% 96.1 95.5 93.7 92.9 92.1 91.0 90.7 89.6

26% 3.5 37 59 0.1 32 23

17 13

$5,000 or More

0.7% 1.4 0.8 0.4 7.0 4.7 6.7 7.6 9.1

Table 18. Nine Counties with the Lowest Percentage of Their Aging Having Incomes Under $5,000 Rank and County 87 Brown 86. Ramsey 85. Wilkin 84. Dakota 83. Olmsted 82. Martin 81. Hennepin 80. Jackson 79. Nicollet

Incomes of the Elderly Under $2,000 52.0% 59.5 62.2 63.1 63 1 64 1

647 652

65.2

$2,000-$4,999

$5,000 or More

40.0% 35.5 31.8 34.1 33.4 31.8 29.5 33.3 33.8

8.0% 5.0 6.0 2.8 3.5 4.1 5.8 1.5 1.0

incomes under $2,000, and therefore the less favorable the income level of the aging. That is, the nine counties with the highest rank numbers are the counties in which the aging have the lowest income, and, contrariwise, the nine lowest counties are those where the aging are in the most favorable income position. When we use both criteria for the 10 per cent of the counties whose aging have the highest level of income, we get a list of fourteen coun55

Aging in Minnesota ties (compared with nine counties which constitute 10 per cent of the total counties — four counties selected by both criteria, five counties selected by the $5,000-or-more criterion, and five selected by the under-$2,000 criterion). (Table 19.) Table 19. Twelve Counties with Highest Income Level for Their Aging, Using Both or Either Criteria County

Rank Order by Income Level of Aging $5,000 or More

Under $2,000

1 2 8 S 4 36 5 22 6 14 7 62 9 73

87 69 86 58 85 84 81 83 36 82 61 80 56 79

Brown* Mowerf Ramsey* Koochichingf Wilkin* Dakota* Hennepin* Olmsted* Lincolnf Martin* Freebornf Jackson* Itascaf NicolletJ

* By both criteria. fOn the basis of the $5,000-or-more criterion. * On the basis of the under-$2,000 criterion.

On the basis of this analysis, in four counties (Brown, Ramsey, Wilkin, and Hennepin) the elderly are in the most favorable relative position. In another five counties (Mower, Olmsted, Freeborn, Martin, and Itasca) the aging are still in a favored position, but there is enough difference between their rank positions on one or the other criterion to suggest some imbalance in the distribution of incomes among the elderly relative to the average for the state. The remaining five counties qualify as most advantaged counties by one of the criteria but not by the other. Nicollet County ranks high because it has a significantly lower than average proportion of its aging with incomes under $2,000, but it ranks fourteenth from the bottom in the number of elderly with incomes over $5,000; very few of the aging have high incomes, but many fewer than average have low incomes. Jackson County to a slightly less extent is in this position, as is Dakota County. In contrast, Lincoln and Koochiching counties rank very high in the number of the elderly with incomes of $5,000 or more, but are in the high-average 56

An Inventory of Our Older Residents and low-average range respectively in the numbers of their elderly with incomes under $2,000. When we turn to the other end of the income range and view the nine counties with the poorest income for their aging the picture is as shown in Table 20. The variation is greater at the lower end — the Table 20. Sixteen Counties with Lowest Income Level for Their Aging, Using Both Criteria County•

Rank Order by Income Level of Aging Under $2,000

$5,000 or More

1 25 2 5 3 13 4 14 46 6 16 7 30 8 9 24

78 87 67 86 76 85 80 84 83 28 82 45 81 58 68 79

KanabecJ Cookf CassJ Hubbard* Mille LacsJ Pinef Wadena* Isantif Lake of the Woodsf SherburneJ Red Lakej ClearwaterJ Aitkinf ToddJ CarltonJ Douglasf

*By both criteria. fOn the basis of the $5,000-or-more criterion. J On the basis of the under-$2,000 criterion.

counties with low income among their aged. The eighteen ranks — the nine lowest for income under $2,000 and the nine lowest for income of $5,000 or more — are filled by sixteen counties. Two counties (Hubbard and Wadena) are low, for income of aging, counties by both criteria. Seven counties (Kanabec, Cass, Mille Lacs, Sherburne, Clearwater, Todd, and Carlton) are low because of the high percentage of incomes under $2,000. The other seven (Cook, Pine, Isanti, Lake of the Woods, Red Lake, Aitkin, and Douglas) are low because of the low percentage of incomes of $5,000 or more. On the basis of this analysis eight counties — Hubbard, Wadena, Kanabec, Mille Lacs, Pine, Isanti, Red Lake, and Carlton — are the lowest counties in the state judged by both criteria. Two more counties— Douglas and Cass — qualify as low on both criteria, but the spread in the difference between the two criteria puts them on the 57

Aging in Minnesota borderline. The other six counties divide themselves into two groups. Todd County is a low-income county for the aged because of the large percentage with incomes under $2,000, but its percentage with incomes of $5,000 or more puts it in a borderline low-average position according to the other criterion. In Aitkin and Cook counties the reverse situation prevails: the percentage of aging with incomes of $5,000 or more is very low, but the percentage with incomes under $2,000 is at a borderline high-average position. Clearwater County has a very high percentage of aging with incomes under $2,000, but is average for incomes of $5,000 or more. In Lake of the Woods County the exact reverse is true, and to the same degree: it is average for incomes under $2,000 but very low for incomes of $5,000 or more. Finally, in Sherburne County there is a very large percentage of the aging with incomes under $2,000, but the proportion of those with incomes of $5,000 or more is high average. The foregoing discussion has compared the counties with poor income for their aging in relation to the two criteria of upper and lower segments of income among the aged only. When the low-income counties are compared on the basis of income of the general population we have a situation comparable to that at the upper end of the scale. There are counties in which both the general and the aging population have consistently much lower incomes than the average for the state; there are counties in which the aging are in a relatively much better position than the general population, as well as counties in which the aging are in a much more disadvantaged position than the general population. A comparison of the ranking of the counties by the three criteria — average income of the general population, percentage of the aging with incomes of $5,000 or more, and percentage of the aging with incomes under $2,000 — reveals nineteen counties in which the income of the aging was relatively better than the income of the general population of the county (Table 21). In seven counties, the aging are in a relatively better position than the general population by both the $5,000or-more criterion and the under-$2,000 criterion. In six of these counties the reason is that the income of the general population is the lowest in the state. In contrast, in Dodge County the income of the aging is in the highest group by both income criteria. In Lincoln County the aging are high on the $5,000-or-more criterion and average for the state 58

An Inventory of Our Older Residents Table 21. Nineteen Counties in Which the Income of the Aged Is Relatively Better Than the Income of the General Population Rank Order of Income County

General Population

Lincoln Chisago Lac qui Parle Dodge Chippewa . Mahnomen . . . Grant Brown Redwood Clearwater . Todd Norman Swift Nicollet Jackson Wabasha Goodhue Lake of the Woods Faribault

78

76

77

62 72 83 81

31 42

74 85

64

63

65

Aging Population with Income of $5,000 or More

Difference between Ranks

6 13 27 21 31 46 47 1 12 45 58 37 38

72 63 50 41 41 37 34 30 30 29 27 27 25

47 61

44

71 35

Rank Order by Aging Population with Income Under $2,000

Difference between Ranks

52

26

24 11 37 83

53 51 35 34

1

30

38 9 8 26 12 42 18

25 56 39 35 32 29 27

on the under-$2,000 criterion. In Lac qui Parle County the reverse is true: the aging show high income on the under-$2,000 criterion, average income on the $5,000 or more. In three counties (Chippewa, Mahnomen, and Swift) the income of the aging by both criteria is average, but this is better than the relatively low income of the general population. In Brown County the income of the aging is very high by both criteria, which puts them in a better position than the general population of the county, who have an average income. In six of the twelve remaining counties the aging are in a better income position relative to the general population on the basis of the $5,000-or-more criterion but not according to the under-$2,000 criterion. In five of these counties the income of the general population is relatively low; in Chisago County the percentage of the aging with $5,000 or more is high; in Grant, Clearwater, Norman, and Todd counties the percentage is average. In Redwood County the income of the general population is average, but the percentage of the aging with incomes of $5,000 or more is high. 59

Aging in Minnesota In the other six counties the aging show a better income position in relation to the general population of their county only according to the under-$2,000 criterion. In three counties the income of the general population is low; in Nicollet and Wabasha a relatively low percentage of the aging has income under $2,000, and in Lake of the Woods County the aging show an average percentage with income under $2,000. In the other three counties (Jackson, Goodhue, and Faribault) the income of the general population is average, but the percentage of aging with incomes under $2,000 is low. Table 22. Fourteen Counties in Which the Income of the Aged Is Relatively Worse Than the Income of the General Population Rank Order of Income County

Cook Polk Carlton Kanabec Clay Nobles Stearns Washington Sherburne Watonwan Morrison Wadena St. Louis Winona

General Population 82 15 29 51 18 43 22 7 24 34 39 58 5 .9

TlnnV OrHpr

Aging Population with Income of $5,000 or More

Difference between Ranks

by Aging Population with Income Under $2,000

Difference between Ranks

87 59 68 78 50 72 49 32

55 44 39 27 32 29 27 25

25 38 9 1

31 35 51 36

6 15 20 4 58 54

58 39 29 26 25 25

By the same method of analysis there are fourteen counties (Table 22) in which the income of the aging is in a much worse position relative to the income of the total population. In four counties the aging have a poorer income position than does the general population on the basis of both criteria. In the three counties (Cook, Carlton, and Kanabec) the income of the general population is average and the income of the aging is low ranked by both criteria. In Polk County the income of the aging is average, but the income of the general population is high. In another four counties the aging have a relatively low income compared with the general population on the $5,000-or-more criterion but not on the under-$2,000. In three of the counties (Clay, Stearns, 60

An Inventory of Our Older Residents and Washington) the income of the general population is high, but the percentages of the aging with incomes of $5,000 or more is average. In Nobles County the income of the general population is average in contrast to the low percentage of aging with income of $5,000 or more. There are six more counties where the aging are disadvantaged in comparison with the total population by the criterion of income under $2,000, but not by the criterion of an income of $5,000 or more. In three of these counties the general population has a high income, but in St. Louis and Winona counties the percentage of the aging with incomes under $2,000 is average. In Sherburne County the aging have very low incomes — that is, the percentage with incomes under $2,000 is very high. In the other three counties (Watonwan, Morrison, and Wadena) the income of the general population is average, but the aging have a low income. It should be clear from this analysis of the various aspects of the income of the elderly that their economic position bears a complex relation to that of the general population and to the distribution of incomes for both general and aging population in the various parts of the state. In absolute terms the individual incomes of the aging are low — significantly lower, on the average, than those of the total population. In those parts of the state where the income of the general population is higher than state average the elderly have the double disadvantage of low absolute income and low relative income in a high-income area. The same disadvantage prevails when the elderly have an even lower income in a low-income area. Yet there are a few places where the aging, even with their low incomes, are in relatively as good a position or a better position than a substantial segment of the general population. Income sources of the aging. Difficult as it is to get an accurate account of the income levels of the aged, it is even more difficult to give an accurate picture of the sources of their income. A major reason for this difficulty is that both the aging and the general population get their incomes from a variety of sources. Some of the elderly work full or part time and derive all or most of their income from employment or self-employment in business, a profession, or farming. Some draw part or all of their income from capital investments and assets. Many more who are not engaged in enterprise or in other gainful employment derive their income in whole or part from annuities, employer's or union 61

Aging in Minnesota pensions, the various government-sponsored social security programs, public assistance (primarily Old Age Assistance), the contributions of relatives or friends in cash or kind, or the support of their spouses or children. Many have several sources. An analysis of the income sources of Minnesota's aging on the basis of data available to the Factbook Sub-committee gives the estimate of sources of cash income shown in Table 23. Table 23. Sources of Cash Income of Minnesota's Aging Income Source Old Age Assistance (total) To supplement Old Age and Survivors' Insurance. Old Age Assistance grants only Old Age and Survivors' Insurance (total) With Old Age Assistance supplements Without Old Age Assistance supplements All other sources Full- or part-time gainful non-agricultural employment

Number „ of«r> Persons

Percentage .of Minnesota's ,„ . Aged population

49,194 . 11,680 37,514 188,150 11,680 176,470 106,586

14.8% 3.5 11.3 56.6 3.5 53.1 32.1

69,280

20.8

The information on the major source of income for the 13 per cent of Minnesota's aging citizens who paid Minnesota income tax reveals that the income of 57.4 per cent came from wages and salaries, 10.9 per cent from business enterprise, 14.8 per cent from farming, and 16.9 per cent from investments. A comparison of the 1958 data for Minnesota with 1959 estimates for the entire United States is shown in Table 24. From this comparison it is evident that the proportion of Minnesota's aging who received Old Age Assistance was about average for the country. A significantly smaller proportion of Minnesota's elderly were drawing Old Age and Survivors' Insurance pensions than was true for the whole country, and this difference was balanced by the other sources of income. The only category within these other sources for which we can compare Minnesota and the entire country is gainful employment. In this respect Minnesota's elderly occupy a slightly more favorable position than the aging throughout the country. The proportion of the elderly in Minnesota with full- or part-time gainful employment exceeded the national average by 1.3 per cent. 62

An Inventory of Our Older Residents Table 24. A Comparison of 1958 Minnesota Data and U.S. Data on Income of the Aging Percentage of Population 65 and Over

Income Source

Minnesota

U.S.

Public assistance* Old Age and Survivors' Insurance All other sources Gainful employment Other self resources Railroad retirement Government employee retirement Veterans' pensions Unspecified sources

11.3% 56.6 32.1 20.8% t f f f 11.3

11.5% 62.6 25.9 19.5% 12.7 3.9 6.0 9.0

Total Minus duplication due to Multiple pensions Employment pensions and insurance

32.2%

51.1% 8.1% 17.1

Other sources

25.9%

* Primarily Old Age Assistance less Old Age and Survivors' Insurance supplements. fData not available.

The data on the individual counties vary, of course, from the state figures. The percentage of the aged with all other sources of income except Old Age and Survivors' Insurance and Old Age Assistance, which averaged 32.1 per cent of the entire aged population of the state, varies from a high of 77.3 per cent of the aging population in Anoka County to a low of 7.7 per cent in Kanabec County. In eight counties (Anoka, Lake, Nicollet, Dakota, Scott, Rock, Olmsted, and Kandiyohi in order) the major income of the aging came from elsewhere than Old Age and Survivors' Insurance and Old Age Assistance; in these counties Old Age and Survivors' Insurance was the second major source of income and Old Age Assistance was last. In sixty-four counties Old Age and Survivors' Insurance was the major source of income of the aging, the second major source was Old Age Assistance, and other income was last. In no county was Old Age Assistance the major source of income for a majority of the residents sixty-five and over. The differences among counties in the proportion of the aging who had cash income from taxable sources varied from Stevens County where 40.1 per cent of the aging had to file returns, to Cass, the lowest county, where only 5 per cent filed returns. The state average was 24.9 per cent. On the other hand, only 13 per cent of the population sixtyfive and over had sufficient net income from taxable sources to require 63

Aging in Minnesota a payment of Minnesota income tax. In the payment of state income tax by the aged the variations extended from Koochiching County, where 18 per cent paid, to Mille Lacs, the low county, where only 1.4 per cent did so. The difference in the ranking of counties for filing returns and paying income tax is the result largely of differences in the number and wealth of farm operators sixty-five and over in these counties: more elderly farmers had sufficient gross income to require the filing of a tax return than had enough net taxable income to require the payment of income tax. There is also substantial variation among the counties in the proportion of their aging who had full- or part-time gainful non-agricultural employment. Ramsey and Hennepin counties ranked highest, with 30.3 per cent and 30.0 per cent of their elderly gainfully employed, as against Chisago County, which ranked last with 8.8 per cent. The state figure for elderly people receiving Old Age and Survivors' Insurance pensions was 56.6 per cent. The variation among the counties in this respect ranged from Red Lake County, with 73.6 per cent drawing such pensions, to Anoka County, where only 17.8 per cent did. The range of variation among counties for Old Age and Survivors' Insurance as the major income source was somewhat less than for the number receiving pensions. On this basis, the variation extended from the highest counties, Wadena and Lake of the Woods, with 67.7 per cent of their aging residents having Old Age and Survivors' Insurance as their principal source of income, to Anoka as the low county. There was also a substantial range in the average annual amount of Old Age and Survivors' Insurance pensions. The state average was $668 for 1958; the range among the counties went from Ramsey County with $739 to Wadena County with $509. The proportion of the aging who have their Old Age and Survivors' Insurance pension supplemented by an Old Age Assistance grant is a reflection of the adequacy of their social security grant. In the state 3.5 per cent of the aging required such assistance. Among the counties the variation ran from the high county, Lake of the Woods, where 12.7 per cent of the aging required this supplement, to Otter Tail County, where only 0.7 per cent did. Ten counties reported no Old Age Assistance supplementation of the Old Age and Survivors' Insurance pensions. As has been indicated, 14.8 per cent of the elderly of this state re64

An Inventory of Our Older Residents ceived Old Age Assistance grants, and of these 11.3 per cent received Old Age Assistance grants but no Old Age and Survivors' Insurance pension. The variation among the counties in the number of elderly residents who received Old Age Assistance grants ranged from Clearwater County, where 40.6 per cent of the elderly were on the rolls, to Nicollet, where only 6.1 per cent were. For those who received Old Age Assistance without any Old Age and Survivors' Insurance pensions, the range went from Clearwater County's high of 40.6 per cent to Anoka County's 4.9 per cent. As against an average annual Minnesota Old Age and Survivors' Insurance pension of $668, the 1958 Minnesota average Old Age Assistance benefit was $972. This varied from Hennepin, the high county, with an average annual grant of $1,151, to Wilkin, the low county, with an average grant of $696. The state average of the elderly who received income from Old Age Assistance and/or Old Age and Survivors' Insurance pensions was 67.9 per cent. The variation among the counties ran from Clearwater, where 99 per cent of the aging received such funds (although 13 per cent had some income from other sources) to the low county, Anoka, where only 22.7 per cent of the elderly had income from either or both of these two sources. Living arrangements of the aging. Important for purposes of planning services for the elderly are the living arrangements and housing conditions in which they live. Because there are no data to use as a basis for reliable estimates of the housing conditions of the aging county by county, this characteristic has not been included in the present study. It has, however, been possible to prepare county estimates of the major categories of living arrangements of the elderly in 1958. The accompanying tabulation shows the number of persons in various living arrangements and the percentage they form of the state's total aging population. A fifth of the elderly were maintaining an independent household and living by themselves. A little less than half were maintaining their own household with their spouse or others. Most of these households consisted of husband and wife, but information was not available as to how many were married couples and how many were households with aging heads and other members. A little less than a fourth of the aging were living in the households of others, most of them probably without a spouse. The number of elderly living, mostly alone but perhaps a few in couples, in rooming houses or hotels, 65

Aging in Minnesota together with the aging population in institutions, made up the remaining slightly more than one tenth of Minnesota's aging. Living Arrangement Number Percentage With spouse with or without others in own household 149,925 45.1 In household of others 76,707 23.1 Alone in own household 67,128 20.2 In rooming houses or hotels 25,067 7.6 In institutions 13,424 4.0 A comparison among the counties of the differences in living arrangements reveals that the range of variation is considerably less for this characteristic than for any of the other characteristics of the aging, although there are several significant patterns. The range of difference among the counties for the proportion of aging living alone in their own household shows a particularly interesting pattern. Although the spread between the counties is not wide, a geographic pattern appears in the variations. The counties with the highest proportion of their elderly in this category, except for Hennepin and Ramsey counties which ranked fifth and sixth respectively, are primarily in the northern tier of counties in the Arrowhead and north central part of the state. The state figure for elderly living alone in their own households was 20.2 per cent. Fourteen counties had a higher average than this, and ten of these fourteen were in this northern area. Cook, Grant, Koochiching, and Lake counties had at least a fourth of their elderly living alone in their own households. It is also of interest to recall that the counties which show a significant predominance of elderly males over females are for the most part the counties which also show the highest proportion of the aging living alone in their own households. This signifies that a large proportion of those over sixty-five living alone in their own households in these northern counties are elderly men maintaining their own households. The variation among the counties is quite small for the number of the aging maintaining their own households with a spouse or others. The state average is 45.1 per cent. The county with the highest proportion (49.3 per cent) of its elderly in this situation was Dakota. The lowest, with 43.5 per cent, was Ramsey. It is noteworthy that Ramsey, Hennepin, Brown, and St. Louis counties were the counties with the smallest part of their aging living in their own households with their spouse or others. 66

An Inventory of Our Older Residents The differences among the counties in the proportion of their elderly living in the households of others varied from Itasca County with 30.5 per cent to Cook with only 15.9 per cent. There is no special pattern in this variation. St. Louis, Ramsey, and Hennepin counties were close to the bottom of the list, ranking seventy-ninth, eightieth, and eightyfirst, with respectively 21.2, 20.1, and 19.8 per cent of their older residents living in the households of others. As might be expected, the counties with the highest proportion of the aging in rooming houses and hotels were Ramsey, Hennepin, St. Louis, and Olmsted. One exception is that Brown County (New Ulm is its major population center) ranks third highest, ahead of St. Louis and Olmsted. The variation among the counties, however, is not great. The spread runs from Ramsey County with 9.8 per cent to Kanabec with only 2.7 per cent, as compared with a state average of 7.6 per cent. The percentage of the aging in institutions shows a narrow spread among the counties. The state average of 4.0 per cent compares with a spread from Ramsey and Hennepin counties, with 4.8 and 4.7 per cent of their elderly in institutions, to Pine and Kanabec counties, with only 2.4 and 1.9 per cent. As would be expected, the counties with the highest proportion in institutions are the metropolitan counties of Ramsey, Hennepin, St. Louis, Anoka, and Dakota (in that order). Health status, health care, and health care economics of the aging. Clearly, some of the most important concerns about the elderly is their health, the amount of medical care they need and get, and the means whereby they pay for it. This is a topic which has aroused not only considerable interest but much public controversy. Some factual national information about these topics exists, but we have very little specific information about individual states or localities within the states. In view of the wide variation among the counties in most other characteristics of the aging, there is no reason to suppose there should be fewer differences in the area of health. Unfortunately, no material from official sources was available to the Factbook Sub-committee on the health status of the aging in each county. Nationally, we have data from the United States National Health Survey for the period July 1, 1957, through June 30, 1958. This survey reports that the population over sixty-five had the lowest incidence of episodes of acute illness of all age groups, averaging only 1.6 such 67

Aging in Minnesota episodes per person during that period of a year, as compared with 1.8 episodes for the 45-64 group and 2.2 episodes for the 25-44 age group. Children and youths had a substantially greater number of episodes of acute illness. Those over sixty-five, by contrast, were much more subject to chronic conditions, and the disabilities and limitations growing out of these conditions, than was any other age group. During this year the survey found that between seven and eight out of every ten aging persons had some chronic illness or limitation. The percentages of chronic conditions and limitations of the aging of this country are shown in the accompanying tabulation. This is the national picture. How applicable it is to the state of Minnesota and, more particularly, to its counties, we do not know. Kind of Limitation Percentage No chronic illness, disability, or limitation of activity 13.8 No chronic illness or disability but some limitation of activity 9.5 Total 23^3 Chronic condition but no limitation in mobility 53.4 Chronic condition interfering with ability to get around alone 15.3 Chronic condition and confined to home 4.7 Chronic condition and in institution 3.3 Many studies point to the fact that the aged require more health care than adults in the other age brackets. The National Health Survey reports that in the 1957-1958 study period, the aged averaged twice as many days in hospitals per person per year as did the general population. They saw a physician 40 per cent oftener than the general population did. For Minnesota, the only evidence of this type available to the Factbook Sub-committee on a county-by-county basis was the health care experience of Minnesota's Old Age Assistance recipients. Data were obtained on medical grants to Old Age Assistance recipients during a sample month in each county. The sample months differed for the various counties, but all were in the period from January through June 1958. This material reveals that, in the month sampled, 51.1 per cent of the recipients had a medical grant. Annually it is possible that as many as 75 to 80 per cent of the Old Age Assistance recipients had some health care during the year. The recipients who received medical 68

An Inventory of Our Older Residents care represent 7.5 per cent of the aged of the state. It cannot be maintained that they are a representative sample of the health needs and health care experience of all the aged in the state, because these included only recipients of public assistance, who constituted not quite 15 per cent of the aged of the state in 1958. Looking at a tabulation of the Old Age Assistance recipients who received medical grants for each county, one is struck by the wide differences among the counties. The variation extends from Itasca County, where 72.8 per cent of the recipients received a medical grant in its sample month, to Cook County, where 29.0 per cent did. As against a 50 per cent average for the state, two counties gave medical grants to almost 75 per cent of their recipients, two counties to 67 per cent, five counties to 60 per cent. At the lower end of the distribution, three counties provided medical attention to only 33 per cent and another ten to fewer than 40 per cent of their recipients. A number of those who received grants were given more than one service in the month; the state average was 1.4 medical services per recipient aided. The number of Old Age Assistance recipients in the state receiving each kind of service and the percentage of all Old Age Assistance recipients so aided is shown in the accompanying tabulation. This tabulation shows that most recipients received drugs; many fewer visited a physician, were cared for in nursing homes, and required miscellaneous health-related aids such as prosthetic devices, special diets, and glasses. Almost six per cent were hospitalized. Dropping sharply was the proportion of recipients receiving dental care or nursing care in their own homes. The evidence from several sources suggests that home nursing services to those over sixty-five is not very extensive, but the question whether this is true because they need no more such services or because home nursing care services are not available cannot be answered on the basis of the information we have. Number of Percentage of Kind of Care Recipients All Recipients Drugs and prescriptions 14,154 23.8 Visits to a physician 6,456 13.1 Nursing-home care 5,584 11.4 Miscellaneous health services 3,963 8.1 Hospital care 2,896 5.9 Hospitalization insurance premiums 1,096 2.2 Nursing care in own home 620 1.3 Dental care 526 1.1 69

Aging in Minnesota The 2.2 per cent of the Old Age Assistance recipients who were aided in paying their hospital insurance premiums call for special comment. It is the policy of the state Department of Public Welfare to encourage older residents who apply for Old Age Assistance to continue their hospital insurance if they already have it when they apply for aid. This is done by including the payment of the premium as a medical grant in their approved budget. The low number who received grants for this purpose suggests that only a very small part of the elderly who must apply for public assistance are carrying insurance. Only thirty-seven of the eighty-seven counties reported medical grants for health insurance premiums. In the thirty-seven counties, the percentage of recipients covered ranged from Hennepin County with 7.8 per cent to Becker County with 0.1 per cent. This situation is, of course, not representative of the health insurance situation of the majority of the elderly population in the state. The distribution of payments for health services differs substantially from the distribution of the number receiving these services. The average medical grant to the over 50 per cent of the recipients who received health services in the sample months was $59.92. The percentages of the Old Age Assistance medical grant funds used for the various services compared with a distribution of health care expenditures for all aged and for the general population (data derived from a national study) are shown in Table 25. In considering the extent of health services by kind of care given the Table 25. Distribution of Health-Care Expenditures of Minnesota Old-Age Assistance Recipients Compared with the Elderly and General Populations of the TJ.S. Percentage of Health Expenditures Health Service

Minnesota Old Age Assistance Recipients

Nursing-home care Hospital care Physician's services Drugs and medications Dental care Other services Nursing care in own home Miscellaneous health servic Hospitalization insurance

35.6% 34.1 11.5 10.7 1.4 6.7 33 3.2 0.2

* Data not available.

70

Population 65 and Over

U.S. General Population

23.8% 34.4 21.2 3.9 16.6

19.7% 37.5 15.1 15.2 12.2

An Inventory of Our Older Residents Old Age Assistance recipients, one is struck by the variations among the counties. The greatest variation, proportionately, is found in the percentage of recipients receiving nursing care in their own homes. Thirteen counties reported no grants for this purpose. In the remaining seventy-four counties the percentage so aided varied from the high county, Le Sueur, with 5.7 per cent, to the low county, Beltrami, with 0.1 per cent. The service with the next greatest degree of variation was dental care. Fourteen counties reported no grants. Among the seventythree remaining counties, the variation ranged from Freeborn County with 2.4 per cent to Fillmore with 0.2 per cent. Next in order of degree of variation among counties were the miscellaneous health care services. Hennepin gave such aid to 24.6 per cent of its recipients, Grant gave no aid, and Wadena County assisted 0.9 per cent. Hospital care grants varied among the counties only slightly less than the miscellaneous health services. All counties had medical grants for this purpose. Marshall County gave the largest proportion of hospital care grants, assisting 12.5 per cent of its recipients. Dodge was the low county, with only 0.9 per cent. The variability among counties for nursing-home care was only slightly below that for hospital care. Cottonwood had the largest percentage (20.9 per cent) of recipients in nursing homes, and Mille Lacs was at the other end of the range, with only 2.0 per cent of its recipients in nursing homes. The narrowest range of variation among counties was in the number receiving grants for drugs and medication. Physicians' services to Old Age Assistance recipients showed the next to the lowest degree of difference among the counties. Grants for drugs and medications varied from Lake of the Woods County, which aided 46.3 per cent of its recipients in this manner, to Cook County which helped 19.4 per cent. Ramsey County was lowest (7.6 per cent), but this is a special situation to be explained in the discussion of physicians' services. Services of a physician to Old Age Assistance recipients varied among the counties from Benton, which aided 36.8 per cent of its recipients in this manner, to Carlton, in eighty-sixth place (with 8.5 per cent). Ramsey County again was in last place, with 1.8 per cent. Both for pharmaceuticals and for physicians' service the Ramsey County figures are artificial. In this county, and in no other, most Old Age Assistance recipients are provided with outpatient medical care and prescriptions through either the county hospital or the voluntary clinics of the com71

Aging in Minnesota munity. Neither of these sources makes charges payable through vendor claims against Old Age Assistance funds. The low Ramsey County percentages for prescriptions and visits to physicians reflect the method of service rather than the amount of service the Old Age Assistance recipients received. Conclusion. The foregoing summary presents a general inventory of some of the major characteristics of the aging population of our state. It should be abundantly clear that the aging differ among themselves, as the counties vary among themselves, and as our state varies from the other states of this nation. To have the most useful facts for the purposeful planning of better services to the aging, each community must examine the situation of its own elderly citizens. The two factbooks, Minnesota's Aging Citizens, A County by County Statistical Report, and Inter-County Statistical Supplement, enable each county to examine the basic facts about its aging citizens. The present inventory gives a general picture. Those interested in the details should refer to these two statistical monographs prepared for the Minnesota Planning Committee for the White House Conference on Aging.

72

Seventeen Hundred Elderly Citizens MARVIN J. TAVES AND GARY D. HANSEN

Records collected by government agencies for various purposes could not tell the whole story about a state's aging population. Information also had to come from the elderly themselves, answering questions about their needs, problems, attitudes, and relations with public services. Securing these data was a long, hard job; the chapter below is a tribute to the many volunteers who helped. The findings are useful not only for planning future Minnesota programs, but they give a picture of older Americans which should have relevance for the nation.

THE general purpose of this chapter is to increase knowledge and understanding about the later years of life as reported by seventeen hundred elderly citizens of Minnesota. Comparisons among different subgroups vividly illustrate marked variations in patterns of living, needs, and resources. People living in rural, urban, and metropolitan residences are contrasted with each other, and throughout this chapter those in institutions and those in other living arrangements in the community are compared. A special section brings out some of the situational and adjustment differences between elderly men and elderly women. We offer some theories and interpretations as plausible explanations of the findings, and we hope that professional persons and lay leaders working in the various fields of gerontology will expand and test these NOTE The impetus for this survey of the elderly in Minnesota was twofold: first, a grant to study the impact of social security on Minnesota farmers and farm landlords was provided to the Minnesota Agricultural Experiment Station by the United States Department of Agriculture and the Department of Health, Education, and Welfare; second, the Minnesota Planning Committee for the White House Conference on Aging was interested in a broader study of characteristics and attitudes of the aging, and of facilities available to them, in a range of communities throughout the state. Arnold M. Rose, in his capacity as Governor's Designee for Planning for the White House Conference on Aging, appointed a survey sub-committee, consisting of Miss Eddice Barber, Roy Fran73

Aging in Minnesota interpretations and implement the findings into useful programs and policies for the aging. This study also provides some guidelines to those who are planning for retirement, inasmuch as the experiences of their predecessors may clarify what they can expect, what decisions they will have to make, and what opportunities and problems may arise. The portrait of the later years is inviting and positive for most, but less than satisfactory for a substantial minority. Each section is addressed to answering several specific questions and testing certain hypotheses and stereotypes. The theoretical orientation is that of social psychology, incorporating symbolic-interaction theory, structure-functional theory, and personality theory and concepts. INTRODUCTION

How do our citizens over sixty-five see themselves? What work were they doing before retirement and what are they doing now? Do they live at home or in an institution? What do they consider the most enjoyable things in life after sixty-five? What do they regard as their cis, Mrs. Hugh Gower, Gary Hansen, John Magoffin, Bernard Nash, Mrs. Opal Tewes, and Marvin Taves, chairman, to develop the design for the urban and metropolitan phases of the research. The study required a cooperative volunteer effort of considerable magnitude. It is estimated that over ten thousand hours of work were contributed by volunteers in the interviewing and processing of the data. Three organizations shared major responsibility for the project: the sociology department of the University of Minnesota, the Minnesota chapters of the American Association of University Women, and the Minnesota Department of Public Welfare. In such an enterprise, individual contributors are far too numerous to mention, but certain organizations and groups deserve special recognition. The Minnesota chapters of the American Association of University Women supervised and conducted most of the interviewing, with help from other local community organizations. The coding was accomplished by the St. Paul Retired Teachers; United Church Women of Greater Minneapolis; Minneapolis Altrusa Club; women from various religious organizations in Wayzata, Minnetonka Beach, and Edina; volunteers recruited by the Volunteer Services Program of Minneapolis; university students; and other people who spontaneously offered their time and talents. Almost every volunteer was a college graduate and was trained for interviewing and coding by experienced professional social-survey scientists. After the information was collected and coded, it was punched into IBM cards and tabulated. The St. Paul Fire and Marine Insurance Company and the Minnesota Mutual Insurance Company contributed free technical supervision, manpower, and machines for these extensive operations. Computations of percentages and further refinements of the data were made by Pearl Nishioka, Karen Bruce, Margaret Snyder, and Annabel Saltzman, and editorial assistance by Marie Samanisky, in the department of rural sociology at the university. The authors and all who may profit from these studies are indebted to those who have been so generous in contributing to this pioneering survey of aging in Minnesota.

74

Seventeen Hundred Elderly Citizens greatest needs? Did they plan or prepare in any way for this period of their lives? Do they have savings, insurance, or social security — in other words, do they have enough money? How do the aging view their health? Are they aware of services available to older residents of the community, and what changes would they like in programs for the aging? Do men and women differ markedly in their attitude toward growing old? Finally — a question of prime interest in this study — how do all these problems of aging affect the elderly resident of the rural area as compared with those in small towns or in the metropolitan centers? Field surveys conducted during 1961 sought answers to these and many other questions about older people. This is a statistical and analytical report of those field surveys. Some characteristics of the sample. The tremendous costs of securing data from every older resident in the state obviously made sampling a necessity. The total sample of seventeen hundred consisted partly of interviews with fourteen hundred persons living in area (city block) samples of those sixty-five or over, in eleven selected smaller cities (referred to as urban) and the metropolitan centers of Minneapolis, St. Paul, and Duluth, as pinpointed in Figure 2. These interviews were conducted by local volunteers under the supervision of the Minnesota chapters of the American Association of University Women. A separate survey was made by professional interviewers of a random sample of three hundred social security beneficiaries whose eligibility for retirement benefits was based at least in part on income from farming. This group makes up the rural part of the sample. The survey of the urban and metropolitan areas was conducted altogether independently of the rural survey and shortly after the latter was completed. The questionnaires are not identical, accounting for the fact that in some of the statistical analyses one segment of the sample may be omitted, thereby reducing the total number on which percentages are based. Note of this will be taken where it applies. All surveys were directed by a team of sociologists from the University of Minnesota. Whenever answers to questions come from a sample population rather than from the total population the study is concerned with, it is important to raise the question of the representativeness of the sample. As in other similar studies, our findings are valuable only to the 75

Figure 2. Location and size of samples in this study of Minnesota's elderly people extent that the sample reflects the situation in the total population. What distortion is apparent in our samples arises mainly from a slight over-representation of healthier, more communicative elderly persons of higher socio-economic status, though in most communities volunteers made every effort to maintain the original structure of the sample. Of the seventeen hundred persons interviewed, slightly over half (54 per cent) were women. The ages ranged from the middle sixties to the nineties (Table 26) with almost half in their seventies. As might be

76

Seventeen Hundred Elderly Citizens expected, those in institutions* tended to be somewhat older than the rest; relatively few of them were under seventy, while half were eighty or over. The majority of those interviewed had not attended high school. There was only a slight difference in the level of educational achievement between persons of the urban and the metropolitan areas, but between these two as a group and those of the rural area there was a great difference (Table 27). Schooling beyond the eighth grade was reported by only 15 per cent of the rural residents interviewed as compared with 44 per cent of the urban and 49 per cent of the metropolitan residents. Also, only 2 per cent of the rural elderly reported any college education, as compared with 18 per cent and 20 per cent respectively for the urban and metropolitan aging. These figures do not include any of the institutional population. These differences probably reflect the inadequacy of educational facilities in the rural areas many years ago, when those now elderly were of school age, even though all of those now residing and interviewed in the rural area may not have gone to school there. Approximately half of those living in the community were married and living with spouses (Table 28), whereas those in institutions were largely widows, widowers, or persons who had never been married. Single persons make up only a tenth of the aged in the community, but more than a fourth of the institutional population. The wealth of these old people varied greatly, the highest being reported by those in the rural area, over half of whom named a net worth of $20,000 or more. As might be expected, the lowest was reported by residents of institutions, over half of whom said they were in debt or had no assets (see Table 33 later in this chapter). A third of the respondents had been employed in private household or other service work, a fifth in professional or technical work, and the rest had been craftsmen, in clerical or sales work, or in farming, either as laborers or foremen, or in a managerial or proprietorial capacity (Table 43). Additional questions arise, not having to do with the representative*For purposes of comparative analysis, though distinctions will constantly be made between those in institutions (homes for the aged and nursing homes) and those in the community (living in non-institutional residences — especially private homes and apartments), the shorter terms "institution" and "community" will be used to distinguish the groups on the basis of residence, with full recognition, however, that all institutions are very much a part of the community.

77

Aging in Minnesota Table 26. The Age of the Elderly Population, by Place of Residence

62-70 71-79 . 80 and over

Institution (N = 401)

Community (N = 981)

Rural (N = 298)

Age

33% 51 16

10% 41 49

39% 45 16

Table 27. Years of Schooling of the Elderly,* by Place of Residence Years of Schooling

1% 12

0 1-4 5-7

8 9-10 11 12 13-15 16 More than 16 h

Urban (N = 636)

Rural (N = 294)

Metropolitan (N = 320)

1% 7 16 32 13 3 10 9 5 4

26

46 8 1 4

1 1

1% 8 17 25 12 4 13 8 8 4

Not including institutional population. Table 28. Marital Status of the Elderly, by Place of Residence

Marital Status Married and living with spouse Spouse dead Widow Widower Single Married and not living with spouse Separated Divorced

Rural (N = 296) 62% 27* 10

Urban-Metropolitan Community (N r= 987) 47% 36 6 9 1 0 1

Institution (N = 402) 5% 44 15 27 4 1 4

*The rural survey did not distinguish between widows and widowers; therefore only the total is given.

ness of the sample, which have local, state, and national significance and which may be illuminated by this research. What is it like to grow old in the United States at the present time? What are the unique problems and opportunities for the aging created by our existing social structure? Social structure, as herein broadly conceived, includes the means of achieving goals in our society, as well as the meanings and values that govern social settings and have bearing upon the attitudes, 78

Seventeen Hundred Elderly Citizens adjustment, and behavior of the aging. This chapter is concerned, in part, with such means, meanings, and values, and will include a broad range of specific facts and images about aging. In addition to inspecting social-structural conditions, we shall give attention to interpretative and philosophical issues on the one hand and to the social service adaptations of our society to meet the needs of the elderly on the other. NEEDS OF THE AGING AS THEMES OF THE RESEARCH

According to the seventeen hundred elderly persons interviewed, the major dimensions of life (social and economic well-being, work, and health), with which this report deals, are of crucial importance and form the nucleus of life in the later years. When asked, "If wishes could change your present situation, in what three ways would you most wish it to be changed?" our respondents chose good health, more money, travel, companionship, and work. These wishes represent learned values, emotionally laden, that are products of a social structure historically based upon the availability to all men of life, liberty, and the pursuit of happiness. These opportunities can be made more specific: (1) health (as total physical and mental well-being — life), (2) money (with which one buys material goods, education, travel, and other opportunities — which suggest freedom of choice and liberty), (3) companionship and work (the social bonds and creative self-expression which contribute to happiness). Thus, these wishes are based on a history which has expressed strong desires to be eternally free and self-directing. These desires became constitutional and inalienable rights which have been maintained and taught to new generations by war, legislation, and judiciary action with such emotional zeal that they have come to be basic values which direct wish-, goal-, or need-oriented behavior, particularly of a sociogenic nature. Through interaction with others, a person's conception of himself is strengthened by the achievement of goals derived from such values. Society's rewards (status, power, approval, acceptance, esteem, recognition) are generally based upon men's introjection of its values and their achievement of their goals. Problems stem from our social structure. Many problems in aging, and hence of society, arise because the opportunities to reach goals are largely controlled by the middle-aged and withheld from the elderly; 79

Aging in Minnesota society emphasizes youth, strength, and vigor; a major industrial objective is mass production for immediate financial gain; industries replace manpower with machines and require high technical training to operate the machines; urbanization and mechanization have increased the mobility of family and friends, often away from the parents and grandparents; and physical and mental capacities decline. All of these prevent the elderly's reaching their goals and cause frustration in their satisfying of the needs they have in common with people of all ages. Needs and wishes of the elderly. A need grows partly out of prior learning and may become stronger in the absence of its object or when that object is hard to get. When society erects barriers to the fulfillment of needs whose satisfaction has brought pleasure throughout life, serious consequences to the individual may result. Health, for example, is highly valued as an indication of youth and strength, and it is necessary for productivity. Old people have more health setbacks, proportionately, than the general population does. Many have lost their jobs and other sources of income while the cost of drugs, hospitalization, and medical services has skyrocketed, in an inflationary economy, along with the cost of other services. Retirement at sixty-five, loss of income, and inflation combine with physical deterioration to cause real worry for the elderly, many of whom say, in effect, "I'll have just enough to live on if my health stays good and if nothing unexpected comes up." It is not hard to understand, therefore, why over half the aging interviewed said that they wanted free or low-priced clinics in their communities. Certainly social security, pensions, and the like will help to meet the mounting costs for those who are recipients of these benefits; but for some time to come such sources will not, for many people, adequately cover the costs of necessary health care. These lacks or inadequacies in the structure of our social and welfare organization have a deleterious effect on the aging. Not only has our society prevented some old people from reaching their goals and satisfying their needs, it has also failed to provide services to help them to fulfill a minimum of those needs — services made impossibly expensive for them because of flaws in our social structure. In addition to the desire to maintain their health, the other principal wishes expressed by the aging (more money, companionship, travel, 80

Seventeen Hundred Elderly Citizens and work) provide central themes for this chapter. Such wishes do not differ very much on the basis of institution or community, or rural, urban, or metropolitan residence; they dominate in all groups in the sample. Only about a tenth said they were satisfied with their present situation and had no wish to change it. It must be concluded that any program of services to the older people of Minnesota should offer opportunities to maintain or improve health, to strengthen one's financial position, to travel more, to increase or provide for companionship, and to make available work or other activities which enhance feelings of usefulness. Enjoyable things in the life of the elderly. The wishes of the elderly reflect their dissatisfactions. What, on the other hand, are the most enjoyable things in their lives? First come indoor activities, such as watching television, listening to the radio, and reading. No difference appeared here between the urban and metropolitan, or between the institutional and open-community residents. Almost a third of all those interviewed rank indoor activities first among the pleasures of daily life. Visits and communicating by phone or letter with family or friends were a very close second — the most enjoyable daily activities for 28 per cent. Working at home or on the job ranked third. (Table 29.) Hobbies or the use of such skills as the ability to paint or play music were of most interest and enjoyment to 10 per cent of each group and Table 29. The Most Interesting or Enjoyable Things in Daily Life Mentioned by the Elderly, by Place of Residence* Community (N = 905) Indoor activities (television, radio, reading) 29% Visiting or communicating (telephone or letter) with family and/or friends 31 Working at home or on the job away from home 14 Hobbies or using skills of painting, music, and reading . . . 8 Religious activities (going to church) 6 Outdoor activities (gardening, hunting, fishing, yard work, etc.) 6 Activities away from home (movies, dances, games, shopping) 3 Nothing is interesting or enjoyable or brings happiness... 1 Traveling (long and/or short trips) 1 Don't know (everything is about equally interesting or enjoyable) 5

Institution (N = 352) 32%

25 2 12 11 3 2 6 1 8

*The percentages are based on number of respondents who actually answered the question. This question was not asked of the rural sample.

81

Aging in Minnesota ranked fourth. Religious activities were fifth, and of more importance to those in institutions than to those in the community. Other activities enjoyed were gardening, hunting, fishing, and yard work. Some did not know which activities were the most interesting to them, and others said that everything was about equally enjoyable. Six per cent of those in institutions compared with 1 per cent in the open community said that absolutely nothing was interesting or enjoyable or brought happiness to their daily lives. Routine activities such as eating, sleeping, and walking outdoors gave the most pleasure to many old people. About half of this group ranked eating first. To complete the picture, some reported traveling, either short or long trips, as their greatest pleasure, although this is not a daily activity, and some enjoyed activities away from home — movies, dances, games, and shopping — most. It is apparent that there is great variety in what the older person finds most enjoyable in his daily life, but the five activities listed most frequently are, in order, indoor activities, visiting or communicating with friends and family, working, hobbies and skills, and religious activities. HEALTH, INSURANCE, AND MEDICAL CARE

Earlier in this chapter we noted that the wish for good health dominated all other wishes expressed by old people. It is one of their most realistic problems and concerns, and one of the most frequently discussed, perhaps because it is regarded as a more socially acceptable topic of conversation than religious and family problems. Health attitudes. If you don't have good health you don't have anything was one of the most-heard responses to questions about health, and it was not uncommon to hear such a remark as "I'd give anything or everything if I could only get my health back." Such generalizations lead the researcher into serious inquiry. Is the state of one's health really so important that it deserves the emotion and conviction it generates? Or is it the scapegoat blamed for unrelated problems? In their efforts to rationalize, do people give too much weight to the condition of their health? How rational or irrational are people about their state of health? A recent report suggests that over half of the older patients seen by doctors have no organically caused defects, and that often social and psychological problems are being manifested through organic symptoms and suffering. Together with social scientists, spe82

Seventeen Hundred Elderly Citizens cialists in psychosomatic medicine are trying to find answers to the demands created by the inter-relationships of the social-psychological self and the physio-chemical self. Aging begins at conception and continues throughout life. Though there is a stereotypical tendency to associate aging with chronic disease, the truth is that chronic disease, like aging, encompasses the entire life span, but is found disproportionately often in early childhood and late adulthood. In old age there are an absolute decline in strength, a loss of motor and mental skills, and an impairment of sight, hearing, and other powers which often lead to extensive physical discomfort and pain. In fact, the change which aging brings to the body is one of the most striking organic processes in reverse. Self-conception of health. What does declining health mean to the aging person? How is the change from being healthy to being chronically ill, totally disabled, or semi-disabled reflected in his life? In order to gain greater understanding of this, we asked old people "Would you say you are in excellent, good, fan*, or poor health?" Their responses, being self-conceptions, form an important part of their self-image. To the social scientist, the self-conception of health has greater meaning than the actual physical state because it puts the physical state within the framework of a value system. Some persons can be organically dysfunctional but, because of a positive attitude or because they put importance on non-physical matters, they will not be seriously impaired. Such persons, however, are exceptional. Health is an all-inclusive concept which refers to every major aspect of personality — physical, social, mental, psychological; and theoretically one's own conception of his health would include each of these major areas. In fact, though, it is impossible to know what weight each person gives each aspect. His judgment may be just a general feeling about life, or it may be a specific, time-bound, situational analysis. Very likely the greatest weight will be given the physical condition, with the person's frame of mind probably carrying the next greatest weight. In this survey, the discussion of the health of the aging citizen will be considered from seven points of view: self-reported health conditions, major health needs uncared for, availability of health services to the aging in the community, the amount of contact between the aging and various health professionals and facilities, the projected use 83

Aging in Minnesota of community health services, the expense of health care during the previous year, and insurance. The data on insurance include life and health and accident, as well as surgical and hospital insurance. Self-reported health condition. One in ten old people conceived of his health as excellent. Of these, slightly more were in the community than in institutions. Good health was reported by about four in ten of the community residents, compared with three in ten of the rural and two in ten in institutions. The majority of the rural residents (53 per cent) considered their health fair, while poor health was reported most frequently by residents of institutions. Since the latter were usually older than the residents of the community, it is not unexpected that they more often would consider their health poor — probably it more often was. Self-conceptions of health have been found to be positively correlated with the actual physical condition in several other studies. In this study, no physical examination or other medical diagnosis of the respondents was attempted. We put confidence in their reports, with the qualification that there is not a one-to-one correlation between one's own appraisal of his health and a medical diagnosis, but that the correlation is high enough to warrant putting faith in self-appraisals. "Feeling miserable most of the time" is the unfortunate report of twice as many residents of institutions as of the community (20 per cent and 10 per cent). This feeling could be caused by chronic illness and disability, or neurosis. On the brighter side, almost ninety per cent in the community and about seventy-five per cent in institutions reported that they did not feel miserable most of the time. The health situation, for about one in every ten old people, appears critical. Of the fourteen hundred interviewed, a hundred and ten agreed that if they could not feel better soon they would just as soon die. When health is so bad that people prefer death to life, the pain, misery, or boredom must be almost unbearable. Residents of institutions more often expressed this poor-health-inspired preference for death than those in the community (one in six versus one in twenty). An additional 8 per cent in institutions were undecided about whether or not they would just as soon die. If some of these were on the borderline of agreement, the total constitutes a very sickly and uncomfortable group. How mobile were the people interviewed? The ability or inability to 84

Seventeen Hundred Elderly Citizens get around undoubtedly influences somewhat one's concept of his state of health. The great majority of persons in the community (88 per cent) and over half of those in institutions said that they were able to go almost anywhere outside their homes without assistance. On the other hand, more than twice as many residents of the institutions were confined to the home or yard than were residents of the community. The greatest difference comes in the number of those confined to bed or chair (20 per cent in institutions, 2 per cent in the community). Again, the more advanced age of those in institutions must be kept in mind. It can be seen from the data that one person in eight in the community and almost half in institutions have some real limitation on their mobility. It would be interesting to know whether the 20 per cent confined to their beds or chairs in the institutions are also those people who say that if they can't feel better soon they would just as soon die. One suspects that they often are. Major health needs uncared for. The aging report a smaller proportion of major health needs uncared for than might be expected. This could be partly a reflection of their subjective definition of what major health needs are. If the question had been worded to elicit a report of all physical or emotional discomforts which have not had the attention of health specialists, the proportion probably would have been greater. About one person in eight reported that he had some major health needs uncared for. Fifty-one said they had bad eyes, twenty-four said they had arthritis, aching joints or muscles, or rheumatism, and seventeen said that they had a circulatory disorder not cared for. There were no important differences between those living in institutions and in the community. Fewer than ten persons mentioned major health needs uncared for in each of the following categories: respiratory, mental, orthopedic, or surgical. About fifty expressed the need for better weather or something else not included in the above categories. Thus, a total of about two hundred uncared for health needs were reported by the fourteen hundred respondents in the study — one or more complaints for every seven persons. Major health needs were uncared for (according to the 40 per cent in the open community and the 25 per cent in institutions who reported such a need) because of the expense, though there were other reasons given with some frequency. Almost a fifth thought that their health difficulty was incurable or nearly so, and apparently believed 85

Aging in Minnesota it was useless to try to effect a cure. Other explanations given equally by from 3 to 6 per cent were the lack of specialist or qualified doctor locally or nearby, the absence of transportation, or some other reason associated with inconvenience. A few, between 2 and 6 per cent of each group, said that they didn't care about the condition, and therefore wouldn't treat it. Other reasons too varied for summary classification were given by over a third of those interviewed. It would also have been desirable to ascertain the presence of minor uncared for health needs and to determine why they had not been taken care of. This would have added a new dimension and made a more comprehensive picture of the health of our old people, but resources did not permit such analysis. Hospital coverage under social security. We know that the predominant wish among the elderly is to be healthy and that one in seven has major uncared for health needs, as well as an unknown number of minor ones. We should therefore find it profitable to examine responses to the question of whether social security should cover hospitalization. Sixty-one per cent of the urban and seventy per cent of the metropolitan dwellers favored this, even though they were aware that it would increase their taxes. About a fourth in the urban areas and a sixth in the metropolitan areas opposed the inclusion of hospitalization coverage under social security. And 8 per cent in the community and 20 per cent in institutions did not know or were undecided on this issue. On the whole, two thirds of the old people favored hospitalization as a part of the social security program, while about as many were undecided about the issue as were opposed to it. It would be useful to know how younger people feel about hospitalization coverage through social security. They might oppose it in greater proportions until they themselves, or others close to them, needed hospitalization and hadn't means to provide it. In the nonbeneficiary rural sample, the younger farmers complained about the older beneficiaries' receiving so much social security after having put so little into it. They feared that they would have to pay the bill for the older ones and that consequently their own returns would be lower. Some respondents were concerned about cost but, in general, they approved and supported the principle of extending social security to include hospitalization benefits for the aged. Availability of health services to older people in the community. 86

Seventeen Hundred Elderly Citizens From two thirds to three fourths of the elderly said that medical care was available to all older people in the community who could not pay for it themselves. From a fifth to a fourth said they did not know whether it was available. And the remainder, from 4 to 11 per cent, said it was not available, the greater proportion of these being in the community rather than in institutions. Only 81 persons out of 1,186 (about 6 per cent) said they had used such services. The services of a public health nurse were available to older people in the community, according to slightly over half of the respondents in the study. About 13 per cent said they were not available, and the remainder, approximately a third, did not know. The services of a public health nurse had been used by only 61 persons out of 1,335. The total number of persons interviewed concerning the medical care and public health nurse services available is less than the total sample of 1,700 because it includes only urban and metropolitan residents. These two questions were not asked of the rural sample. Frequency and kind of contacts with doctors and various health facilities. The respondents were asked about the frequency and purpose of their seeing various health specialists and using facilities during the previous year. Table 30 and Figure 3 show the answers. About 15 per Table 30. Purposes of Elderly People's Contacts with Various Health Specialists and Facilities, 1959* Health Specialists and Facilities General practitioner Eye doctor Dentist Chiropractor or osteopath Public health nurse Hospital Nursing home

Illness 48% 14 14 6 3 15 9

Accidents Operations 6% 0 0 1 0 3 1

5% 1 1 0 0 5 0

Physical Exam or Checkup

Other

10% 5 4 0 0 0 0

9% 7 10 2 1 2 4

* Percentages total more than 100 because some respondents gave several answers.

cent in the community and 10 per cent in institutions reported no contact at all with a general practitioner during the previous year. In terms of people (Table 30) rather than of percentages of contacts (Fig. 3), almost half the total sample reported having seen a physician because of illness, and a smaller proportion for physical examinations and operations or because of accidents. 87

Seventeen Hundred Elderly Citizens The eyes, it will be recalled, were most often neglected by the elderly: slightly over half in urban areas and more than a third in metropolitan areas reported not visiting an eye doctor at all during the previous year. Most of those who did visit an eye doctor consulted him because of illness. (Fig. 3.) No visits to a chiropractor or an osteopath were reported by 80 per cent. Again, most people went because they were ill (Fig. 3), a total of seventy-eight. Of all visits to the dentist during the previous year, by far the greatest number were for such reasons as illness and toothaches. These were more often the reasons for metropolitan than for urban residents. Checkups ranked second with 15 per cent of the community and 6 per cent of institutional population interviewed. But no visit at all had been made to the dentist during the previous year by over half in the metropolitan and about 40 per cent in the urban areas. Even though over half the respondents in this study were aware of the availability of a public health nurse's services, 95 per cent in the community and 75 per cent in institutions said they had not, during the previous year, seen a public health nurse. In fact, only 4 per cent of the total interviewed said that they had seen one, almost all of them prompted by illness (Table 30). Some 61 per cent of the residents in the open community and 45 per cent in institutions said they had not been in the hospital during the previous year. No significant differences between the groups appear by residence. A total of 122 people, slightly less than 10 per cent of all those interviewed, said they had been in a nursing home for illness, and about 1 per cent said they had been there because of an accident (Table 30). The total percentages are shown in Figure 3. Of those who responded "yes" or "no" to the question whether or not they had during the previous year been in a nursing home, about 94 per cent in the community and 27 per cent in institutions said they had not. Projected use of services. There is a clear discrepancy between the current use of available community services and facilities and the knowledge of their availability and the projected future use. For example, referring back to the discussion of the use of the services of a public health nurse, we recall that few persons employed such services at any time. Yet when the elderly were asked whether they would do 89

Aging in Minnesota Table 31. Comparative Costs of Health Care for the Elderly, by Residence, 1959* Community (N = 843)

Cost 30-349

Institution (N = 172)

soyc

$50-$199 $200-$499 $500 and over

4oy0

36 25 13

20 15 19

*The number on which the percentages are based includes only urban and metropolitan residents. This question was not asked of the rural sample.

so if the services were available in the future, over 50 per cent in the community and slightly over 40 per cent in institutions said they would. About a fourth of each group said no, and another fourth was ambivalent. Proportionately more in the community said they would use such services if available. The same generalization about the discrepancy between knowledge of services and actual use, on the one hand, and projected use, on the other, appears to hold true of free medical care. Over half in the community and over 60 per cent in institutions said that they would use free medical care if it were available, compared with 30 and 20 per cent, respectively, who said they would not. About 15 per cent were undecided. Cost of health care. The aging in institutions reported having either relatively high or relatively low health care expenses during 1959. Community residents dominate the two middle cost ranges (Table 31). When these ranges are combined, over 60 per cent in the community and 35 per cent in institutions lie within the combined range. Table 32. Life Insurance Held by the Elderly, by Residence* Kinds of Life Insurance None Ordinary Endowment Term Unspecified . . . ,

Urban-Metropolitan

Rural (N = 289) 66% 31 3 1

Community (N — 954)

Institution (N - 355)

46% 41 8 2 9

81% 12 3 1 6

* Percentages total more than 100 because some respondents gave more than one answer. 90

Seventeen Hundred Elderly Citizens Insurance. More than half of the old people interviewed did not have life insurance (Table 32). Considerable variation exists between institutional, rural, and community residents, and in all three categories more community residents have life insurance. Of the six hundred persons who said that they had life insurance policies, a hundred and twenty-eight, or 21 per cent, report that the policies now provide income (Fig. 4). For most, this income is monthly, for about a third it is yearly, and the remainder received it in a lump sum. About two thirds of those deriving income from insurance policies in the urban, and

Figure 4- Older people's annual income from insurance, by residence 91

Aging in Minnesota about half in the metropolitan areas, said the annual amount is between $1 and $99. Figure 4 shows a breakdown of the annual income from insurance; the twelve persons who reported receiving between $500 and $3,000 almost certainly are those who received their benefits in a lump sum. Over three fourths in institutions and a third in the community report having no hospital insurance. Only a few bought hospital insurance before they were fifty. Community residents had most often bought it between fifty and sixty-five (25 per cent). Over a tenth bought it at sixty-five or later, and the remaining tenth who had bought it did not recall how old they were when they did so. The widespread lack of insurance protection among the institutionalized aging is apparent: almost nine out of ten report no medical or surgical insurance. About half in the community are in the same plight. Only one person in twenty bought medical or surgical insurance before he was fifty. A fifth in the community and 4 per cent in institutions bought it between ages fifty and sixty-four. Less than a tenth bought it at sixty-five or over and the remaining tenth in the community and 4 per cent in institutions did not remember how old they were when they bought it. In summary, we find that both major and minor uncared for health needs are of great concern to the elderly person, because his greatest wish is for good health; but the number of such needs reported is smaller than might be expected. There is some correlation between the self-concept of health and the actual state of health. We may assume then that the older citizen of the metropolitan area is in better health than his opposite number in other areas, because the majority in the metropolitan area reported their health good or better, and the majority of those in the rural area reported it only fair. Elderly people living in the community are remarkably mobile: about 88 per cent reported being able to go outside their homes without assistance. As might be expected, the largest number of those confined to their beds or chairs are in institutions. The cost of treatment is their main explanation for not taking care of health needs. This is no doubt one of the reasons why they favor hospitalization protection as a part of the social security program. Even younger people who have not yet benefited from social security believe that it should include hospitalization for the aged. The major 92

Seventeen Hundred Elderly Citizens uncared for health need concerned the eyes, but many persons reported no visit to an eye doctor during 1959. In fact, there is a discrepancy between the knowledge of availability and the use of all medical and health care facilities, including free medical care. Over half of the elderly interviewed did not have life insurance, and those policies which provided income paid a very small annual amount. Few had hospital, medical, or surgical insurance, and most who had it bought it after they were fifty, which probably meant that they were paying a higher rate at a time when they could least afford it. Younger people today are probably more conscious than their elders were of the need for insurance of all kinds. If this is true, and if social security does extend its benefits to include hospitalization and increased medical care, the problems may not be so acute for the aging in the future. ECONOMIC RESOURCES AND INCOME MAINTENANCE

Net income, net worth, and one's own conception of the adequacy of his income are all measures of financial security. The last is sociologically relevant to this study because, like one's own conception of his health, it includes values. Dissatisfaction may be more closely related to feelings of economic deprivation than to actual net income, but to those who are economically dependent, money is one of the greatest worries. Planning for the future. Only a minority of the aging had made financial plans for life after sixty-five. This failure to plan appeared more characteristic of the rural than of the urban or metropolitan residents; perhaps rural people made fewer definite financial plans because they relied on farm investments for economic security in old age. Those in institutions had also planned less than those in the community, partly, perhaps, because of age differences. In all, 81 per cent of the rural, 71 per cent in institutions, and 55 per cent in the community had not planned ahead for their life after sixty-five. Not only was there a paucity of planning, but most plans that were made did not materialize completely. Few of the aged were able to carry out their plans completely — only a fifth in the community, a tenth in institutions, and a twentieth of the rural residents. An additional fifth in the community, a tenth in institutions, and a tenth in rural areas were able to carry out their plans almost or somewhat completely. The rest said either 93

Aging in Minnesota that they were not able to carry out their plans at all or that they could not tell yet how successful their plans were. Of those who made financial plans for their retirement years, at least a fourth of each group made them before thirty. Slightly more than a fourth planned between thirty and fifty, a third in the community and a fourth in institutions between fifty and sixty-four, and the remainder after they were sixty-five. Greater proportions of the rural people planned at later ages than the urban and metropolitan residents: over a third of the rural residents made their plans after sixty, compared with only 14 per cent of all the non-rural planners. Of those who made plans, a substantial majority — 86 per cent rural, 60 per cent community, and 63 per cent in institutions — had no help in the planning. The respondent's spouse was reported most frequently as having given help, according to a fifth in the community and proportionately less in institutions and in the rural respondents. Other family members helped next most frequently. As might be expected, agencies, legal advisers, and non-relatives helped more in the community (14 per cent) than in institutions (10 per cent) or rural area (4 per cent). Most of those who made plans — 70 per cent in the community and 55 per cent in institutions — said that nothing had happened to change them. Two thirds of the total had experienced no changes, while the remaining third said that some changes had come about since the plans were made. Sickness or poor health was the major cause of changed plans for four in ten; the depression or the loss of money in other ways ranked next. Other reasons, too varied for meaningful codification and summation, were given, and some of the respondents could not pinpoint the exact reasons for changes in their plans. What specific steps did the present elderly take before sixty-five to insure an income for themselves after? Less than half of all urban and metropolitan aging residents and less than a fourth of the rural residents had made any investments. We studied three kinds of investments: farm land, non-farm real estate, and others. Of those who invested, about 70 per cent made only one kind of investment. Between a fifth and a fourth made two kinds of investments, and only 7 per cent had made all three. Investments in farm land were made by about one in seven of the total. A fourth of the community dwellers, a fifth in institutions, and only 3 per cent of the rural population had 94

Seventeen Hundred Elderly Citizens invested in non-farm real estate. Of those who invested elsewhere than in farm land or non-farm real estate, the greatest part, about half of the total, had invested in commercial and government stocks or bonds. Insurance policies formed the next largest group of investments, followed by investments in savings accounts and in houses. It will be noted as the study progresses that conscious financial planning, specifically for life after sixty-five, and investments made to insure income later in life are not necessarily associated positively with net worth or the accumulation of wealth. Net worth. After sixty-five, one's financial well-being is often more dependent upon previous accumulation of wealth than upon current earnings. In this study the rural aging report a substantially high net worth, those in institutions report the lowest net worth, and residents of the community rank between (Table 33). At the low extreme are Table 33. Net Worth of the Elderly, by Residence* Net Worth In debt or $0 $l-$4,999 $5,000-89,999 $10,000-$19,999 $20,000-$49,999 $50,000 and over

Urban-Metropolitan

Rural (N = 282) 1% 8 7 28 40 16

Community (N = 669)

Institution (N = 237)

12% 16 13 31 18 10

60% 23 7 5 3 2

*The reduced numbers of respondents (particularly in the community, 32 per cent, and institution, 40 per cent, groups) reflect hesitancy on the part of the non-professional interviewers to persist in getting answers about income and net worth. Only 6 per cent of those interviewed by the professional interviewers failed to give this information.

those who have a net worth of zero, or who are in debt — 60 per cent in institutions, 12 per cent in the community, and only 1 per cent in the rural area. Similarly, only 16 per cent of the rural residents reported a net worth of less than $10,000, compared with 4 per cent of those in the community, and 90 per cent of those in institutions; also, those in the $50,000-or-over category were predominantly rural. Thus, even though the rural population did not make as many investments specifically designed to produce income after sixty-five and therefore are not drawing high returns on their investments, the farm land they purchased for other more immediate economic and social reasons puts 95

Aging in Minnesota them in the highest categories of net worth. This also reflects the selectivity of the social security program among farm people: it is mandatory only for those earning a given minimum from farming. Savings or checking accounts are somewhat more frequent in the community than among institutional dwellers, 61 to 42 per cent respectively, and 56 per cent for the total non-rural sample. About a third in each group reported an account of less than $500. Proportionately, there do not appear to be large differences in the size of the accounts of community and institutional residents, except that those in institutions tend to be represented more in both extremes and those in the community more often have middle-sized accounts. Net income. Net incomes for 1958 show that most of those in institutions (51 per cent) had an income of $1,000 or less (Fig. 5) compared with a fourth in the community. By contrast, almost the same percentage in each group had a net income of $5,000 or over. The average net income was highest and about equal for the metropolitan and urban aging, $2,681 and $2,669 respectively. Urban institutional residents averaged about $300 less. Residents of metropolitan institutions averaged only about $1,863, or over $800 less than urban or metropolitan aged persons in the community. How did actual net income compare with the old people's own judgments of the adequacy of their income? The association is consistently positive. Proportionately more community residents judged their income to be adequate or more than adequate to meet their needs. The following question about the adequacy of total income was answered the same in equal or very similar proportions by both those in the community and those in institutions: Would you say your income is just enough to meet all needs comfortably, just enough to get by on, or not enough to live on? A slight tendency appears for the aging in the community to evaluate their total income as more adequate. The tendency of those in institutions to feel that their income is inadequate or just barely adequate to meet their needs may be somewhat related to their adjustment level; 94 per cent of the residents in institutions are at the average or low adjustment level, the larger proportion (66 per cent) being at the low adjustment level. This is true in spite of the fact that many institutions provide shelter, food, and so on for the resident, and hence his financial needs are less. As the average of their incomes 96

Figure 5. Older people's net income, by residence

shows, however, many residents of the institution actually did have very low incomes. Sources of income. Among the sources from which income came during the previous year, OASI (or social security) was being received by all rural respondents because of the nature of the sample. Among persons in the metropolitan and smaller cities, social security was mentioned most frequently by those in the community (44 per cent), while old age assistance was most frequently listed by those in institutions (39 per cent). Other sources of income in order of frequency are shown in Table 34. We find that either OASI or OAA provides the source of 97

Aging in Minnesota Table 34. Sources of Income of the Elderly, by Residence, 1959 Community (N = 995)

Sources of Income

OASI Pension Investments Work Savings Insurance Children or other relatives OAA Medical assistance and/or aid to blind . . . ADC Friends Other

Institution (N = 401)

44% 28 27 26 23 13 10 10 3 1 1 14

27% 17 9 3 15 6 12 39 5 0 1 16

* Percentages total more than 100 because multiple answers were given by some respondents.

income for two thirds of those in institutions, and for almost as many in the community. As might be expected, pensions are far more prevalent in the metropolitan than in the urban or rural samples, and old age assistance is reported most frequently in smaller cities. Money needed per month. The total amount of money needed per month for living expenses for the respondent and spouse appeared very modest (less than $100) for 16 per cent of the rural, 21 per cent in the community, and 36 per cent in institutions (Table 35). Approximately Table 35. Money Needed Each Month by the Elderly for Living Expenses, by Residence Money Needed Per Month $l-$99 $100-$149 $150-$199 $200-$249 $250 or more

Urban-Metropolitan

Rural (N = 255)

Community (N = 810)

16% 23 24 23 14

21% 24 17 13 25

Institution (N = 235) 36% 30 17 7 10

a fourth in each group said that they needed between $100 and $149. Almost half of the rural, 30 per cent in the open community, and a fourth of those in institutions said they needed between $150 and $250 a month. The need for more than $250 a month is greater in the open community — 25 per cent — than in the rural area — 14 per cent — or in institutions —10 per cent. Therefore, our previous judgments that 98

Seventeen Hundred Elderly Citizens persons in institutions seemed to be getting by on less than those in the community were correct. But this comparison may not be accurate because those in institutions are much less frequently married and hence would be reporting only their own expenses rather than their companions', too. We cannot conclude that individually it is less expensive to live in an institution than to live in the community: in fact, the opposite may be truer. About two thirds who had savings accounts had not drawn on their savings in 1959. Slightly over 10 per cent of each group had withdrawn less than $500, and about 15 per cent had withdrawn between $500 and $1,500. Those in institutions had more often withdrawn $1,500 or more than had those in the rural areas or in the community. Help with financial problems. About two thirds of those interviewed reported that help with financial problems was available through the county welfare department to older people in the community. Less than a tenth of the total said that it was not available, and about a fourth said they did not know if it was or not. About a hundred respondents, or one in every fourteen, said that they had used this service at one time or another. The proportion who said that they would use such help if it were available (33 per cent in the community, 40 per cent in institutions) is much higher than those who have actually used it (7 per cent of all). When asked about future use of almost all community services, the old people's estimate is higher than their current use would suggest. Their actual future use will probably be somewhere between the current and the projected usage. About a half in the urban areas compared with a third in the metropolitan said they would not use the facilities and between a fifth and a fourth of each group were undecided. Responsibility for the aged. It is usually accepted that the primary responsibility for a man's welfare falls upon himself. Nevertheless, in a complex industrial society, a person is often very much at the mercy of forces beyond his control. When this happens, who should have the major responsibility for providing what the older person cannot provide for himself? Each person interviewed was allowed to lodge responsibility with as many persons or groups as he chose; the percentages of responses reported therefore total more than one hundred per cent. A third suggested that children should help. Another third suggested 99

Aging in Minnesota that pension plans ought to be used. With these alternatives eliminated, the responsibility is most often given (by approximately 40 per cent) to some level of government, with national, state, and local sharing about equally in the frequency of mention. Just over a third of the respondents feel that the church should share the responsibility, and less than one in six would involve fraternal, business, or commercial organizations. Obviously, old people generally have accepted the philosophy that federal and state governments are responsible for providing a decent minimum level of living for the older person not able to provide it for himself. THE IMPACT OF SOCIAL SECURITY

The Federal Social Security Program — designed eventually to replace Old Age Assistance through prepaid insurance — was established by law in 1935. The goal was to limit the economic and social dependency of old age, retirement, disability, and death. But many rural people — farm operators, landlords, and hired hands — were not included because of the administrative and technical difficulties of making equitable tax assessments for an occupation with multiple investments, assets, and kinds of production. Twenty years later, about six million rural people became eligible by amendments made to the Social Security Act. As may be inferred from the following report, this twentyyear lag in eligibility has probably deprived a number of elderly farm people of economic and emotional security, independence, and opportunities for creativity and social participation. What are the meanings of social security in the lives of the elderly? How does it affect their financial situation and emotional security? Are they more able to buy things, keep property, and engage in community affairs? Do proportionately more beneficiaries live in institutions or in the community? We expected that these questions might be answered and that some conclusions might be drawn from this study, since well over half of the persons interviewed were recipients of social security. The incidence was almost twice as high in the community as in nursing homes or homes for the aging (63 and 39 per cent). Both the open-end and the structured question were used in trying to determine the advantages and disadvantages to recipients of monthly social security payments. The following two questions and the 100

Seventeen Hundred Elderly Citizens answers to them are examples of the vague and unproductive responses to open-end questions. What things have you been able to do which you could not have done without your social security income? Slightly over a third said "nothing," while about a fifth said that they had been able to keep their bills paid. About one person in ten living in the community reported that social security had made it possible for him to travel; this, not surprisingly, was mentioned by very few in institutions. Between 1 and 4 per cent of each group said social security benefits had made it possible for them to quit working, to do charity work, pay medical expenses, live better generally, visit children, and enjoy more or better entertainment. About a fourth of the responses were so varied as to be unclassifiable, and, individually, would not constitute a significant effect. (See Table 36.) Can you think of other things or other ways in which the income from social security has affected your life? Has it helped you or given you difficulties in other ways? A fourth replied that social security income had not affected them. The predominant response, given by slightly over a third of the total who were receiving social security, was that it had been of general assistance in meeting current expenses. Another 7 per cent said that it had provided income for old age and had lessened that problem, 2 per cent said that it had helped pay medical expenses, and another 3 per cent said that they could now buy extras or have a little surplus cash. Shifting to the psychological benefits of Table 36. Distribution of Responses to "What things have you been able to do which you could not have done without your social security income?" Benefit Nothing Keep bills paid Travel Live better generally Quit working, retire Charity work Pay medical expenses Visit children More or better entertainment Other Total

Community

Institution

Total

No.

%

No.

%

No.

%

158 91 51 21 14 15 14 6

32 19 10 4 3 3 3 1

42 20 3 4 3 2 3 2

38 19 3 4 3 2 3 2

200 111 54 25 17 17 17 8

34 19 9 4 3 3 3 1

8 110

2 23

0 28

26

8 138

1 23

488

100

107

100

595

100

101

Aging in Minnesota social security, about one in seven of the aging said that it had made them feel more secure, about one in ten said that it had made life more pleasant or comfortable, and one in twenty said it had reduced their worries. The structured question may have reminded those being interviewed of some of the ancillary rewards, for it was found to be more productive of definite and classifiable information. Some of the information elicited by the structured question concerned the retention of property and the purchase of more or less specific items. Retention of property. Only one person in twenty in institutions said that social security had been of help to them in retaining property, compared with one in three in the community. Also, in the community, one person in seven was able to keep his automobile or truck because of his social security payments. More persons in urban institutions were enabled to retain property than their metropolitan counterparts in the proportion of 12 to 3 per cent. Making purchases. Over half of each group said social security had not enabled them to make any purchases they would not otherwise have made (Table 37). Those who were able to make purchases because of social security ranked them as follows: personal items, improvement or repair of home, car or other vehicle, appliances, and household furniture. Some said that everything was bought with money from social security. The increased number of responses to a structured over an open-end question may be noted by comparing the following proportions of all those with social security who said that it had affected them in specific ways (Table 38): A gratifyingly high proportion, over two thirds of those who had social security, said that it enabled them to remain self-supporting. Twice as many rural and community residents as those in institutions said that social security made possible more activity for them in social, religious, or community affairs, and that social security had made more time available to them for recreational and creative activities. Over half in the community and somewhat fewer in institutions said social security had freed their children from the necessity of supporting them. Only 22 per cent of the rural residents reported this benefit. The difference is significant, but the cause is difficult to isolate. It could be that rural people have less need for financial assistance, or the higher expectation of such filial support, or the lower return from social security among the rural re102

Seventeen Hundred Elderly Citizens Table 37. Purchases Made Possible to Elderly Persons by Social Security Payments (Structured Interview Question) Institution

Community

Purchases

Total

No.

%

No.

%

No.

%

.225 None Personal items 40 Improvement or 23 repair of home Car or other vehicle 17 Appliances 16 Household furniture 21 Everything purchased with social security 28 Other 80

53 8

61 14

60 14

316 54

54 9

5 4 3 4

0 2 1 1

2 1 1

23 19 17 22

4 3 3 4

6 17

2 21

2 20

30 101

5 18

100

102

100

582

100

Total

480

Table 38. Comparison of Specific Effects of Social Security Payments, by Residence* Effects of Social Security

Rural (N = 264)

Allowed respondent to be self-supporting Made possible more activity in social, religious, and community affairs Made more time available for recreation, creative activities Freed respondent's children from supporting him financially Caused respondent to retire earlier Caused respondent to retire before he really wanted to Caused respondent to retire later None of the above; nothing; no effect

Community Metropolitan (N = 394) (N = 97)

67%

73%

62%

39

39

18

34

34

14

22 17

53 12

43 16

2 4 20

6 6 5

6 9 14

* Percentages total more than 100 because multiple answers were given by some respondents.

spondents. Social security was reported to have caused a few more of the rural people to retire earlier, but the difference is slight. Less than 10 per cent of any group said it caused them to retire later, and less than 5 per cent of the urban and metropolitan sample said that social security caused them to retire before they really wanted to. It would appear that social security helps retirees to do things more often than to buy things. Most important may be the feeling of financial and emotional security it engenders. A further clue to the rural beneficiaries' thinking about social security is reflected in their answers to the last question of the interview: 103

Aging in Minnesota "Do you have anything else you would like to tell us?" To this question, 40 answered in the affirmative, going on to make unqualifiedly favorable comments about social security; 20 per cent said that the benefits should be higher; about the same number spoke of the inequities of social security, or recommended changes in the relation between the tax rate and the benefits. Only about 2 per cent of the rural aging did not apply for social security benefits because they opposed social security on principle. Comparable data on the urban and metropolitan aging were not secured about this or about the amount of monthly benefits. Most of the rural beneficiaries (93 per cent) did not know how much their monthly benefits would be before they received them, partly, perhaps, because coverage of farmers by social security legislation is a recent (1954) innovation. A fifth of the rural beneficiaries reported OASI or social security eligibility as the reason for a change in farming arrangements. Not so high a proportion among the younger groups of the rural sample was affected by eligibility and credits.* This refutes the popular idea that everyone who can do so is making gross changes in farming and other property and income arrangements to boost the benefits; evidence suggests this is more fantasy than fact. Rural beneficiaries have a higher regard for social security than do other rural respondents. The younger farmers are concerned about the "gravy" going at a minimum cost to current beneficiaries, but they are counting on social security and wish they could retire sooner and with higher benefits. This probably could be generalized to all groups and is a hypothesis for future research. As previously reported, most of the aging favor the expansion of the social security program to include hospitalization, knowing that a tax increase would be necessary to make this possible. Summary. The impact of social security has been felt in many specific ways. It has changed farm operations and enabled many persons to hold on to income-producing property and buy household furnishings and appliances. By providing them a regular income, it has reduced the economic worries of the aging and helped them to remain financially independent of their children. It makes more time available *A full report of the rural study on the impact of social security legislation on farming and farm families is available from the Rural Sociology Department of the University of Minnesota, St. Paul 1. A sample of farm owners, renters, and landlords of all ages was selected from three representative rural counties in Minnesota. 104

Seventeen Hundred Elderly Citizens to them for participation and leadership in community affairs and for creative activities and hobbies. Thus, it can be said, social security is having a dynamic effect on individual behavior. These findings are undoubtedly gratifying to those who initiated and supported social security legislation. It is satisfying also to others to see the success of this program to which almost everyone in the labor force of the country is contributing. Social security may even, because of its many peripheral benefits, surpass its original objectives. RETIREMENT AND EMPLOYMENT

It is a paradox of modern times that we expect to retire when we are old whereas all our lives great emphasis is placed upon work, achievement, production, efficiency, and self-development. Opportunities for progress and the wise use of time must often seem dismally meager to the retired person. Interviewees frequently say: "The hardest thing to get used to is not having something to do." On the other hand, almost as frequently they point out as the thing they like best or enjoy most about retirement the freedom they have from all the hard, routine, demanding, scheduled work. But free time appears to be a plague to those who have failed to provide adequate substitutes for the work they no longer have. Havighurst and Albrecht report eight meanings of work that came from their researches: a basis for self-respect; a source of prestige and recognition by others; a focal place of social participation (a place where one enjoys companionship with other people); a source of intrinsic enjoyment or of creative expression or self-expression; a way of being of service to others; a way of making time pass — a pleasant routine; a way of earning a living; a heavy and unpleasant burden.* Work is not more intrinsically satisfying than play as a source of meaningful experience, but recreation offers a greater variety of activities and is a more flexible way to achieve of creative self-expression. The challenge for the modern man who is living in an economy of abundance and a society shifting from work to increased leisure is to learn the arts of leisure. By learning these arts well he can enjoy his retirement more than he did his work. The non-economic meanings of work can almost all be better realized by leisure-time activities. * Robert J. Havighurst and Ruth Albrecht, Older People (New York: Longmans, Green and Co., 1953), p. 109. 105

Aging in Minnesota Work and play could be valued more equally, since many of the satisfactions of one can also be derived from the other. Play is generally free from compulsion, which is rarely true of work. The promise leisure holds out is the combination of freedom from compulsion and the satisfactions formerly found in work. If this combination can be successfully made, the problem of retirement will be solved.* Millions of American workers have little or nothing to say about when they will retire. Besides enforced retirement due to waning physical or mental capacities, two other pressures are heavy and often irresistible: the age provision of OASI and the involuntary retirement policies of most of the nation's larger employers as embodied in the provisions of their pension plans .f Thus it often happens that the energetic and resourceful man of sixty-five with needed skill and competence is retired along with the man who is not well trained, or ailing, or unwilling. The impact of these facts about the structure of the economy upon the average American worker is potentially great and deserves further study. Table 39. Elderly People's Preference Concerning the Establishment of Retirement Age

Preference Mandatory retirement age (N = 813) Flexible retirement age (N — 943)

Who Should Establish Policy? Labor

Management

Both

Neither

6% 7

15% 23

26% 54

53% 16

Voluntary retirement preferred. Most workers do not like involuntary retirement. A small majority of the respondents (53 per cent) object to establishing a mandatory retirement age, while at the same time 54 per cent suggest that a flexible retirement age policy be established (Table 39). Only a fourth want labor and management to join in establishing a mandatory age. Only one in twenty thinks labor alone should have the responsibility, while four in twenty would assign it to management alone. It would be a serious error to conclude that company policies and * Eugene Freidmann, et al., The Meaning of Work and Retirement (Chicago: University of Chicago Press, 1954). t Committee on Employment Security and Retirement, Background Paper on the Employment and Security and Retirement oj the Older Worker, White House Conference on Aging, July 1960, p. 68. 106

Seventeen Hundred Elderly Citizens social security are all that causes people to retire at sixty-five. Only 23 per cent in the community and 15 per cent in institutions said that it was their company's policy to retire them fully. Why else do they retire? Among the fully retired, 38 per cent in the community and 25 per cent in institutions apparently did so simply because they wanted to. Most elderly people in institutions (55 per cent) and a third in the community retired because of poor health. Of all who were only partly retired, about a fifth had arrived at that status because of company policy. But twice as many in institutions as in the community had retired partly because of bad health (Table 40). Among the partly retired in the community, over two Table 40. Reasons for Full Retirement, by Residence* Reasons for Retirement Health Company policy Personal choice Other Total

Institution

Community

Total

%

No.

%

No.

%

152 97 159 11

36 23 38 3

127 34 58 11

55 15 25 5

279 131 217 22

43 20 33 4

419

100

230

100

649

100

No.

* This question was not asked of the rural sample.

thirds said that they never planned to retire fully. One person in twenty said that he would retire before seventy-five and about one in ten claimed it would be after seventy-five. Knowing that health, company policy, and personal choice enter into the decision to retire, we may also ask why workers keep on working. Of the approximately two hundred who were working, 50 per cent said they were working because they needed the money. The other half said they liked to work — work has pleasurable as well as financial significance to them. Age of retirement. Slightly less than 10 per cent of each group had retired before they reached fifty. The reason for this early retirement should be studied. It appears that sixty-five is the modal age for retirement, with about one person in five retiring then; about a third in the community and a fourth in institutions retired between sixtyfive and seventy; these two groups combined include half of the retirees. One in seven of those completely retired did so between fiftyone and sixty-four. Retirement after seventy was predominant among those in institutions. 107

Aging in Minnesota Labor and management relations with retirees. Almost half of the aging thought that both labor and management should help former employees with their problems after retirement (Table 41). Approximately three in ten assigned the responsibility to either labor or management, with more putting the responsibility on management, and about the same number said that neither labor nor management should help ex-workers with retirement problems. Table 41. Respondents' Beliefs as to Who Should Bear the Responsibility for Retirees Responsibility to Employee Help with problems after retirement (N — 925) Jobs for older workers (N — 926) Education for retirement (N — 885) . . .

Who Should Bear the Responsibility Labor

Management

Both

Neither

5 6 6

22 32 20

44 45 45

29 17 29

Again, almost half the old people assigned labor and management the responsibility of getting them jobs. Labor or management was singly assigned the responsibility by 38 per cent, and 17 per cent did not think that either labor or management was responsible for getting jobs for older people. Who, if anyone, is responsible for education for retirement? Slightly fewer than half of those interviewed thought that management and labor together were responsible, whereas 29 per cent of each group thought neither was. The responsibility was given to management alone by 20 per cent and to labor alone by 6 per cent. Association with former fellow employees. Some of the major meanings and values of work are found in associations and social experiences. Retirement brought fairly complete separation from former fellow workers for about half of the elderly interviewed: 40 per cent in the community and 62 per cent in institutions said that they had not visited any of their former work associates in the past year (Table 42). The opposite extreme of much contact was maintained by over a fourth in the community and a tenth in institutions, who visited nine or more of their former fellow workers. As might be expected, a slightly higher proportion of community residents had visited between two and six former fellow workers in the preceding year. In addition to the amount of association they were actually able to maintain, the retired persons were asked about how much association 108

Seventeen Hundred Elderly Citizens Table 42. Former Fellow Workers Visited by Retired Persons during the Previous Year, by Residence* Number Visited

Community (N = 517) 40% 8 29 2 26

None One Two to six Seven to eight Nine or more

Institution (N = 233) 62% 6 20 2 10

* This question was not asked of the rural sample.

they would like to keep up. A third in the community and half in institutions said that they would like to have more, about 5 per cent said they would like to have less, 4 per cent said that they wanted none, and the rest said that they wanted to keep their association with former fellow workers about as it now is. Retirement likes. What does a person like about retirement? What is the most enjoyable part of it? The chance to do as he pleases: 17 per cent of those interviewed said that the thing they liked most was having leisure they could use as they wished, especially at home. Very similar to this, and following in second and third order, were the freedom from responsibility and obligation and the freedom from having to work so hard or so much. It should also be mentioned that about a fourth of the total said they did not like retirement at all! Retirement difficulties. We have recognized for some tune that retirement from work can be a traumatic experience. Retirement not only frees a person from his job, but it also denies him the opportunity to continue to follow an established pattern of occupying his time. It usually means the reduction of, and often the loss of, association with colleagues of long standing (as we have noted) and friends; for many, it results in the loss of incentives and stimulation. Complaints about retirement problems come most frequently from rural residents, and the next highest number come from the urban. Those currently in institutions report retirement problems more often than others. Boredom caused by regimentation or lack of stimulation, and the inability to adjust to institutional life, probably account for many complaints. The fewer complaints from the metropolitan sample may result from the more thorough and complex retirement programs available to them. 109

Aging in Minnesota Respondents were asked to mention what was hardest for them to get used to after retiring. Their answers reveal a paradox: previously they had looked forward to the free time, the freedom from responsibility, and the reduction of heavy work; but this was also hardest for them to get used to, especially the rural respondents, of whom 70 per cent said that the lack of work was the hardest for them to get used to. Next came those in institutions (38 per cent) and in the community (30 per cent). This paradox makes it obvious that there is a need for older citizens to develop capacities that will smooth the transition from employment to retirement. Pre-retirement education could be of great help in this process of adjustment, as could flexibility in retirement ages and a gradual reduction in the amount of work and time spent on the job. The next key problem of the retired person has to do with changes in associations or companionship: he misses his former fellow workers or suffers a lack of association with his friends, or he has no one to talk to. Community-dwellers mentioned this lack much oftener than did those in institutions. The next most difficult thing — mentioned by 6 per cent of the total sample — was being restricted because of poor health. Combining the number of those having no work who were doing nothing or just sitting around with the number who said they had too much time on their hands, we got 40 per cent in communities and 46 per cent in institutions. In rank order, the absence of work, doing nothing, or just sitting around is first; the absence of or failure of readjustment in association is second; too much spare time is third; and restrictions because of health are fourth. It is important for people to be able to use their time in ways that satisfy them. Hobbies, organizations, work skills or habits, and learning could be better used to increase satisfactions if people were given training — if necessary — and opportunities. Companionship is desired by almost all. Former fellow workers, old friends, members of the family, and neighbors are the "significant others" in a retired person's life, and association with all of these people should be encouraged by the programs which specialists and legislators design for the aging. When ill health restricts an older person, it would be very desirable for activities to be brought to him. Why was it so difficult to get used to retirement? The reasons given 110

Seventeen Hundred Elderly Citizens were first, the person had worked all his life or was accustomed to hard work, and it was difficult to break the routine; second, he was accustomed to being active and moving around; third, poor health holds a person down too much or changes conditions. Several reasons placed fourth, including loss of income or purchasing power, not enough to do, or the sudden lack of responsibility after being used to it most of one's life. About 6 per cent said that they were lonesome for their associates on the job. Advice for future retirees. When retirees were asked if they had any advice to offer someone about to retire, 10 per cent in the community and 30 per cent in institutions said they had not. These responses could be looked upon as subtle indicators of the importance of advice to the persons reporting; that is, they may not be direct estimates of the importance of advice, but rather reflect what these people think has been or would have been important for them. The most frequent advice — from 30 per cent in the community and 15 per cent in institutions — was to "stay active and keep thinking" or "to get activities or hobbies." The next most frequent advice (14 per cent of each group) was not to retire if you don't have to. Combining these two shows, we find, that between 35 and 40 per cent advise either staying active or not retiring. The next most frequent advice was to plan wisely for retirement and the future. This may be evidence that quite a few of these people did not plan and now wish that they had, or it may be that they did plan and are happy about it; the former appears more likely. Are the suggestions that people stay active and to do some work truisms which have been known and recommended for a long time for the avoidance of degeneration and mental illness? Kinds of work learned. About three in ten persons in the community and two in ten in institutions had learned professional, technical, and kindred work. Approximately the same proportions in the community as in institutions had learned private household and other service work. For further data, see Table 43. Kinds of work done most. A slightly greater proportion had learned professional or technical work than had actually performed it; but the difference is not very great. About a fifth in each group reported that the main kind of work that they had done was professional, technical, or kindred (Table 44). This is surpassed proportionately only by those — about a third — who report having done private household and 111

Aging in Minnesota Table 43. Kinds of Work Retired Persons Had Learned, by Residence Community Institution (N== 690) (N = 307)

Kmd of Work Professional, technical, and kindred Private household and other service Clerical and kindred Craftsmen, foremen, and kindred Farm operator or manager Sales Operatives and kindred Manager, official, proprietor (except farm) Laborer (except farm) Farm laborer and foreman Housewife, other

30% 19 17 13 8 9 8 7 7 4 9

21% 21 11 16 6 5 4 4 14 7 6

Table 44. Kinds of Work Retired Persons Had Done, by Residence* Kmd of Work Professional, technical or kindred Private household and other service Clerical, sales, and kindred Farming as operator or manager (managerial, official, proprietorial) Craftsmen, foremen, operatives, and kindred Farm laborer and foreman None

Community (N = 686)

Institution (N = 276)

21% 34 19

19% 32 14

11 16 12 3

9 15 23 3

* Percentages total more than 100 because some respondents gave more than one answer.

other service. About 3 per cent reported having done no kind of work most. The difference is not great between those in the community and those in institutions who report having been craftsmen or foremen or done kindred work; clerical, sales, and kindred work; and farm managerial work. Farm and non-farm labor was reported, however, by about twice as many of those in institutions as in the community. Changes in occupation. Slightly over half of each group reported that they had not changed occupation since they were fifty (Fig. 6). The change to an occupation of equal or higher status before sixty was made by slightly more in the community than in institutions (17 per cent compared with 12 per cent). Between sixty and sixty-five, the opportunities to change occupation are fewer than at earlier ages; there was less change to either higher or lower occupation during these years and after. The proportion of women who have worked for an income at some 112

Figure 6. Change in work status among older people in the community and institutions before age 60, between 60 and 65, and after 65

time in their life is higher for metropolitan than for urban residents, 76 per cent compared with 68 per cent. The remaining fourth of the women in metropolitan and a third of the women in urban areas reported never having worked for pay. Skills. As one might expect, the opportunities to use skills are greater in the community than in institutions: 10 per cent in the community and 8 per cent in institutions said that they were now using professional, technical, or kindred skills (Table 45). It should be remembered that some nursing-home residents are there temporarily and that some residents of homes for the aging still use certain skills, as evidenced by their report. None, however, reported being able to use managerial or sales skills in institutions, which a small number in the community were still able to do. About twice as many in the community were able to use clerical and kindred skills as well as those of craftsmen, foremen, 113

Aging in Minnesota Table 45. Vocational Skills Now Used by Retired Persons, by Residence Vocational Sills Professional, technical, and kindred Private household and other service Clerical and kindred Craftsmen, foremen, and kindred Sales Operatives and kindred Manager, official, proprietor (except farm) Laborer (except farm) Farm laborer and foreman Farm operator or manager None, other

Community (N = S

Institution (N=220)

10% 17 6 15 3 3 2 2 0 1 41

8% 8 3 7 0 2 1 72

and kindred workers. Private household and other service work was reported as still being done by the largest proportions —17 per cent in the community and 8 per cent in institutions. When the aging were asked if they had any special skills not being used now which they would enjoy using again, craftsmen's, foremen's, and kindred skills were the most frequently mentioned, by about 10 per cent of each group. Professional, technical, and kindred skills followed closely, with 8 per cent of each group wishing they could still use them. Clerical and kindred skills ranked third, preferred by 4 per cent. Skills associated with farming, farm labor, and non-farm labor were mentioned by about 3 per cent of each group. The respondents were also invited to tell what kinds of work they felt they would be able to do well now. Three kinds were reported in almost equal proportion, always with more in the community believing that they would be able to do that kind of work well. About 15 per cent in the community and 6 per cent in institutions said that they would now be able to do professional or technical work. Similar proportions, from both groups, named private household and other service work. Clerical and kindred work ranked third, mentioned by about 10 per cent in the community and 3 per cent in institutions. Farm work and non-farm labor were each mentioned by 2 per cent of each group, and sales, operative, and managerial work by 5 per cent in the community. Craft and foreman work were named by 10 per cent in the community and 5 per cent in institutions. Employment status and preference. The following discussion vividly illustrates that one or two specific retirement or employment possibili114

Seventeen Hundred Elderly Citizens ties are not enough to meet the needs and interests of all the aging. Some are happy being fully retired, some prefer to be working a little bit, and others want to be fully employed. A flexible policy, tailored to the needs, feelings, and wishes of the individual retiree, would cope better with the wide range of individual differences. Only with such flexibility can the meaning, values, and rewards of work be fully realized by older people, for the benefit of society as a whole. It would, however, be impractical and unfair not to consider the situation of the employer in such deliberations: a reasonable balance needs to be achieved, so that the employer cares for the aging worker and the worker has sufficient concern for the company to recognize when he is clearly no longer able to render valuable and useful service. Full retirement satisfied 42 per cent in the community and 52 per cent in institutions. Of the total sample, one older person in six is fully retired but would prefer a change in the direction of working at least a little. Some are fully retired and apparently not at all pleased with it, for they would rather be fully employed. Residents of institutions (17 per cent) are most often in this unfortunate situation, compared with 8 per cent in the community. Being partly retired and preferring it was reported by 15 per cent in the community and only 2 per cent in institutions; 4 per cent in the community and less than 1 per cent in institutions are partly retired and would prefer to be fully employed. An indication of the relative content and discontent about work and retirement that exists among the aging is reflected in their response to the question "Would you like to find a suitable job if you are not now working?" The numbers who said yes are not so great as may be popularly expected: only one in six living in the community and one in ten in institutions. Many were undecided, but about 80 per cent in the community and 75 per cent in institutions would not like to find a job. Attitudes about work. Having definite work to do is not necessary for happiness, according to 40 per cent in the total sample. About the same number say that they are happy only when they have definite work to do. The remainder were undecided. Old people who are happy only when working and who feel that they have no work to look forward to are in a difficult psychological situation. In institutions 58 per cent and in the community 23 per cent agreed that they had no work 115

Aging in Minnesota to look forward to. About 5 per cent of each group were undecided, while the rest felt that they did have work to look forward to. Some 80 per cent in the community and 61 per cent in institutions were satisfied with the work that they were now doing. The remainder either were unsatisfied or did not know. Almost twice as many in institutions as in the community (two thirds compared with one third) said that they had more free time than they knew what to do with. What does this mean in terms of failure to use the human resources of our society? This should be a major consideration for social action in the future. In summary, it appears fairly clear that most do not want more work as such, but meaningful substitutes for work — activities that are interesting, challenging, and enduring enough so that the person can find himself in them without assuming a lot of responsibility or enduring undue stress. Most elderly people want to keep thinking, to do useful things, and to stay active, the achievement of which requires reasonably complex tasks or activities that stimulate and reward for long periods of time — not just occasional entertainment. A minority, however, want work full or part time and do not like retirement at all. HOUSING AND LIVING ARRANGEMENTS

A typical American spends his early life in the household of his parents. Then, as a young adult, he may live alone or with friends in an apartment or rooming house. After marriage, he establishes his own household and probably becomes a parent. Later, when the children have grown up and left home, the family contracts again to two persons. Upon the death of a spouse, the survivor may elect to live alone again, staying in the family's residence or moving to an apartment; or he may choose to join the household of a married son or daughter. In advanced age, or when he is disabled, he may live in a nursing home or home for the aged. There are, of course, variations in this sequence, but this is the usual process of family formation and dissolution that provides the basis for changes in living arrangements. In this study, we are interested in the housing of people in the later years of life. Where and with whom do Minnesota's elderly live? How many want to move? Do many complain about their present housing? What housing do they consider ideal? Are communities meeting the housing needs of the elderly? 116

Seventeen Hundred Elderly Citizens Current living arrangements. What were the living arrangements of the old people we interviewed? By far the greatest majority prefer to live with their spouses or alone. Fewer than 10 per cent said they wanted to live with their children. Two thirds of the urban and half of the metropolitan community residents were living in detached houses which they owned. Another 5 per cent lived in houses owned by a relative, and 8 per cent did not own the house they were living in. The apartments they occupied were owned by 4 per cent, but the other apartment-dwellers (16 per cent of the urban and 25 per cent of the metropolitan respondents) did not own their apartments. The big difference between the living arrangements of the urban and metropolitan elderly is that more urban than metropolitan residents live in detached houses which they own, and, conversely, more metropolitan than urban residents live in apartments which they do not own. Of those in institutions, 86 per cent were in homes for the aged and 14 per cent in nursing homes. Desire to change living arrangements. It is understandable that the desire to change living arrangements was more prevalent among the institutional residents (Table 46), and also that there was more indeTable 46. Elderly People's Expressions of Desire to Change Present Living Arrangements, by Residence Desire to Change Yes No Don't know Other response

Community (N = M1)

Institution (N = 375)

12% 83 4 1

21% 70 8 1

cision among them as to whether or not they would like to change. This prevalence of the desire to change may reflect poor adjustment, but it is surprising that the large majority of those in institutions (70 per cent) expressed no desire to change. About 83 per cent in the open community said they were satisfied with their present living arrangements. This is similar to the proportion who said they had no complaints about their present housing, as will be explained in more detail later. Housing and living arrangements may have been interpreted as being about the same thing, although the term "living arrangements" is intended to include the people one lives with, the kind of physical 117

Aging in Minnesota environment, and the social and psychological atmosphere. Housing may or may not have had all of these connotations for the respondents. Living location preferred. Where do the aging prefer to live — in a big city, in a suburb, in a village, or on a farm? Almost two thirds of the metropolitan residents said they liked to live in a big city such as Minneapolis or St. Paul. Even the suburb of a big city was preferred by a higher proportion of metropolitan respondents. Comparatively few urban dwellers shared this feeling. This points up a tendency, of course, toward a certain amount of ethnocentrism. Over three fourths of the urban and metropolitan respondents are living in locations which they prefer. Other details of the comparison are shown in Table 47. The urban institutionalized group is the only one which showed a significant proportion of persons desiring to live in a village of up to 1,000 population or in rural farm or non-farm areas. This group seems the least satisfied with their place of residence. Many may well have come from villages or rural farm or non-farm areas and simply want to return. This dissatisfaction with their place of residence is probably one factor in their low level of adjustment. Why do the aging like to live in the locations they mentioned? The answers of about a third of each group implied that they preferred to maintain the status quo. Convenience, which included the fact that it was easier to get around, that they could walk wherever they wanted to go, or that there was less traffic, was the next most important consideration. Friends and relatives were mentioned by 13 per cent of each group as the basis for preferring to live in a particular place. The advantages of existing facilities (that they were greater in number, variety, or services rendered) ranked third, and the kind of people in the area ranked last. Reasons not mentioned were the presence of utilities, nearness to medical facilities, or the presence of public services. Mobility. In how many residences have elderly people lived since 1953? Three fourths in the community and a third in institutions said they had lived in only one place. About 17 per cent in the community and 43 per cent in institutions said they had had two residences; 8 per cent in the community and 26 per cent in institutions reported three or more residences since 1953. The great difference in mobility between community and institutionalized residents is probably owing to the relative youth of those in the community and the resulting greater likelihood of their still being in their own homes, while those in institu118

Table 47. Preferred Living Location of the Elderly, by Residence

Big city like St. Paul or Minneapolis . . . Suburb of big city Large town (10,000-25,000) Small town (1,000-9,999) Village up to 1,000 Rural non-farm Rural farm Other Don't know Total

Metropolitan

Urban

Preference

Total

Community

Institution

1

11 5 70 54 26 9 20 2 3

100

200

8

1

21 29 274 288 18 7 8 1 5

851

100

651

32

34

344

342 44 16 28

3

4% 4 40 40 6 2 3

3% 4 42 45 3 1 1

5% 2 35 27 13 4 10 2 2 100

Total 309 52 47 61 12 3 11 7 12 514

60% 10 9 12 2 1 2 2 2 100

Community

Institution

211 42 24 32 6 2 5 2 2

98 10 23 29 6 1 6 5 10

326

65% 12 7 10 2 1 1 1 1 100

188

53% 5 12 15 3 1 3 3 5 100

Aging in Minnesota tions may have been moved several times before settling in a nursing home or home for the aged. Housing costs. What did housing cost the elderly last year? Costs of less than $250 were reported by a tenth in the community .and a third in institutions. Between $250 and $750 were reported by half in the community and a tenth in institutions. A fourth of each group reported the cost as between $750 and $1,250. Housing which cost $1,250 or more was reported by 12 per cent of those in the community and by a fourth in institutions. Thus, the institutional dwellers more often reported high (over $1,250) and low (under $250) housing costs, in contrast to the average net income of those in institutions, which inclines toward the lower end of the scale (75 per cent have less than $2,000 a year — in fact, 50 per cent have less than $1,000). Half of the community aging spend from $250 to $750 per year for housing, while half of those in institutions spend $750 or more. Heating the home. Cooking stoves appear to be on the way out as a method of heating the home; less than 2 per cent reported using them for that purpose. One in ten persons in the community said that their houses were heated by space heaters. One in seven of the total had heat provided by floor or wall furnaces. Other kinds of central heating system were used most frequently by three fourths of those in institutions. Complaints about housing. It is interesting that over two thirds of the aging interviewed had no complaints about their living arrangements. The most frequent by those in institutions, a complaint mentioned by 10 per cent, was a lack of freedom or of privacy. The most common complaint of the aging in the community (7 per cent) was that stairways or steps were unsatisfactory. Other things mentioned in almost equal proportion by the two groups, but all under 4 per cent, were unsatisfactory location, inefficient or inconvenient floor plans, not enough space, housing in poor condition generally, furnishings or appliances in poor condition, and a shortage of furnishings. Only 1 per cent mentioned a need for rails on stairs, steps, or tub, or complained about transportation. The proportion of those expressing discontent is considerably less than might have been expected. Household items in poor condition. Residents of institutions complained less about household items being in poor condition or inconvenient to use than did community dwellers, possibly because they made less use of these items. But even in the community the propor120

Seventeen Hundred Elderly Citizens tion reporting such inconveniences is reasonably small. As might be expected in this era of automation, the household items most complained about were electric washing machines, sewing machines, vacuum cleaners, television sets, and radios. Such complaints were registered by 12 per cent in the community and 4 per cent in institutions. Items which ranked second as being in poor condition or inconvenient to use were electric or gas stoves, refrigerators, and flush toilets (9 per cent in the community and 4 per cent in institutions). Luxury items — refrigerators with deep freeze units, separate freezers, clothes driers, dishwashers, garbage disposal units, incinerators, air conditioners, and record players — received the fewest complaints, probably because fewer people had them. Household items desired. The respondents were invited to tell which household items they did not have now that they would particularly like to have. A separate freezer or a refrigerator with a deep freeze unit, an air conditioner, and a sewing machine all rank approximately the same: about one out of every eighteen persons wants some one of these. As might be expected, sewing machines are desired much more by those in institutions, while separate freezers and air conditioners are more wanted by community dwellers. An electric garbage disposal unit or an incinerator ranked fourth, desired mainly by community residents. Clothes driers and television sets are desired by almost equal numbers. An interesting finding was that about three times as many in institutions as in the community wanted an automobile, which probably reflects their need for greater mobility. The twenty-five household items were arranged in three groups, the first seven items necessities, the next nine items conveniences, and the last nine items luxuries: 1 — necessities: electricity, cold running water, electric stove or gas stove, refrigerator without deep freeze unit, kitchen sink with drain, flush toilet, and tub or shower bath; 2 — conveniences: gas, hot running water, electric washing machine (not automatic), automatic electric washing machine, sewing machine, vacuum cleaner, television set, telephone, and radio; 3 — luxuries: refrigerator with deep freeze, separate freezer, clothes drier, electric dishwasher, electric garbage disposal unit, incinerator, air conditioner, record player, and automobile. When interviewed 40 per cent in the community and 70 per cent in institutions said they wanted none of these. As one would expect, items

121

Aging in Minnesota in the luxury group were desired by the greatest proportion of the aging — 30 per cent in the community and 10 per cent in institutions. Only about 12 per cent of each group said they wanted items from among the conveniences and less than 3 per cent wanted items from the group classified as necessities. The reason appears to be that they already have more of the necessities and conveniences, so that luxury items are all that is left to desire. Living arrangements needed in communities. Respondents were asked if they thought there was a need for any of the following kinds of living arrangement in their communities: separate cottages for the aged, apartments designed for the aged, boarding or nursing homes (Table 48). Residents of institutions in significantly greater proportions want nursing homes, boarding homes, and apartments especially designed for the aged. Rural residents express the least need for any additional living arrangements. On the whole, nursing homes were desired in greater proportions than any other living arrangement by all groups in the sample. Apartments designed for the aged rank next, then boarding homes, with separate cottages last. Living arrangements 'personally desired. It is one thing to say that a community has a need for certain living arrangements for the elderly and another to say that you personally would want to live in such an arrangement. But nursing homes were mentioned most frequently by 40 per cent in institutions and 13 per cent in the community. About a third in the community and a sixth in institutions said they would like to live in apartments especially designed for the aged. Most people prefer to go on living in the kind of arrangement they are accustomed to rather than to make radical changes. Location of living arrangements. In considering new living arrangements for the elderly, where do the older people we interviewed think they should be? Table 49 shows that almost half would like to see such arrangements close to downtown or near a large shopping area, although a fairly large percentage, especially among those in institutions, would like to see them away from the population center. This difference of opinion among those in institutions probably exists because those who are bedridden or otherwise immobile do not like the noise and confusion of a downtown or shopping area, whereas those still able to make use of these facilities are glad to have them nearby. Surprisingly, between 12 and 18 per cent want these living arrangements to 122

Seventeen Hundred Elderly Citizens Table 48. Aging People's Answers to Questions About Living Arrangements Needed, by Residence Living Arrangement. andj Answer

Urban Rural

Separate cottages Yes 70 No 191 Apartments designed for the aged Yes 104 No 157 Boarding homes Yes 110 No 154 Nursing homes Yes 138 No 126 Other (old people's homes and private old people's homes) Yes No Other answers not included above No information 17

Metropolitan Institution

Community

Community

Institution

23% 64

215 176

32% 26

53 54

26% 28

129 95

39% 29

53 51

27% 26

35 52

353 106

53 16

66 37

33 18

204 46

62 14

88 23

44 12

37 51

288 104

43 16

92 16

46 8

156 60

47 18

75 25

38 13

46 42

397 69

60 10

123 13

61 6

207 53

63 16

100 17

50 9

17 58

3 9

5 21

3 10

14 44

4 13

9 27

5 14

42

6

23

11

19

6

22

11

49

7

21

10

15

5

29

15

6

be in a private community for the aged. Over a third say they would like to be close to friends and family, suggesting that, for them, the location isn't so important as the people they are near. Responsibility for developing living units. Who is responsible for providing these living arrangements? The state government was most frequently assigned this responsibility (by 43 per cent), with the federal government, church, and local government a close second, third, and fourth. About 15 per cent thought that fraternal organizations should do this job, and 10 per cent assigned it to business organizations and commercial builders. It is apparent that a high proportion of the elderly in this study thought that some agency or level of gov123

Aging in Minnesota Table 49. Elderly People's Opinions of the Best Location for Their Living Arrangements, by Residence* Urban Location Away from population center Close to friends and family In a private community for aged Close to downtown or large shopping center Don't know No information Not applicable

Community

Metropolitan Institution

18% 38

61 67

30% 33

80

12

31

15

287 19 80 15

43 3 12 2

68 5 31 4

34 3 15 2

120 25

Community 69 123

Institution

24% 37

51 52

24% 26

52

16

35

18

154 9 35 11

47 3 11 3

78 13 32 5

39 7 16 3

* Percentages total more than 100 because respondents could give several answers.

eminent should be responsible for providing suitable living arrangements for the aging. Guides for planning living arrangements. What do old people want if they move to another residence? The two most desirable features mentioned are having all the facilities on the same floor (65 per cent), and living on the ground floor (50 per cent). Public transportation is the third most frequently mentioned item. Understandably, a garden plot was desired by more residents of the community than of institutions (33 compared with 25 per cent). Again, it must be remembered that those in institutions are older and more apt to be in poor health. Many residents of nursing homes and homes for the aged have only one room of their own, and would of course prefer more, whereas many of the aging in the community are left alone in what was at one time a family residence, and they would prefer less space. This study shows that 25 per cent of institutionalized residents want more space and 17 per cent in the community want less. Summary. The present generations of the aging population, seeking housing within their communities, prefer independence and separateness of living arrangements. Most of them want and are able to live in their own houses. Some of them, as they grow older, prefer an apartment designed for the aged or a boarding home. A smaller number, particularly in the very late years when infirmities have increased, prefer, or should accept, living in a nursing home or other home for the aged. But, whether in separate houses or apartments or in some form of group dwelling, the basic objective of independence is the same, 124

Seventeen Hundred Elderly Citizens the only difference being in the extent to which it is capable of realization. In assuming the responsibility for human services, society supports the corollary that whenever it is possible and whenever they want to, older people should remain an integral part of the community in which they spent their earlier years and should be encouraged to live the most independent lives possible for the longest time practical.* FAMILY RELATIONS

Social structure of the family. The family has been described as a unity of interacting persons that shapes the personality development of its members and is adaptable to social change.f It "tends to be a more or less closed system of interaction. Each family may be seen as an arena of interacting personalities each striving to obtain the satisfaction of his own basic desires."]: Broadly speaking, the parents build the family and other institutions in our culture. The children are socialized into and become executors of the meanings and values of this culture, while the parents are the administrators, teachers, and examples. This generalization is subject to considerable variation, depending upon the attitudes and practices — patriarchal or democratic — of the family. Impact of the social structure on the aging. It may be helpful in assessing the influence of the social structure on older people to assume that the structure has a different impact depending upon differences in age, sex, intellect, and class. In the process of socializing and teaching the young, the parents become more socially stable and predictable. Their own meanings and values become more specific and systematic, helping them to assume leadership in many areas of adult life and to perpetuate cultural traditions. An interesting study of adults would be one that examined the relationship between mental health, personal and social responsibility (as dependent variables), and the presence, absence, or degree of these people's former responsibility for the socialization of the young. There is research support for the theory that married people live longer and * Committee on Housing, Background Paper on Housing, White House Conference on Aging, March 1960, pp. 1-2, 17. t Ernest W. Burgess and Harvey I. Locke, The Family: From Institution to Companionship (New York: American Book Co., 1945), p. vii. tWillard Waller and Reuben Hill, The Family: A Dynamic Interpretation (New York: Dryden Press, 1951), pp. 26-27. 125

Aging in Minnesota better and have more material assets than the single, divorced, or widowed. According to most studies, living with a spouse, family intimacy, and shortness of widowhood are all positively associated with good adjustment to aging.* The role of the aging. What are the roles of older people in the social structure? They are no longer either imitators or socializers, and in fact for many a process of desocialization seems to take place. Is this because they have lost the mental stability that came from socializing the young or from exercising work skills and leadership? At the 1960 Minnesota State Conference on Aging, it was suggested that the task of our society was to create a role for the aging. The normal adult's role in the family is radically reversed for many of the elderly because they become dependent and childlike with their own young, a relationship that is unattractive to both generations. Social change may be hardest on the elderly. Industrialization and urbanization have left their mark on family relations by stripping the family of numerous functions, reordering the division of authority and labor within it, and putting new demands on it. With the loss of family functions came a loss of usefulness to the family of grandparents and other older relatives. Machines do many chores which were formerly grandmother's. In the social realm, conflict may become especially intense between generations if a grandparent tries too vigorously to socialize the grandchild, attempts more often labeled interference than assistance by the mother. The rural patriarch had command of production and property, but in urban life the corporation and the bureaucracy replace him. A more equalitarian family norm has developed, limiting the authority of the head of a household. The number of households containing three generations is small (2 to 3 per cent) in the United States as a result of a high mobility in the labor force and of personal choice. Most grown children and parents do not want to live together, preferring to live independently and manage separate households. Nor are today's city houses and apartments big enough for the extended family. Burgess and Locke speak of the alteration of the family from an institution to a companionship, but for many of the aging it is neither. Husbands or wives have died, children have moved away, and it has *Gary Hansen, "Personal Adjustment in Aging," University of Minnesota master's thesis, 1960, p. 25. 126

Seventeen Hundred Elderly Citizens become more acceptable and fashionable to isolate the elderly parent in a "home" of some sort. For those whose customary links with family and friends have thus been broken, the St. Peter Regional Conference on Aging recommended that interaction, communication, and shared activities should be promoted between the aging and their families, and that friendly visiting programs be developed in each community in the state.* As we talked with the elderly, a recurrent theme was their desire to see more of children, brothers and sisters, former fellow workers, and friends. It seems reasonable to conclude that a substantial number are tragically lonely and isolated, hungering for some minimum of personal human association. Marital status of the aging. We found important differences in the marital status of the aging (Table 3). Most rural respondents and almost half in the community were married and living with their spouses, but of those in institutions 60 per cent were widows or widowers. There were six times as many widows as widowers in the community, and three times as many in institutions. Proportionately, there were about three times as many single persons in institutions as in the community or rural areas. These last can have little contact with children unless it is with the children of their brothers and sisters or friends, and close association and intimacy with the opposite sex would probably be limited. The only family relations in which they are not limited is with brothers and sisters, who may or may not be living within visiting distance, or whose physical condition may confine them to their own homes, nursing homes, or homes for the aged. When death severs the most meaningful family tie — the companionship of husband and wife — whether unexpectedly or after a lingering illness, a period of crisis and adjustment always ensues. Then too, many of the elderly, especially those in their seventies and eighties, outlive their friends and associates, even their children; the personal and social consequences which result appear extensive. The degree to which these emotional voids may be filled for residents of institutions by association with non-relatives and new friends is not clear from the data. A community organization of social-service-minded people who would visit them and the kindness shown them by nonrelatives and by the administrators and staff of the institution may * Governor's Citizens Council on Aging and the Minnesota Department of Public Welfare, Minnesota's Aging Citizens: Recommendations for Action, 1960, pp. 8-9. 127

Aging in Minnesota contribute to their happiness and satisfaction and compensate somewhat for what they have lost. The following analysis of the data about family life hinges mainly upon associations with children, brothers, and sisters. A measurement of older people's attitudes toward their family relations will also be reported. Relationships with children. Of the urban-metropolitan sample, over twice as many in institutions as in the community said they had no living children (Table 50). Of those with living children, a higher proportion were in the community, and larger families appeared in the urban than in the metropolitan area. This parallels general population statistics: small families are typical in areas of greatest urbanization. Living in a home for the aged or in a nursing home almost entirely precludes the possibility of children's living with their elderly parents. Occasionally, when the children are over sixty-five and thus elderly along with their parents, it will happen; but 99 per cent of those in institutions had no children living with them, compared with 78 per cent in the community. Not only do dwellers in institutions have fewer living children, but they are also much less likely to have any children living with them. About half of the total sample did not have children in the same town or within twenty-five miles. There is a large difference (48 compared with 81 per cent) between the urban and metropolitan groups who said they had no children living in other parts of Minnesota. This may be a function of increasing mobility as people from cities migrate to larger metropolitan centers, and it is a result of proportionately more large urban families. More respondents in institutions than in the community report no children living outside Minnesota (61 per cent and 50 per cent respectively). Family contacts: relationship, kind, and frequency. About a third of the entire sample said they had regular or frequent contact only with their children; a smaller proportion saw other relatives also (Table 51). In institutions, 19 per cent, almost four times as many as in the community, reported no contact with any member of their family. This high percentage may be the result of several causes: there are more single persons in institutions; 39 per cent of those in institutions have no living children (Table 50). Since children more often than any other member of the family provide the contact with the institutionalized 128

Table 50. The Number of Elderly People's Living Children and Their Location, by Residence Number of Children 0 1-3 4-6 7-10 or more Total

0 1 2 3 or more Total 0 1 2-3 4 or more Total 0 1 2 3 or more Total 0 1-4 5 or more Total

Community

Institution

160 17% 500 53 215 23 7 71 946 100 Living with Respondent

674 78 163 19 20 2 8 1 860 100 Living in Same Town or within £5 Miles 361 43 250 SO 163 19 71 8 845 100 Living in Other Parts of Minnesota 425 57% 194 26 68 9 57 8 744 100 Living outside Minnesota 420 50 399 48 18 2 837 100

137 155 46 17 355

39% 44 IS 4 100

296 1 2 0 299

99

100

161 73 46 19 299

54 25 15 6 100

212 44 18 16 290

73% 15 6 6 100

181 106 8 295

61 36 3 100

1

Table 51. Elderly People's Regular or Frequent Contacts with Family Members, by Residence Regular Contacts with Family Members __ Yes Children only Children, brother(s), sister(s), or parent(s) Brother(s), sister(s), or parent(s) only Children and other relatives Other relatives, niece, nephew, cousin, aunt, uncle only Children, and brother(s), sister(s), and/or parent(s) and other relatives Brother(s), sister(s), or parent(s), other relatives No Some contact No contact

129

Community (N = 963)

Institution (N = 379)

36% 24 15 7

32% 9 16 4

4

9

4

2

8

5

2 5

4 19

Aging in Minnesota person, it is understandable that those without children see many fewer relatives. Complete absence of face-to-face meetings with members of their family is reported by a fifth of those in institutions but only 7 per cent of the others. One of every four outside and one of every twenty in an institution sees a member of the family daily. About half of the institutional residents and a fourth in communities, on the average, do not see any member of their family even once every two months. Not only do dwellers in institutions see less of their families, but they talk less often with them on the telephone: 71 per cent in institutions, compared with 32 per cent in the community reported no telephone calls from members of the family. Telephone calls at least daily to at least once a week were reported by 42 per cent in the community, but only 13 per cent in institutions. About one elderly person in ten had a telephone call from a relative only once every other month to once a year. Thirty-nine per cent in institutions compared with 24 per cent in the community reported no letters from members of their families. Letters at least once a week to once a month are mentioned by a significantly higher proportion in the community. Letters every other month to once a year were reported by a slightly higher percentage in institutions. About twice as many hi institutions as in the community reported that they had no living brothers or sisters (Table 52). Just over half of the total responding had from one to three living brothers or sisters. About five per cent of those responding reported very large families by current standards, including from seven to ten or more living brothers or sisters. The great majority of the elderly reported having no brothers or sisters living with them (Table 52). Those who did had only one or two. About two thirds of the total sample reported no brothers or sisters living in the same town or within twenty-five miles (Table 52). Most of the others had from one to three brothers or sisters within the twenty-five-mile radius. About a third of all responding said they had no brothers or sisters in other parts of Minnesota or outside of Minnesota. Slightly over half the sample had one to three brothers or sisters in other parts of Minnesota or outside Minnesota.

Attitudes about family relationships. When the respondents were 130

Seventeen Hundred Elderly Citizens Table 52. The Number of Elderly People's Living Brothers and Sisters and Their Location, by Residence Number of Brothers and Sisters

Community

0 1-3 4-6 7 or more

168 529 219 62

Total

978

0 1-5

Total 0 1-3 4-6 7 or more

Institution 17% 54 23 6

100

126 203 47 14

32% 52 12 4

390

100

Living with Respondent 828 93 _59 7

302 JL2

96 4

887

314

100

212 91 8 3

67 29 8 1

314

100

100

Living in Same Town or within 25 Miles 529 61 229 35 28 3 8 1

Total

864

0 1-3 4-6 7 or more

Living in Other Parts of 245 465 137 29

100

Total

876

or outside Minnesota 28% 110 53 175 16 23 3 5 100

313

35% 56 7 2

100

asked to agree or disagree with three attitudinal statements about their family relationships, some interesting differences were revealed between institutional and community dwellers. The first statement was "My family is always trying to boss me." Only 5 per cent of the total agreed with this; a surprisingly large number, about 92 per cent, disagreed; and the remaining 3 per cent were undecided. No significant differences appeared between the groups. A further analysis should be made to determine if those actually living with children in their children's homes differ from those who do not. The second statement was "I wish my family would pay more attention to me." About one out of four in institutions and one in ten in the community agreed. This difference is significant in practical and statistical terms, but not unexpected after a study of the comparative data on family and non-family contact of the two groups. Only about 2 per cent of the total sample was undecided and the remaining 72 to 88 per cent disagreed. 131

Aging in Minnesota The third statement was "I am perfectly satisfied with the way my family treats me." In the community 90 per cent and in institutions 79 per cent were satisfied. This latter figure complements the 23 per cent who wanted more attention from the family. In summarizing family relationships, both structural and affective, it is possible to contrast the institutionalized aging with those in the community. The old person in an institution is more often single, divorced, or separated as opposed to being married and living with spouse; is older and more likely to be widowed; is more likely to be a widow than a widower; has fewer living children; usually has no children living with him; has fewer children living in the same town or within twenty-five miles; has fewer children living in other parts of Minnesota; has fewer children living outside of Minnesota; has less regular or frequent contact with anybody in the family; is less likely to see a family member face to face daily; is less likely to hear from family members over the telephone; is less likely to get letters from his family; is twice as likely to say that he wishes his family would pay more attention to him; is more likely to disagree with the statement that he is satisfied with the way his family treats him. Recommendations. Since seeing members of their own families is impossible for many of our old people it seems desirable for us to organize programs that will help them to establish strong friendships with other men and women. This can be done by visiting them; through social and recreational clubs and day centers; by having younger members of the community take an interest in the elderly, particularly those in congregate housing; by the creation of friendly relations between administrators and other personnel of homes for the aged or nursing homes and their residents; and by the employment in these homes of people specifically trained or experienced in recreational or social activities. SOCIAL LIFE AND FRIENDSHIPS

How do organizations as part of the social structure affect individual adjustment to aging? Insofar as his self-image is maintained by interaction and represents others' responses to him, it would appear that participation in organized social life is necessary and favorable to each person's good adjustment. Thirteen investigations have found that organizational membership and attendance, social or club participation, total activity scores, group activities, and office-holding are posi132

Seventeen Hundred Elderly Citizens Table 58. Elderly People's Membership and Leadership in Organizations, by Residence* Membership and Leadership Organization

None Religious organization Civic organization Social organization Professional organization Other

Urban-Metropolitan

Rural (N = 295)

Community (N = 968)

Memberships 14% 76 3 3 45 4

20% 64 14 31 8 9

Leaderships (Officer or Conimitteeman) Religious organization 6 3 2 Civic organization 5 1 Social organization 5 2 Professional organization 2 1 Other 3

Institution (N = 375) 45% 52 6 10 2 4 2 1 1 1 1

* Percentages total more than 100 because some respondents gave more than one answer.

lively associated with adjustment. These studies demonstrated clear linear relationship between increasing involvement in an organization and greater adjustment: members of organizations were better adjusted than non-members, actual attenders and participants were better adjusted than members in name only, and officers and committeemen were the best adjusted of all.* This is related perhaps to the importance, discussed earlier, of the elderly person's having a role or function. Another indication of the effects of social life on adjustment in aging is the response to the question "What is the most interesting or enjoyable thing in your daily life?" Many reported that they enjoyed visiting and communicating with their families and friends more than anything else. Together with indoor activities, this ranked first among their daily pleasures (Table 4). Membership in organizations. Religious organizations, in comparison with all other kinds, appear to have the strongest appeal to the elderly. Most are members of some religious group (Table 53), and memberships in all other organizations combined do not equal the membership in religious and church groups. Church membership is proportionately * Hansen, op. cit., p. 65. 133

Aging in Minnesota highest among the rural older people, and lowest among those in institutions, although 52 per cent there report membership. Almost half in institutions have no organizational affiliation, which may be explained in part by their more advanced age, poor health, and decreased mobility. Half of the institutional residents claim affiliation with one organization, but the proportion varies inversely as the number of organizations increases. Memberships in other organizations lag far behind the religious. The urban-metropolitan residents more often belong to social and other non-religious organizations, with the one outstanding exception of professional organizations, in which 45 per cent of rural respondents report membership. Either the professional farm organizations retain a much higher proportion of their older members or fewer of the city's aging ever belonged to professional groups. The rural elderly person is more apt to be a leader in his religious organization, but in all other kinds of organizations the elderly of the urban-metropolitan community are more often officers or committeemen. Desire to join other organizations. Not very many of the elderly want to belong to more or different organizations than they now belong to: 90 per cent in institutions and 85 per cent in the community have no desire to join any new organizations. The two kinds of organization which seem most important are the religious organizations, and the social or neighborhood clubs for visiting, coffee, and cards. Membership in civic, professional, hobby, charity, or service organizations was desired by less than 1 per cent of each group. The senior citizens' club or "golden age" club was mentioned specifically by only 2 per cent in the community and 1 per cent in institutions. One would gather from these data that the formal organization as such is not nearly so important to the aging as is companionship or some kind of social life. A large discrepancy shows up between the proportion who want to see more of family and friends and those who want to belong to more or different organizations. The activity level for many elderly people did not change after they reached sixty-five. When the level changed, it was usually in the direction of less activity. For example, we note that whereas 23 per cent in the community and 14 per cent in institutions say they are more active in church or religious organizations, about 75 per cent in each group 134

Seventeen Hundred Elderly Citizens say that they are less active. The religious organization, however, is the predominant one, and even though participation now is less than it was before sixty-five, the relative time, energy, and thought it receives from the elderly citizens in our society appears to be great. The highest proportion of those who said they had become active in civic, social, and professional organizations were from the community, but more than three times as many in the community reduced their activity in professional organizations rather than increased it. Obviously, after retirement from a profession, participation in the related organization declined. Inactive memberships. Over three fourths of each group said that they kept up no inactive membership in any organization. This is a high proportion and warrants further investigation. Of those who said that they did keep up inactive membership, the predominant one again was in the religious organization or church. The aging in institutions reported this to a greater degree than in the community —14 compared with 8 per cent. A smaller number reported inactive memberships in civic, social, and professional organizations. The principal reasons given for inactivity were bad health and disability. Lack of transportation to meetings and "getting too old now" or "getting along in years" ranked next. Only 1 per cent in each group suggested that the reason for the inactivity of membership was lack of interest in the organization. Inactive memberships were reported by rather small proportions of the sample and most maintained such membership in only one organization. Senior citizens' clubs. Clubs for older people were reported as more available in the metropolitan than in the urban cities, 56 compared with 32 per cent. Over a third in the urban and almost a fifth in the metropolitan area said that such clubs were not available, and slightly more than a fourth in each group said they did not know if the clubs were available or not. The projected desire of older persons to use a club is greater among those in the community (42 per cent) than those in institutions (28 per cent). About one person in six did not know whether they would like to use such a club or not. The small number of persons reporting participation in or use of senior citizens' clubs does not give us an adequate sample from which to draw definite conclusions. Commercial entertainment. Television, for purposes of this study, is 135

Aging in Minnesota not classified as commercial entertainment because it differs markedly from entertainments which must be actively pursued and which require a person to leave home, buy a ticket, and make a definite effort. Excluding television, we find that the aging in institutions had less commercial entertainment than those in the community, 62 compared with 49 per cent. The greatest proportion of old people said that the commercial entertainment they enjoyed most was movies. Of those who had commercial entertainment at all, more than four in ten reported going to movies once or less than once a month and about 10 per cent went two or three times a month. Most frequent attendance at movies (four or more times a month) was reported by 5 per cent in the community and 12 per cent in institutions. It would appear that greater proportions of residents of nursing homes and homes for the aging saw movies more frequently than those in the community. Sports were second in popularity: about a fourth in the community and 7 per cent in institutions watched sports events once or less a month. Dances ranked third and were reported by 7 per cent of each group as having been enjoyed once or less often a month. All these entertainments are group activities, and as such provide the social communication and interaction so necessary to the older person. Social attitudes. Over a third of the total sample said they have more friends now than they have ever had before. But half in institutions and almost as many in the community said they have not, which is related perhaps to the fact that the older you get, the more of your old friends have died. The importance of friendship to an older person can be seen in the fact that more than seven out of ten in institutions and eight out of ten in the community agreed that "their many friends made their life happy and cheerful." Only one person in ten in the community and two in ten in institutions disagreed. On the other hand, quite a number of the aging, especially in institutions (27 per cent), said they have no one to talk to about personal matters (this was the complaint also of 12 per cent in the community). The consistency of their responses is suggested by a similar proportion who said that they have so few friends that they are lonely much of the time —18 per cent in institutions and 7 per cent in the community. This is one of the most fascinating and provocative problems of 136

Seventeen Hundred Elderly Citizens the entire study because it touches practical issues that could be the target of community action. The challenge is to find the lonely people, those without friends, and to provide some satisfying companionship or other less intense relations for them. A fairly large proportion (over half of the total) said that they would like the chance to make new friends; more of these were in the urban (59 per cent) than in the metropolitan areas (45 per cent). Conversely, more of the metropolitan (41 per cent) than the urban residents (28 per cent) said they would not like to have an opportunity to make new friends. To account for this adequately would require further investigation; theoretically, the reasons could be variations in people's knowledge about the importance of friendships and about the frequency and intensity of their establishment. Substantial discussion in sociology and psychology of the impersonality of the large metropolitan center suggests that people in the metropolitan areas have greater need for friends because they don't have them. Learning theory, on the other hand, suggests that people do not inherently need certain amounts of friendship, but that their need for friendship is determined by previous experience, including satisfactions, with it. Contact with work associates. When retirement cuts off contact with fellow workers of long standing, there is a drastic change or curtailment in one's social life (see also pp. 132-34). Suffice it to say here that the proportion wanting to see more of their former fellow workers closely parallels the proportion who said they had not seen them during the past year (33 per cent in the community and 50 per cent in institutions). Over half of those in the community (60 per cent) wanted to maintain their present amount of association with former fellow workers, while the majority in institutions wanted more contact, which emphasizes again the greater need for friendship and lasting associations among those in institutions. More than a fourth of the residents of institutions report no regular or frequent non-family contacts, another fourth gave vague responses indicating several or a few, and almost a fourth more said they had regular or frequent contacts with from one to three persons. This means that almost three fourths of the institutionalized saw only three or fewer such persons, a small number indeed. More of the story is told in Table 54: 9 per cent of those in institutions said that nobody ever stopped by to see them. A smaller percentage, 2 per cent, in the com137

Aging in Minnesota Table 54. Elderly People's Regular or Frequent Non-family Contacts, by Residence* Urban-Metropolitan Non-family Contacts

Community (N = 972)

Yes: 1-3 Yes: 4-6 Yes: 7-9 or more Vague responses: several or few No regular or frequent contact

Institution (N = 379)

13% 15 38 27 7

21% 13 16 24 26

* The number is smaller than the total sample because this question was not asked in the rural area. Table 55. How Often Somebody Stops by to See Elderly People, by Residence* Urban-Metropolitan Frequency of Visit

Community (N = 995)

Institution (N —401)

28% 47 11 6 2 6

10% S3 23 15 8 11

Once or more a day Once every two days to once a week One to three times a month Once in two months (or rarely) Never No information

* This question was not asked of the rural sample. The number is based on actual responses, its small size reflecting the fact that many did not answer or had no definite opinion.

munity said the same. The differences in the frequency of contact are clearly shown in Table 55. One in seven of the residents of institutions had someone stop by as infrequently as once in two months or more. The whole area of the social life and friendships of our elderly citizens is fertile ground for individual and community action. RELIGION

Religion is concerned primarily with the meaning of existence. It does not ask "What am I?" and "How do I live?" but rather "Who am I?" and "Why am I here?" Underlying the thought and activities of all major religious groups is the belief that the answers to these questions and others about the meaning of life are to be found in a relation with God. Religion has meaning for people of every age. It is perhaps no more 138

Seventeen Hundred Elderly Citizens significant for one age group than another, although it may be viewed from a different perspective at the various stages of the life cycle. Our conclusion that the importance of religion increases as people grow older is supported by the fact, for example, that the majority of people sixty-five or older — as many as 76 per cent in the rural sample — belong to religious organizations (Table 53). There are proportionately more inactive memberships in church organizations than in other kinds of organizations, meaning, perhaps, that the older person clings to this tie with the group even though he is no longer physically able to be active in it. Also, the church is one of the two kinds of organization which respondents mentioned a desire to join if they were to increase their participation in organized activities. The Bible and religious stories ranked third among all kinds of reading as the most interesting to the aging (Table 56), and many of them subscribe to religious periodicals. All these things suggest that as the years accumulate and life runs out, the thoughts of many people turn to things which may give some hope of life beyond death; they re-evaluate their lives in religious terms. The importance of religion to the elderly is perhaps most strongly demonstrated by their own assertions: between 86 and 92 per cent of the urban and metropolitan residents agreed that religion was a great Table 56. Hours Spent in Reading and Type of Reading Preferred by Elderly People, by Residence Community 0 1-6 7-12 13-20 Over 20

Total History, autobiography, biography Mysteries Bible, other religious articles Western, cowboy stories Love, romance stories Sports stories

Institution

Hours Per Week Spent Reading 33 67 4% 260 121 28 60 276 29 24 58 228 139 50 15 936

100

19% 34 17 16 14

Total 100 381 336 286 189

8% 29 26 22 15

356

100

1292

100

33 21 35 25 16 5

12 8 13 9 6 2

213 145 131 76 68 44

20 14 12 7 6 4

Type of Reading 180 124 96 51 52 39

22 15 12 6 6 5

139

Aging in Minnesota comfort to them, and over two thirds of those interviewed said that religion was the most important part of life. About one in seven said that religion was not the most important thing in life, and slightly more than that were undecided. The aging respondents appeared to have more favorable attitudes toward religion as an influence in their lives than toward any other item on the adjustment scale. The only other item with as high a favorable response was the family, perhaps because they feel it is more socially acceptable to reveal negative attitudes toward the problems of health, retirement, non-family social contacts, and morale than the more sacred or secret areas of religion and family life. Because the aging are more disposed to accept the services offered by religious organizations, we hope that such organizations will greatly extend these services, especially to the infirm, the invalid, and the permanently institutionalized. As the Background Paper on Religion and Aging of the White House Conference said (pp. 23-24): "In its teaching, ritual and organization, religion is equipped to contribute greatly toward making the latter years . . . a time of fulfillment. Amid the confusion naturally attendant on a period of rapid social and technological changes and in the face of the vastly increased number of persons living into old age, it offers the great service of helping us to remember the dignity of each person as an individual . . . It locates individual worth . . . in what a person is ... not in what a person has or accomplishes. . . . It stands with an individual at the moment of death, pointing ahead in hope, just as it had offered to an individual's life, over his allotted span of years, a framework of meaning and values. . . . In the years ahead . . . it should seek to offer a series of positive affirmations and proposals for long-range action, by individuals and community, with respect to our senior citizens, their needs and position in our society." EDUCATION

In this section we shall set forth the attitudes, experiences, and needs of Minnesota's older people in the area of both formal and informal education. This description is designed to provide a foundation for an answer to the question: How do we educate older people? The answer requires personal and societal interest, legislation, financial resources, administration, professional personnel with special techniques, space, and physical facilities. In order for the aging to get more of the best 140

Seventeen Hundred Elderly Citizens education, there must be considerable planning, organization, and cooperation by various agencies, schools, and state departments. Education can be a vital force in conserving, developing, and using the talents and resources of older people for their own benefit and society's. Older people, especially the retired, have plenty of free time, and education can determine in part whether this time is spent creatively in satisfying leisure-time activities, or in doing nothing. An analysis of the educational background of the old people we studied shows the urban-metropolitan sample to have achieved a somewhat higher level than the rural: 50 per cent of the urban-metropolitan, 60 per cent of the institutionalized, and 85 per cent of the rural had completed eight years or fewer of school (Fig. 7). Only 2 per cent of the rural had more than twelve years of schooling, compared with between 15 and 20 per cent of the urban and metropolitan residents. Reading patterns. A few elderly respondents (Table 56) said they do not ordinarily read anything in a week's time (2 per cent in the community, 12 per cent in institutions). Most, however, read the newspaper, by far the most popular kind of reading material among 94 per cent in the community and 80 per cent in institutions. Magazines were second choice in both groups (80 per cent, in the community and 60 per cent in institutions) and books ranked third, with almost half of the respondents saying that they read books during the usual week's time. Newspapers and magazines apparently reached more than three fourths of those over sixty-five. When we asked how many hours a week they spent reading, only 4 per cent in the community and 19 per cent in institutions said they spent no time at it. The data show clearly that reading is very popular among older citizens. In fact, 15 per cent — one person in seven — reported reading more than twenty hours a week, about half of a normal work week, and about 20 per cent averaged sixteen hours a week. What kind of reading do they prefer? Histories, autobiographies, and biographies as a group ranked first; mystery stories, second; and the Bible and other religious materials third, with no significant differences between community and institutional residents. Only 1 per cent of the total sample mentioned a liking for comics, joke books, or humorous stories. The three preferred kinds of reading may be judged relatively complex and detailed. It is interesting that stories dealing with the past rank first; mysteries — fantasies or "escape" stories — are second; 141

Figure 7. Years of schooling completed, by residence

then the Bible and religious stories, which tie in with the increased interest of the elderly in the church and religious activities. Informal education, especially through the mass media, could reach and perhaps bring satisfaction to many old people, because so many of them enjoy watching television or listening to the radio. Instruction by television or radio for those who like to use their skills in painting and music might include information on how to create new things or improve the quality of their production or performance. In addition to instruction by radio and television, those who like to stay at home or 142

Seventeen Hundred Elderly Citizens are confined indoors might find correspondence courses appealing. More formal educational programs should provide some opportunity to visit or socialize. However, since only a small proportion enjoys activities away from home most, formal classes will have to be very helpful, stimulating experiences to compete favorably with home or neighborhood activities. Traveling was what a fifth in the community and a tenth in institutions had hoped to do in their later years. Those of the elderly who have realized this ambition might enjoy sharing what they have learned about other people and places with children and other interested adults. This kind of sharing maintains motivation and broadens perspectives. Library services available: recommendations. In our discussions with Hannis Smith, Director of Libraries of the Minnesota Department of Education, Library Division, we learned that all the metropolitan and urban communities in the sample actually have library and study services available to all people. In fact, every incorporated place in the state with a population of 2,500 or more has a public library. The three metropolitan cities and some of the urban communities have had library and study services for more than fifty years. But there are serious discrepancies between respondents' knowledge about and the actual existence of such services, and this generalization applies in varying degrees to almost every public and private service available to the aging throughout the country. The rural aging are accurate in reporting that fewer library and study services are available to them than to other groups. County-wide public library services are not available in two of the three rural counties studied, and in the third county the services may not be adequately available to or used by the residents. But the state library director and planners visualize a consolidated, large-area, rural library system covering several counties with each unit. This plan would make library services available to all residents in each area, and the quality of the service, which would include deliveries by bookmobile, would far surpass existing services. In this study, 40 per cent of the urban and 60 per cent of the metropolitan residents said that library and study services were available to older people in the community; about a third of the urban and 13 per cent of the metropolitan groups said they were not. About a fourth 143

Aging in Minnesota of all interviewed did not know whether or not such services were available. Those who said the services were available were asked when they had last used the services: about 25 per cent in the community and 15 per cent in institutions reported that they had never or seldom used them, and only one person in twenty had used them occasionally, frequently, or very often. When respondents who had said "No" or "Don't know" were asked if they would use such library services as bookmobiles, talking-book records, and study groups, if available in their communities, 33 to 42 per cent of all groups said they would; between 34 and 50 per cent said they would not; and between 11 and 23 per cent were undecided. At present, libraries need to publicize more completely, on television and radio and in newspapers, the scope of their services. This would be very helpful to aging citizens, who spend so much time with these communication media. Specific materials about preparing for aging and life in the later years are available to the elderly, but libraries need to draw older people into existing general programs and services and also to provide separate and special programs for them. There is also much reading material available for the professional person working with the elderly. The public, especially community and library leaders, needs to be alert to the handicaps that prevent old people from using libraries more. Interesting reading materials with large print in understandable language should be multiplied, especially for the elderly with little education. Transportation to the library is not always available and when it is the older person is often faced, upon arrival, with a climb to a monument rather than a building designed to serve all the public. One librarian's experience includes regularly serving six avid older readers by meeting them at the base of the steps to give them books. Such service is needed at all libraries. If the patron is homebound for any reason, a visiting service could be established. Youth could serve the aging well by delivering reading materials; Boy or Girl Scouts could perform such services. People responsible for libraries at all levels do and should recognize that librarians' ability to render good service is dependent upon their intelligence, training, vigor, organizing ability, and sensitive perception of individual, group, and community needs. Adult education classes. Another area in which libraries could render 144

Seventeen Hundred Elderly Citizens an eminently useful service to the aging is by making space and materials available in the daytime for adult education classes. Those who work with older people generally find that they prefer day classes to evening classes. Since schools are already troubled by crowded classrooms and half-day schedules, it is logical that libraries, which are used more in the late afternoons and evenings, could provide facilities for day instruction for the elderly. These courses would be in addition to, or in conjunction with, current informational film programs available to all, and would be of special interest to those who can't read well. Classes for older people were reported to be available in their communities by slightly over a third of all groups (Fig. 8). They were reported as not available by a third of the urban and almost a fifth of the metropolitan residents. Thirty-two per cent in the community and 45 per cent in institutions did not know whether these classes were available or not. Of the 415 people who said they were available, 42 said that they had attended a class at one time or another, meaning that about 1 in 10 had taken part in an adult education class. This represents 1 person in 33 of the total study and parallels the 1957 national average of 1 person in 30 over sixty-five who took part in adult education classes. The community residents were represented more often than those in institutions; 15 of the 42 participants said that they took part frequently, often, or very often. When those who said classes were not available or that they didn't know were asked if they would use such classes if they were available, about a fourth said they would, slightly over half said they would not, and about a fifth were undecided. Responsibility for education and counseling services. Labor and management jointly were assigned responsibility for retirement education by 45 per cent of the respondents in this study. About 25 per cent said neither was responsible, and the rest assigned responsibility to management four times as often as to labor. Asked whether or not they would favor government information and counseling services, two in five wanted both, one wanted information only, one was undecided, and one opposed it. If there were sufficient demand for such services, they could probably be organized through the already existing county welfare offices, county extension services, or social security offices. 145

Figure 8. Older people's knowledge of available adult education classes, by residence

A key question is when education for aging should start. In order for the attitudes, values, and practices in our society to be positively changed, education must take place during the most impressionable developmental years: early childhood. Since the children imitate their parents and learn more from them than from anyone else, it is of the utmost importance that parents lead the way in providing an exemplary set of attitudes and practices. In order for our society to achieve its highest potentials in this respect, parents will have to provide the models for their children to follow in dealing with aging. Reason and family social psychology attest to this. It would seem advisable to put courses for aging into the existing 146

Seventeen Hundred Elderly Citizens school curriculums at each appropriate level, giving favorable conditioning toward aging during the early years, specific planning and preparation to persons thirty and over, and fairly intensive retirement preparation beginning at sixty. It also seems essential and practical for employers and social service agencies to give separate additional courses. The older person probably should not be required to pay fixed or high tuition rates for education because this will immediately eliminate many who would otherwise take them. The free tuition policies of various universities should be studied to determine their effects upon the older students. Where free-tuition arrangements are possible without serious negative results, it seems highly desirable to have not only classwork but assemblies, theater, symphonies, convocations, library work, and so on. However, it may be necessary for some older people to finance themselves in order for them to retain a self-image of independence. Some institutions need some money from older people in return for the services rendered; they might arrange tuition rates and fees for other services on the basis of the individual's ability to pay. Although this amount may be small in some cases and nothing in others, it will at least partly satisfy both individual and institutional needs. USE OF TIME

The increasing quantity of free time available to almost every segment of our population deserves considerable attention from the leaders of governments, industries, churches, libraries, and schools, as well as from citizens generally. Free time is particularly abundant for the elderly and the retired, and wasting this time is unfortunate because of our great need for capable and mature people to keep abreast of developments in a changing world; to study international cooperation, understanding, and reciprocal services; to help interpret the world, its history, and the meaning of today's events; to aid scientific investigation and the discovery of truth in every sphere of activity or subject matter; to help provide services to the sick and the needy; to work toward the creation of better living conditions, improved social relationships, and greater personal satisfactions. We cannot as a nation afford to waste the free time we have. In the future, the ability to use free time in a useful, creative, and satisfying way may be as important to individual happiness and development as is the training for, prepara147

Aging in Minnesota tion for, and execution of work today. Any surplus of time should be harnessed to do the social and individual chores of an independent, affluent society. In an effort to assess more precisely the meaning of time in the adjustment to aging and retirement, we asked about the activities in which the elderly now spend more time and those in which they now spend less time than they did before reaching age sixty-five. Nine out of every ten mentioned some activities at which they now spend more time. A general comparison of institutional and community residents suggests that those in the community are markedly freer to use their time in such psychologically rewarding activities as working around the house, working with hobbies, taking part in social activities and volunteer work, and doing other things they did not have time for earlier. On the other hand, residents of institutions more frequently report increases in just sitting and thinking. When the data about activities in which old people spend more time are compared with the data about activities in which they spend less time, a definite pattern emerges. Sizable proportions spend increased time around the house, listening to the radio or watching television, just sitting and thinking, or doing things they had always wanted to do. On the other hand, time spent leading social or community organizations is more often decreased. These general patterns introduce us to a more specific, detailed analysis of the distribution a,nd use of time. Percentages have been combined to make possible a comparison of rural, community, and institutional residents, disregarding metropolitan or urban considerations. Understandably, more than twice the proportion of rural and community residents as compared with those in institutions say that they spend more time around the house with their spouses — 60 per cent compared with 25 per cent. When elderly wives get together, part of their joking as well as more serious discussion concerns the fact that their husbands get in the way around the house and are really a general nuisance. After the husband retires, he frequently hasn't enough to do and he tries to help at home. Being unskilled in the arts of homemaking, he may hinder more than he helps. About a third of all community respondents spent more time in household duties now than they did before age sixty-five. But about 40 per cent say they spend less and another 30 per cent say they 148

Seventeen Hundred Elderly Citizens spend the same amount of time doing such chores. Naturally, almost all (90 per cent) in institutions spend less time doing household work than they did before they were sixty-five. There is a dramatic increase in listening to the radio and watching television among all groups, with 57 per cent of the metropolitan and urban, 45 per cent in institutions, and 40 per cent of the rural respondents reporting such an increase. The use of informal channels of education and entertainment is thus increased by almost half after sixty-five. Only 9 per cent of those living in the community, compared with 25 per cent in institutions, report a reduction in the amount of time spent listening to the radio or watching television. A great number of institutional residents report just sitting and thinking as an activity absorbing more of their time. For the 60 per cent who reported this, most of this time may be spent in sitting rather than in thinking, with the thoughts directed more toward the past than the present or the future. Even in the community, 40 per cent said that after sixty-five they spent more time sitting and thinking. The large amount of time now spent around the house with one's companion and working, watching television, listening to the radio, or sitting and thinking might very well be spent, in part, in other useful and perhaps more satisfying activities. It might be expected that a majority of the elderly would have hobbies and would spend more time at them after sixty-five, but this does not appear to be the case. Only a fourth in the rural area and in institutions compared with over a third in the community reported spending more time with hobbies. It may be that many people sixty-five or over do not have hobbies, or that many hobbies require more money than is available. As will be brought out later in this chapter, however, even though many people did not spend more time at hobbies, many others spent a great deal of time with their hobbies, and still others expressed a desire to do so. Apparently, residents of institutions have much less opportunity to do the things they always wanted to do —18 per cent compared with 33 per cent of community residents. As might be expected, volunteer work in community activities is higher for community than institutional residents —10 compared with 2 per cent. There is little difference between the groups in the amount of participation in social organizations. 149

Aging in Minnesota Now that we know the general areas of activity in which those over sixty-five have spent more time than they did before that age, we might consider how they would prefer to spend even more time, given their present state of health. In reply to a general question asked of the rural and metropolitan samples, slightly over a fourth of each group said they would like to be doing things in their free time that they were not doing now. This means that twenty-five out of every hundred might be interested in the activities mentioned in the first few paragraphs of this section. About 60 per cent said that they would not like to be doing anything else in their free time, and about 10 per cent did not know. Some of this 10 per cent might also be interested in new creative activities. In replying to specific questions as to whether they would like to spend more, as much, or less time in particular activities, only 25 per cent mentioned no kind at which they would like to spend more time. This is in contrast to the 60 per cent who said they would like to be doing anything else in their free time. That large percentage may be the result of the vagueness of the open-end question. Also, older people may be more content with their present use of free time than with the time which is committed to tasks or responsibilities. The specific data reveal much more discontent than one would exTable 57. Activities in Which the Elderly Would Like to Spend More Time, by Residence* Activities See more of: Children Friends or neighbors Brothers or sisters Take more part in church or religious activities Participate in other social organizations Hobbies Radio, television Working around house Staying around house with spouse Sitting and thinking Taking part in the leadership of social and community organizations

Community

Institution

342 302 299

54% 48 47

101 124 103

43% 53 44

444 426 402

51% 49 46

256

40

108

46

364

42

181 253 158 157

28 40 25 25

60 66 78 46

26 28 33 20

241 319 236 203

28 37 27 23

127 84

20 13

21 46

9 20

148 130

17 15

78

12

16

7

94

11

Total

* Percentages total more than 100 because an increase in more than one activity was desired by some of the respondents.

150

Seventeen Hundred Elderly Citizens pect with the present use of time. The three activities in which the greater proportion of people would like to spend more time were all social: they want to see more of children, friends or neighbors, and brothers and sisters (Table 57). These were all desired by over five hundred of the aging in the sample, which is about half of the eight hundred sixty-eight who said that there were activities in which they would like to spend more time. Thus again we see social needs predominate as they did in regard to the most enjoyable things in daily life (Table 29) and also, although not so strongly, in their wishes to change the present situation. The desire to spend more time in church or religious activities, which ranked fourth, is further evidence that the importance of religion grows in the later years, as discussed earlier. How could church leaders, ministers, and priests develop programs for the aging which would captivate their interest and meet this apparently strong desire to affiliate themselves with a religious group and to be more active in such an organization? This problem invites thoughtful planning and work among leaders. Over three hundred persons suggested that they would like to spend more time working at hobbies, which ranked fifth. To those in the economy who specialize in the development and distribution of hobbies, craft materials and kits, and so on, this may be a clue to a fairly substantial market. Because taking part in leading social or community organizations ranks last among the activities in which the elderly express a desire to spend more time, one might conclude that they do not want to assume an active leadership in society. But these ninety-four elderly people who want to lead are about one in fourteen, which may be fairly close to the proportion of persons at other age levels who are leaders in organizations. The desire to lead lessens as age increases, based on the limitations imposed by reality, including a feeling that others should have the opportunity and the experience; but a substantial number of the aging could provide leadership, direction, and stimulation to other old people and to society at large. How do those living in institutions compare with those in the community in their desire to spend more time in various activities (Table 57)? The proportions of institutional and community dwellers desiring to see brothers and sisters and friends and neighbors were about equal, 151

Aging in Minnesota as were those wishing to participate in church or religious activities. More institutional dwellers wanted to listen to the radio or watch television, and just to sit and think, whereas more residents of the community wanted to do things now that they never had time for before, to see more of their children, to spend more time around the house with spouse, to work around the house or at hobbies, and to lead social or community organizations. Many of the differences are the result of logical, realistic conclusions. For example, residents of institutions who want to spend more time watching television, listening to the radio, and sitting and thinking may be those who are sick or disabled; they would be creating frustration and discontent for themselves by wanting to do things they are not able to do. More community residents have children whom they can be with and they also have greater opportunity to take part in leading social and community organizations. Spend less time. As a sequel, we shall look now at activities which consume less time during the later years. The following proportions are based upon all respondents, disregarding differences in residence. About a fourth said there wasn't anything they spend less time at since they reached sixty-five (Table 58). This may be somewhat related to Table 58. Activities in Which the Elderly Would Like to Spend Less Time, by Residence* Activities See more of: Children Friends and neighbors

Brothers or sisters Take more part in church or religious activities Participate more in other social organizations Hobbies Radio, television Working around house Staying around house with spouse Sitting and thinking Taking part in the leadership of social and community organizations Doing things always wanted to but didn't have time for

Community

Institution

Total

19 91 30

6% 29 9

15 62 16

12% 50 13

34 153 46

8% 35 10

79

20

42

32

121

23

106 37 72 143

27 9 18 36

61 46 42 49

47 35 32 38

167 83 114 192

82 16 22 36

122 222

31 70

35 75

27 61

157 297

30 68

207

52

71

55

278

53

58

18

43

35

101

23

* Percentages total more than 100 because more than one activity was mentioned by some of the respondents.

152

Seventeen Hundred Elderly Citizens the fact that quite a few of them were just past sixty-five and there had not been any drastic changes in their routines. They may have remained employed and in good health. Some were probably housewives who have kept up the same routine since the last child left home. The old people strikingly reduced their participation or at least spent less time in social organizations (50 per cent less) and also at volunteer work in the community (46 per cent less). Another paradox of growing old is revealed in the fact that though the need for social life may remain fairly constant, the activity in social organizations is significantly reduced, creating a rather large disparity between the need and its fulfillment. Almost a third say that they spend less time working around the house now; a fourth spend less time following their hobbies and doing things that they always wanted to do but previously did not have time for. About a seventh spend less time listening to the radio or watching television and also less time just sitting and thinking. Less than one in ten reports a reduction in time spent staying around the house with the spouse. There is no difference between the two groups in the reported participation in volunteer community work. This may mean that institutional residents consider the institution as the community and that they are doing volunteer work in the community when they give assistance to other residents of the institution. As Table 58 shows, two activities have the least appeal to the greatest proportion of the elderly: just sitting and thinking (68 per cent) and taking part in the leadership of social or community organizations (53 per cent). Other activities in which they would like to decrease the amount of time spent are working around the house, taking part in non-church social activities, and staying around the house with the spouse, in that order. About 35 per cent said they would like to spend less time seeing friends or neighbors and children. It appears that it is easier for the aging to reduce the amount of time spent in things that they don't like than it is to increase the amount of time spent doing things they like. Use of time in hobbies. Hobbies were about three times as common in the community (35 per cent) as in institutions (12 per cent). Sewing, knitting, or crocheting appeared to be the most popular for about a third of each group, attracting far greater proportions than any other 153

Aging in Minnesota category. Gardening, which ranked second among community dwellers, was, naturally, not chosen by such numbers in institutions. Collecting stamps, coins, rare books, or antiques was low on the list of hobbies, probably because these are expensive and also because as one gets older it seems less and less urgent to acquire a large collection of material things unless there is someone to share the interest and, presumably, carry it on. The percentage of the urban-metropolitan sample interested in various hobbies is shown in Figure 9. This question was not asked of the rural sample in a way that allows comparison. A hobby which requires concentrated time and effort, captures the imagination, and is complex enough to be challenging may be one of the best substitutes for some of the satisfactions that people earlier derived from working. Hobbies provide a way of being useful and original and are activity-oriented; hobbyists are socially recognized and rewarded. The products of such hobbies as sewing, knitting, crocheting, and craft work may become gifts which are enjoyed by the people important to the older person, or they may be sold and thus provide an important bond between those who make them and those who receive them. Field, outdoor, and certain indoor sports, gardening, and the like provide opportunities for physical activity which is helpful in maintaining a healthy body. It would be interesting to know to what extent hobbies may also deprive the aging of certain satisfactions. Do hobbies that center on reading cause social isolation or are these readers leaders in organizations? Avid readers have a good deal to share with others, and the knowledge and new experiences gained through reading might enrich not only their own lives, but the lives of others. They could perhaps organize discussion groups and stimulate others to think about issues of our time, to keep abreast of international and national events, and to spark local community development, particularly in behalf of the aging. The elderly citizens, frequently experts in their hobbies, might make a major contribution by teaching younger people these satisfying freetime activities — sewing, knitting, crocheting, craft work, hunting, fishing, golf, and other field sports. Undoubtedly they could teach and encourage such youth groups as the Boy Scouts, Camp Fire Girls, the YMCA and YWCA. Plans for after sixty-five. Apparently, few of the aging made special 154

Figure 9. Older people's reports of hobbies, by residence

Aging in Minnesota plans before they reached sixty-five for life in their later years, and fewer in institutions than in the community had made such plans. A clear majority — 70 per cent in institutions and 60 per cent in the community — said they had no plans for life after they reached sixty-five. Most of those who did make plans wanted to travel — 20 per cent in the community and 11 per cent in institutions. This question was not asked of the rural sample. Among those who did have things they wanted to do after sixty-five, almost half in institutions were not able to do them at all and a high percentage (28 per cent) in the community were also altogether frustrated. About a fifth in the community and only 4 per cent in institutions said that they were able to carry out completely plans for the things they wanted to do after sixty-five. Only about 10 per cent of each group said that they had done, or expected to do, the things they had planned that they were physically or financially able to do. Not only did the elderly not plan ahead of time for life after they reached sixty-five, but also they had no plans for the future at the time of the interview. Over three fourths in institutions as compared with 55 per cent in the community said they had no future plans. About 10 per cent of each group planned only to continue as things were now. The only plan for the future of a substantial number (15 per cent in the community and 4 per cent in institutions) was to travel. COMMUNITY SERVICES AND FACILITIES

The following discussion should be particularly useful to persons interested in social and community organization. The data suggest many possible directions for the development of organized services and activities for the elderly. Planning on local, county, and state levels might be more useful to the aging and more in harmony with their needs and thinking if it is based upon their actual responses. The topics vary from recreation and pleasure to the basic essentials of social welfare. Adult education and library services have been discussed above (pp. 140-47), and will not be considered here. Community services and facilities needed. Help with financial problems was mentioned as available to older persons through the county welfare department by two thirds of all respondents (Fig. 10), while 5 to 11 per cent of all groups said such services were not available and about a fourth of all groups said they did not know. Of the 775 who 156

Figure 10. Services available and used, available and not used, and unavailable and desirable to urban and institutionalized older people

Aging in Minnesota said they were available, only 9 per cent had used them, and 4 per cent had used them within the preceding six months. About 21 per cent said that they never, rarely, or seldom received help with financial problems from the county welfare department. Respondents were also asked if help with non-financial problems was available for the elderly through the county welfare department. About half of all groups said Yes, 12 per cent said No, and slightly over a third did not know. More of the metropolitan institution residents did not know than any other group. Of the 593 who said these services were available, only 8 per cent had used them, 2 per cent within the preceding six months. A fifth said that they had used them never, rarely, or seldom. Medical care for which they themselves cannot pay was mentioned as available by almost three fourths of each group; 7 per cent of each group said that such care was not available, and about a fifth did not know. Of the 827 people who said it was available, only 9 per cent said they had used it, 4 per cent within the preceding six months; 16 per cent said they never, rarely, or seldom used it. How available is legal counsel to older people in their communities? Twenty-five per cent of the urban and 40 per cent of the metropolitan elderly citizens said it was available; 31 per cent of the urban and 16 per cent of the metropolitan residents said it was not; 44 per cent of all groups did not know. Of the three hundred and sixty who said it was available, only 9 per cent had used the service. Only two persons had used it within the preceding six months, and 14 per cent said they never, rarely, or seldom used it. During the later years legal counsel should be quite helpful in dealing with wills, transfers of property, insurance policies, liquid assets, and personal properties. It could give older people peace of mind to know that their affairs have been settled in the correct legal manner, but the data suggest that very few of them use legal counsel in the community. When asked whether clubs for older persons were available in communities, 32 per cent of the urban and 56 per cent of the metropolitan respondents said Yes, while 36 per cent of the urban and 18 per cent of the metropolitan residents said they did not know. Of the five hundred people who said Yes, only 13 per cent said they had used these services, 4 per cent within the preceding six months. About a fifth said they never, rarely, or seldom used them. 158

Seventeen Hundred Elderly Citizens The services of a public health nurse were reported as available to older persons by 45 per cent in institutions and 53 per cent in the community. Slightly over 10 per cent said they were not available and about 30 per cent didn't know. Of the six hundred sixty-one who said they were available, only 8 per cent used them, 2 per cent within the past six months; 30 per cent said that they never, rarely, or seldom used them. How many community services do the elderly use? None, replied 75 per cent in the community and 60 per cent in institutions. About 17 per cent said they had used one. Another 5 per cent in the community and 13 per cent in institutions said they had used two. An additional 7 per cent had used from three to six services. It is possible that some who did not specify whether or not they used certain services actually had used them, in which case the percentage of use would be higher than that shown in Figure 10. With one exception, Figure 9 shows fewer than 10 per cent using any service available to older persons in the community. The exception is clubs for older people, which 13 per cent reported using. Only 2 to 4 per cent reported using any of the services the six months before the interview. How much do the aging know about the availability of community services? About a third were completely informed about the availability of the services. Between 15 and 30 per cent said they didn't know about one or two services. An additional 25 per cent did not know about three to five services, and 12 per cent were uninformed of at least three fourths (six to eight) of the services available. Thus, at least 40 per cent could be considered not well informed. This might appear to reflect a lack of community awareness, but the institutional residents were only slightly less informed than those living in the community. It would be interesting to know whether those who know least about the services are those who need them most. When those who had said Don't know or No to the question of whether or not community services were available were asked if they would use the services if available, 30 per cent of the urban and 40 per cent of the metropolitan respondents said they would use help with financial problems if it were available. Forty-six per cent of the urban and 35 per cent of the metropolitan residents said they would not use such help. About a fifth of all groups did not know. Help with other than financial problems would be used by a third of 159

Aging in Minnesota all respondents and not used by about 40 per cent; a fourth did not know. Free medical care would be used by 53 per cent in the community and 63 per cent in institutions. A fifth in institutions, compared with a fourth in the community, said they would not use it, and about 15 per cent of all groups were undecided. A club for older persons would be used by 43 per cent in the community and 28 per cent in institutions. But it would not be used, they say, by about 40 per cent in the community and 52 per cent in institutions. About 17 per cent of the entire group was undecided. Half in the community said they would use legal counsel if it were available, whereas a third in institutions said they would use it. About a third of all groups said they would not use it. The services of a public health nurse would be used, say 55 per cent in the community and 40 per cent in institutions. Over a fourth said they would not use them and about a fourth were undecided. Other community facilities and services desired. In another series of questions, respondents were asked to tell whether they wanted certain facilities and services, and also whether they would use them if they were made available. The latter implies a much stronger personal interest in and need for the service than merely reporting a lack of the facility in the community. Obviously, more people said the community needed various services than said they would personally use them. The following data are based on the statement of willingness to use or participate rather than a mere expression of desire for availability (Table 59). For simplicity's sake, the responses of the community group will be given first, those of the institutional group later. The two items desired by over half of the community residents in both the metropolitan and urban samples are free or low-priced health clinics and visiting programs. Card games, social organizations or recreational clubs, and homemakers' service were each mentioned by more than a third. Almost as many expressed a desire for prepared meals delivered to the home at reasonable cost, adult education classes for the elderly, movies, and hobby shops (see Table 59 for the complete list). Almost always, the proportion of institution residents who promised participation was smaller than that of community residents, except that those in institutions were slightly more interested in watching 160

Seventeen Hundred Elderly Citizens Table 59. Community Services, Activities, and Facilities Desired by the Elderly, by Residence* Facility

Community

Free or low-priced health clinics Visiting Social or recreational club Card games Homemakers' service Prepared meals delivered Adult education classes Movies Hobby shops Outdoor sports Board games Indoor sports Dances Pool

57% 52 39 39 88 32 SO 80 28 22 21 19 12 9

Institution 36%

43 21 27 18 21 24 33 21 11 19 10 10 8

* N's not provided because the N differs on separate items. Percentages based on total who responded to each item.

movies. Items mentioned by a third or more of the residents in institutions were visiting programs, free or low-priced health clinics, and movies. On the whole, the reported potential in all activities and services paralleled the community group at a somewhat lower level of interest, except that the institutional group was markedly less interested in social and recreational programs, as well as in outdoor and indoor sports. A clue to the relative activity of the aging in the community and their ability to get around to do things, or to be thoroughly free in their mode of transportation, was found in the number of driver's licenses they hold and the number of days of the week that they actually did some driving. Perhaps the outstanding, but not surprising, fact was that those in institutions drive or are licensed in much smaller numbers than those in the community. Over 90 per cent in institutions did not have licenses, whereas about 60 per cent in the community did not. Another indication of the lack of involvement in the community — particularly among those in institutions — was the fact that 84 per cent of the institutionalized as compared with about 12 per cent in the community who have licenses did not drive at all. So, even among the small number in institutions who had licenses, the overwhelming majority did not drive anyway. In fact, only five people in institutions drove at all. To what extent or how frequently do those in the community drive? About 25 per cent of the licensed said they drove from one 161

Aging in Minnesota to three days a week; about 15 per cent drove from four to six days a week; and, interestingly enough, over 40 per cent drove every day. Only about 6 per cent said they drove less than once a week, not including those who said they did not drive at all (12 per cent of the community residents). PERSONAL AND SOCIAL ADJUSTMENT

A person's own ideas about the state of his health and about his age represent a summary of many relevant influences. His self-image is determined by his combined conceptions of himself and is also a reflection of others' responses to him, received through communication and interaction. Self-conceptions are social-psychologically loaded because they often include an assessment, on the basis of his values and goals, by the individual of his circumstances or conditions. Other people important to the person react to his conditions, values, and goals with sanctions that reinforce the acceptable. Thus, if one's associates reject old age, one will probably make this value his own and as a result reject himself and thus create a negative conception of himself. What are the consequences of negative conceptions of health and age? The aging who conceive of themselves as old or elderly are significantly more poorly adjusted to life than those who consider themselves middle-aged. Those who consider their health fair or poor are more poorly adjusted than those who feel they are in good or excellent health. Conceptions of health and age are more highly associated with personal adjustment than any other variables studied and previously reported.* Respondents were asked at what age they thought of themselves as old. About one in six said that they first thought of themselves as old between fifty-four and sixty-nine (Table 60), and about a third said it was between seventy and seventy-nine. Over 40 per cent first considered themselves old at eighty or over, and about one in seven said that they never have thought of themselves as old. The modal age for all age groups was between eighty and eighty-four. It is interesting to note that only about 5 per cent thought of themselves as old at sixtyfive. This is quite different from society's definition of the beginning of old age — the age at which a person is no longer free to choose his *Hansen, op. cit., p. 76.

162

Seventeen Hundred Elderly Citizens Table 60. Age at Which Urban-Metropolitan Residents First Considered Themselves Old* Age

No.

%

54-69 70-79 Over 80 Never

152 297 386 128

16 31 40 13

Total

963

100

*This question was not asked of the rural sample. The number is based on actual responses, its small size reflecting the fact that many did not answer or had no definite opinion.

work and to operate with as much freedom as before. It is also important that less than 2 per cent thought of themselves as old before sixty and to compare this with the denial of jobs to people as young as forty or forty-five. In terms of individual human values, this represents a marked inconsistency between society's definition of old age and the conception older people have of themselves. The aging, social-psychologically speaking, are being strongly discriminated against, because, even though they do not think of themselves as old, they are rejected because of their age. Favorable adjustment by older people to this situation is difficult to achieve and is not a simple matter to be ignored through employers' arbitrary policies. Morale and adjustment. How much happiness do the later years hold? Is life then inviting and happy? How does it compare with morale and satisfaction earlier in life? The following analysis suggests that, for many, life is still full of happiness and that the later years can be some of the best. Slightly over half of all respondents said that they were as happy as they had been when they were younger; on the other hand, about 40 per cent felt less happy now than before. About 8 per cent of all were undecided. If many older people say that these are the best years of life, we have substantial evidence for concluding that the later years are full of potential riches — emotional, social, spiritual, and economic — and that the elderly deserve a more positive place and distinctive role in our society. Between a fifth and a third of all respondents said that these were the best years of their lives. For 60 per cent these were not the best years of their lives or they were as good as other years. Ambivalence and indecision were expressed by 10 per cent. People who say that their lives are still busy and useful are most 163

Aging in Minnesota likely active in social roles. Almost two thirds of the sample said that their lives were still busy and useful. About a fourth disagreed, and another 7 per cent were undecided. Going one step beyond this statement about usefulness, we also asked whether or not this was the most useful period of their lives; between a seventh and a fourth agreed that it was. The above discussion of the data clearly shows that about one in four of the aging were happier now than ever before and that about one in five felt that the years after sixty-five were the most useful of all. If these responses can be taken at face value, life for them must be very satisfying. All were not, however, in this fortunate minority, as we shall see. Negative morale indicators. To what extent is the life of the elderly full of worry? Only 7 per cent in the community and 18 per cent in institutions reported that it was. About 6 per cent of each group was undecided, and the remaining 71 to 88 per cent of each group said that it was not. This suggests that it is easy to over-generalize about the difficulties that aging people face and especially to over-generalize about how they look upon such problems. According to 7 per cent in the community and about 21 per cent in institutions, sometimes there was just no point in living. This percentage almost parallels the number who said their life was full of worry, and they may or may not have been the same people. About 5 per cent of each group were undecided, with the remaining 65 to 91 per cent definitely disagreeing. The very small proportions, particularly in the community, who said that sometimes there was just no point in living should be compared with responses at other age levels. At other ages there may be about as many people who feel this way sometimes when they are faced with particularly difficult circumstances, some unforeseen crisis, a task which seems impossible to accomplish, or, especially, a situation where there is an accumulation of negative experiences or influences that are continually discouraging. Adjustment levels. To what extent may adjustment be a function of the size of city or the population base of the aging person's residence? To what extent does living in the open community, or living in an institution, affect adjustment? We used an attitude scale to divide the respondents into categories of high, average, and low adjustment based upon composite scores. The modified version of the Cavan, et a/., adjustment scale used in this study covers the areas of health, family, 164

Seventeen Hundred Elderly Citizens Table 61. Personal Adjustment Level of the Elderly, by Residence Adjustment Level High Average Low

Urban-Metropolitan

Rural (N = 289)

Community (N — 971)

25% 52 23

23% 50 27

Institution (N = 391) 6% 28 66

work, friendship, religion, and morale.* Cavan's scale included no items on finances, leisure-time activities, or satisfactions in general. The criteria for inclusion of an item were the consensus of the authors and their colleagues as to the representativeness and sensitivity of the item and the ratings given the several items by expert and student judges in the original Cavan inventory. Good personal adjustment as measured by this scale means feeling good about one's health, enjoying a number of close friendships, being satisfied with work, finding security or comfort in religion, feeling useful, putting positive value on the later years, being relatively happy (i.e., relative to one's earlier happiness), and experiencing satisfaction with one's family, excluding both domination and rejection by the family. Composite scores on the attitude scale for the rural, urban, and metropolitan community and institutional groups were used to answer the questions raised. Apparently it doesn't make any difference whether one is living in a city of half a million people or on a relatively isolated farm homestead as far as composite adjustment level is concerned. Happiness or adjustment to aging does not appear to be a function of geographical residence. This observation rests upon the fact that almost equal proportions — roughly 25 per cent in rural, urban, and metropolitan areas — were highly adjusted; almost half of each group were in the middle range; and another fourth was in the low adjustment group. There was, however, an important and significant difference in adjustment level, favoring community residence rather than institutional residence (Table 61). Only 6 per cent in institutions were at a high level of adjustment, compared with about a fourth in the community. Overwhelming numbers of residents of institutions were on a low adjustment level — two thirds as compared with a fourth in the com*A detailed discussion of the modification is available in Hansen, op. tit.

165

Aging in Minnesota munity. This may be an indication of difference in age, of health problems, of rejection by family or friends. And it may reflect the feeling of some people that entering an institution means final confinement or commitment to a place where they have limited freedom and little capacity to do the kinds of things they like to do. It also may be related to the fact that they are placed in the company of older people who have already accepted institutional living, partly out of necessity, and, though it may be the best alternative for the newcomers, it is not fully acceptable to them. Thus, this measure of adjustment differentiates as sharply, or more sharply, between institutional and community residents as do the other aspects discussed earlier. Whether it is that the poorly adjusted enter institutions or that institutional living contributes to low adjustment cannot be determined from the data at hand. Both may contribute. A more intensive longitudinal study could provide the answer. Several recent experiments have shown almost miraculous improvement among the poorly adjusted when the social and psychological environment is improved. The next logical query is: What, if anything, contributes to good adjustment among the elderly? Preliminary study of the rural data suggests that the happier old person views himself as middle-aged or elderly rather than old; views himself as in excellent or good health instead of fair or poor health; is in the employment or retirement situation which he prefers; is more likely fully employed than fully retired; considers his income adequate; has health insurance for himself and his family; is a member of, participant in, or leader in social organizations; lives in a house he owns; is less than seventy-one years old; and has completed nine or more years of school. The following were found not associated with level of adjustment: net worth, amount of income, financial planning and investing for old age prior to sixty-five, present marital status, sex, ownership of real estate other than house, and area of residence within the state. These findings raise serious questions about whether current policies really provide the situations most conducive to adjustment. The emphasis upon financial adjustment per se apparently, at a certain point, becomes less rewarding than increased emphasis on policies which allow the elderly person to continue living in his own home, extending his education, participating in social and community organizations, be166

Seventeen Hundred Elderly Citizens ing assured of availability of health services, and having employment arrangements commensurate with his interests and abilities. DIFFERENCES BETWEEN ELDERLY MEN AND ELDERLY WOMEN

This section points out some of the situational and adjustment differences between elderly men and elderly women. Not all the items in the questionnaire were analyzed for this purpose, but a selection was made of those deemed most meaningful and significant. They are arranged below in the order in which they are discussed in earlier sections, as far as this was practicable. Because of the small numbers in many categories, this section merely analyzes a trend, and the differences discussed are not necessarily statistically significant in all cases. Most interesting or enjoyable things in daily life. Judging from the differing expectations of men and women in our society, the complementary roles which they normally play, and our ideas about masculinity and femininity, we should expect that enjoyments and interests would vary somewhat between the sexes during the later years. Women more than men consistently reported that visiting or communicating with their family or friends was the most interesting or enjoyable thing in daily life to them. This was true for residents of nursing homes as well as for those in the community. The women were also more interested in religious activities. Except for those in the metropolitan community, more women were also interested in indoor activities. Interest in traveling appears to be shared about equally between men and women, as was the enjoyment of hobbies. But in the community, more men than women reported hobbies as most interesting to them. In institutions, men and women were more nearly alike in choosing hobbies as an interest in their lives, perhaps partly because fewer activities are available to them. Self-concept of health. As has been mentioned before, enjoyment of life is closely related to one's state of health, or, more particularly, to how one feels about one's health. Slightly more men than women said they had never felt better in their lives, and more men were also undecided about this issue. Conversely, more women could not say that they had never felt better in their lives. A strong expression of one's health and one's attitudes toward it is reflected in the statement, "If I can't feel better soon, I would just as soon die." This very unpleasant situation, as one would expect, was reported by many more 167

Aging in Minnesota people in nursing homes and homes for the aged than in the community. Of those in institutions, proportionately more men made this assertion. Although the differences are slight, it is certainly not correct to assume that the women have the strongest sentiments about their physical condition. More women may be troubled by minor ailments, but proportionately more men have major physical and health problems. Cost of health care. Costs of less than $150 were reported most often by metropolitan institutional residents, particularly men (Table 62). Table 62. Cost of Health Care for Men and Women, by Residence, in the Year Preceding the Study Metropolitan Cost

Institution

Urban

Community

Institution

Community

Men Women Men Women Men Women Men Women (N=28) (N=61)(N=112XN=154)(N=28) (N = 52)(N=200)(N = 347) $04149 71% $150-^299 ...14 $300-$499 ... 4 $500 and over. 11

59% 20 S 18

47% 22 18 18

43% 24 15 18

60% 11 11 18

52% 15 6 27

50% 26 12 12

59% 21 11 9

This may be owing to their failure to discriminate among housing, food service, and health-care costs if they pay a lump sum to the nursing home or home for the aged. Elderly men and women in urban institutions reported the highest health-care costs, and metropolitan community residents paid more than those in metropolitan institutions. The cost of health care among the elderly appears to vary more by residence than by sex. Although there are slight sex differences, they assume no pattern. Ownership of life insurance. Over three fourths of the men in institutions and almost as many women (about 70 per cent) said that they had no life insurance policies. As discussed above, those in the community were more likely to have life insurance policies, only between a third and a half had none (Table 32). Significantly more men and women living in the community than in institutions had ordinary life insurance policies: over half of the men, and slightly less than a third of the women. This is probably because of the relative youth of those in the community. Source of income in 1959. The single source of income on which the 168

Seventeen Hundred Elderly Citizens highest number of men and women had drawn was Old Age and Survivors' Insurance. Somewhat higher numbers of metropolitan than urban respondents had income from this source, and of these, proportionately more were men. More people in the community, both urban and metropolitan, than in institutions received money from OASI. On the other hand, much higher proportions of older people in institutions than in the community derived income from old age assistance. Within the institutions, more men than women received this aid. There were no important differences between the proportion who received medical assistance or aid to the blind, or relied on friends as a source of income. But a different pattern emerged with regard to income from children or relatives: more women than men drew support from these sources. About 14 per cent of all women received income from children or relatives, whereas less than half as many men did. A small, although about equal, proportion of men and women living in institutions had incomes from work — 3 per cent. In the community, however, significantly more men than women had income from work, a third compared with a fifth. In the community, men were more likely to have drawn on savings in the year preceding the survey, but in institutions, the women had drawn on theirs. More metropolitan than urban residents were drawing pensions, perhaps as a result of the greater number of pension funds and plans for metropolitan workers. In the metropolitan and urban areas there is a similar pattern, with many more in the community than in institutions, particularly men, drawing incomes from pensions — probably because community residents are younger, and more of them were eligible for pensions at the time of their retirement. Investments were the source of income for slightly higher proportions of women than of men in institutions, but were more nearly equal between men and women in the community. Change in present living arrangejnents. Men and women were alike in their desire to change or maintain living arrangements. As one might expect, those in institutions, in slightly greater proportions, wanted to change their present situation. But within each category, men and women in equal proportions desired a change: this ranged from 10 per cent in the urban community to 21 per cent in metropolitan institutions. 169

Aging in Minnesota Preferred location. As noted earlier, very few urban respondents chose to live in a metropolitan city. Among metropolitan residents, those in institutions in the smallest proportions wanted to live in the big city — 42 to 53 per cent — with proportionately more males discontented. Between 57 and 68 per cent of metropolitan residents in the community want to continue to live in the big city, with the women (68 per cent) again being more contented with their arrangement. Suburban living appeared most attractive to the metropolitan men in the community and next most attractive to their female counterparts; almost 20 per cent of those men and 10 per cent of the women preferred a suburban residence. The percentage in all other categories who preferred suburban living was between 2 and 6. As previously discussed, proportionately more urbanites prefer large and small towns. Among urban residents, those living in the community appeared more content with their arrangement than those in institutions, but differences between the sexes were slight and probably insignificant. Those who aspired to village living were, more often than any others, living in urban institutions — 11 to 16 per cent. More of them also wanted to live in rural non-farm areas, as well as in rural farm areas. Family relationships. At every age, people are working toward some kind of balance among dependence, independence, and interdependence in family life. Some older people have achieved a very satisfactory balance, some are dominated by their families, and others are rejected. Or they themselves may be dominating or rejecting their families. Two items in the attitude scale aimed at getting a clearer picture of this situation. The first, "I wish my family would pay more attention to me," attempted to determine to what extent people felt isolated, rejected, or ignored by their families. The differences between men and women were very slight in the desire for more attention from their families. Those who seemed to have the most pressing needs were in urban institutions, where about one in seven would like to have more attention from his family. In contrast to this, one in ten in metropolitan communities and institutions expressed this desire, and even fewer in the urban community. At the opposite extreme, people who felt and stated that their families were dominating them and trying to boss them around (giving them too much attention, guidance, and so on) were a very small minority. Those living in the community report this more often than those in institutions, again a function of the frequency 170

Seventeen Hundred Elderly Citizens of personal contact, communication, and proximity, perhaps, and the fact that people in institutions have fewer living children and those children or brothers and sisters may be living farther away. Even those who do visit probably leave discipline to the nurses or administrators of the institution. Family and non-family contacts. We have noted that persons living in nursing homes and homes for the aged had less personal or written communication with their family, friends, and neighbors. It is interesting to explore how these men and women differ in the amount of contact they had with outsiders. More men than women in metropolitan institutions (over 33 per cent compared with 13 per cent) reported no contact at all with members of the family. A similar situation existed in urban institutions, where almost a fourth of the men and slightly over 10 per cent of the women reported no regular or frequent contact with any member of the family. The differences between men and women living in the community were not so great. We must therefore conclude that men living in institutions appeared to have less contact with members of the family than women do. A similar pattern was evident in non-family contacts. For example, in the metropolitan institutions, 43 per cent of the men and 21 per cent of the women said they had no regular or frequent non-family contacts. The differences were not so substantial for the urban institutionalized men and women. Friends. A major part of one's social life hinges on friendships, and the older people interviewed in the study are very consistent in their answers concerning this subject. Those reporting the greatest number of friends were the urban community residents, where almost half of the men said they had more friends than ever before. More men than women in all categories except metropolitan institutions reported more friends than at earlier times in their lives. For the total group, the range was from a third to almost half who said that they had more friends now than ever before, the highest proportion being those in their own homes in the community. The man in the metropolitan nursing home or home for the aged, however, appeared to be in the most difficult situation. He was the one least likely to say he had more friends, and most likely to say he had no one to talk to. It will be recalled that he had the smallest number of family and non-family visitors, so it is understandable then that he 171

Aging in Minnesota also reported the greatest amount of loneliness. Almost a fourth of these men in both urban and metropolitan institutions said that they had so few friends that they were lonely most of the time. Only about 10 to 12 per cent of the women in institutions reported this situation, but there were no differences between the sexes on this item for community residents. Except for men living in institutions, no pattern of differences in companionship emerges between men and women. Almost equal proportions reported having no one to talk to. In the community this was about one in ten, whereas in urban institutions two or three in ten said they had no one to talk to about personal matters. Religion. It is common knowledge that more women than men take part in and are members of religious organizations. One would expect, therefore, a difference in the degree of satisfaction and comfort that women and men derive from religion. Women popularly are characterized as more overtly emotional and sensitive, men as more rational or objective. Occupations in science, business, and technology, the theory runs, require men to be more objective and detached in making decisions and solving problems, and such an attitude may compete with and displace overt expressions of sentiment, emotion, and faith. In this study, higher proportions of men than women consistently reported that religion does not mean much to them — from 7 to 19 per cent among the men and only from 2 to 5 per cent among the women. At the opposite and complementary extreme, women in higher proportions reported that religion was the most important thing in their lives. For example, among the metropolitan institutional residents, 55 per cent of the men and 66 per cent of the women named religion as the most important aspect of life. Among urban community residents, 52 per cent of the men and 71 per cent of the women agreed. The differences were slight but consistent between men and women in their responses to the statement that religion was a great comfort to them, and more women than men agreed with this statement. Community services and facilities. Respondents were invited to choose from a list of community services and facilities those they would like to have available in their own communities and those in which they would like to take part. What follows is a comparison of the differences between the choices of men and women. The only response analyzed in detail is the response Yes — meaning a desire for a 172

Seventeen Hundred Elderly Citizens given service and a willingness to use it. Men consistently, but in not much larger proportions, wanted to have board games and card games available. As previously mentioned, men and women in institutions were alike in their choice and desire to use hobby shops: 12 per cent of each sex. This was in contrast to the community, where proportionately more men than women said they would like to have hobby shops available. Similar proportions of men and women in the community and in institutions said they would like to have movies. Playing pool was clearly a masculine choice. Fortunately, about equal proportions of men and women wanted to have dances in their communities. Men and women in metropolitan homes for the aged and in nursing homes were the least likely to say they wanted a visiting service. Of substantial interest is the finding that proportionately more men than women consistently want to have a visiting service available to them, complementing the finding that proportionately more women than men had contact with family and friends. Men and women in the urban community desired a visiting service in greater proportion than any other respondents. More men wanted social or recreational clubs than women: twice as many men as women in the metropolitan institutions and 12 per cent more men than women in the urban community. Outdoor and indoor sports were clearly favored by more men than women. The percentage of men who wished to have outdoor sports available was almost three times greater than the percentage of women. The differences between men and women in the desire for indoor sports was not so great, but the ratio was about two to one. Much had been said herein about the importance of health and facilities for health care. Men and women in metropolitan and urban communities rather than in institutions had the strongest desire for free or low-priced health clinics — approximately 45 per cent in the communities, as compared with a fifth in institutions. This seems logical in the light of the fact that persons in nursing homes or homes for the aged usually have immediately available to them professional medical and nursing services and facilities, whereas persons living in their own homes in the community may not. Both men and women have good reasons to want prepared meals delivered to their homes. Some men do not like to cook and do not have 173

Aging in Minnesota a companion to cook for them. Women also undoubtedly would like to share this responsibility occasionally with some agency that could prepare meals and deliver them at a reasonable price. We should therefore expect men and women to be somewhat alike in their desire for prepared meals to be delivered at their homes, and this was indeed the case: very few differences existed between the sexes concerning the desirability of this service. Of more importance than sex was residence; those living in the community, in almost twice the proportion to those in institutions, wanted to have meals delivered to them at a reasonable cost. This again was to be expected, because in the nursing home or home for the aged, meals are usually provided and there would simply be a duplication of services unless the older person was living in an apartment with cooking facilities. Homemaker services also were more attractive to residents in the community in at least a two to one ratio. When work in the community on beautification or improvement projects was discussed, significantly more men than women said they would like to take part. Higher proportions in the community than in institutions were concerned about community projects. Within each category, except for metropolitan institutional residents, almost twice as many men as women were interested. Slightly over a fifth of all respondents expressed a desire for adult education classes, except in urban institutions, where only half as many were interested. Morale. Slightly higher proportions of men than women agreed that they were just as happy now as when they were younger. A much stronger statement is "These are the best years of my life." Slightly higher proportions of men, again everywhere except in urban institutions, reported that these were the best years of their lives (30 per cent of men compared with 23 per cent of women). As has been true before, the community dwellers more often exhibited this positive attitude. Poor morale is shown by the statement "My life is full of worry," to which over a fifth in the urban institutions agree. Those living in urban institutions appeared to be consistently less well adjusted than those in metropolitan institutions, perhaps because this kind of living arrangement is relatively new in the urban area. They may also be living closer to their own children and families and would prefer to live with them, or in their own homes or apartments, than in a nursing home or home for the aged. When respondents were invited to agree or disagree with the state174

Seventeen Hundred Elderly Citizens ment "I am satisfied with the work I do now," women were almost always more satisfied than men with their present work. Residents of the community were also much more satisfied or more able to agree with this statement than residents of institutions. Having no work to look forward to was the report of six in ten men in both metropolitan and urban institutions. Women were much less prone to say that they had no work to look forward to —15 per cent compared with 27 per cent of the men. A PHILOSOPHY FOR AND ABOUT AGING

Social action. Social-psychological concepts have been useful in helping to understand more clearly the behavioral dynamics in aging which are directly related to the social structure. In addition to the academic and research task, social scientists have the responsibility and the opportunity as citizens of interpreting findings, initiating proposals, and suggesting possible courses of action, as we have taken the liberty of doing. We shall raise some speculative questions and make some observations about aging in Minnesota and the United States. Will the aging become a highly organized and perhaps independent political pressure group? What is their future role in American society and in shaping the culture? The influence of elderly people will depend upon the interaction between them and the younger generations, an interaction conditioned by the philosophy and values which all hold about aging. The American public is probably now as aware of aging as it was of kindergartens in 1900 and adolescence in 1920. This awareness will increase and be organized, it is hoped, with understanding. The aging are a major part of the population (sixteen million) now. Their destinies will be partly determined by the action of the next few years. As one of the richest intellectual, social, and religious resources of any nation, they can maintain distinctive and contributory roles if they seek or are provided with opportunity. The conservation of their health, happiness, and creativity is of vital importance to the national health and welfare. Many current personal and societal values may reduce the possibility of their achieving a good adjustment: the emphasis on youth and the rejection of the old; the orientation toward the future which ignores those whose future is brief; the clamor for uniqueness, selfactualization, personal gain, achievement and work — for these we pay 175

Aging in Minnesota a high price in making more difficult the adjustment of those unable to meet the expectations. In short, a positive philosophy for aging appears lacking, and its development should be given careful consideration by the family, the school, the church, and the mass media. What values might be part of such a positive philosophy? For their own good, older people could and should be more concerned with the present and immediate future, less with the past and the distant future. A specific job would be less essential if a broad range of activities was cultivated. Less concern with financial independence and self-sufficiency seems desirable for some. Society could put more value on and provide opportunities for the aging to be active in and rewarded for social competence, exchanging ideas, creativity of many kinds, service to others, expanding horizons of new experience, flexibility of roles and activities, leadership derived from wisdom and experience, cultural expressions of art, music, and literature; it could encourage them to devote more free time to healthful sports and hobbies and to social interaction through visiting, as well as to participation in organizations and concern with major social problems and political issues. The talents and resources of capable and interested older people could be tapped in many ways to improve institutions and communities. An emphasis on the aforementioned values should reduce mental illness, institutionalization, senility, and the exaggerated concern over poor health which are often a part of the social-psychological changes in aging. Even if the rest of society came to hold new values, it remains just as vital for the aging themselves to cultivate new values. The shift from emphasis on youth and the future to a more equal emphasis on age and the present would be expedited if the aging could make themselves seen and heard. Young people get attention because they assert themselves and challenge others. Thus age as such is not the most significant variable; age is only a measure of time and need not lessen the importance of the individual and his social life. Leaders and workers in the field of aging, particularly in areas of personal and social adjustment, should direct their efforts toward building and maintaining in the aged positive self-conceptions. Individual differences in attitudes, in combination with circumstances, allow for many interpretations of similar life conditions, although the self-conceptions and the self-image appear to reflect reality for the 176

Seventeen Hundred Elderly Citizens large majority of the aging. Individuals, organizations, communities, and states have many focal points from which to begin their planning and work for the aging. In individual cases and in communities where the actual circumstances or environments are discouraging to older people, efforts to change toward a more satisfying situation must be made. For others, those who are discouraged by their own or society's negative attitudes and outlooks, efforts could be directed toward reconditioning education, counseling, and other stimulations. Almost every community will require both efforts simultaneously. If a more positive public image for and about aging is to be achieved, work must be done with the young and middle-aged generations as well as the older. All concerned should try to design and implement programs which keep older people moving in the mainstream of life at a speed equal to their interests and capacities. In addition to this integration, separate special classes, activities, and organizations should be established to maintain their association with other old people. Thus both integration and segregation seem desirable to maximize the rewards and opportunities for all age levels. Specifically, in order to provide a happy and well-adjusted old age, measures should be taken to achieve and maintain health, education, social participation and leadership, financial security, health insurance, home ownership, and some employment rather than full retirement, or either employment or retirement at the preferred level. Positive selfconceptions about health, age, work preference, and income adequacy should be developed. Accumulations of negative situations or conceptions are particularly destructive to good adjustment and should be avoided. Good or poor adjustment once established seems to persist through later life, so it is important to achieve good adjustment early. According to other studies, sudden role changes, lack of significant roles, rigid behavior, different treatment from younger people, and lack of association with friends are negatively associated with adjustment. Insofar as these influences can be reduced, the adjustment level should rise. Aging can be most satisfying and meaningful only if and when the social climate or society's attitudes, values, and practices toward aging are altered through reconditioning. This major task may presently be best accomplished if mass-communication media and our educational institutions teach positive attitudes and display favorable practices to177

Aging in Minnesota ward older people. Education for and about aging will have practical returns as older people serve their communities, help to educate others, cooperatively vote for community development, create products for market, manage finances to retain independence, and so on. The possible returns are many. It is the responsibility of the person himself, the groups he belongs to, and the local, state, and national governments to help eliminate the vacuums of nothing to do, absence of association, lack of stimulation, and feelings of uselessness. Personal development is a desirable and potentially realistic goal at every age, and, logically, should be more rewarding with increasing maturity. If more high-quality programs can be made available to the elderly, continued development for them and others in mental, physical, spiritual, and social health is very probable. The goals of programs for the elderly should be designed to help them keep their motivation, freedom, and happiness, and to achieve satisfactory personal and social adjustment. They should be designed to fulfill needs, to encourage development, and to enhance positive selfconceptions. The difficulties, challenges, and opportunities that aging brings could be met with increased security and capacity if the attitudes, values, and actions of our society so dictate. Guidelines for professional and lay leaders. In planning programs for and about the aging, it is necessary to consider different appeals for several kinds of people in every age group. First are the leaders, who may be characterized as self-actualizing, internally motivated, creative in many activities and thoughts, and flexibly operative in a variety of roles. The leaders take part in formal and informal groups as they search for stimulating thinkers to interact with and react to. Such leaders will spark programs for the aging at every level. The followers are the second type. They require an outside stimulus before they become interested in programing for themselves or others. They are the largest group and may profit most from programs. They are tolerant, agreeable, and will go along with almost anything, but they are frequently noncommittal when it comes to taking a stand themselves, or exerting leadership and active influence. Fortunately they are trainable and some will eventually approach being leaders. The lethargic are a third type. They couldn't care less about most things, especially aging. To the lethargic, world events and personal 178

Seventeen Hundred Elderly Citizens circumstances are automatic and predestined. Personal energies and resources might as well be saved for the big crisis like a yearly bath, a lost bridge game, or a downpour on a sailing day. Major changes in circumstances, counseling, or teaching might alter their behavior now; and their attitudes and actions perhaps could have been altered by preventive education at earlier, more impressionable stages of the life cycle. Isolates withdrawn from cooperative or competitive association are the fourth type. They may be socially incompetent iand are potential sufferers from serious neuroses or psychoses. Among them are some of the lonely, the idle, the cynical, and the pessimistic. Unfortunately, with continued isolation, their prospects of developing a more positive point of view are dismal. These four groups obviously require different appeals and programs. The approach for the first two can consist of both formal and informal programs especially designed for the elderly. But for the latter two, rehabilitation and intensive counseling or other similar services will be necessary. A big concern of leaders of programs and educators is to prevent future recruits to the lethargic and isolate categories. For the professional leader and educator of the aging, there are certain personality characteristics or actions which, if taught and practiced, would be helpful in adjustment to aging: flexibility instead of rigidity, expansion rather than constriction, tolerating ambiguity rather than requiring prescription, creativity instead of docility, variable interest and activity patterns, empathy, autonomy, and the ability to solve problems. Survey results stimulate action. The results of this survey have been used in many practical ways, directly benefiting the elderly and the communities where interviews were completed. A statistical summary of the data has been prepared and made available for each community. Neighboring communities with similar characteristics may also find this information helpful as a basis for policies and programs. Lectures with visual presentations have been given in the communities studied. Several communities have formed study groups to gain clearer understanding of the survey results and examine ways of making the findings work most effectively for them. In order for leaders in gerontology, scientists, educators, business and industrial personnel, social service professionals, and other citizens 179

Aging in Minnesota of the communities to develop an adequate, high-quality, far-reaching program for Minnesota's aging citizens, it is of first importance that organizations be maintained or established to achieve communication, planning, and coordination. Action in the immediate future and longrange planning are the goals. FUTURE RESEARCH

It is appropriate to consider possible research tasks for the immediate future as well as over the long range, and to establish some priorities. The following list suggests some gerontological research topics which logically follow from, or are supplemental to, the studies just completed: comparative study of life in homes for the aging, nursing homes, and boarding homes, and under other types of congregate care; health needs as a basis for the development of health services; the impact of social security on urban and metropolitan beneficiaries; the meaning of friendship and love during the later years; the social psychology of mental health in aging; adjustment to retirement under different employer policies and practices; special problems of adjustment in the menopause and involutional period; the older husband and wife; family communication, interaction, and activity; the creative use of free time; the political behavior of the elderly; the aging as a minority group; the housing needs of the elderly. Experimental research is needed to provide information on how to build programs to help farmers plan for retirement; consequences to the aging of having taken part in the five-county demonstration project; establishing distinctive roles for the aging; developing and utilizing the human resources embodied in the aging population; determining the value of personal visiting services. At present there is no concerted effort in Minnesota with an ongoing program of basic and applied research in aging. If a coordinated effort could be organized and financed it would contribute greatly to the tasks ahead. Organized participation by public and private universities and colleges is needed. Thus far, participation in research about the aging has not maximized interaction between professionals. Conferences and organization are needed to bring all interested professionals in the state (or region) together for discussion and cooperation. Currently, 180

Seventeen Hundred Elderly Citizens only a few interested persons are known to each other. This means duplication of effort and repetition of errors. The state Public Welfare Department and the Governor's Citizens Council on Aging are the central organized service agency and group providing leadership. Other professionals need to lend support to them and complete the organization of professionals, older people, and other community leaders working in gerontology.

181

We Who Are Elderly ALDENA CARLSON THOMASON

The most careful study runs the risk of being meaningless for some readers if it is statistical. Statistics merely summarize large amounts of data, but many not used to them remain unaware of the underlying human conditions they describe. So we include a perceptive description of older people by an eighty-yearold Minnesota citizen. She says — more personally and more beautifully — much that has been said above. Earlier chapters are more objective; her chapter has meaning for more people. Though she adopts the device of speaking to all older people, she writes also for everyone who would understand the aging.

LET'S be our age. As has already been evident in the title, this chapter is primarily by and for those of us who, despite modern admonitions to "keep young," are willing to admit our age. To the term "elderly" we have no objection. We might not wish to be called "old," since that term seems more fitting for shoes and houses, and we might object to being labeled "aged," especially when pronounced as one syllable, which had better be reserved for wine and cheese. "Ancient," of course, refers to history and what else has to do with the remote past, to which we do not regard ourselves as belonging; but we do not object to "elderly," which so obviously refers to age of human beings and which has a friendly sound. "Oldsters" we like to keep to use of ourselves in a semi-jocular mood; the term "senior citizens," more recently conferred on us since it was recognized how considerable our voting strength is, is also a pleasant enough term, with a hint of honor in it. As to what age the term "elderly" should apply, let us make it, say, seventy and above. Not that the line need be so sharply drawn but that those of sixty-five and a bit more, or even just sixty, may not ask 182

We Who Are Elderly to be included as belonging to our group. Those in the mere fifties will hardly understand this chapter, because they will lack experience. But they have been provided for, as well as all who are still younger, as "expect to be's." By making the term applicable to chronological age we shall eliminate all such trite and tiresome admonitions as "Keep young in heart," "A woman is as old as she looks, a man as old as he feels," "Eighty years young," "You don't look a day over —," and all other similar expressions designed to outwardly convey flattery, but really conveying the idea that to be and to admit to being elderly is to admit having reached that bourne at which no traveler ever willingly arrives, much less returns from. This is not to deny that people of a certain age may not look, feel, and, biologically speaking, actually be in various respects younger than others of the same age. There are two reasons why we who are elderly should not seek to disguise that fact. The first is that, as every woman knows, or should know, there is no surer way of calling attention to one's age than to dress and act too young. A woman who must appear in public constantly and whose livelihood may seem to depend on retaining a "youthful" appearance, may by desperate effort manage to look "young," only to have it said of her, "How young she looks! Why, she was acting (or singing or dancing or whatnot) when I was a child!" Besides, it is now much more possible for elderly women to look less unattractive and still be their age; white hair and lines, with a reasonably pleasant expression and appropriate dress and suitably dignified bearing, can and do give distinction. This is of course equally true of men who are satisfied to be their age. As for the oldster who, convinced that he can make himself attractive to young women, becomes a renovated beau, or a sugar daddy, an angel, or just a plain meal ticket, with or without benefit of a divorce from an elderly wife, he presents a figure much more pitiful than Holmes's "Last Leaf upon the Tree," as any teenager will readily agree. The second reason has to do with these very teenagers, has to do with youth. It need hardly be said that in this time youth is overemphasized as never before. Youth is an asset to the young woman because as never before, except perhaps in the ancient slave markets, it has commercial value. And though this commercial value has nothing to do with slavery, but relates instead to high position and big money 183

Aging in Minnesota and often to fame and fortune, there is still about it a poignant, even a tragic, aspect; for it gives to fleeting youth a desperate sense of need to make the most of it not for its own sake but because, so it comes to be seen, youth lost, all is lost. While this is not so generally true of men, youth is still emphasized in many respects, most often to the point, as even middle-aged men have begun to realize, where youthful qualities such as resilience and agility are rated higher than the qualities of experience and proven worth. And as industry and many other means of making a livelihood become more and more mechanized, this over-valuing of youth will increase. If then the elderly devaluate themselves, if they bemoan and seek to hide the fact of their age, if they openly and fervently express envy of youth, they increase the over-emphasis on youth, and in so doing they are doing a disservice to youth as well as age. To make young women and young men feel that once youth is past there is nothing much worth living for is to distort their vision and take away both their hope for making life better as they go on living and their sense of the need to prepare for old age. For just as one builds a house with the need of long-lasting qualities well in mind, so youth should have age in mind in building both body and mind. Time was, and still is among many peoples, when age received respect and veneration for its own sake; when to have lived to grow old was taken as evidence of good building in youth. Age, too, can of course be overemphasized and its claims can be over-stressed; there is no inherent virtue in merely living to old age, as is so often revealed when very elderly people are asked the secret of long life. The point of the whole matter is that no age is so to be valued in itself that it causes a depreciation of value of all other ages. That there are disadvantages in being elderly we shall very definitely admit throughout this chapter; in fact, we shall expose some disadvantages that are not commonly known or at least made clear. But at the same time we are prepared to say, from our experience of both, that there are some very severe disadvantages in both youth and middle age that luckily disappear when one becomes elderly. We who have known them both know that youth and middle age have no monopoly of happiness or even peace of mind. We have only to recall the tragic discouragements and the loss of confidence and faith in ourselves and 184

We Who Are Elderly in others and even in life itself we suffered, as never quite so poignantly again, in youth and early middle age. Moreover, we who are now elderly are, so to speak, pioneers in longevity. There have always been individuals who have lived to extreme old age, but they have been so manifestly exceptional that they have been singled out for special wonder and comment. We, however, are part of an ever-increasing number of elderly persons who have already become a percentage of the entire population. And whereas, as has already been said, the extremely old person was generally asked for his or her advice as to how to live long, it is known of us all now that we are living longer because of less exhausting labor, better knowledge of laws of health, better facilities and knowledge for avoiding or recovering from diseases and injuries formerly generally fatal, better knowledge of dietary needs and more means for providing ourselves with them. It still also holds true that, as it has jocularly been said, we were wise enough to choose long-lived parents. For the increase in longevity is after all no sudden or entirely unpredictable phenomenon. If our grandparents lived to be seventy or nearly so, it is quite likely that our parents lived to be eighty or more. Finally, before we bemoan our being elderly we should remember the pungent observation that the only way to escape being old is to die young, and that since we obviously have not availed ourselves of that alternative, it behooves us now to accept age and ourselves as elderly, not just with fortitude but with reasonably good grace and certainly with honor. Certainly we will not let ourselves and our juniors down by pretending that to be elderly is worse than being dead. It needs pointing out now what being our age does not mean. It does not mean, first of all, that we need to make out of age a halter to peg us down, so that we feel that our lives are now circumscribed and that we must live by a narrow routine and without question or protest consider ourselves and declare ourselves too old for this, too old for that, ready to be put on the shelf and meekly stay there, ready to be relegated to this and that corner and not to stir therefrom — in short, ready to lose our independence and even our personalities. A short and sure way to lose our independence is to feel and declare ourselves unequal to anything that requires effort and venturesomeness, so that we want only to lean back and be taken care of, excusing ourselves and asking to be excused by others from all activities and responsibilities, 185

Aging in Minnesota merely because we are so and so old. Those of us who are unwise enough to try this way of being elderly are soon finding that they are not living, though still existing, and that they have come to belong to that group of oldsters who are pitied because there is nothing in life for them to live for. For those of us who are reasonably well, and for many of us who are not, to give up our dependence on ourselves and relinquish our interests and responsibilities is unthinkable. We are not denying our age or what it has done to us, but it has not — and we will not let it do so— robbed us of our independent ways, our ways of self-help in caring for ourselves and our homes whatever or wherever they may be. To become a burden upon others, sons or daughters, or other relatives, or friends, or neighbors, is so distasteful to us that we will to the last try to evade and resist it. We may totter a bit, or lag a bit, or find the going a bit hard, but we will still walk alone so long as we can do it with a fair degree of safety and success. Moreover, we will conserve our health and strength so as to lengthen this period of continued independence, neither over-doing nor underestimating our power to do what we want done; neither being disregardful of our health, nor becoming "chronic complainers"; neither refusing to see any alleviation of our physical ills because we "know it won't do any good," nor taking up with every health fad, new or old, because we exaggerate our ills and find our own symptoms in every advertisement of nostrums. Being our age does not necessarily mean that we must give up our own homes and ways of living. It is more and more being recognized that living by ourselves is commonly better than living with relatives or friends, no matter how much we have been urged to do so. But if living by ourselves becomes impossible or very undesirable, then being elderly does not mean that we must make our age a weapon with which to force upon those we live with our tastes, our ways, and our demands. We still read harrowing tales of well-meaning relatives or friends who find themselves victimized by elderly persons they have taken into their homes, so that their lives are disrupted, their homes not any longer really their own, and they and their children constantly irritated by criticisms and disapprovals. Not that the upbringing of children cannot easily enough seem to need criticism by us who are elderly and unused to modern methods of existing, or non-existing, disciplines; but we must not infringe upon the rights and prerogatives of those in 186

We Who Are Elderly whose homes we live. We have only to recall how bitterly we would have resented any interference with our own home life. If, however, we are still living in our own homes or what is home for us alone, then we can of course afford ourselves much more latitude. We can dress as we like, considering our own comfort and convenience; eat what we like as long as it does not make us ill; and in general spend our time as best suits us; all this provided we do not unduly interfere with some one else's liberty and pursuit of happiness. This provision, however, is a reminder that we still owe consideration to those who have concern for us or to whom we owe obligations. For surely life has increasingly taught us how priceless is any degree of consideration shown us from any quarter; and surely, too, having received anything so valuable we should be willing to also give it. For those of us who are too ill, weak, or disabled to stand the strains of ordinary life there should of course be special concern, and we should also have concern for ourselves, so that if we cannot find the necessary comforts in one place, we must seek them elsewhere. Fortunately this is not so impossible or even difficult as it often was in earlier times. The increasing numbers of nursing homes or rest homes, and the much improved standards of these as to food, warmth, convenience, and safety, make such homes a reasonably satisfactory substitute for one's own home. And becoming a resident in such a home no longer means, or needs to mean, that one surrenders one's independence in really essential respects. For though a regular routine is necessary and conforming to it required, the regimentation so obnoxious to many of us used to living our own lives has been greatly lessened, and even the term "inmate" has been discarded because of its distasteful connotation. To some degree nearly all of us must suffer infirmities due to age, but we need not make of these infirmities something which those around us must always have in mind and compensate for. Our slowness we must compensate for ourselves by always giving ourselves the extra time needed to keep up with the procession, so to speak, or by keeping out of situations where the hurried pace is beyond us. Our loss of hearing is no small inconvenience for us, but if we cannot compensate for it by wearing the necessary hearing aid, we must not expect those around us to make the compensation for us by gauging the conversation to our ability to hear. We can make ourselves intolerable by withdrawing 187

Aging in Minnesota ourselves into a martyred silence, or by evidencing resentment because we are "left out," or by equally resenting shouted remarks aimed in our direction now and then in a kindly but desperate effort to include us. But while being our age does not mean that we can expect others to compensate for our infirmities, it does mean that we can and generally do feel much freer to speak out concerning our dislikes and to refuse such conformities as have in earlier life been more or less forced upon us. Clifton Fadiman has made it clear that even at fifty a man is free to say that he considers baseball a bore. That is no small declaration of independence in our land in our times. Fortunately, for most of us our minds wear better than our bodies. This might be taken as a result of our having used them less! However, we are told that use of the mind contributes to its wearing well, this of course setting aside physical damage to the brain. It is particularly important that we who are elderly keep our minds alert, that we continue to read worthwhile literature, and to listen to what is worthwhile in radio and television, lectures, and discussions, thus keeping up with the changing times instead of falling behind and feeling ourselves lost. We need to remain aware of the life around us if we are to continue to be our own individual selves and truly alive, not as it is scornfully said of the elderly and even those younger that they are dead though not buried. True, we must live in our memories to some extent, but we must resist the tendency or temptation to live entirely in the past, so that we become oblivious to the passing scene and the trend of events, big and little. We still have the right to hold to our own convictions until we willingly discard them, to carefully evaluate what is new, and to form our own judgment; for if we make mistakes, so do all human beings, and the likelihood is that we will not make more than our share. It is sometimes necessary, however, to curb our tendency to give too much credit to what experience has taught us, so that we will not appear too wise and all-knowing, and we will of course need to remember that only asked-for advice stands any chance of being considered, and that even such advice is by no means sure to be followed. To be mentally alert does not, however, mean that we must court attention by being over-sprightly, over-sweet, over-gallant, or so up-todate in our appearance that we seem intent on rivaling the young. Nor does it mean that we must show such awareness of our age that 188

We Who Are Elderly we become saintly or self-effacing. A bit of vanity does not come amiss if it makes us wish to appear as well as possible and to take satisfaction in being admired for qualities natural or honestly acquired. To have it said of us that we have worn well is a far greater compliment than to have it said that we look so young. Naturalness, dignity, and self-respect are the qualities that best become us, and a sense of humor and incongruities will often save us from any suspicion of being in our dotage. Some few of us have even come to see the incongruity of the modern morticians' attempts at exaggerated prettying-up, as if the lines etched by age and pain were somehow obscene. To us it seems that death confers its own dignity upon the stilled countenance and the folded hands. But many others may differ with us in this and each one may have his own preference. Since we are pioneers in longevity, it behooves us to make the later years of life seem liveable. True, when Browning said, Grow old along with me! The best is yet to be, The last of life, for which the first was made. he was not speaking to the really elderly, he himself being then just past fifty. But fifty then was as old as our seventy, so that the invitation and the assurance are still for us. To keep up our interests and even acquire new ones, to be still curious, still learning, to be still capable of concern, of enthusiasm, and, when called for, indignation, makes us still a part of the ever-changing world, still able to testify and demonstrate that time is too precious a commodity to be merely wasted at any age, and even more so when the years ahead become ever fewer. Says Rollo Walter Brown, in his "Growth of Years": All then is clear enough in my mind. I plan to be a busy man. Only one thing can stop me, and that is something beyond my control that I therefore do not need to worry about. To be able to rise up morning after morning with no cricks in one's body — or so far as one can tell — in one's mind, and work in quickened awareness at something that one wishes to do and that seems worth doing — where has anybody ever found a deeper satisfaction than that? Let us take account, then, of the time and the capabilities that still remain to us and waste none of them in useless repining and idle weariness. These bodies and minds of ours have served us well; let us have continued regard for them, care for them, nourish them, use them sensibly, and let them continue to serve us well till time is no more for us, 189

Aging in Minnesota The most challenging expression of the way to meet, regard, and make use of old age is found in the closing lines of Tennyson's "Ulysses": My Mariners, Souls that have toil'd, and wrought, and thought with me — That ever with a frolic welcome took The thunder and the sunshine, and opposed Free hearts, free foreheads — you and I are old; Old age hath yet his honour and his toil; Death closes all; but something ere the end, Some work of noble note, may yet be done, Come, my friends, 'Tis not too late to seek a newer world. Tho' much is taken, much abides; and tho' We are not now that strength which in old days Moved earth and heaven; that which we are, we are; One equal temper of heroic hearts, Made weak by time and fate, but strong in will To strive, to seek, to find, and not to yield. The aging process. The "aging process" is a term those of us who have had to consult doctors for ailments, minor and major, have become very familiar with. It is used to explain, or at least label, various ailments we find ourselves or those close to us afflicted with. We are not without suspicion at times that the term is used to cover what the doctors themselves are at something of a loss to explain adequately. At other times we may feel that it is used to put us off, to satisfy undue curiosity as to the changes we find in ourselves and the reasons for them; for most doctors have not yet reached the stage of wanting to tell patients "too much," or even, as the patient may see it, "enough." There may, of course, be good reasons for this reticence from the doctor's point of view. He knows that few persons who consult him are at all well enough informed to really understand what he could tell them, even if he used non-technical terms, and that consequently they would not interpret or evaluate the explanations offered in a way helpful to themselves or in a way to actually represent his diagnosis fairly. We are all familiar with the garbled account of what "the doctor said" as recounted by patients who are not elderly, and this is of course intensi190

We Who Are Elderly fied with the elderly patient who is afflicted with loss of hearing, who does not understand English very well, or who is inclined to exaggerate his symptoms and ailments and what the doctor said about them. Fortunately, the seriously afflicted elderly patient can usually find a younger person to accompany him or her to better hear, understand, and interpret what the doctor finds it wise to impart about the patient's condition. But even then the "aging process" is a convenient term often used to convey the general nature and cause of the ailment, with, almost inevitably, a certain sense of the difficulty and perhaps impossibility, if not of the uselessness, of doing anything about it. Time was, indeed, when doctors quite generally dismissed the elderly patient suffering from some troublesome and even serious ailment with the dictum that there was nothing to do, nothing much to hope for. Thus more than one doctor, often himself elderly, dismissed illnesses of elderly persons with the philosophic dictum that there was not much to do with "a worn-out machine"; often enough giving the patient no encouragement to seek either hospitalization or needed surgery, merely prescribing some nostrum calculated to relieve pains not to be eliminated, and so not infrequently starting the patient on the way to drug addiction as well as chronic invalidism until death. Fortunately this time is past. Modern doctors are far from ignoring the elderly patient, and though the study of geriatrics has not yet caught up with that of pediatrics, the study has increased with remarkable speed in very recent years since the increase in the numbers of the elderly has become so notable. Not only are conscientious and skilled efforts made to diagnose and treat ills peculiar to the elderly when these ills are already present, but there is increasing advocacy for preventive medication to safeguard the elderly from ills formerly considered inevitable. In fact, much is now being written about the possibility that the "aging process" itself is not inevitable, and that in time to come it may be escaped, not by recourse to miraculous means such as discovering fountains of youth or subsisting on fish entrails, but by scientific discovery of what causes aging. But whether or not this can be brought about at some future time, the aging process is still with us who are now elderly, and we need to understand some of its components and results; and still more do we need the advice and aid of competent doctors who are both understanding and sympathetic and who definitely consider our aging bodies 191

Aging in Minnesota and minds as indeed reparable and not simply worn out. Those of us who in time of need have found such a doctor can congratulate ourselves and be ready to express our very deep gratitude to him or her. We can also appreciate and express our gratitude for the advance of science in ameliorating if not always curing the so far practically inevitable ills that the aging process brings. Such scientific studies of the aging process as have so far been made are admittedly far from being either complete or conclusive. What has been accomplished is what is the general first step in any scientific investigation — the clearing away of the underbrush of supposition, legend, and general misconception and misinformation, and the beginning of a foundation of accurate information based on experiment, observation, analysis, and experience, and accumulated data obtained through study of actual cases. But so recent is the beginning of intensified interest in this study that the body of reasonably established facts is still very much smaller than that accumulated and made available in pediatrics or the general practice of medicine and surgery. It is not to be wondered at that to many doctors the concern felt for children far exceeds that felt for elderly patients. The child, with his lifetime before him, is generally regarded as far more important to society than the elderly person, whose lifetime is largely spent. There is also the factor of sympathetic interest: the helpless child arouses the protective feeling in practically every adult. This is far from being the case with the elderly, who are often seen as having had their chance at life and living and not entitled to very much concern. To a still considerable number of doctors the elderly patient is a bit of a nuisance, with chronic ailments that in many instances not much can be done about, and with chronic complaints about imaginary as well as actual ills. However, the already great number of books and articles dealing with the discoveries made and verified by eminent medical scientists, testifies to the growing interest in gerontology, the study of the aging process, and geriatrics, which has to do with the diagnosis and treatment of the ills of the elderly. Moreover, there is a growing sense of the importance of care and concern for the health and welfare of the elderly if the now so well recognized trend toward longevity is to be made desirable for society itself as well as for the elderly, so that the elderly do not become a burden to society as well as to themselves. 192

We Who Are Elderly To most of us who are elderly such scientific understanding of the aging process as has been gained can best be left to the doctors, our chief and perhaps only interest being in what can be done for us and our ailments as a result of the better understanding and greater information gained.* But some general understanding of what the aging process is may not come amiss, especially as such understanding can be given by reducing scientific terms to common language. A convenient comparison can be made between the gradual deterioration of the aging body to that of an aging house. In both cases the aging process, we are told, actually begins long before the later years — begins in fact at birth, just as we may say the house begins to age as soon as it is built. The real aging process is probably always related to changes in the body cells, comparable to the changes in the material of the house. However, there is this important difference: the body is a self-repairing structure, so that the cells can and do replace themselves throughout the entire life of the human body. This process of repair is, however, always to some extent, often to a serious extent, subject to deterioration as the individual reaches advanced age, and sooner than that in many cases, depending upon the nature of the body structure at the beginning. For just as the strength and durability of the house depends upon the quality of the material put into it at building, so the human body never quite outgrows deficiencies at birth. This has of course long been recognized in relation to the child and his chances in life, in fact, his chance to survive at all. The need of the child to be well-born, to inherit through the parental genes a sound body, has long been stressed, though perhaps its importance in regard to longevity and the condition of the body when age is reached has not been much regarded. For, because of constant cell replacement throughout life, childhood deficiencies and imperfections often seem to disappear and the child "outgrows" this and that ill. The study of gerontology, however, tends to establish that such deficiencies do in part remain through life and begin to again show themselves in old age when body resistance is lowered. The same is, we are told, true of childhood diseases, which leave their traces throughout life; hence, too, the greater concern with elimi*Mrs. Thomason reminds us here of what should be obvious to all readers: namely, that she is not a physician or scientist, and cannot therefore provide the most modern medical advice. Like the rest of this chapter, medical observations by the author are to be regarded simply as the opinions of a wise, elderly lay person. (Ed.) 193

Aging in Minnesota nating childhood diseases formerly regarded as part of growing up and so inevitable at some time of life that it was best for the child to have them and be through with them, particularly as they were likely to be more severe if not contracted till in later life. Because of this misconception, parents not seldom deliberately exposed children to such diseases as measles, whooping cough, and mumps, whereas now serums are in use to gradually root out such diseases. The parallel continues, then, when we consider the effects of what doctors call "accidents" or "insults," meaning any experience that causes adverse effects, to which both the body and the house are subjected— the strains they have to withstand, the adverse conditions they have to adjust to, the harms they suffer — in short, the damage they undergo. And as in the house, so in the body; the repairs, or the lack of them, count heavily. Thus an injury suffered in early life and left unrepaired or badly repaired may make its effects felt long after it has been all but forgotten. Some of us have even gone through youth and middle age without discovering that a bone fracture in childhood, not realized by ourselves and escaping parental notice, was the result of some well-remembered accident, and that it is now the cause of the pain that is plaguing us. Scar tissue due to a relatively mild case of tuberculosis may also be first discovered in age, because of chest X-ray pictures now so common but not known of in earlier years. Generally such evidence of injury unrepaired or undiscovered until late in life is dismissed with the assumption that there is nothing to be done about it at that late stage and that if no serious effects have been noted earlier there cannot have been any "to worry about." This may not, however, be a safe conclusion and is not unquestioningly accepted in the increasing study of the aging process. An even more serious factor in the aging process is the deterioration of an irreplaceable structure, this again being true of both the house and the body. There is, however, in both the possibility of "compensation" to some degree. This is possible if the structure itself is so strong that it can survive the damage and/or if the function performed by the deteriorated part can be assumed by another part. This power of "compensation" is very remarkable in a strong and healthy body and accounts for the almost miraculous power of such a body to survive and to regain relative health after the removal of a diseased or injured organ. 194

We Who Are Elderly There is finally the general wear and tear upon the house and similarly upon the body — the use made of the former, the "rate of living" that affects the latter. Here, though, the parallel breaks down to some extent because of the power of the body to renew itself, to be actually strengthened by considerable hard use. It is also true of the aging body that it deteriorates seriously with lack of use, so that to become too inactive in later life hastens rather than retards the aging process. It does, however, remain true of the body as well as the house that it can be worn out by injudicious over-use and hard use, and very particularly by abuse. This accounts in no small part for the premature aging and early death of farmers and their wives and others engaged in hard and exhausting labor in earlier times, and for the great increase in longevity with the increase of labor-saving devices. We who are elderly have known many a farmer who "worked himself to death," and the housewife who succumbed to labors beyond her strength and endurance in childbearing and the care of a large family and the manual labor in the home. Of the traditions and misconceptions having to do with the aging process many have concerned diet. That old people need little food is a legend that may well have had its origin in past ages when food was scarce and when old people were not expected to consume too much of what was more needed by the active workers; women and children were often discriminated against for the same reason. It is now recognized that the elderly person is in need of approximately the same amount of food as the ordinary adult — excepting those who are engaged in extremely hard work — depending, regardless of age, on size and structure of the body and on activity. Meat, once thought best left out of the diet of the elderly, is instead an important element, since lean meat is one of the best sources of protein, needed for the continued growth of body cells. Fat meats are generally to be avoided because of their indigestibility, as are various very starchy foods. The fact that some elderly people have very poor appetites is not to be taken as merely a sign of the aging process but of possible malfunctioning of some organ, or of lack of activity, sometimes too of mental depression and lack of interest in life. Gaining weight through too much consumption of food is, however, not desirable. Obesity is as undesirable in old age as at any other age, and sudden gaining of weight in the elderly may invite or worsen old-age ailments. 195

Aging in Minnesota The common earlier assumption that ill health is an inescapable accompaniment of aging is also now discarded in favor of insisting on examination of the cause of ill health. Certain diseases formerly regarded as fatal for elderly persons have also been found to be curable, notably pneumonia, which is now found as easily curable in the elderly patient as in any other age group, because of the use of antibiotics. Operations once not considered feasible even by eminent surgeons, because of the age of the patient, are now performed as a matter of course and with good hope of success, if proper methods are used and bad post-operative consequences avoided. Much of the danger consequent upon operations when undertaken was due to keeping the elderly patient in bed, the supposition being that the older the patient the longer the recuperative period in bed needed, with no activity and particularly no exertion. The danger of this treatment of the elderly patient is now well recognized and counteracted by getting him out of bed as soon as possible and having him walking about at the earliest possible time, often only a few hours after the operation. The chief danger thus averted is that of respiratory difficulties. While surgery is never to be regarded too lightly, surgical techniques have now been so perfected that even a very elderly person should not continue to suffer present discomfort and the danger of worsening conditions, because of fear of undergoing an operation. This applies to such common ailments as hernia, prostate gland troubles, appendicitis, prolapse, hemorrhoids or piles, polyps and other growths internal or external, obstruction of any kind, or other conditions for which surgery has been advised by a competent doctor or surgeon. Needless to say, no patient of any age should put himself, or be put, into the hands of an inexperienced or incompetent physician or surgeon, or even of one in whom he does not have faith; for confidence is in all cases of medical aid an invaluable aid to success. Nor should the elderly suffering from such conditions as chronic indigestion, constipation, loss of normal appetite, insomnia, and the more serious arthritis, hardening of the arteries or arteriosclerosis, high blood pressure or hypertension, and diabetes, fail to consult a qualified doctor and avoid being misled by advertisements of nostrums which offer easy and inexpensive "cures." The present high cost of medical attention and services will be discussed later in this chapter. But prohibitive as such costs seem, and serious and undesirable as they un196

We Who Are Elderly doubtedly are, it is doubtful if any elderly person will be utterly unable to secure such attention and services if he or she undertakes to find them, since in probably every state there are now provisions made for medical care for those unable to pay for it. What is needed first of all is an understanding by the elderly patient that the feeling that one has to continue to endure old afflictions is not either intelligent or longer necessary. Even long-endured foot troubles can often easily be remedied or at least lessened by a visit to a chiropodist and securing better shoes. Our generation is less likely to suffer chronic constipation because there is now such general knowledge of the inadvisability of getting the laxative habit, and that constipation can best be avoided or cured by sensible diet and regular habits. But since constipation can sometimes be merely a symptom of more serious trouble, an examination is often advisable; and periodic examinations and check-ups are now considered wise for all persons in or nearing the elderly group; for such diseases as diabetes and even tuberculosis may be present in a mild form and become virulent when the body begins to lose its resistance powers. Lessened resistance is one of the conditions generally inevitable for the aging body and will continue to be until preventive measures are, in time to come, discovered and put into general use. Another of the traditions regarding the results of the aging process that has already been disproved is that mental deterioration is inevitable. Scientific investigation has already established that it is by no means impossible for the elderly person to continue intellectual pursuits and to continue to learn by reading and other means. In fact, there is good reason to believe, and it has in some instances been proved through extended tests, that the mind may improve with age; that though we may learn more slowly when elderly, we learn more thoroughly and have better powers of retention and ability to apply what is learned; that our judgment may be greatly improved, as should seem likely through experience; and that there is no reason why we should consider it beyond our powers to keep up with the times and changes when it comes to understanding and using our critical powers. Of this, and of the many elderly persons of both sexes who have demonstrated and are demonstrating its truth, much more will be said in following sections of this chapter. It may be said here that retention of mental faculties seems to depend very much on education, habits of reading, and of doing our own thinking throughout life. 197

Aging in Minnesota In other words, how great and well preserved our mental powers will be and are in late life depends on how our minds were trained and how much we have added to or compensated for lack of early education or its imperfections, by learning and thinking. If the mind has already been made receptive and continued to be so, we can make good use of our leisure by reading and listening to lectures and so on; but if the mind has atrophied already because of lack of use, there is probably little hope of its becoming active in old age. Such matters as thinking for ourselves and forming our own judgments regardless of current opinions, and insisting on clarity in thinking and reasoning, especially in refusing to harbor contradictory beliefs or ideas, have much to do with retaining sound mental health and vigor. For the mind is a delicate instrument, and to expect it to function well after accustoming it to tolerate, more or less comfortably, entirely contradictory and antagonistic ideas is very like expecting a fine watch to keep accurate time after forcing its hands to run in opposite directions. Though this seems almost incredible, it has also been established that actual deteriorating of the physical brain due to aging does not necessarily mean deterioration of the mind. This seemingly miraculous fact is due to the compensation that here too operates and serves to preserve mental powers. Nevertheless, it must be recognized that one of the most serious and tragic aspects of aging is still all too frequent loss of mental faculties. One form of such loss, generally more or less expected and once thought generally inevitable, is loss of memory. Often this is followed by loss of judgment, of ability to concentrate and to keep details in mind, and in general, if it grows more and more serious, incapability of handling any problem or project that requires mental concentration. It must also be admitted that in regard to serious mental impairment, no medical or surgical technique has yet been found to bring about a "cure," a restoration of the powers lost. However, even in this field studies are increasingly undertaken and means are already at hand to bring about some alleviation or at least to prevent further deterioration, so that by no means should such conditions be neglected by failure to seek medical advice and aid. Much can also be learned by those closely associated with the afflicted person as to what may be done for him, and advice in this respect should easily be obtained from some of the doctors who are becoming specialists in the understanding and treating of mental impairment. In the more serious cases there is 198

We Who Are Elderly now available in most states special medical care and special hospitals to give aid to elderly mental patients as well as those of any other age. General good health is also of much importance in preventing and combating mental deterioration, and we can do much to maintain our mental powers if we can train ourselves away from unfortunate habits of extreme worry and undue emotional upsets. In this connection there is already advocacy of "training for old age," the time when undesirable habits of mind are most likely to become troublesome. It is also well to be a bit prepared for the changes that are to be expected with the oncoming of age. In general, it appears that those who escape serious mental deterioration are those who were well-born as to potential mental endowments, who have had access to mental development either through formal education or self-education, and who throughout life have either escaped serious stresses or have been emotionally able to cope with them, and, as has already been emphasized, have remained mentally active. Independence of mind and the ability to "fight back" against unfavorable circumstances of all kinds are factors that do much for the retention of a clear and efficient mind in old age. Mere placidity and unquestioning conformity are not conducive to continued mental power, but may instead lead to "vegetative" states. We may now devote some space to a discussion of the more familiar and more inevitable deterioration and ailments of the later years of life, with, incidentally, some comparison between the aids available in our earlier days and those of today. Eyesight is usually the first faculty to begin to fail us, and to us who are elderly this began so long ago that we have almost forgotten that there was a time when we were not dependent on "specs." Even getting used to bifocals is a long forgotten ordeal; and most of us are unable to detect if there is any real difference between seeing with the naked eye or through well-fitted "storm windows." To most of us our eyeglasses are precious aids so much a part of ourselves that they go on first thing in the morning and stay on till bedtime; and are so taken for granted that they are never thought about except when — sad mishap — they are mislaid or, worse yet, broken. Nor need we complain of misfits, for the science of optics is now so well advanced that perfect vision can be assured us by merely changing lenses when this is required by the aging process. This of course unless actual disease or 199

Aging in Minnesota damage affects the power of vision itself. Such an affliction common enough, especially among men, is cataract, which, however, can now be so easily and safely removed that, unless there are complications, one need only secure the services of a properly trained optical surgeon. More serious are separation of the retina and diseases of the optic nerve or the eye itself, notably glaucoma. But these are not really a part of the aging process but can and do occur as often in the young and middle-aged. Any defect in vision should of course at once lead to examination by an optician. To fully realize how improved are methods of retaining or restoring good vision, we who are elderly need only think back to the days of our parents. "Specs" were of course in common use and were generally available, but the common practice was to secure them from the drug store by the process of trying on and deciding for ourselves which pair fitted best. It was quite common, indeed, to choose a pair which magnified too much, on the theory that one would grow into them, which was then also the common practice in buying children's clothes, particularly shoes. Not infrequently the dispenser of spectacles was the itinerant peddler who sold glasses among other easily salable wares. Often enough the number of pairs available in either drug store or peddler's pack was very limited, and the buyer settled for what he could get, only to later discover that he or she could see better with the old pair. The truth was, of course, that the spectacles were simply magnifying glasses of various strengths, offering no adjustment to the individual eye and therefore not really restoring vision — much less correcting any eye defects due to aging. But nature often did offer the elderly of that day, as it still does today, the boon of "seeing without glasses," in very late life. This boon must have been the blessing of blessings to our still earlier ancestors, who with no glasses available, or at least procurable, had only this miracle to look forward to when vision had failed to the point of near-blindness. Twice to be pitied was the elderly man whose eyes had been dimmed with cataract and to whom therefore this boon was denied, and who must spend his last years in inescapable blindness. It needs to be said in regard to the treatment of cataract that while the removal of the clouded lens is generally entirely successful, the substitution of an artificial lens in the form of special glasses is not yet as perfectly satisfactory as could be wished and is generally promised. 200

We Who Are Elderly Vision is generally restored, but satisfactory and comfortable adjustment is still too often not brought about, and just where the failure lies is not easily determined by the uninformed patient. But since remarkable advances have been made in recent years regarding the operation, notably in the discovery that it is not necessary to operate at a certain specific time when the cataract is "ripe," and that very elderly patients can still be successfully operated on, there is good hope that better results in the fitting of the special glasses will soon be the rule. A period of adjustment and a reasonable amount of patience and tolerance must of course be accepted by the patient as necessary. Becoming more or less hard of hearing is another hardship to be practically expected as old age advances, and for this condition there has not until recently been any real and satisfactory remedy. Hearing aids are now being more and more perfected, but much, perhaps too much, of the attention of the makers has been directed to making them as inconspicuous as possible, or even invisible; this to spare the feelings of such persons, not generally the elderly, who do not wish to be known as being hard of hearing. Among women especially, deafness is still regarded, as near-sightedness once was, as something seriously detracting from the charm and worth of personality; so much so that many young and not so young women would rather be thought inattentive and stupid than hard of hearing. For men engaged in business that requires contact with the public, loss of normal hearing is often regarded as indicating unfitness for employment. The old fashioned hearing aids were admittedly too conspicuous, as well as inconvenient and uncomfortable to wear. And as was at first the case with eye-glasses, too many of the hearing aids have been and are being sold by agents neither competent to serve the buyer or, in this case, always entirely honest as to charges. In such cases the loss of money is not the most serious evil for the elderly patient. For many, disillusioned as to the promised and hoped-for benefits, as well as antagonized by the high cost of the hearing aid and of soon-needed upkeep and repairs, become embittered to the point of not using the aids or securing needed repairs, and still less of considering getting another and better aid from a more reliable source. The result is that far too many of us who have marked loss of hearing have a hearing aid lying about while we still have to be shouted at or sit isolated from the conversation going on around us. Securing a satisfactory 201

Aging in Minnesota hearing aid is of course a matter of first consulting a competent specialist or a general practitioner who has had special training, and obtaining reliable advice as to the best aid for our needs, and then accustoming ourselves to the continued use of the aid until we feel no undue discomfort in its use. Deafness is, we are told, a serious impairment because it causes a form of isolation and withdrawal that affects both physical and mental well-being. Not but that there are in this day and age certain benefits or at least compensations afforded by partial loss of hearing; such, for instance, as shutting out intolerably boring singing commercials and other, to us, undesirable radio and television offerings! Boring conversations, speeches, and music not to our liking can also be shut out and many annoying noises can be eliminated, especially at night. But even such relief is bought at too high a cost if the price is increasing loss of hearing. Even before we experienced loss of hearing, most of us had to begin using "store teeth." Here again advancement in comfortable fitting has been great, though not great enough, considering that the use of artificial dentures was known, though not at all commonly, in the later part of the eighteenth century. Washington, we now know, wore a pair of uppers and lowers, a pair in the real sense, since they were hinged together, the contrary fact not having yet been discovered and it still being the unquestioned belief that both jaws were and of necessity had to be created movable. What Washington suffered we can well understand from what we saw and knew of the discomfort and pain endured by our parents and grandparents even as late as sixty or so years ago. Like the uncomfortable hearing aids of recent times, false teeth generally reposed if not "on the piano" in a glass on the kitchen shelf, while the unhappy owner gummed his way through ordinary meals and wore the dratted teeth only when company came or he was away from home, they becoming a part of being dressed up, so to say. Badly fitting or broken or damaged dentures should of course not be tolerated. Not only can they cause mouth sores, which in turn can cause serious trouble, including cancer of the mouth, but they also tend to make foods that are hard to chew distasteful. This may be the reason some elderly people are sure they do not like meat and should not eat it, and the same may be true about hard fruit, nuts, and so on. Nor is it wise to try to make dentures fit better by operating on them 202

We Who Are Elderly oneself, as this generally causes rough surfaces, which will only increase the discomfort. All in all, perfection in this kind of dentistry is far from having been reached, for few of us are completely comfortable with our dentures or can wear them as we do our glasses, throughout the entire day; still fewer of us can tolerate them at night, though there are those who can tolerate them best when asleep. Some of the difficulty in securing a comfortable fit is of course due to shrunken gums, especially when some time elapsed between loss of teeth and replacement. There is another objectionable feature about wearing even the best of dentures, which few of us, or none of us, could know about except through actual experience. This is the considerable loss of the sense of taste because of the area of the mouth shut off by the upper plate. This is one reason why certain foods do not taste as they used to and would not even if we could have them of exactly the same quality, "like mother used to make," a point to be remembered by wives subjected to the timeworn comparison with Mother as a cook. To get "the real taste" many of us at times resort to gumming where that is possible. These three, then, impairment of sight and of hearing and loss of teeth, are the three most common and practically inescapable deteriorations due to the aging process. But there are of course many more ailments and diseases originating in or becoming aggravated in the later years of life, which plague great numbers of us who are elderly. Arthritis is one of the most common, the most troublesome, and the most difficult to obtain cure of or even lasting relief from. But since special attention is now being given to search for both treatment and prevention of this disease, we may hope to see it largely eliminated even in our lifetime. We can to some extent relieve at least the milder forms of it ourselves by proper diet, by avoidance of overweight, and by keeping warm by wearing proper clothing and keeping room temperatures at a fairly high level. Respiratory diseases, notably asthma and bronchitis, cause the elderly much suffering, especially when they become chronic. Various forms of stomach and bowel trouble also cause many of us much misery, though generally they are more amenable to treatment and attention to diet. Heart ailments, strokes, and cancer, though they have always been prevalent among the elderly, are becoming more frequent as people live longer and survive the infectious diseases. 203

Aging in Minnesota For all these ills and many others there is of course no hope of any real cure or even relief except through skilled and conscientious physicians and surgeons. Unfortunately, faith healers and other charlatans are still flourishing, victimizing still further those already suffering serious ailments. And it is to be feared that the already atrociously high and steadily increasing cost of medical services, due to inflation, is driving many of us back to shoddy practitioners even though we basically know better. Fortunately, however, costs of needed aid for the elderly can be eased by the various "plans" now well established, or by the use of Social Security benefits or Old Age Assistance. There are, finally, a number of impairments not in themselves serious or painful, but annoying and often leading to accidents. It is cruelly disturbing to find that the so long reliable hands and fingers that we could trust with the safe and careful handling of anything have become at times undependable and will let go at unexpected moments of this and that — the expensive reading glass, the delicate instrument, the long-used dish — unsuspectingly intrusted to their care. Plastics have come to our aid in some of these instances, and many of us have found it wise to replace breakable things with this type of unbreakable one. Sad it is, too, to find our memories slipping in regard to recent happenings and concerns, the while we can recall with what seems intensified clarity the past, even, or especially, as far back as childhood. This impairment of memory, we are told, is due to the hardening of arteries and consequent lessening of blood supply to the brain. The physical nature of memory is as yet far from being fully understood. But sensing that some sort of record, permanent or at least lasting, must be made in the brain itself, perhaps much like the indentations on records, we are led to wonder if there is not also hardening of the brain tissue, which thus causes difficulties in making the records that were so easily and permanently made in early life. Explanations about "electric currents" and "brain waves" may not seem to us satisfactory as constituting the memory records themselves, though they could seem acceptable as stimuli in both creating and reproducing the records. Interesting and intriguing it always is to try to figure out what has happened when one suddenly recalls what has seemingly been forgotten, a name, for instance, that for days and weeks has eluded our most intensive effort to recall. Suddenly it is there, much as when we are 204

We Who Are Elderly searching for an article in the storeroom and suddenly come across it. Where has it been, we wonder. For unlike the article, it certainly has not been "lost" simply because its exact location had not been known! Another interesting experience is to trace the chain of memories that have led to thinking about something of little or no consequence to us; this we can of course understand much better than the sudden recalling. Much that would be interesting to us who are elderly and have much use for memory could be, and in the future very likely will be, made clear to us. But while annoying and sometimes exasperating, the to-be-expected impairment of memory can be borne with well enough unless it becomes actual loss of memory, as it not commonly, but still far too often, does. Not to be able to retain a clear picture of ordinary happenings of daily life, from day to day, is not only a severe handicap to the one so afflicted, but also sometimes even more trying to those with whom he or she is closely associated. And unfortunately there is no memory aid which can be procured and used in such cases; though writing down what should be remembered so that it can be re-read at need is sometimes an alleviation. What, if anything, can be done to restore the power of memory already lost is something we shall have to leave to the intensified study of gerontology and geriatrics to determine. Happily, many of us are spared any serious mental impairment due to the aging process. There are even those who reach what is still called advanced age, meaning now well over eighty, without any serious impairment of either body or mind. But such individuals are still only happy exceptions, who, however, can give us an understanding of what successful aging might be for all of us and may become in the future. Some changes resulting from age will probably always remain unescapable. The lessening of resistance powers, the lowering of the tolerance level, the impairment of circulation, the loss of elasticity of muscles and tendons, the lessened amount of reserve energy and strength which in turn decreases endurance and slows recuperation, the weakening of organs through use, over-use, and abuse — all of these effects and many more are likely always to remain as part of the aging process, at least until the secret, if there is one, of arresting the process itself and prolonging life indefinitely, is discovered. Knowing, then, what we are probably up against as we continue to age, it is up to us to make the proper adjustments. Knowing, for in205

Aging in Minnesota stance, that our bodies are no longer so able to adjust to temperature changes as in youth, we need to avoid extremes of both cold and heat; knowing that our strength is limited and there is no longer a great reserve to call upon, we need to avoid over-exertion and to be cautious about placing ourselves in hazardous situations. And knowing too that though our minds may indeed be functioning as well as or even better than formerly, they are not invulnerable, we need to avoid as much as possible too great strains and demands upon fortitude and endurance. In short, though we continue to play the game of life reasonably and even remarkably well, it is wise for us to remember that we no longer can count very much upon the lucky fall of the cards; that it is wise for us to use well the skills we have acquired, not to rely too much on luck, and not to make the stakes too high or indulge in gambling. Not that this means that we are or should be bent upon using all our efforts to merely continue to exist and be as comfortable as possible, as succeeding sections of this chapter should make amply clear. With so much said and written in recent times about the danger of placing reliance on self-styled "healers" and glowingly advertised nostrums, there are far fewer of us who are elderly who need any further warnings. But until there are none of us who need them, warnings and cautions are not to be entirely eliminated. It is easy enough to understand that any of us who has become discouraged because of long suffering from nagging ailments of disturbing symptoms of what may be serious disease and have not yet been able to secure any lasting relief or satisfactory assurance, can arrive at the stage where we yield to the blandishments of offered "sure cures" to the point where we say to ourselves that "it can't hurt to try" this or that nostrum or some "healer" who is rumored to be performing wonders, if not miracles, of healing the sick. To be further told that the "healer" does not ask payment also may tend to make some of us feel that he certainly must be both reliable and noble. The fact is of course that the "healer" may, by not asking or receiving payment as such and leaving it to the patient to "give" what he feels the treatment to have been worth, be evading laws against practicing healing of any sort and asking and accepting payment without a license, such license being of course not procurable by him. He can also generally count on the generosity of the patient who believes he or she has been or is being restored to health, and the generous fee thus offered can be called not a payment 206

We Who Are Elderly but a free-will gift, thus also removing the possibility of prosecution for malpractice. The money paid out for what will eventually be seen as having been of no benefit is, however, not the greatest loss. The far worse loss is of time. The often cited danger is delay in cancer cases, where early detection and prompt treatment are of such vital importance. But in other diseases or ailments also, delay may greatly aggravate the condition. There is also the additional loss of the patient's confidence in medical treatments of any kind, due to severe disillusionment. Because of the constant warnings against them and the legal steps taken for their elimination, the number of "healers" has been very considerably lessened. But we hear now of "clinics" operating in smaller towns and advertising the use of supposedly newly discovered means and methods, and gaining prestige also by using the label "clinic." This new kind of highly questionable medical establishment is particularly prevalent in states where laws relating to medical practices are lax, afford too many loopholes, or are practically non-existent. It is well for us to remember that reputable doctors and clinics never advertise and never need to, and that by the same token the more persistently and extravagantly a patent remedy is advertised, the more its worth is to be questioned. Nor should we neglect the excellent advice to eliminate such ills as indigestion, constipation, and deficiencies of one kind or another by means of diet rather than by continued use of powders, pills, and vitamins, unless prescribed by a reputable doctor. We need also to keep in mind that delay in seeking information and aid from reputable sources is never advisable or profitable, except in some very rare cases where further development of the ailment is necessary to allow accurate diagnosis, and this must of course be determined by proper medical authority. For besides the danger of making worse what may already be bad, delay has a harmful effect on the mind in causing tension, fear, and anxiety, all of which are enemies of health both mental and physical. Finally, even those of us who have, because of strong bodies, sensible living, and some amount of good luck, avoided infectious diseases and injuries from accidents may not in advanced age retain such powers of evading and resisting ills and/or recuperating from them; therefore, though we have through many years been able to dispense with medical aid, we may eventually need it, and we should not allow ourselves 207

Aging in Minnesota to become too set against doctors and doctoring. For though none of us would wish to become a hypochondriac, always concerned about our health and perhaps suffering from imaginary ills, it is well to keep an open mind toward what can be done to prevent, eliminate, or alleviate ills, especially in these times of constant research and new findings. Thus, while we have good reason for looking forward to greatly increased medical facilities and improved means and methods both of prevention and cure or alleviation of ills due to the aging process — this perhaps within a decade — we should certainly avail ourselves of such facilities as already exist, if and when need for them arises. What it means to be elderly. A frequent complaint against us who are elderly is that we are slow and reluctant to "adjust." Adjusting means, of course, accepting and adapting ourselves to new circumstances, ways of living, modes and manners, attitudes, habits, tolerances; to new forms of recreation, voices, relationships; as well as, and most of all, to new industries, new products of all kinds, new means of communication and travel — all this adjustment in the name of progress, which much of it is. But before we submit to all this adjusting, we elders have to deal with our doubts; we have to ask ourselves if by merely submitting we are really furthering the welfare of ourselves and our fellow human beings. For by merely living so many years we have come to see that not all change is progress; we have also come to see that for every discarding of the old in favor of the new something is invariably lost as well as something gained. Of this matter of adjustment much more can and will be said when we presently undertake to make clear some of our reactions to the present-day world. We wish, however, at this point to assert what has already quite generally been conceded, that no generation in all the world's history has ever faced so many and such radical changes as has ours. Our immigrant forbears who came to this "new world" did indeed find much that was appallingly new, from new means of making a living to a new language; this was largely true also for those who immigrated to other new and strange places. For those who were already elderly, the necessary adjustments were difficult and painful indeed, and in many instances were never more than partially made. But basically they were still in the same world they had always known, and fundamentally things were the same, however different. Moreover, 208

We Who Are Elderly they could and generally did lessen the need for adjustment by settling in homogeneous groups where they could substantially re-establish the cultures of their homelands. Only the negroes who were brought directly from the African jungles can be said to have found, and as inescapably faced, as many and as completely new conditions of life and living as has our generation; and even then their adjustment was made for them and forced upon them, so that their adjustment could not become a problem nor even something of which they could have any real comprehension. We who were in our late teens or twenties at the turn of the century were firmly convinced that marvelous changes were about to take place simply because the century was new. The telephone, X-rays, and electric lights were already in use. Electricity was the marvelous power that would transform everything, and rubber was the material that had already made it possible for us to ride on air. For the time being, those marvels were enough for us to incorporate into our daily living. While we are generally spoken of as having been born and brought up in the horse-and-buggy days, many of us had really begun life in the oxen and lumber-wagon era. For we who spent our childhood in rural communities in the Middlewest can well recall the eventful and not too frequent trips to the nearest village, sitting on a board laid crosswise in the back of the lumber-wagon, the "spring seat" being reserved for Father and Mother. With only a folded bedquilt between our rears and the very hard board, we were carried along at a pace slower than slow walking, the common description of the oxen's pace being that they took two steps forward and one back. If the village was some eight miles away, the trip was started about nine in the morning, after chores were done, and lunch was taken along and consumed somewhere along the way around noontime. If we were young children, we were unconscious of anything especially undesirable about such a mode of transportation except the slowness of our progress and the hardness of the board. But we heard tales of young ladies who preferred to get down from the board or the grain sacks and walk the last quarter of a mile into town to make an entrance a bit more in keeping with their sense of dignity. The trip homeward always seemed shorter, and was, since the oxen walked faster when homeward bound and could even be prevailed upon to run a few steps now and then. And all our thoughts and talk were about the exciting episodes of the afternoon in town, the 209

Aging in Minnesota while we munched cheese and sweet crackers, delicious because they were "boughten." Our next means of transportation was by horses hitched to the stillused lumber-wagon, or perhaps a newer one with even a second spring seat. Later we rode in spring-wagons, buggies, and surreys drawn by horses used only for lighter driving. This we thought was surely the ultimate in fine riding. But soon bicycles became the delightfully fast and independent conveyance of those of us who were in our teens, and we made tremendously long trips, even "century runs," on them, not of course without frequent tire punctures and/or summersaults over the handlebars when descending steep hills with loose sand at the bottom. Then appeared the first automobiles, which as they came chugging to meet us or, worse yet, to overtake us from behind, frightened our unsophisticated farm horses into near or actual runaways. Many were the warnings given out by officials of both villages and townships about stopping automobiles and waiting by the roadside till the hysterical teams of horses could be led past. What to do when overtaking a horsedrawn conveyance the automobile drivers presumably had to figure out for themselves. But many a farmer preferred to drive into the brush on the side of the road or to escape to a side road, when he became aware of the approach of one of the dreaded machines, ruefully thinking how with sturdy Buck and Jack he could have kept to the middle of the road. Motorcycles were also coming into use, the owners and would-be riders running alongside, trying to mount, and even more luckless ones, once mounted, finding they had forgotten how to stop the machine and being forced to drive around and around village streets to the accompaniment of barking dogs and screaming women and children until the gas gave out, all very reminiscent of John Gilpin's famous ride. Those of us who spent our childhood and youth in the city had witnessed a succession of private carriages and hired hacks, horse-drawn streetcars, trolley cars, and electric cars which often stalled for an hour or two at any time of day or night; and of course much earlier than country and village dwellers, we had seen the advent of bicycles and automobiles, and already heard talk of congested traffic on city streets. From this early background, we who are now elderly have been faced with adjustment to sound-barrier-breaking flights in the air. Small 210

We Who Are Elderly wonder that many of us stubbornly refuse to adjust to air travel in any form, preferring to remain on the ground instead of possibly being hurled back to it from tremendous heights in crashes of which the report is "There were no survivors." As for trips to the moon, the only mention of such a project we heard in our youth was in the song, "I'm in love with the man in the moon; I'm going to marry him soon; I'll go up in a great big balloon . . ." From that we are now asked to adjust to the imminent competitive undertaking of trips to the moon in space ships, and not for love. We can but shudder at the probable loss of life involved, and we are by no means convinced that any great good will ensue. As for ourselves, it is not likely that many, if any, of us will be clamoring for tickets, no matter how commonplace the trips may become. Incidentally, we are remembering that our ancestors spoke of the wisdom of remaining on terra firma as against venturing to cross the ocean, that we are now sensing the wisdom of remaining on terra, and that soon we shall be objecting to leaving the terrestrial atmosphere! Our ability to adjust to other changes, which, while not so dramatic, have been great enough, has come to trial again and again through the years. From tallow candles still made and used by our great-aunts, to kerosene lamps, and thereafter by even faster leaps, to gas lights, electric bulbs, arc lights, and neon lights, to fluorescent lights, to whatnext. From home grown and canned, smoked, and salted foods to packaged frozen foods ready to bake, boil, or fry or merely thaw. From made-over log houses and story-and-a-half frame houses to large "square" houses with upstairs rooms in which one could stand erect even close to the walls, and city mansions with their huge high-ceilinged rooms, to present-day bungalows and ramblers, quonset huts, and house-trailers, and strange new glass houses for which there are yet no definite names. From store buildings with false fronts to add to their height, to supermarkets spread out over the landscape, with no owners or clerks with whom to dicker over prices, and with doors that open and shut automatically before us and behind us. From one-room frame schoolhouses with entries and grass-grown yards where we played pom-pom-pullaway, to one-story buildings that look like factories, with playgrounds that look like glorified chicken yards, where heavily armed youngsters play cops and robbers. Surely this enumeration, even if unnecessary and possibly boring, 211

Aging in Minnesota has served to prove that adjustment, for our generation, has been something far more than the to-be-expected adjustment to changes from generation to generation. But it is not only adjustment to outward things that concerns us when we try to analyze the situation in which we find ourselves as "elderly." As at all stages of life, there are advantages and disadvantages that must be realistically seen and appraised. Of physical changes due to the aging process, much has already been said; but something more should be added here. To be elderly nearly always means to be more accident-prone. For several related reasons we are especially given to falling. We stumble because of failing eyesight or disturbances of the inner ear which cause dizziness or decrease our sense of balance, or because we no longer so deftly lift our feet over the edges of floor coverings or steps or other elevations. We are thrown off balance more easily, as, for instance, when a child or a dog runs up against us, or when we are jostled in a crowd, or when a foot encounters an unexpected obstruction. And to be thrown off balance is much more serious for us, for we have lost much of the power to right ourselves quickly, since our reflexes both of nerves and muscles have become much slower. So for us a stumble quite generally results in a fall. And falls are much more serious than they used to be, for our bones have become brittle, and the injury sustained may be out of all proportion to the fall itself, as, for instance, when a fall on the floor results in a hip fracture, the especial bane of the elderly. It stands to reason, therefore, that we must learn habits of extra carefulness both at home — one might say especially at home — and elsewhere. It is hoped that elderly women no longer take the risk of wearing high heels, and that all elderly persons should unashamedly seek the support of handrails when walking stairs, turn on lights rather than risking a fall in darkness, wear rubbers or overshoes when there is danger of encountering icy spots, and be ready and willing to take many other common-sense precautions. Even the use of a cane when and if needed should not be spurned because of hurt to pride, for here a peculiar meaning attaches to the old proverb that pride goeth before a fall. And though we may look foolish wearing galoshes on a mild winter day, we would look much more foolish sprawled on an icy crossing with a broken limb or hip. 212

We Who Are Elderly Because our vision is dimmer, and much more because our reflexes are slower, it is obvious that we should not place ourselves in situations where instant judgment and action will be required of us. For this reason it is not generally advisable for elderly persons to drive cars on today's congested highways, the fact that they have driven cars safely for twenty or thirty or more years notwithstanding. The young and the middle-aged suffer or cause traffic accidents largely because they have never really learned caution or respect for caution; the elderly because caution no longer suffices for them. Being accident-prone is often also due to mental conditions. We have all experienced the exasperating days when everything goes wrong. An examination of our state of mind will usually reveal that we were disturbed, absentminded, "upset," before the first mishap and, of course, increasingly thereafter. One of the frequent causes of accidents is that elderly persons are so much given to brooding, over-anxiety, and forebodings. When the mind is, so to speak, over-occupied with problems of its own, it cannot function to guard the body against hazards. Hurried or harried, the elderly person is over-exposed to danger from seemingly trivial and common circumstances and incidents. We have to learn to recognize and accept our limitations and not to demand too much of ourselves, however displeasing and annoying it may be to ourselves and others, or how "impossible" it may seem to avoid situations of strain. Elderly persons, no matter how level-headed under ordinary circumstances, may, like children, panic when confronted with sudden danger and, again like children, become too confused and clumsy to avoid hazards or to save themselves from injury or death from fire. For this and other reasons it is not always safe for elderly people to be living alone even though they may seem very able to take care of themselves. Also the need to use unaccustomed tools and utensils and materials and to deal with unaccustomed means and methods may also contribute to accident-proneness. An interesting study might be made of how much accident-proneness in elderly persons is the result of an environment that changes too swiftly for them, which is in itself taxing. Accident-proneness need not and should not make us fearful. It needs to and should make us careful. Some of us have found that a sign, "Be Extra Careful Today," displayed only on days when we feel under strain, may serve to put us on guard and also actually reduce the feeling of strain because it makes us smile. Grade-school children 218

Aging in Minnesota will be very happy to make such signs, appropriately illustrated perhaps, for grandparents and great-grandparents. The time may come when the effects of the aging process have become so much reduced that the elderly are not incapacitated because of age. But that time has not yet arrived. It has already been pointed out that while extremely few of us can escape physical deterioration as a part of the aging process, many of us find ourselves with mental capacities largely unimpaired, except for the slowing-up processes discussed in that connection. Thus while we cannot rely on our being able to instantly grasp a situation, make an instant decision as to the proper response, and act instantly upon it, we can, given time, think as clearly as ever, understand better, and form opinions and judgments far better than ever before. For in regard to these matters we who are elderly have an advantage over those who are younger, most especially over those who are really young. For the young, no matter what their mental endowments, must necessarily lack one thing without which no valid conclusions can be drawn, no fair judgments arrived at. This quality unattainable by the young is perspective, and it is unattainable by them because it is based on experience, and experience, in turn, is dependent on time spent in living. To point out to the young themselves and to those who have dealings with them that the lack of perspective accounts for much, very much, of their misjudgments, miscalculations, misconceptions, wrong decision, rashness, and lack of forethought and considerations would need a lengthy article, one might almost say a book; but it is something we who are elderly can do verbally, piecemeal, as occasions arise, if we can do it sympathetically. But since this present discussion is about us who are elderly, the point to be made here is that the acquisition of perspective is one of our great advantages. The sense of perspective saves wear and tear on our often sorely tried patience and, in fact, counteracts the tendency to impatience which afflicts us because of our conscious or unconscious sense that time is shortened for us with every passing moment and that we no longer can look with complacency on the, for us, ever more rapid passing of time. Perspective reminds us of the many times when the keen urgency we felt about the doing of this and that, which unwisely had been left undone and postponed time after time, caused us anguish. This in matters concerning ourselves, our community, our state, the 214

We Who Are Elderly nation, and, increasingly in these times, the world. What soothes us now is to recall that many such things were in the past at long last done, and that there can therefore be hope of other things being accomplished eventually. Not that we should too complacently simply wait for them to be accomplished if it lies in our power to aid in their being accomplished or at least attempted. Perspective also comes to our aid when we begin to feel that what is growing more and more unendurable will never cease to afflict us, for we can recall that wise saying of the Venerable Bede, which expresses the very essence of perspective, "This too will pass away." It is possible sometimes for us to better endure physical pain or severe mental distress by looking ahead to a time — tomorrow, or next week, or a month hence — when relief is bound to have arrived. Even anguished waiting or torturing suspense can be alleviated by looking forward to a time when it must necessarily come to an end. Nor is perspective limited to matters of time. It also has to do with seeing things in proper proportion in relation to other things. As we grow older we are apt to make mountains out of molehills for the reason that we, again consciously or unconsciously, feel our strength waning and that we are growing more and more helpless in a changing, and, it may seem, hostile, world, in which we have less and less power to hold our own. In this feeling we are of course reverting to similar feelings in childhood, but then, while we had others to depend on and to fend for us, we lacked perspective, which can effectively come to our aid now. Perhaps what seems so upsetting, what becomes almost or in fact an obsession of which we cannot rid our tortured minds, can be made to lose some of its power over us if we can but bring it into proper perspective against other things. Our lacks too, when measured against what we do have, can become more endurable or even entirely acceptable. "Count your blessings instead of sheep" may not be bad advice, though neither kind of counting is especially conducive to sleep. At any rate we shall not be so much time's fool or suffer quite so much from self-pity if we incorporate a good leaven of perspective into our philosophy of life and living. Finally, perspective both as to time and as to relative importance often saves us from misjudging others or despairing of them if we are distressed by their shortcomings; and it is almost certain to increase our tolerance and generosity toward others, as well as save us from hates and jealousies. 215

Aging in Minnesota The almost inevitable lessening of desires, of the obsessive yearnings to have, to do, to be, which in our younger years robbed us of peace, drove us too hard, brought on alternate moods of wild hopes and dreams and deep despair, may also be looked upon as an advantage. We generally find ourselves requiring less, settling for less, growing more complacent. It must be said, however, that this growing complacency, while a real good for some, is not attainable by or desirable for all. Many of us feel ourselves still unsatisfied, still striving, and as time grows shorter for us, more and more insistent on accomplishing what we feel we must do or achieve while yet there is time. And if time, strength, and opportunity are granted us, we may well still achieve long-sought goals. To many of us complacency with things as they are is so unthinkable that we still feel the truth and force of the simple little verse we learned in childhood: For every evil under the sun There is a remedy, or there is none; If there be one, try to find it; If there be none, never mind it. For those of us who still aspire to be up and doing, the third line is the all significant one. Nor do we lack examples of worthy efforts and actual success in old age. Whether, then, we who are elderly should relax and vegetate a bit or be up and doing depends on such factors as health and ability, quality of spirit, and, most of all, whether we feel that our work is done and that we now may and should rest, or that it is yet to be done or finished and that "Up and at it" is still our motto. There is nothing disgraceful about either attitude. One of the greatest hardships of being elderly is that we must constantly experience the loss of those whom we have known through the many years, some of them older than we, some our contemporaries, many of them younger. Whether they be close to us — a husband or wife, or other close relative, or a friend — or merely an old acquaintance, the loss of them is to most of us a very hard one in a very special way. For as we grow older, we lean and need to lean more upon one another; so the death of a loved one is much like the cutting down of one of two trees growing so close together that neither is in any real sense independent of the other. Roots are intertwined so that the death of one tree often is the beginning of the death of the other, or, 216

We Who Are Elderly at the very least, its roots are so disturbed that the remaining tree is never quite itself again. It is true also that because of our interdependence, the one left behind suffers from the sense of not having done enough for the other, no matter how loyal the devotion and unceasing the ministrations and efforts to succor and save. One of Rabbi Liebman's greatest contributions in his Peace of Mind was his pointing out that this sense of not having done enough for the one now gone is indeed universally experienced by all sensitive persons and is not by any means due to one's own shortcomings, real or imagined. It is part of the sense of the finality of death. Universal too is the feeling of the need to communicate this or that to one with whom there was once so much and so ready communication, a sense of renewed shock when we again realize that communication is forever impossible, whether to tell something very important or very joyful, or to ask about this or that matter about which only the one gone could have enlightened or advised us. This sense of needing to communicate can be compared to the sense of seeming pain in an amputated limb. It is understandable, though very deplorable, that this sense of need to communicate with the dead sometimes delivers the elderly, as well as the not so elderly, into the hands of unscrupulous charlatans. The total effect of the passing of more and more of those long known to us is that we feel that the background of our lives is falling out and that more and more we are left to stand in an unfamiliar environment. We can make new acquaintances and even new friends, and the older members of our families and relationships are replaced by the oncoming generations. But as we see in the circles and crowds about us fewer and fewer of "the old familiar faces," we sense with a new poignancy the true significance of Tennyson's lament, "But oh, for the touch of a vanished hand, / The sound of a voice that is still." In many ways these constantly recurring losses to death may be seen as one of, if not the greatest of, the penalties of growing old. Another depressing fact may well be that we cannot avoid the sense of the constantly increasing nearness of our own death. For even if we do not fear death, even if we accept it sensibly and are resigned to it, its nearing can hardly be conducive for most of us to any real happiness. Only to the very ill or the very weary can death seem entirely desirable. For most of us the best we can do is to accept the inevita217

Aging in Minnesota bility of death, remembering that it must come to all, and that since it has stilled the song of a Caruso, the hands of a Paderewski, the heart of a Lincoln, the mind of an Einstein, the voice of a Franklin Roosevelt, it ill becomes us to deplore too greatly the eventual yielding of ourselves and our powers. Perhaps we can recall or reread "Thanatopsis," which we read and declaimed so dramatically in our youth, when the significance of death was so incomprehensible to us that we could with real enjoyment dramatize it. Our own experience in the deaths of relatives and friends, as well as what we are told by doctors and nurses, has largely dispelled the once common delineation of dying as a lengthy travail of terror and anguish. Death, we are now assured, is an easy matter for us all, young or old. Whatever has been our reluctance to face the inevitableness of death, its actual coming brings no terrors. And this is as true of the death of the unbeliever as that of the believer, the tales of the ghastly fear, the frantic repentance, and the fervent seeking of salvation having long since been proved untrue. Those guilty of hidden crimes may indeed feel the need of deathbed confession, and there are those who seek the forgiveness of those they have wronged or think they have, but for nearly all death comes far easier than birth, being a gradual or sudden yielding of the bodily powers and the will to live, and the yielding to unconsciousness much like yielding to sleep. Many of us would like to meet death like a child, who, reluctant to leave his play, is too drowsy to cling longer to his toys, and who loses all sense of loss and regret as sleep overcomes him. There is no reason why we who are elderly should let ourselves become obsessed by the thought of death and either try to foresee or try to escape its coming, remembering that eternity, however spent, will be a very long time — time to enjoy what we hope to find beyond death, or time to forget all our troubles and trials and find rest in the long sleep, the depth of which we cannot fathom. As to the significance of religion in our view of both life and death, it should be said here that since this chapter is intended for all of us who have this one thing in common, that we are elderly, nothing can be said about religion except this: that for the believer life and death are of course greatly simplified, since belief in an omniscient and omnipotent God must necessarily include the realization that everything, evil as well as good, comes with His knowledge and by His willing, and according to His plan, and that therefore all must be accepted without 218

We Who Are Elderly undue protest or bewailing. For the unbeliever, on the other hand, the hard facts that the human will, alone and unaided, is responsible in all human undertakings, that life is largely now what human beings make it, and that death means oblivion, must be found acceptable and borne with courage and fortitude, the only compensation being perhaps the satisfaction of clarity and integrity of mind. This also should be said that we who have lived for many years and among many people of varying creeds or no creeds and have found good among them all, have come, or should have come, to see that freedom of religion should mean to us freedom not only to choose one's creed but also freedom to reject all creeds, and that to be truly tolerant is to question no man's right to accept or reject, however much we may regret the way this one and that one exercises that right. Failing this, we can hardly see ourselves as upholding true American freedom of religion. In any other way it would be foolish, as well as unwarranted, at this time to urge any change of mind regarding views held and cherished through a lifetime by us who are now elderly. Nor are social or political views to be investigated or questioned here, or personal principles. To each the right to accept the truth as he sees it, defend it if need be, gain from it as much as he rightfully can, and act according to it. There are, of course, times and places for discussions, arguments, exhortations, protests, and every form of assent or dissent, and the elderly are by no means either incapable or afraid to take part in such, often with great good to others and to the general public. If this is to be a fair representation of what it means to be elderly, it is time now to take stock of ourselves as to faults and weaknesses which are generally incidental to the aging process, but which are not always without remedy. Psychologists tell us that most objectionable traits of the elderly have been lifelong traits and have merely become intensified with age. This is very likely true of self-centeredness. This trait is often confused with the tendency to withdrawal in the elderly •— the constant decrease of interest in the outside world and in interests formerly enjoyed. Withdrawal may indeed indicate self-centeredness, but it may also be only an expression of weariness, lack of energy, or sheer boredom with what one has already experienced too much to be longer interested in. Thus, those of us who have long been accustomed to being in the public eye may feel fed up with anything that 219

Aging in Minnesota has to do with public appearances or taking part in public gatherings. We may feel we have talked ourselves out, and often enough to no avail. So to draw back into our shell seems restful and eminently desirable. Nevertheless, our interest in people, even if not in individuals, and in the general welfare, may still be great, and on occasions that contain for us a real summons, we may yet speak up. The really self-centered person, on the other hand, may still seem very sociable and very out-going in his or her readiness for contacts. Such contacts may, however, always be and remain very casual and involve no giving of himself or having any real interest in or concern for others. The real test of such a person is in close contacts, in desire to make real friends and keep them, in real concern for others. To the self-centered person other people are not really real in the sense that understanding them and having concern for their actual interests, needs, and welfare, has any meaning. They are merely figures that appear and reappear in his own life and are desirable only insofar as they "give" in one way or another without expecting return. This trait, though possibly harmless to the individual, is not so to those who must associate closely with him or her; and of course if it became universal it would dissolve all human society. Discovering such a trait in oneself, therefore, should mean instant effort to eradicate at least the extreme forms of it, instead of letting them intensify, as age makes likely. Moodiness, often intensified in age by physical causes, is a trait that can make us unpleasant to live with. We need to recognize it as akin to our childish pouting, returning in a somewhat different form. Here again we need to be on our guard, since recurring moodiness may become sullenness, and will in any event harm ourselves as much as it exasperates our associates. For there is no longer any question that unhappy and unhealthy states of mind cause physical ills and deterioration, just as they are caused by them. This vicious circle needs, then, to be recognized and counteracted. But in all fairness it must also be said that those who by their speech, manner, and/or actions cause moodiness in others are much more culpable than those who become their victims. To cause, by act or word or even tone of voice or look, well known and even anticipated undesirable reactions in others is often more reprehensible than to do them bodily harm in more direct ways. Obviously, family relationships can become ideal hotbeds for the seeding and cultivating of means of irritating and upsetting others. 220

We Who Are Elderly Luckless is the husband or wife or child or parent or other person, old or young, whose weaknesses, real or conjured up, are made the means of constantly victimizing him or her in this manner. Nor does becoming elderly lessen the pain and harm of such victimizing, however much the victim tries to become used to the pinpricks and ignore them. In this connection it may be pointed out that the tendency in some persons, elderly and not so elderly, to keep still when annoyed or hurt is often a survival of this tendency in the child who is ashamed to admit a hurt and who has not the courage to strike back in any way. It has become well recognized that children, especially the timid, should be encouraged to give tit for tat when they are being intentionally hurt or annoyed, and this holds good for adults at any age, and not the least so in old age, when we should have the right to expect good sense and good manners, even if not real concern, from others. We need not fly off the handle at every affront, nor imagine hurts where none were intended, but certainly we should not endure browbeating or tormenting by either children or their elders. Many a grandparent more or less forced to live in the home of a son or daughter can become the tortured victim of the smart remarks, ridicule, and even tricks, of grandchildren. This is certainly an affliction not to be endured in silence. Relative to the same situation, it almost goes without saying that elderly people forced to become dependent upon others are as a general rule extremely sensitive to implications or imagined implications that they are looked upon as burdens and that their demise or at least departure would be welcomed. This is again a situation that the elderly should not silently brood about but should insist upon bringing into the open so that it may be clarified and remedied in one way or another. On the other hand, such elderly dependents can make martyrs of themselves and much more real martyrs of those seeking to do their best for them in what may be a trying situation, by constant reminders that their death cannot be far off and that they will not continue to be a burden for much longer. To use the inevitability of death as a threat or as a clinching argument or as a weapon with which to beat down any criticism of oneself is, whatever one's age, not only childish but obviously unfair. The only practical defense against such unfairness in discussing a problem is to affect a cheerful agreement with the solution offered, just as the best answer to a child's threat to run away from home is to calmly offer to help pack his bag. 221

Aging in Minnesota Another trait that is often complained of in elderly people is garrulousness. This trait is apt to develop in old age because we feel we still have so much to say and that it is hard to find listeners among the busy people around us. Our own lack of busy-ness, if it exists, may also contribute to our desire to at least keep talking. Our garrulousness may take many forms, but most often it takes the form of reminiscing. Now reminiscing is certainly not a fault in itself, and it is natural that we should wish to talk of what we have known and experienced and remember so well but which to those around us is not known. The trouble is that we do not always choose wisely as to listeners. Young children often ask grandma to tell about what she did when she was a little girl, and grandsons may like to hear about what granddad had to do and learn when he was a "youngster like you," especially, in these days, if "gramp" in his childhood ever had anything to do with cowboys, Indians, or outlaws. But even children tire of too much reminiscing, and having been for a time brought to live in the recalled past suddenly feel a keen desire to be back in the real present. And after childhood, many people lose all interest in tales of the past, are apt to question their truth, and, contrasting them with circumstances of the present, feel them frightfully boring. Also, sons and daughters and grandsons and granddaughters may often be on tenterhooks in the presence of outsiders, fearful that the recounting may include indiscreet details of family history, inadvertently or with malice aforethought on the part of the teller. All in all, the best audience for reminiscing is our contemporaries or our elders, for these will know what we are talking about, lack no interest in the past as they themselves also knew it, and are, moreover, desirous of having a chance to reminisce themselves. Many a happy hour may thus be spent in which reminiscing becomes not a fault but the giving and receiving of pleasure. It is true, to an extent which can never quite be known or understood except through one's own experience, that those who are elderly actually find themselves living in two worlds, that of the past which they know so well and remember so clearly, and the present which is often much less knowable and understandable to them. And it may again be pointed out that never has a generation of elderly people faced so wide a divergence between these two worlds as has ours; and never has a generation been told so in222

We Who Are Elderly sistently that dwelling in the past is inadvisable and unhealthy. This may or may not be true, but it makes many of us feel guilty when we find ourselves reminiscing, even in our thoughts. That dwelling on past unhappiness is unwise we are ready to accept, though acceptance of that fact does not always insure ability to act upon it. A happy present is of course the best antidote against unhappy memories. Other forms of talking too much are complaining of one's poor health, with detailed accounts of illnesses and operations and near fatalities, and of the selfishness and neglectfulness of relatives or friends or neighbors; contrasting unfavorably our present circumstances with those of our past; bewailing our lack of friends, means of amusement, lack of attentions, and many more details of woes and misfortunes. Some of these complaints of ours may be very well founded; but no matter how politely the listener pays attention and even makes sympathetic exclamations and remarks, his or her real reaction is more than likely to be that we are complaining unduly, that we like to feel abused and miserable, and, "like all old people," are ready to bore others with what we should keep to ourselves. In any event, our complaining will have done us no good and make no improvements in our unhappy situation, real or imagined. There are numerous stories illustrating the incurable dissatisfactions of the elderly. One of the most whimsical is the following: A sympathetic woman, visiting a former neighbor now an inmate of what used formerly to be called the county poor farm, asked her if the food served was all right. "Oh, yes," was the reply in a tone of deep resignation, "what there is of it." "Oh," exclaimed the distressed visitor, "don't they give you enough to eat?" "Oh, yes," said the resigned one, "such as it is." Other faults we may well be on our guard against are over-criticalness — carping, as it is generally called; increased possessiveness, which demands too much of those near and dear to us and infringes on their right to live their own lives; suspiciousness, which allows us no real satisfaction in contacts with relatives, friends, or neighbors, and which continually attacks our composure because we question meanings and motives and the true worth and intent of what is said and done. This last is a really painful affliction and can become an obsession unless it is recognized in time and definitely checked. Other faults of similar nature are intolerance for everything new because it is new, all change because it is change, and opinions and be223

Aging in Minnesota liefs merely because they differ from our own; clinging to prejudice and preconceived notions merely because we accepted them long ago; and in general refusing to re-evaluate the old because of innate fear and dislike of the new. This is not to say that because we are often suspected of these faults, we should hurry to accept the new merely to escape suspicion of being set in our ways and hostile to change. We often need to remain neutral toward what is new until we have had time and opportunity to investigate and evaluate, or until time has proved its good qualities or exposed its bad. Prejudice, which of course means prejudging, without investigation and evaluation, is as unbecoming in the elderly as in people of any age; and to help make it seem a common, not to say universal quality of the elderly is doing a disservice to ourselves, the community, the state, and the nation. For the opinions of persons or groups of persons generally regarded as prejudiced are not likely to carry any weight even when well founded and potentially useful and needed. But again this does not mean that we should remain neutral toward blatant evils just to prove that we are not prejudiced. There are people, ideas, and conditions regarding which we should be not only suspicious but openly opposed and decidely hostile. Nearly all of us who are elderly have also recognized in ourselves some tendency to obsessions and compulsions, and some of us suffer from phobias; all of these may have been with us through life, or they may have developed in later life because of frightening experiences. A fire which has caused us great fright, discomfort, and harm may as an after-effect have left us with such an obsessive fear of fire that we must check or recheck any possible danger or hazard from that source. Others of us suffer from obsessive fears regarding leaking water or gas or the use of electricity in our homes, so that we are constantly uneasy and compel ourselves to inspect again and again to obtain reassurance. Many obsessions of this sort, which compel us to seek reassurance again and again even when we know very well that nothing is amiss, are often amusing to our juniors, as, for instance, the sight of the elderly man who returns again and again to reassure himself that he did lock the door of his shop behind him. Obsessions, compulsions, and phobias are not signs of mental illness or of deterioration of mental faculties, at least so long as they are recognized for what they are. To be mentally ill means not to be able to recognize any of the workings 224

We Who Are Elderly of one's mind as unrelated to reality. In fact, some of our compulsions, annoying as they may be, can at times be useful; they sometimes become a real check on our forgetfulness. However, it is wise not to take them too seriously; in fact, they can best be counteracted by our admitting them freely and laughing at ourselves for being victimized by them. Sadly enough, in these times elderly people are also exposed to dangers because they cannot readily be convinced that they actually exist. Elderly men and women who have all their lives walked freely about city streets, even in outlying districts and late at night, cannot always become aware or convinced of the serious risks in continuing to do so, and become victims of attacks by criminals. Such attacks always result in loss of money and other possessions, often also in severe injury from blows or knockdowns, and not infrequently in loss of life. Frequently, too, elderly persons who venture out after dark or in early morning hours are run down by hit-and-run drivers, who, if apprehended, quickly absolve themselves of blame by claiming not to have seen the elderly victim. The grim quip that the quick are those who get out of the way of speeding cars and the dead those that don't has application here, and the elderly, not being quick, are likely to be among the dead. Elderly people are also often victimized by swindlers and worse. Elderly widows who seek to escape loneliness often become easy victims of sweet-talking crooks and are bilked of their money, and, under circumstances where it is desirable and profitable to get them out of the way, lose their lives. Nor are elderly men safe from becoming victims of similar schemes. Instances have been many since World War I of elderly, and not so elderly, bachelors being induced to send money to promised brides in other states or foreign countries, the bride supposedly being on her way to his home to marry him. Sometimes the disillusioned bridegroom finally seeks the help of authorities in tracking down the swindlers, usually an organized ring of men and women, or a man and wife, and having their racket exposed and stopped. But this does not save the victim from loss of money, sometimes the greater part or all of his life savings, nor from anguish of mind and the humiliation of having been duped. Elderly women who are still being taken in by the "pigeon drop" racket, and elderly men who with very little objection permit the manipulations of a "gypsy" who kindly offers 225

Aging in Minnesota to "rub out" the victim's rheumatism by passing her hands over his body, but really rubs out nothing but his wallet from his pocket, seemingly never read the papers nor listen to radio news reports. But very well-informed men are still easily enough victimized by the flattery of young women who are seeking an advantageous marriage which need not last long if the man is very elderly or can be cajoled into excesses. Very intelligent elderly people may also be betrayed by their generous impulses to befriend and take into their homes boys and girls, and even young men and women, far too often with very unhappy results. Many have had to suffer severe disillusionment and heartache, loss of money, and again not infrequently loss of life, through such generous but ill-advised efforts to help others. No befriending of this sort should be undertaken without much investigation and help from authorities, just as no hitchhiker should ever be picked up even if he wears a uniform. In these matters, we who are elderly have to accept the sad fact that we now live in &, world in which lurk dangers practically unknown in our earlier years. To come back to a lighter note, we might confess that many of us succumb to a habit which is not really harmful to us or others but which is nevertheless undesirable because it so often brings mild ridicule upon us. This is the habit of showing undue curiosity about our younger neighbors and their doings. Elderly people who have too much time on their hands and too little in their own affairs to interest them often seek diversion in keeping track of their neighbors, frequently by such innocent means as watching through windows, but too often by also questioning them about their doings, their coming and goings, their plans and intentions. No real harm is, as has been said, likely to come from such practices, except that, as has also been said, they expose us to ridicule, lower estimation of the elderly as a group, and serve to confirm in our juniors the belief that all elderly people are childish, too curious, too meddlesome, and, in short, more or less obnoxious. Our sense of dignity should save us from all this. Let us at least be no more curious about our younger neighbors than they are about us. Finally, elderly people are often credited with what is looked upon as an endearing quality: mellowing with age. That many of us, especially elderly men, do not always want to lay claim to this quality is illustrated by the story of the crotchety oldster known for his feuding with other equally crotchety townsmen, who when asked by a younger 226

We Who Are Elderly man at a homecoming festival if the apparent ending of the feud was due to the mellowing of the feudists, exclaimed indignantly, "Mellowin' nuthin'! All the danged cusses are dead!" A fresher story is of the village editor who had for years been opposed by his townsmen in every move and suggestion for change and improvement in the village, until in disgust he finally moved himself and his paper to a larger town. Not finding a desirable sale for his home in Littleville, he rented it to a young couple newly come to the village. After some weeks the young wife wrote him to complain that some animal was apparently trying to make its home under the house, and ended by writing, "and we are terribly afraid it's a skunk." To which the editor replied, "The animal trying to make its home under the house is very likely a rabbit. The skunks in Littleville all have their own houses." We may now feel that we have confessed our faults and taken stock of our weaknesses, at least the most common of them. Many undesirable traits have, as has already been said, been with us all our lives but may have become intensified or more noticeable and noticed. Other faults may be caused by personality changes wrought by illnesses, stresses, worries, disasters, or merely by the aging process. Whatever their origin and nature, it is helpful if we can bear to recognize them in ourselves, analyze them, and, as far as is possible, eliminate or check them, or at least modify them to the extent that we do not in our later life detract from the personalities that were ours earlier and so come to misrepresent ourselves and lessen the earned good opinion that others have through the years held of us. But lest our frank confessions be misunderstood, it is time now to say that nothing in our admission of faults, frailties, and limitations is to be construed as apology or self-abasement. We are neither apologizing for having lived so long, nor depicting our unfitness to live longer. To admit one's faults and limitations is not an indication of weakness but evidence of strength, and we heartily urge the middleaged and the young to follow our example. This the more so since we accept the understanding that our faults are not newly acquired in a new and separate existence called old age. We, too, are a part of all that we have met, and most of it we met in earlier years and are merely appraising now as to its effects and what needs to be done about them. We have reminded ourselves and our juniors that we of our 227

Aging in Minnesota generation are faced with adjustments which tax our powers — our necessarily limited powers — very heavily, but that nevertheless we intend to live in the present. We do not propose to become a drag upon progress, but neither do we propose to join the rush to accept the new merely to prove that though our pace is slow, we are frantically anxious to escape the accusation or even the suspicion of being confirmed obstructionists. In short, while we do not intend to stand still in hopeless bewilderment and resignation, we do propose to set our own pace, one suited to our limitations and, to no less a degree, determined by our more or less seasoned judgment. Still less has it been our intention to depict old age as a time of ending, of giving up, of eating out our hearts in loneliness and despair, or frantically searching for means, however drab or futile, to fill the empty hours of the empty days of our empty lives. An ironic picture this is to the many of us whose greatest problem is to find time and energy for all that we so fervently wish to do. Nor, surely, can we be thought to have, even in our candid admission of what time has done to us, displayed envy of those still outside our age group. We have indeed pretty well concluded that every age has its disadvantages and that ours has its share of advantages. When we wish to understand the distaste of the young for old age, we have only to recall how as children intensely interested in our toys and our play, we deeply pitied the grownups who could not play or live in a world of make-believe. Even when we think of death as uncomfortably near, we realize how, especially in these times, it hovers nearly as closely over the young. We realize also that the grief and loneliness we have described as inevitable for us when we suffer the loss of those we have long known and loved, are no doubt fully matched by those of parents, brothers and sisters, young wives, who have suffered the loss of those they have loved less long but no less well. This much said, we are ready now to make a clear analysis of our needs, not as a demand that they be met, but again to make clear what is not easily realized by those whose experience of what it means to be elderly is still to come, and also to make clear to ourselves how much it still lies in our power to satisfy our needs ourselves. Our needs. The basic needs of us who are elderly can pretty well be summed up under five classifications: security, health, affection and/or understanding and respect, someone to talk to, something to do. 228

We Who Are Elderly There would be little disagreement among us as to the prime importance to us of security. There are many forms of security — all of them, it seems to us, eminently desirable for the later years of life. But the first and foremost meaning of security is a place to live, a place secure to us for the rest of our lives, which we need not fear to lose, and from which we cannot be driven. Such a place is of course a home, and for real security, a house of our own, already an actuality or a desire not unattainable. For a house is a place where we can live as we choose, be ourselves, and to a large extent control material conditions; a place where we can store away and find again — though not always without considerable searching! — our treasures, our comforts, our necessities. Fortunate indeed are those of us who are still living in a house long owned, long used, and long loved. It may have become, like ourselves, a bit old-fashioned and even decrepit; it may, like ourselves, need more and more repairs, and it may very likely need to be refurbished a bit, again like ourselves, if we wish to keep up appearances. But still, and increasingly so, a dwelling whose walls enfold us ever more snugly, more protectingly, more needfully, so it seems to us. We who have this security feel a poignant stab of sympathy when we hear or read of elderly people dispossessed of their houses for one reason or another. In the past such dispossessions were frequent, especially those due to lack of funds to pay rent, and earlier, often due to mortgage foreclosures. Fortunately there are now agencies through which the elderly can be spared such tragedies. But in recent times we have witnessed new and even more tragic forms of dispossessions, in other lands. The dislocation of whole communities of people at the word of brutal conquerors has in recent years become horrifyingly common, and hearing and reading of such brutalities, we, though believing ourselves forever safe from similar atrocities, have nevertheless suffered anguish through sympathetic understanding of the plight of the victims who have been driven like cattle from their homes and communities to, especially in the case of the elderly, die of exhaustion, deprivation, illness and despair, even if not herded into gas chambers or concentration camps or slave labor camps. Dislocations not due to human, or rather inhuman, purposes have of course come nearer home. Dislocations and destruction of homes through natural disasters — hurricanes, tornadoes, tidal waves — have 229

Aging in Minnesota increased in recent years; so too have dislocations, at least temporary, through floods, a form of disaster certainly due to human negligence. There have been also steadily increasing losses of homes through fires and explosions, those necessarily due to negligence and carelessness in some form on the part of someone. In all these cases the greatest sympathy of us who are elderly has been for those of our own age group, for we understand well that it is the elderly who suffer most from the loss of home. Few elderly people can have any sort of real comfort, or even health, without, as has earlier been pointed out, physical aids and forms of medication, and when homes are demolished or have to be evacuated, such aids are often destroyed or lost or left behind. Even the loss of much-needed rest periods can mean great detriment to the health and well-being of the elderly; so too can be the upsetting of familiar routines and the loss of familiar surroundings. It cannot be stressed too much that it is the elderly who, as a general rule, suffer the most in the loss of a home. Children do not feel any great or any prolonged sense of loss as long as Mother's arms are a refuge. Young children are easily consoled as long as at least one parent is at hand, and if both parents are, they are as likely as not to see the disaster as a form of adventure, much enjoyed for its excitement and change of scene, circumstances, and routine. Older children and young adults, while feeling a degree of loss and discommoding, are likely to find compensation in the publicity and attention they get as disaster victims, and, not too seldom, in the temporary release from school and work. But to the average mature person none of these compensations offers any real relief, and to the elderly man and woman the prospect of trying to salvage a house and its contents after a flood is almost overwhelming, and the actual undertaking a hardship hardly to be understood by iany of us who have not ourselves experienced it. True, in all disasters the evident courage of even the very elderly and their determined effort to fight back and bring about restoration, to the utmost of then- powers, is remarkable. But the suffering endured and the harm sustained are probably never quite overcome and show their effects sooner or later. It is therefore with feelings hardly to be described that we who are elderly hear of the new and formerly unimaginable dangers that now threaten us and that involve such dislocations as never before suffered 230

We Who Are Elderly except by a very small segment of humanity — in that entire cities and whole communities may not only be destroyed, but that immense areas surrounding them will remain uninhabitable for years to come. Small wonder that we are constantly accused of apathy in the face of such a paralyzing threat. What is there for us to plan, to do, to hope, if overwhelming and complete disaster suddenly becomes real? We are told there will be means of flight if warning reaches us in time. But many of us have pretty well decided that for us there will be no flight. We may lack adequate means of transportation ourselves and have very little hope that we will be remembered by others in a time of such extreme panic. We may doubt our ability to survive when so violently and so completely uprooted. And what hope, we ask ourselves, would there be for our future? What would there be to return to, even when and if return became possible? What would life mean, with everything familiar destroyed, with relatives and friends gone, with the great and good we have venerated lost to us, with all life become as empty as a gutted building? No, we decide, for us flight will be both impossible and useless. For us there is no solution, no solace, except the neverdying hope that sanity and reason will still prevail, and that what seems impossible will prove to be so. So we wait and hope. We wait and hope as do the millions of old and young all over the world. We used to wonder how the early settlers could live in the shadow of the fear of Indians, how the many generations lived at the foot of active volcanoes and in places and times of recurring plagues. Now we know. They lived from day to day, occupied with labors and concerns of their own. They reassured themselves and one another. They told themselves that the threatened disaster wouldn't happen to them, and that if it did there would be means of escape. They waited and hoped. If people had not continued living in such places and under such circumstances, there would have been many empty, many waste places. Certainly they could have gone elsewhere to live, but they lacked the means or the will to do so. But there were still safe places elsewhere. What if there comes a time when there are no longer any safe places? Why scold us for our apathy? What can we who live in a democracy do except give our government such powers and means for preparedness and action as lie in our powers to give, and trust that they who can act will act wisely? So we wait, and our hopes rise and fall as the pall of the threat lifts and falls. 231

Aging in Minnesota In the meantime, those of us who are still living in secure homes cannot forget the plight of the men and women of our age group who are still not safe from dispossessions and dislocations even in these times of peace in our land; the many who are practically homeless, whatever temporary shelter they may find; the many more who in the course of city improvements are forced out of such homes as they have long occupied, to be relocated somewhere and somehow. Many of these victims of "progress" belong in the upper brackets of our age group and so have arrived at a time when any disruption is exceedingly disquieting and painful to them, for it is certainly no lighter matter to uproot and transplant elderly human beings than to uproot and transplant old trees, a procedure not often recommended or undertaken. A new form of arbitrary dislocation, ascribed to "progress," that of dispossessing elderly people of their homes in the course of straightening highways or building new ones, is frequently a most ruthless form of dislocation. It is obvious that at the very least, suitable and acceptable quarters should be provided for those about to be dislocated, long before dislocation is actually forced upon them, and that these quarters should be so clearly equal or definitely superior to the old that accepting and adjusting to them would be pleasant enough to compensate in some degree for the pain of dislocation. Federal housing projects should much more than at present be concerned with providing housing for the elderly, even those not homeless but only in need of quarters more suitable for their growing limitations in strength and energy as well as in material resources. An ideal form of housing for the elderly might well be patterned upon that established more than thirty years ago by a Colorado philanthropist named Stretton in Colorado Springs, where cottages, grouped together but each having its small space for grass and flowers, form a community in which no one need feel strange or lonely. The cottages are designed for husband and wife, but can also be occupied by two elderly women or two elderly men. In this haven for the elderly who have no means whatever to provide for themselves elsewhere, all necessities are provided free and even delivered to the doors of the cottages as ordered; but no such charitable measures would be necessary in present times, at least for those who can rely upon social security payments or old age assistance. Apartment buildings can also afford acceptable homes for the elderly, provided that they offer proper facilities and that care 232

We Who Are Elderly be taken to settle there only those adapted to live in close association with others. In these times when transportation and delivery of goods can easily be provided for, it would be possible, and often desirable, to locate such housing projects out of the city, as is now done with the so-called developments designed for younger people. In such case, larger plots of ground than in city developments could be provided for those still interested in gardening and in beautifying the place where they live. Consideration should also be given to those who find the thought of living in homes for the aged or in institutions unacceptable, even when it would seem to younger people that such places, greatly improved as they now are, should be entirely desirable and acceptable. So great is the inbred fear of many elderly persons of being relegated to such places that they prefer death. For them too, acceptable adjustments should be provided: many of them are among our most intelligent and sensitive elder citizens. Whatever the means used, it should no longer, in our prosperous land, remain impossible for the elderly who wish to have a place to live where they can feel comfortable and reasonably safe, to secure that boon. Security also means financial security, the assurance that we need not lack the means for a decent standard of living. There has in recent times been a tendency to cry down security in this sense — security from the cradle to the grave, as it has been derisively called by those who would consider the cost above all else. And while this tendency has largely been denounced, there are still those who consider that providing needed assistance to the elderly is a way of inviting neglect of preparing for one's old age, encouraging spendthrift ways of living, and destroying pride in being able to care for oneself throughout life whatever its length. Such opinions reflect, of course, gross lack of regard for actualities. Most of us have always remembered the famous cartoon published during the depression of the thirties, the depression. It depicted an elderly man sitting idly and dejectedly on a park bench, beside him on the ground a pert squirrel munching nuts. "Why," asks the squirrel cockily, "didn't you prepare for your old age?" And the elderly man's answer is, "I did." Many, very many of us saw and still see ourselves in that elderly man on the bench. 233

Aging in Minnesota For, again, no generation of Americans has ever gone through so many changes of economic conditions as has ours. There are those of us who recall the panic of 'ninety-three, though we were rather young to really feel its effects. We remember it principally as the occasion of agitated discussions and denouncements of the "boom and bust" policy of our country. "Hard times" was a term we often heard then and later, and futile harangues against low prices for labor and for farmers' products; "the eight-hour work day" and "a dollar a day" were familiar terms in those days. But we grew accustomed to prevailing conditions and their failure to change much, and as we grew into young manhood and womanhood, somehow obtained our education or training in professions or trades and found positions in which to begin and continue our chosen work. The year 1918 brought us our first experience of inflation. We saw our parents and other elderly relatives desperately trying to stretch their meager savings and incomes to cover costs rising so sharply that there was no keeping pace with them, while at the same time goods deteriorated or became unavailable. It was now that we, married or unmarried, found ourselves trying to soften the blow for our parents and other elderly dependents by contributing substantially to their livelihood as their means were depleted more and more rapidly. Still we knew that this was but a temporary inflation, though we realized that it might leave elderly people entirely without funds before it ended, which soon proved to be the truth, so that we had thereafter to assume permanently the care of the elderly who had no one else but us and no other means but our contributions to look to. How bitterly our parents talked of the need of pensions for the elderly which would have made dependence upon their children unnecessary. Bitter were the reflections of those who had spent their entire lifetime working hard, and who thriftily, though necessarily very gradually, had managed to improve their living conditions and also lay by something for old age. Came then the post-war boom, and our salaries and wages increased to the extent that we bore the double burden of caring for our elderly ones and ourselves and our families well enough. We even began saving for our own old age, so substantially, we thought, that we might never need to find ourselves in the plight of our fathers and mothers. Besides, the war to end war was over, and there would be no more war-inflation for us to meet. There were many "never again's" in those 234

We Who Are Elderly long-gone days, and how fervently we expressed them and believed in them. So we put our savings in banks and bought stocks and bonds. We cut coupons and cashed interest checks, often putting the proceeds back into more savings and investments. Not all of us became aware immediately of what had happened in October 1929. It was not till the early part of the thirties that some of us awoke to find our investments incredibly shrunk in value, gone sour, or at best with service on them suspended indefinitely. We found ourselves among the millions who were said to have suffered paper losses, which were not that to us but the loss of actual dollars and cents invested in what we were now told had always been highly speculative securities. Not all of us jumped out of windows or succumbed to nervous breakdowns or took to drinking. Some of us sought to relieve the unbearable sense of having been robbed, outrageously robbed, of our savings — savings often accumulated at the expense of foregoing not only pleasures but actual necessities — by going to our investment agents who had sold us the highly speculative stocks and bonds with full assurance that they were entirely safe, and even to the investment firms who had handled the securities. Needless to say, we were met with fervent declarations of "nothing we can do — we have lost money ourselves," and a general shrugging off of any responsibility. Insistence only brought about a stiffening manner and often actual rudeness. So we gradually gave in to the bitter realization that our savings acquired from actual labor, not from speculation, were gone, and that it was up to us to take it and begin all over again. Our spare cash now went back into banks with which we had dealt for years. In 'thirty-two many of these banks closed, some temporarily, some permanently; our savings were tied up and their full value was never recovered, though we kept receiving dribbles for some years. Fortunate indeed were those of us who had jobs that did not fail us through the depression. Came World War II. We were older now; we were experienced; we expected inflation, and our expectations did not lack fulfillment. The Korean War did not have much meaning for us financially; we were too benumbed by then. The ensuing increased inflation merely hastened the swallowing up of our savings and left us dependent on the little that could be had from the new Social Security, a form of insurance unobtainable to many of us because we had retired too early to 235

Aging in Minnesota come under its benefits; we had simply been born too soon. But there was still Old Age Assistance; within some states we had to mortgage our houses to the state to get it, the mortgage not to be collected on, fortunately, during our lifetime. Yes, all this is ancient history, but it is still living history for us who lived through it; and there cannot be too many recountings to explain to our juniors of why we can say with the man on the park bench, "I did." In the meantime, we rejoice that laws regarding investments offered for sale have been so much strengthened as to practically prohibit the selling of "speculative" securities; that Social Security has been extended to cover more and more people and its returns increased considerably; and that there have been arrangements made and agencies established to save the elderly from actual distress and destitution. For we who are elderly are largely the generation who were robbed of our hard-earned savings and who have a right to expect from those who have benefited from our work in the professions, in industry, on the farms, and in the trades, some form of restitution even if they were not to blame for our experiences and our plight. Let's hold up our heads; what aid is afforded us is not charity but back payments for the work we did and the savings we were robbed of; due us also for the gobbling up of what we had salvaged, by the present inflation, during which only those actually wealthy can survive without an income. We are not forgetting the losses suffered in the untimely deaths of sons and grandsons in wartime; these losses can never be repaid; but we are talking now of financial security. And whatever our political affiliations, we who have come to need help and have received it cannot and should not ever forget what we owe to Franklin Delano Roosevelt. Nor should succeeding generations forget that they too owe this great humanitarian a great debt in that they have been spared what we had to suffer. Present inadequacies of incomes provided by Social Security payments and Old Age Assistance and the unintelligent attitude toward these provisions still manifested by the uninformed and unthinking, must and will eventually be eliminated. Physical and mental impairments due to the aging process we have already considered, but too much cannot be said of health as one of our needs. We need also to constantly remind ourselves of how much we ourselves must do to maintain, and if need be, regain, our health. 236

We Who Are Elderly Even if medical aids are available, many of us tend either to rely on old home remedies or to take the position that nothing can be done to relieve our ills. Home remedies that we have had long experience with and found beneficial are by no means to be discarded, but continued reliance on them when body conditions have changed, or when new ailments have developed, is not advisable. Cancer is one of the enemies of the elderly, and because it has now become so well known as a thief in the night, whose presence may not even be suspected, and because it so urgently needs to be discovered early, frequent physical checkups are always desirable for us. Such checkups, we are often reminded, also serve the good purpose of relieving needless anxieties. As for the belief that nothing can be done about the ailments of old age, it is of course a fallacy regarding many such ailments in the light of everincreasing research and invention, though still true of some. Here again the admonition, "If there be one [remedy], try to find it" is especially applicable. Many of us suffer from extremely painful foot troubles which are not only afflictions in themselves but can, we are told, undermine general good health and good dispositions. Many of us suffer such ills because in our childhood nothing was known or done about special shoes for young children; they were simply made on conventional lasts for adults and cut down to size; and in buying, the only care taken was to get those that were supposed to wear long and that were large enough to allow for growing into them. Copper-toed shoes, many of us remember, had a way of outlasting even the growing-into process, even though the wearing out was, especially by boys, hastened a bit by surreptitious use of grindstones and even hatchets when the shoes had become too intolerably tight. Then in our teens, or even sooner, some of us discovered the dreadful fact that we had inherited large feet and that we were in line for a lifetime disgrace scarcely less than that of having red hair. Size five for ladies of any age was positively the limit, and even those who could wear a size four and a half managed to squeeze into a four, to remain as far as possible from the fateful limit. The torture undergone by those of us girls who soon had size six and even seven feet to disguise that fact by wearing shoes one or two sizes too small, was fully equal to the tortures we are undergoing now because of broken-down feet. If we were also what are now called, with no slur intended, tall girls, we did not hesitate to have the heels cut, thus spoiling what little fit remained in the shoe. The advent 237

Aging in Minnesota of the pointed toe finished the ruining of our feet. Many of us also suffer from congenital and inherited defects and weaknesses in foot structure, which in these days would have been discovered in childhood and remedied then. However, much can yet be done to alleviate painful foot conditions if aid is sought and found, including special shoes designed for troublesome feet. Likewise, remedial measures such as cataract operations; removal of suspicious growths; treatments for arthritis; finding out what to do for indigestion, constipation, skin troubles, and many more pestiferous old-age troubles, should be sought without delay. Waiting often intensifies ailments and makes them harder to deal with, and repeated assertions that one is sure there is no help for them often intensify one's reluctance to back down from this position, however painful it may be to hold it. Diet, so much discussed in these days, is of course of special importance for us who are elderly and whose bodies more than ever need nourishing food. There cannot be many of us who still stick to the tea and toast diet so common with elderly persons in former days. But there still are ways of thinking about what is, or is supposed not to be, good for the elderly that need to be changed. One of them is believing that meat is not wholesome for older persons and should not be included in their diet. As a matter of fact, doctors now assure us, lean meat — beef, pork, veal, lamb, and poultry, all rich in protein — is very desirable for the elderly because it is body-building and, when not needed for added growth, is still needed to renew wornout tissues. Eggs and cheese and all dairy products are also needed. And a good variety of vegetables, especially fresh and green vegetables, is much more of a necessity than many elderly people realize. Leafy green vegetables are especially needed in winter and should be eaten every day; fortunately they can now be obtained through the entire winter season and are not very expensive. The same is, of course, true of fresh fruit, especially apples and oranges. An apple a day is as good as ever for keeping both the doctor and digestive and elimination ills away. Canned fruits are also good and canning can still serve in lieu of deep freezers, which may not be suited to either our means or our needs and which may prove more troublesome than useful to those of us long used to other means of preserving foods. Indeed in many ways canned fruits are still more tasty to some of us than frozen fruits. Old-fash238

We Who Are Elderly ioned sauce of peaches, pears, plums, and apples in many forms is a valuable part of the diet for elderly persons, much more so than the same fruits eaten as preserves, jams, and jellies, which because of too much sugar content can interfere with digestion and elimination and also increase weight. Milk is as useful for the elderly as for the young, and, while moderate use of tea and coffee is not likely to do harm, such beverages have of course no nutritive value and should not be used to the exclusion of milk. Though people of moderate means are often urged to use the cheaper grades of meat, this is not always advisable, since it may mean buying more waste than in the case of better qualities, and it may also mean poorer taste. It is, therefore, generally preferable to buy only the best and freshest meat obtainable, even if the price is higher. This does not mean that the cheaper cuts of meat may not often be a good bargain, provided they are of best quality. The same holds true of vegetables and fruits; only the strictly fresh and tasty are worth buying at any price. Dishes concocted of many ingredients are often not advisable for us elders, as the inclusion of some one ingredient we do not enjoy or which we cannot tolerate may make the whole dish unpalatable or unwholesome for us. Good plain food, well cooked and served in pleasant surroundings, with an occasional luxury now and then, will probably do much to keep us well and serve to make our meals a pleasure, which they should be to be of most benefit to us. This is just as true, and even more so, for those of us who have to eat solitary meals. Finally, unless the habit of having dinner at night is too firmly fixed to be changed, the old-fashioned dinner at noon, with a much lighter supper, is often more conducive to sound sleep for us who are not so active as in younger days. Counting calories for reasons of vanity may not have much importance for us, but some of us do need to keep a careful eye on our eating habits in order to keep our weight at a healthful level. Gaining weight in old age is eminently undesirable for both men and women, since it is very conducive to ills such as diabetes, high blood pressure, poor circulation, and increased tendency to arthritis, heart weakness, and paralytic strokes, besides making needed surgery much more difficult to undergo and recover from. That gaining weight is due to overeating and not to mysterious glandular troubles is a now well established, though uncomfortable, fact, as is also the corollary that the 239

Aging in Minnesota best and the safest way to reduce one's weight is by lessening the intake of food. Enough exercise without over-exertion is of course the best for us. Such exercise can take the form of recreation; golf and various forms of ball games are favorites for great numbers of both men and women. Walking is also an especially good form of outdoor exercise and one too often neglected since the advent of the automobile and superhighways. If a quiet country or village or suburban road can still be found, nothing is more pleasant or beneficial than a stroll, preferably one that gives opportunity for interesting views and points of observation and time for quiet thought. A stroll along city streets can also be pleasant and beneficial, though not so conducive to quiet thought. Exercise in the form of work can also be pleasant and beneficial and doubly satisfying because it means the accomplishment of necessary and worthwhile purposes. Gardening is among the most popular forms of exercise and work combined. It will be further discussed when we speak of something to enjoy. And for those of us who are still housekeepers, exercise will never be lacking even in these days of prepared foods, handy gadgets, and work-saving appliances. It may often be well to separate our exercise from our search for fresh air and outdoor surroundings by getting the exercise in our household routines and taking the air sitting quietly on the porch or patio or under the trees. Many a pleasant afternoon can thus be spent enjoying the outdoors in sunshine or shade, and perhaps watching the world roll by. But if exercise is indispensable, rest is no less so for elderly bodies. Regular rest periods throughout the day are very desirable, since they insure that the need for rest will not be forgotten or ignored. Frequent rests are also advisable during any extended piece of work; to lay down the tools, sit down, and take an over-all inventory of what has been accomplished and what remains to be done is a good way to get our second wind, which means the courage and energy to go on. Obviously no elderly person should overtax himself by working too long or at tasks too hard; to do so is to invite damage to aging muscles and joints and, most of all, to aging hearts. To conserve our health, as well as our peace of mind, it is also very necessary that we be spared annoyances, unnecessary worries, strains, and tensions, and labors that should not fall to our lot. Many such harmful influences we can spare ourselves by eliminating them as soon 240

We Who Are Elderly as we become aware of them. To us who live in our own houses or in rented ones, anything from a dripping faucet to a leaking roof, from a squeaking door-hinge to an unsafe stair-step, from a broken dish to an electrical appliance out of order, from a shrub that needs trimming to an eye-sore that shames us — in short anything that causes us annoyance, distress, bad temper, extra labor, emergencies, or potential danger, we should eliminate before it frays our nerves and increases wear and tear on our bodies. To set a specific time for such final elimination and to allow no procrastination beyond that time is the wisest measure. The relief felt when the deed is done is proof of how much it needed doing. But because those who are much younger than we do not always, or cannot ever, understand what it means to be elderly, we may sometimes be confronted with harmful conditions over which we cannot have direct control. It is pretty generally known that children's love of noise is owing to the thickness of their eardrums. Their shouting and screaming at play is not merely a means to enable them to be heard above one another, but a pleasure in itself, since it releases energy and pleases their ears. They are not aware that in age eardrums grow thin and lose much of their elasticity. The same is true of those in their teens and even twenties who still enjoy dins and clamors and cannot see anything but intolerance in the frantic objections raised by their elders. Nor do dogs, though the ears of many of them are very sensitive to many other sounds, ever exhibit any sensitiveness to their own barking, yelping, or whining by night or by day. Faced with the problems of being relieved of annoying noises, disturbances, encroachments, and situations that cause us unnecessary work and worry, we who are elderly should not be deterred, by fears of our being thought intolerant and troublesome and therefore disliked, from taking necessary measures to secure needed relief. For though the immediate consequences of taking such measures may cause distress, they are not nearly so harmful to us as continued endurance when the point of endurance has been passed. And once we have made it clear all around that though we certainly mean to hold our own despite our limitations, we are neither disagreeable nor tyrannical, matters are generally comfortably settled. Obviously, since we are aware of our limitations in doing and enduring, it is very necessary for us to plan, to foresee, to arrange for, even 241

Aging in Minnesota to do some premature bridge-crossing, to save ourselves from emergencies that would overtax us both mentally and physically. Crossing bridges only when they are reached may be all right for those younger, who feel certain of mental and physical powers to meet emergencies when encountered, and who may even feel a certain exhilaration in proving themselves equal to whatever difficulties may suddenly face them. But Grandpa and Grandma and Aunt Mary can well afford causing younger relatives and neighbors amusement by what looks like overcautiousness and preparedness beyond all possible need, if they thereby save themselves experiences they have long since learned to avoid. Not of course that caution and preparedness can always prevent untoward happenings or harassing situations; not that we who are elderly can always avoid seeking the aid of our juniors. As has already been pointed out, our lessening powers are not always equal to the changed circumstances and the new demands of the world in which we now live. That, in addition to the friendly help often offered us and greatly appreciated by us, we are often in need of services to be paid for, and that such services are more and more difficult and costly to obtain, we shall discuss later. In general, however, we are content to do our own planning and our own carrying-out of plans, never forgetting that those younger than we also have their own concerns to which to give their time and thought. Psychologists tell us that the greatest need of all human beings from birth to death is love. But as Shelley long ago wrote, "love" is "too oft profaned for me to profane it," a feeling certainly not shared by modern song writers, fiction writers, or even writers of non-fiction. We elders should, however, be very willing to give the overused word a rest and largely substitute for it the word "affection" as expressing one of our needs. Those of us who have children and grandchildren can generally hope to have for the rest of our lives enough affection to warm and sustain us. Fortunate indeed are those of us who have happy family circles still largely intact, with husband or wife still living, and with the new generations forming ever-widening circles about us. For thus we not only have affection assured us but are spared one of the real hardships of old age, the lack of ready understanding and unasked aid in time of need. To have a daughter or son to turn to in time of stress and in time of grief is to be armed against that sense of 242

We Who Are Elderly aloneness which at such times is hard to bear. A place to live is often offered us by our children, but we are increasingly warned that living with one's married children and their children may not always be either convenient or comfortable. Even in a close family circle the difference between the generations is too great to be easily bridged in close contacts, and it is often best and happiest to remain in our own homes, knowing that our children are near at hand or can come to us when we need them. But many of us lack children and many of us have never married and so lack family circles when those into which we were born no longer exist. We therefore must stand alone except for distant relatives and faithful friends; and for those of us so situated there must be found other ways to sustain ourselves — ways of independence, of assuming our own burdens, of so organizing our living that we may be equal to whatever meets us, whether the unexpected or the inevitable. The strength of will and purpose developed in us under such circumstances is often a gauge of the human spirit and lends no small measure of dignity to humanity. To "live alone and like it" may be a jocular phrase of defiance, but to many of us it is and must necessarily be the sustaining principle by which we live and rule our lives. And living alone has of course its compensations for any and all of us who cherish independence. As to love in its finest sense of devotion that needs never be questioned and that survives all the vicissitudes of life, many of us have never known it. Even >as children we may have lived in a family circle where love was neither spontaneous nor cultivated. Our parents had concern for us, saw to it that we had the necessities of life and some degree of pleasure and were taken care of in time of sickness, safeguarded against dangers, received at least an elementary education, and in general brought up. But of love for us they neither spoke, nor, very likely, thought; or if at moments they felt it, they did not, perhaps through a sense that it was not fitting, give any demonstration either in word or act. We were taken for granted and so were our practical needs; but if we were perchance hungry for love, we were not fed. Few of us ever learned to love our brothers and sisters, though we did have a strong sense of loyalty to them as well as to our parents. Loyalty was indeed the indestructible quality that held and still holds the family members of our generation together. Loyalty to par243

Aging in Minnesota ents was seldom questioned, and loyalty to sisters and brothers became at times even stronger. It was not something we spoke about or gave assurances of, but it could be counted on and it was manifested in action when called for. We were often widely separated when the family circle was broken and we might not meet too often, but we kept in touch by visits when practicable and by correspondence between times, nor did our parents ever need to be ignorant of our whereabouts. It was no longer common for sons to "go out West" and not be heard of for many years or ever, as had often been the case in earlier times, when many places were remote from railroads and delivery of mail uncertain. We, as young people, even became curious about cousins in faraway states whom we had never known and had scarcely heard of, and as letter-writing was not the task to us it had been to our parents, contacts were soon established. Presently immigrant parents began seeking renewed contacts with brothers and sisters they had more or less lost track of through the difficult years of taking root in the new land. Thus it was that uncles and aunts became known to us of the younger generation for the first time, though we had long heard of them and wondered about them. The sense of kinship was strong, and loyalties were readily extended to those still practically strangers to us. This sense of loyalty to all who had any claim upon us we carried over into our own families as a matter of course. Even in marriage and parenthood many of us may never have experienced love or affection as openly spoken of or demonstrated. The brief flame of romance that led to marriage may have decorously been left to burn itself out and we found ourselves again taken for granted, and so too our loyalty. And even with our own children we may have in general followed the pattern of our own upbringing. Thus only in late life may we have come to know how real is the need for affection, expressed and demonstrated, and how important a role it plays in human happiness and the sense of security. Happily many of those close to us have also gained this new insight. In any event, however, we do know that great as is its worth, love is not indispensable; and failing to find it we may accept as a substitute understanding, and, failing even that, respect. Affection, understanding, and respect are not, of course, mutually exclusive terms, and the respective qualities may or may not be found together. Understanding is the rarest of the three, for no one can truly £44

We Who Are Elderly understand the qualities of another unless he finds some vestige of them in himself. But to the person who can find none of them in himself, loyalty, sensitiveness, integrity of mind, heroism, are not and cannot be understood or even recognized, even though they may be given lip service. Likewise, to one who measures all qualities by their relationship to success, wealth, or high position, such qualities as ability, integrity, the courage of one's convictions, are pushed aside as worthless or worse. One who has no loyalty accepts it in others as something to be taken advantage of or at best taken for granted, nor does he or she understand the searing hurt that disloyalty is to the loyal. Few of us escape learning such facts as these, and we can deal with them better if we find some measure of understanding in ourselves. And if we do now and then encounter understanding in another, if even to a very limited degree, we have reason to prize highly what is afforded us. Respect is the most indispensable of the three, the best wearing, and the most needed as we grow older and therefore to some degree unable to defend ourselves against life. For respect, or at the least outward respect, saves us from what is ugliest and most intolerable in our association with even the most inconsiderate. It is well known that Americans do not have any great amount of respect for the elderly merely because of their age; the contrast in this matter between Americans and the peoples of most European and Asiatic countries is very marked and has grown increasingly so in recent years. Children well brought up may indeed show respect to the elderly at least in the form of good manners; but teenagers are very likely to leave such things behind them as being outgrown, and mature people tend to have an unconscious dislike of the elderly, who remind them of their own inescapable future. Also there is the feeling that the elderly are out of step, given to idiosyncrasies, demanding, and generally in the way; and where softer feelings are displayed they are too often pity in disguise. By those caught up in the ever-swifter currents of modern living, scant respect can be afforded to those who are more and more slowing up, falling behind, and by and large holding up the line like the despised slow driver on the highway. We who are elderly have yet to prove that keeping ahead, or even keeping up, is not the most indispensable quality in human life — prove it if we can. At any rate, let's not become too humble and hang our heads and shuffle along as though we had lost our right to live simply because we have experi245

Aging in Minnesota enced the passing of many years and cannot disguise, or want to, what they have done to us. Outward respect, which helps us maintain selfconfidence, we must insist upon; and it remains for us, the pioneers in longevity, to bring back and increase genuine respect by demonstrating that we are not crushed and abject, waiting to be relieved of the burden of life, but instead still maintaining our self-respect, modestly sure that we have contributed our full share in the past and may yet be able to add to that contribution. There are, of course, regards which we do not need and do not want. We do not want pity, which indicates the feeling that age is a dreadful state and we its miserable victims. We do not like to feel that compliments on our having lived to be so elderly really cover up a deep aversion to sharing our longevity. Younger people are very apt to express a conviction that they will never live to be our age, at which we inwardly smile, knowing that they will no more elect the alternative than did we. We do not like to have the very young size up our physical decrepitudes, inwardly shuddering at the mere thought that they might come to such a state — but, remembering that we ourselves once felt the same way, we are more ironically amused than offended. We do not want condescension — our younger relatives, our children and grandchildren apologizing for us, being treated with ostentatious special consideration by dignitaries at public functions, and other unnecessary attention; at least most of us do not, though some of us may feel that this kind of thing lets us out of much exertion while still letting us in for benefits. Most of us prefer to be treated as equals in the give and take of discussions and planning and sharing labors in public projects, at least to the extent to which our waning powers make this possible. We are not unlike the ill or crippled child who wants from his mates a chance to play the game like the others, with absolutely necessary consideration for his limitations given in a matter-of-fact way. Such an attitude among children is not uncommon nowadays, as we rejoice to see, and the crippled boy plays baseball on equal terms with the others, with someone to run bases for him as a matter of course, and without being considered a handicap to his team if he is a good pitcher, hitter, or catcher. Generally we do not like patronizing in any form. Being taken under the wing of a younger person is seldom satisfying, though it 246

We Who Are Elderly may be more acceptable to the very helpless. We know that patronizing is likely to result in our being put in a corner, a comfortable corner, to be sure, but we shall be left there while our benefactors are distracted by other things, and life goes on about us while we are marooned. Few of us like to have done for us what we can and want to do for ourselves, or what we do not want done at all. There is for us special humor in the story of the Boy Scout who, when being questioned about his late appearance at a Scout gathering, explained that he had been helping an old lady across the street. "And that took you over half an hour?" asks the scout master. "Yeah. She didn't want to go." The truth is that facing up to difficulties and maintaining our independence plays a big part in our remaining fit — in our own estimation. This does not mean, however, that we do not deeply appreciate help with what we know and readily admit to ourselves and others we are no longer capable of doing for ourselves. As sons and daughters, grandchildren, and even husbands and wives know very well, we are not very open to advice, especially in regard to changing, particularly our habits or ways of doing things, or in accepting new ideas not agreeable to us, or in any way being brought up to date. Regarding all such matters, we, and this means pretty much all of us, feel that we should remain free to make our own changes when and as they seem necessary and desirable to us. No doubt there are times when this stubbornness has harmful results for us, as when we are urged to give up this and that indulgence, habit, pleasure, or occupation that we prefer to cling up to the end if possible. A doctor can sometimes convince us when no one else can, or perchance some unhappy experience will do the convincing so thoroughly that our resistance melts before it. Nevertheless, we feel we should in most matters be left to live in our accustomed ways, follow accustomed routines, live where we prefer to, keep our homes as old-fashioned as we wish, and seek the pleasures and satisfactions that have long sustained us and that have in all events seemingly not shortened our lives. In short, we prefer to retain our right to accept or reject whatever life and living offer, insofar as changed conditions and our own abilities allow us to. In many of the present-day discussions of "the plight of the aging" special emphasis is laid on our lack of something to do. This lament 247

Aging in Minnesota had its beginning shortly after the turn of the century, and it then had to do with the plight of retired farmers who, having sold their farms or turned them over to sons or sons-in-law, had moved into the nearby villages, where, so it was said, they soon died from sheer boredom. No doubt these elderly men did look somewhat forlorn — with their bent backs, their heavy gait, their weather-worn faces and their toothless mouths partly covered by their heavy gray beards — as they were seen slowly pacing the village sidewalks or sitting at some corner idly watching with weary eyes the everyday happenings of the slowmoving village life. It was generally said of them that they portioned out their days by the mill whistle, ambling down to the business section of Main Street soon after the whistle announced the beginning of the day's work, staying around till the noon whistle blew, and spending the afternoon in the same way until the six o'clock whistle signaled the end of the workday. This picture of the retired farmer's life is true as to outward facts, and as viewed by observers. But that the farmers themselves felt any lack or loss in being thus idled is very doubtful; certainly they never expressed any such feelings. In fact, they often spoke of their final release from toil as something to be supremely thankful for. And no doubt their work-weary bodies could soak up much rest without any but beneficial effects. In fact, the chief reason that they chose to move into the villages instead of remaining on the farms after retirement, as had been the practice of earlier farmers, was that they wanted to get away from work they knew they could never hope to escape while on the farms, where there were always chores to be done, even for the elderly and for children. Their wives had been equally eager to escape from the farm; for though they of course still had their household tasks, these seemed far lighter in the village, where the only food they were expected to produce was what they raised in their gardens for their own use. Both the farmers and their wives took a great deal of satisfaction in being village residents and were ready to speak of their new freedom and the many comforts and conveniences now theirs, whenever they entertained company from their former communities. And though they delighted in making visits out into the country, they congratulated themselves on no longer being slaves to the heavy routine of work there. True, the retired farmers did not live long, for, in the first place, 248

We Who Are Elderly very few of the elderly lived long under any circumstances. They considered themselves as aging at fifty, really old at sixty, and did not expect to live much beyond seventy. The few still alive in the late seventies considered themselves, and were spoken of, as having remarkable longevity. As for octogenarians, they were in a class by themselves, regarded with real interest and even awe, especially if of the three or four of them in the community, one or two remained active to the very end of their lives, some of them cutting their own firewood and showing other remarkable evidence of strength and energy till very near the end of their days. In the second place, the farmers of those days literally wore out their bodies with the exhausting labor so largely performed without the help of any but the most indispensable kinds of machinery; and many of them had farmed for many of then* earlier years with practically no machinery, such tasks as cutting hay, planting corn, cutting wood, and digging ditches having been done entirely by hand. The problem regarding the retired farmers as the villagers saw it was how to counteract their tendency to vote down every measure for village improvement in order to keep down taxes. Their problem, as they themselves saw it, was to make their savings last through their lifetime, something which, as has already been said, became impossible for those still living during and after World War I. As to the elderly village and city dwellers of that time, most of them continued at their work until illness or death took them from it. Elderly storekeepers usually secured the aid of younger men as needed, but they themselves remained at the helm, seeing to it that everything was managed in a safe and sane manner, without the introduction of too many risky innovations. Even village blacksmiths and harness makers remained at their work until the advent of automobiles made their work more and more obsolete and they had to turn to other jobs. Doctors, druggists, lawyers, and bankers grew old with the village or city community and continued their work there to the end of their lives. Even preachers kept their pulpits at least until they were declared superannuated and entitled to pensions, and they often remained as supply pastors even after that. In the cities, workers in industry and all those not self-employed often lost their jobs or were forced to give them up because of sickness and depleted energy and strength; but since generally no pensions 249

Aging in Minnesota were available, men, and women employed under much the same circumstances, clung to their work as long as possible. And because many of them had lived narrowly grooved lives with no interest outside of their jobs, there was no doubt a serious sense of loss when work had to be given up; and such people's lives were no doubt sometimes shortened because of loss of interest in living, though still more often by wornout bodies. The city worker's great grievance, and one that still persists, was the loss of importance he felt when he gave up or was forced out of work that made him at least a needed cog in the wheel in his place of work and which gave him still greater importance at home. For the day in the home was largely geared to the goings and comings of the man of the house, and his earning capacity was considered important above anything else. To give up his work, therefore, meant literally giving up his place both in the working world and in his home. Too often he found himself relegated to the position of a handy man and errand boy by his still busy wife or hustling daughter-in-law. This entire situation obtains also for the small shopkeeper whose business has failed through intensified competition from larger concerns, from inability to keep pace with revolutionized methods of buying and selling, and from the impossibility of operating on and receiving profit from a small capital and of securing labor at costs that can be met. To add to the distress of such dispossessed workers and small shop owners there is the lack of other interests of any and all kinds where such have not been cultivated through the years, the entire time and energy having been given to the business and work at hand as long as it lasted. Meanwhile it is no less true in our generation than in previous ones that professional people, now, in increasing numbers, women as well as men, continue their work into very late life if not to its very end. The same is true for those in the arts. Moreover, men who have been skilled workers in industries are also making use of their skills in the modern flurry of do-it-yourself projects, and many a modernized basement has become a well-equipped workshop where much time can be spent both pleasurably and profitably in producing handmade articles often of considerable worth and great beauty. For elderly women the problem of finding something to do, even something very profitable if need be, has never been so well solved as 250

We Who Are Elderly in recent years. It is now common to find women long past middle age engaged in both industrial and commercial work. In fact, elderly women have often been able to secure work when it was denied to their husbands. And there has now been opened to them the entirely new profession of baby-sitting, in which, because of their age and experience, they are likely to outshine their teen-age competitors. Women not needing work for earned income have also found occupation as assistants and helpers in hospitals and other institutions and in charitable work of many kinds, where they give services greatly needed and greatly appreciated. So there is little reason for women who have lost their former status as mothers constantly needed by their children to complain that their lives are empty and meaningless because they no longer feel needed and have nothing to occupy their time. Finally, for all those of us who own houses, which of course includes the largest number of all classes of workers, there is never-ending work for both men and women, and the need, as has already been pointed out, is for time and energy, not for something to do. Homemaking still affords occupation and interest also for widowed women who do not wish to relinquish the comforts and pleasures of a home of their own. And for single women retired from professions and business, who have for years planned and saved with the hope of eventually having a house of their own, the realization of that hope brings unlimited satisfactions, as well as plenty of work, of course. There are also a goodly number of widowed and single men who prefer to remain in their own houses instead of entering homes or clubs, where, as they see it, they would have nothing to do. All in all, it would seem that comparatively few of us who are now elderly are in greater need of commiseration because of lack of something to do than were our parents in their later years. Restless souls there will always be — persons, older and younger, who cannot find interests within themselves or outside themselves unless interests are provided for them and literally thrust upon them by the traditions of the times. But this number will probably always remain comparatively small. However, while lack of something to do was not a serious problem for our parents when elderly and is not in general one for our generation, it may well become one for the next generation or two of elderly men and women. For, as is well known, there is already a trend toward 251

Aging in Minnesota lowering the compulsory retirement age in many occupations and an even stronger trend toward refusing work, especially in the industries, to men even in early middle age. The general inadvisability and ill effects on society at large of these current practices, as well as the injustice and harm done to the individual, will be further discussed on pp. 286-288. Also, the professed aim of young women is now to marry early, raise their families as early and as fast as possible, and then, so they plan, be free to engage in work outside the home, never questioning that such work will still be available for elderly or even middleaged women at that future time. For this reason it behooves the younger generation to be concerned about the time when they will be elderly, to a greater degree than ever before. But this must necessarily be their problem, not ours, and it may well be that all conditions will be so changed by that time — still some forty or fifty years away — that nothing that could be prescribed now would fit. Our need for someone to talk to varies with us as individuals. Some of us feel this need at every turn and change in our own and outward circumstances, as well as in regard to the usual daily occurrences that constitute our own special interests and concerns. Others of us have acquired a great ability to say nothing to anybody, even in times of great stress. This latter tendency has usually been strengthened by the experience that telling often does not find understanding or the expected and needed relief, but instead adds to our distress the sense of having been unduly lacking in reticence, exposing ourselves and those close to us to unnecessary revelations, and lowering our dignity in the eyes of those who have, inadvisedly, been made confidants. As a rule, it is safest for us to restrict really important telling to our doctors, lawyers, or clergymen, all of whom are especially qualified to keep confidences and give both advice and comfort. Within our own families it is usually safe to speak out, and indeed, as has already been said, often very advisable and necessary to do so. Some of us may also be fortunate enough to have some one special friend from whom we can always expect understanding and genuine sympathy and even, in time of need, real help. Still such a friendship should never be tested too far or too often, lest its finest qualities be harmed. We who are elderly have come far indeed away from the easy and ready confidences of childhood and youth. But still the need to talk things over has never quite left us and even the hardiest of us 252

We Who Are Elderly will continue to feel this need, which at times may become so acute as to threaten health and even sanity if it cannot be met. To stand alone, completely alone, is perhaps the most severe test of human strength and fortitude ever exacted by life, and we should not force this test upon ourselves unless we already know that our inner resources will enable us to bear it. We have now perhaps said enough to convince ourselves and others that for us who are elderly, security and health are our greatest needs, and that if we are not further robbed or deprived of our well-earned measure of security, and if science can help us in maintaining health, we ought to be, and probably shall be, largely able to satisfy our other needs ourselves. What can we enjoy? In the past any question as to how the elderly were to find enjoyment would certainly have been thought superfluous and even ridiculous, if not actually wicked. Those comparative few who survived beyond the sixties were expected to have left thoughts of pleasure behind them and to be concentrating on thoughts of their demise and the hereafter. Even reminiscences among the elderly usually took the form of recounting past hardships, philosophizing on the vanities and futilities of this life, and expressing longing for that to come after death. A few more hardy and daring among the men might indeed insist on continuing to enjoy such lifelong recreations as hunting, fishing, card-playing, and attending gatherings of old cronies to discuss this and that political issue of the day. But the concern would have been rather how to wean them from too much interest in such matters than to encourage them to continue to enjoy them. For women of any age who were not actually bed-ridden there were the bees of various kinds and the church sewing circles and socials, and for both men and women of the few who were members of lodges there were the meetings to attend and the occasional social affairs, most of which were for the purpose of fund-raising. Any and all of these were generally considered legitimate enough and as certainly offering all the entertainment and recreation that elderly folk had either the desire or the capacity to enjoy. But here too the change has been great and we who are now oldsters are encouraged and even urged to seek and find enjoyments, often such as were once indecorous and impossible for those of our advanced age. There are now, however, actual problems in finding forms of recrea253

Aging in Minnesota tion that we can really enjoy. Our desire for more strenuous activities is inevitably lessened, which rules out many forms of pleasure that we enjoyed in our youth and middle age. Likewise, most of us still have a feeling against indulging in pastimes that seem undignified and unsuitable for our age. And most of all there is the change in taste, or the lack of such change, both of which limit our enjoyment of modern forms of recreation; for the change in the forms of recreations themselves has been very great in many instances. A change of taste would inevitably make it impossible for us to enjoy such kinds of books, plays, games, and parties, to say nothing of dancing and sports, as we formerly enjoyed. This change of taste as a matter of maturing and aging has been so long established and taken for granted by both the aging themselves and the still youthful, that any failure to allow for it has seemed ludicrous — as did the argument against dancing as a pastime for the young, advanced by a normal school president. Dancing, he said, did, after all, not hold any lasting pleasure for anyone. His wife, now the mother of several children, used, he said, to be overly fond of dancing, but now she found it not the least interesting. This argument caused considerable hilarity among the students and even faculty members but carried little persuasiveness among any of them. That the grown-up and "settled," as well as the elderly, could no longer enjoy what the younger generation did and that they would almost certainly look upon such enjoyment with disfavor was so taken for granted as not to cause any surprise, though often grumbled about, as part of the battle between the generations. This remains the state of affairs, at least in large part. But the fact that some of us have not entirely changed our tastes does not help us to enjoy what now passes for the same kind of enjoyment that we once were, and continue to be, interested in. The change in the pleasures themselves has to a large extent made it impossible for us to enjoy them. Changes have always come about, and the objections of the elderly to the newer forms have been accepted by the younger generation as evidence of the complaining elders' inability to accept and approve of anything new. To some degree we must admit that there is often validity in this accusation, but there is, on the other hand, no reason why we should abandon all our critical faculties in order to escape it. Reading is for most of us one of the chief — if not the chief — forms 254

We Who Are Elderly of leisure-time enjoyments, one possible for nearly all, regardless of state of physical health or handicaps. It is also one for which the means are constantly increasing and becoming more available to all through the increasing number of public libraries and bookmobiles. "Of the making of books there is no end" was said long ago and is certainly increasingly true. The same holds for papers and periodicals, with the unfortunate exception that the better class of magazines has been more and more pushed to the wall by those of lower quality but greater appeal and has been forced to decrease size and, in some cases, suspend publication. Fortunately for those of us who through many years have come to love and respect some of these periodicals, the very best of them have been able to still continue publication, though in much smaller size, and, unfortunately for us, with considerably increased subscription prices. The rise of the small magazines and the digests has, however, compensated to some extent, and since they have been able to keep down costs of both content and publication and to provide funds through expensive advertisements, they are generally available, at low cost, for even those of us with very limited means. All in all, it is now practically impossible for anyone who wants to read to lack materials. If, however, we have any critical faculties at all, we have to be greatly concerned about the quality of what we are offered to read, not only because we want to avoid what is trashy and not worth spending leisure time on, but because so much of what is offered in such quantity not only gives no enjoyment but often cause disgust, irritation, and, not seldom, anger and indignation. This is in no small degree true of what passes for "good literature" in contemporary fiction and poetry. More about this will be said later in various connections, but let it be said here that fiction dealing almost entirely with over-emphasized sex, insanity, violence, and crime, with degenerates and perverts, and in general with life in its most sordid and unwholesome aspects, cannot be found acceptable to us as a source of entertainment and enjoyment in reading, however necessary it may be as a source of information to those who have to deal with such matters in actual life, and of some fundamental understanding on the part of the public that such things do exist and need to be dealt with. Accustomed as we have been throughout all our reading life to expect and find in fiction not only enjoyment but also wholesome inspiration and increased understand255

Aging in Minnesota ing of normal life, it cannot but be antagonizing to find that what the reading public is now supposed to enjoy is what shocks and horrifies and suggests that a low mental and moral level is not only the usual condition to be expected of human beings, but that this level is the only normal one and indeed the only wise and wholesome one, since all effort to rise above this level is not only vain but vicious — is in fact to be labeled with that all-condemning adjective, neurotic. So we are led to infer if not actually taught that denying or restraining impulses, urges, and instincts, and allowing ourselves to be ruled by inhibitions and "moral cant" is "unnatural"; in short, what we need to free ourselves from is civilization. Nor does it lessen our anger to know that such writing has no other purpose than to become a best seller and to achieve notoriety for its author; and that while it is purportedly giving people what they want, it is deliberately creating and stimulating a taste for what is unwholesome and degrading and, above all, vicious for young readers. Even humor, once offered as a medium for creating wholesome and relaxing laughter, is now so larded with the risque and the salacious that laughter is superseded by gagging. So generally have fiction writers followed the models set by best sellers that to most of us fiction has become practically unreadable. Fortunately, however, this has also become an era of excellent nonfiction, particularly biography. That biography has become very frank and relentlessly revealing of weaknesses and undesirable traits in its subjects and so has overturned pedestals and wrought havoc with many pretty traditions does not either distress or antagonize us, so long as its purpose is to make the truth known. For certainly our experiences of life have proved to us that no person, however great and good, has possessed a perfect character and lived a flawless life; but that at the same time the truly great have presented a much more than balancing number of admirable qualities, qualities that have greatly contributed to human advancement and welfare. Modern biography has in fact become much more informing, interesting, and actually inspiring because it gives the reader a satisfying sense of authenticity and truth, and relieves him of the suspicion of being hoodwinked. To some extent, biography is, of course, more valuable reading because it deals with actuality and gives increased understanding of the past. But good fiction also has its values in that it widens our horizons and 256

We Who Are Elderly makes it possible for us to put ourselves in others' places by identifying ourselves with the characters presented. And to those of us who have in the past many years come to thoroughly enjoy good fiction there is a lack felt that cannot ever be supplied until we can again find novels, stories, and dramas that really satisfy our tastes and enable us to enjoy, not to say endure, reading fiction. Fortunately there are still one or two living American novelists whom we can read; but by and large, fiction is for us an unpalatable mess from which we turn in disgust and anger. Poetry has never been of general interest and enjoyment to readers of our generation, and such knowledge of it as has been offered us (or forced upon us!) in literature courses in schools and colleges has remained unused throughout our lives except for some particular passage or poem which has had special appeal for us and remained with us permanently. But even to those of us who have cultivated a real enjoyment of poetry, much of the present output has become uninteresting because it is and remains un-understandable. The past tenets regarding poetry were that it must have either meaning or beauty, or, if really great, both. True, poetry did not always have the surface-clear meaning of the work of Longfellow, Tennyson, and Wordsworth, but it did have unmistakable meaning, which could be discovered by careful reading or at most by intensive study. Shakespeare and Browning were indeed considered hard to understand, but what they wrote made sense, as we were made to discover in our literature classes. Other poets, notably Poe, we found enjoyable because of the exquisite beauty in imaginary and musical effects. That form did not matter as much as once thought we discovered when we began to read and enjoy the "new" poetry of the early teen years of this century, the verse of Frost, Sandburg, Lindsay, Robinson, and Millay, to mention only a very few of those whose poetry, though fiercely questioned by those ultraconservative about form, we soon found had both meaning and beauty or at least one or the other. The new forms we accepted as manifestations of greater freedom in the writing of verse, and we found that they often served to clarify and to emphasize meaning, as well as to intrigue by their newness. They did not distort or resort to fantastic misuse of established mechanics of spelling and punctuation or to inventions of meaningless terms; in short, they did not seek by the use of entirely unpoetical elements to disguise emptiness of genuine 257

Aging in Minnesota meaning and significance, or by violent and harsh effects to compensate for lack of beauty — an element which they did not affect to despise; all this was left for much more "modern" versifiers to contrive. Fortunately, again, there are still poets, old and new, whose work we can and do enjoy; but the poetry of by far the greater number of the very new, hailed as the foremost poets, we can neither enjoy for casual reading nor find rewarding in study. To write in such manner as to require careful reading for full understanding is and should always be the privilege of the poet, and he can still be regarded as writing for readers. But to write in such manner as to convey no meaning or, at the very best, deliberately confused and obscure meaning, necessarily must mean that the poet writes for himself only. It also means that he is doing poetry itself a disservice, since he deepens the sense of the general reader that poetry is not for him. Many of us find real enjoyment in re-reading the authors we formerly greatly enjoyed, early American writers of both fiction and non-fiction and earlier English writers as well. We can even find enjoyment in re-reading books we read in childhood, finding in them new meanings and subtleties which we entirely overlooked in our early reading; the classic example is Alice in Wonderland. Still more of us find pleasure in re-reading Dickens, Thackeray, Eliot, the Bronte sisters, Rider Haggard, Conan Doyle, Hawthorne, Alcott, and Cooper, as well as many more recent writers: Conrad, Galsworthy, Bennett, Twain, Howells, Wharton, Jewett, Freeman, Garland, Gale, Suckow, and again many others. For the younger readers the "realism" of these writers may seem too remote to be really understood and enjoyed, but to us it is realism more real than anything written recently; for it concerns life and circumstances with which, often, we had intimate acquaintance as actualities, instead of the horrors and depravities of which we were lucky enough to know little in our early years and in which we are not interested now. Many of us also enjoy re-reading the poetry of earlier and more recent poets mentioned; much of this verse we have long been familiar with, parts of it we memorized in childhood and youth — the poems of Bryant, Stevenson, Wordsworth, Lowell, Holmes, and many more. As to non-fiction, we like to read again and again at intervals, Thoreau's Walden, and the essays of Emerson, notably "On Self-Reliance," which, when we first read it, very likely as an assignment in high 258

We Who Are Elderly school English, gave us the first intimation of the tremendous significance of "Trust Thyself; every heart vibrates to that iron string," and the first startling suggestion that we were to respect ourselves and our powers and worth, instead of being weighed down with the then common understanding that children and youths were far more liabilities than assets, and to be considered as suspect and unproved in all things. In fact, we gleaned from that famous essay our first understanding of our duty to free ourselves of what we later learned to call inferiority complexes, the very term as well as its meaning then not known to us. Not that we could miraculously and at once free ourselves from the stifling sense of inferiority, but we were never again quite so craven. Many of us who long enjoyed stage plays also feel a deprivation because stage plays are now so infrequently available except in the very largest cities, and also because so many modern plays are inferior in content, though generally far superior in technic both of writing and presentation. Revivals of old stage plays, including those of Shakespeare, are frequently pleasing to us, though many disappoint us because of changes, adaptations, and modernizations, which antagonize us both because they thus render the familiar unfamiliar, and because they seem to us to violate ethics in taking liberties with a piece of work which should be respected enough to be presented only as created by the author. This feeling holds true for by far the most of us in regard to all forms of art, and more will be said about it later. For those of us who were city-bred, the memory abides of the enchanted Saturday afternoon matinees when we sat entranced seeing and hearing such celebrated players as the James O'Neills, Sothern and Marlowe, Walker Whiteside, and many less famous but still great in our eyes. There is a nostalgia for the magic we knew in those days that can never be assuaged by the movies, television, or little theater plays of these. For that enchantment we would even gladly again endure the torture of the disillusionment that always came upon us as we stepped out into the garish shine of the early evening street lights that showed us the way back into the everyday world. Never to be forgotten either, or ever compensated for, the glory of the evenings when, dressed in our very best, we sat listening to the overture, saw the curtain go up, and then knew we were among the earth's favored as we sat spellbound, watching Maude Adams playing her immortal role in The Little Minister or What Every Woman Knows, or Forbes 259

Aging in Minnesota Robertson in Hamlet, or Joseph Jefferson in Rip Van Winkle, or, a little later, Mrs. Fiske in Shaw's Pygmalion (which modern theatergoers have come to know in its musical form as My Fair Lady), or Ethel Barrymore in Hedda Gabler. Later, too, we were carried away by the suspense of Mr. Antonio as played by Otis Skinner, and laughed heartily and unabashedly at Charley's Aunt. Entrancing were the plays of Ibsen, Pinero, Jones, Galsworthy, and others, when the new drama technic had been perfected and we were old enough to understand and enjoy the skill in construction and presentation, as well as the plots and the players. "No, you can't take that away from me" is a modern song refrain that echoes in the minds of many of us when we remember the past greats of the theater world. We have heard and seen what neither radio, television, nor motion pictures at then* best can afford us now. The list of the notables that we who were connected with city life in our youth and middle age saw and heard is a long and distinguished one; and while we admire some of the greats of the screen, we cannot feel from mere picture presentation that direct impact of the living personalities. And though we enjoy the presentation of scenes so far beyond the possibilities of stage settings, we never felt in stage plays the lack of the scope now afforded, the less so because the dramas were largely adapted completely to interior settings or relatively simple street scenes and the like. All in all, we do not expect to find again in OUT lifetime the supreme enjoyment that was so easily available to us in younger years. With music we fare better because so much of it, both vocal and instrumental, can be obtained in canned form and reproduced so exquisitely by machines in our homes that we can well believe we are listening again to the living music of the great artists of the past. Fortunately, the lowly phonograph record was invented in time to preserve for us the skill of Paderewski and the voices of Caruso and SchumannHeink, to mention only so few of the many greats in music and song we heard and saw in person. Besides, there is the possibility of reproducing for ourselves the music we love, so that for those of us skilled in the playing of some instrument, generally the piano or the violin, enjoyment of the music we love can never be taken from us. For though the fingers may lose much of their limberness, they can still perform well enough to give satisfaction and enjoyment to ourselves. And in music, as well as in poetry and drama, repetition does not dull 260

We Who Are Elderly the sense of enjoyment, but rather enhances it, so that we can enjoy hearing played or ourselves playing the same beloved pieces interminably. We are thus to a considerable extent freed from dependence upon the modern kinds of music which we cannot enjoy because of the lack of composition and harmony, and the harsh impingement on ears grown sensitive as the eardrums grow thinner and less elastic. Music such as is generally provided by radio, for instance, is much more of a torture than enjoyment to the elderly. Indeed, it would be hard to find many, if any, elderly persons who can and do enjoy jazz and other blaring and discordant offerings of popular orchestras, bands, and soloists. Still more unenjoyable to sensitive ears is what passes for popular singing, the "hit tunes," and their rendition by singers of both sexes whose main claim to singing ability seems to be related solely to volume of sound. Nor can we enjoy the so-called lyrics consisting of endless repetitions of one phrase, of which it may well be said that it was never worth giving out even once. This kind of "music" is, of course, presented to the general run of us who are elderly enough to be largely stay-at-homes through the medium of radio and television. These two modern inventions have constantly been hailed as a special boon to the elderly, since they could provide such an amount of pleasurable listening that the elderly would never lack for entertainment. Unfortunately this possibility has never become a reality and does not give too much promise of becoming so, for we who are elderly and whose tastes were formed through other forms of entertainment feel that much of what is afforded by radio and television can appeal only to the very young and the very uncritical. We can find no more enjoyment in hearing the tales of horror, crime, and depravity, of pseudo-scientific atrocities and catastrophes, of the hostility and viciousness of imagined inhabitants of other planets, and so on. In fact, the hearing of such tales with their accompanying sound effects only intensifies our distaste for and utter rejection of them. Of the actual viciousness of such programs, there is much that should be said, but here we're dealing only with our enjoyment or the lack of it. Soap operas, often ridiculed and seldom interesting to many of us, are, however, not vicious, and they do give enjoyment to a great many, women especially. By and large, there is far too much presented in radio and television that, if not actually vicious, is too fatuous and in261

Aging in Minnesota fantile to afford us any enjoyment. This is true also of many recent interviews with little-known personalities, who have neither anything interesting to say nor the ability to say it interestingly. Of the atrocious taste and harmful effect of presenting interviews with criminals, mention only is enough. Many of us who are elderly have come to feel that radio and television programs of special interest and enjoyment for our steadily increasing numbers might well be provided. Such an hour or two should be labeled as especially for us, and should be given at hours when we can be expected to be listening, avoiding, especially very late hours at night, which had better be reserved for younger listeners. Such programs could and should include old songs and instrumental music, though not exclusively so, since there is of course much in modern music that we can and do enjoy; we like plays not too complicated and not designed to thrill, horrify, or frighten, nor dealing too exclusively with romance. Problem plays such as were common a few decades ago are generally acceptable to us elderly folk, who can identify ourselves with the characters, from our own life experiences. Papa Is All proved a delightful play to many of us when presented a few years ago, being new to us and yet not so "new" but that we could recognize it as dealing with real life, and also having the whimsical humor that we so enjoyed in plays of earlier days. News and interpretations of news are of general interest to us; talks and comments by well-known and respected personalities, and informative talks by those who know what they are talking about, are always welcome to us who have interest in both the old and the new. There are of course already offered programs by great musicians and singers of this age, for which we are also extremely grateful. Even some disc jockeys afford us the pleasure of listening to worthwhile music, though such programs are too often relegated to late hours. We should especially appreciate programs suited to our taste on Sundays, particularly good musical programs; and the same holds true for early Saturday evening hours. The return to composition and harmony at least in the ballad forms is also pleasing to us. Art, in the special sense of painting, has never been of very great interest and enjoyment to the general run of us who are now elderly. Landscapes and home scenes, both interior and exterior, and a few well-known paintings, such as "The Angelus," "The Gleaners," "The 262

We Who Are Elderly Horse Fair," "The Last Supper," and "The Doctor," all in more or less good copies, have adorned our walls and still do in many homes, since it became old-fashioned and out of style to display enlarged and colored family photographs — a style which is now in a small way returning and may soon be in full force again. These examples of art we have enjoyed because they had and have meaning for us as related to the life and interests we knew, even if not to those of the present day. Of artistic merit we are not very critical, because we generally have little knowledge of art, though a few of us have absorbed some little knowledge in women's study clubs. But we have held to the principle that a pictorial representation should bear as accurate as possible a resemblance to what it represents. That this effect can be brought about by suggestion better than by actual identity we may not sense, or if we do, it does not interfere with our enjoyment so long as a satisfying resemblance is there. But that a painting that bears no resemblance to what it is supposed to depict and is so unrecognizable as a representation of anything we have ever seen or known that we have to be told what it is supposed to represent or "mean," and even which side of it is up and which down, can be called a work of art and be admired and enjoyed, we never were, are, or probably ever will be, able to understand and accept. Hence there is for us no enjoyment in modern futuristic, abstract, or symbolic art, unless it be that it amuses us. We are also amused by accounts of what some of these paintings are — the daubs of children, accidental smearings of paint, "experiments" of various sorts, many of them often hung upside down without any detriment to their appearance. The eager acceptance of these "art forms" and the acclaim they receive from the supposedly more informed viewers and art critics, reminds us of nothing so much as Hans Christian Andersen's story, "The Emperor's New Clothes," in which, we remember, it took a little child to point out that the "clothes" that had so satisfied the Emperor when told of their beauty and fit by his tailors, and that had won such cries of admiration from the courtiers, were really non-existent and that the Emperor was in fact stark naked. For us, the overwhelming majority of our generation, art, whether poetry, music, or painting, that has neither meaning nor beauty that can be discerned by us, can well be left to the appreciation of its creators and those others who can, or say they can, find enjoyment in it. 263

Aging in Minnesota If this be evidence of narrowness, lack of taste, or just plain ignorance, we are satisfied to let the more "knowing" make the most of it. Dancing, for many of us the favorite pleasure of our youth and even middle age, would in any event have become impossible for many of us to enjoy, once the infirmities of age had come upon us and once the change of taste already alluded to had occurred. But even if we have remained hale and hearty enough to still enjoy active forms of amusements, we can hardly hope to find strength and energy enough for the wild gyrations and violent flings of modern dancing. We have no quarrel with such dancing, which originated before we actually became decrepit, and to some extent we regard it as amusing to watch, though we miss the grace of carriage and the lightness of foot that we so admired and cultivated in our own dancing days. Fortunately, the recent revival of the square dance and the radio and television programs of old-fashioned dance music has made it possible for the more hardy of us to enjoy "tripping the light fantastic" even if only in our own living rooms. Card-playing can be and is a favorite amusement for many of us, though many of the newer games have become too intricate and too professional for us to enjoy or even learn. The concentration required in many of these games and even more the tenseness that arises in trying to hold one's own and outwit one's opponents, has, it seems to us, made the playing more of a contest than a mere game, more hard work than relaxation, more often a source of vexation and humiliation, not to mention quarrelsomeness, than of enjoyment and satisfaction. So we are often content to become mere lookers-on when skilled players are enjoying their games, unless we can manage a foursome of our own age group and enjoy a quiet old-fashioned game which allows for at least intermittent conversation and in which a bit of forgetfulness as to dealing and playing is not much cause for notice and comment and none for actual censure. Chess and even checkers are enjoyable games, the former for the special few among us, the other for a still considerable number. There are also many old and new word games we enjoy. Of active outdoor enjoyment for those able to enjoy them there are a good many not too difficult. Golfing is still a game to be enjoyed by both men and women of our age group, though the nine-hole game is often found preferable to the eighteen-hole, and being propelled around 264

We Who Are Elderly the course to walking, which, however, is good exercise for us, as is often pointed out. Other sports, such as fishing, hunting, rowing, and skiing — the snow kind — are not beyond the many of us fortunate in possessing health almost unimpaired, though of course we all must have regard for caution against overdoing, which in the old days would have seemed unendurable to us, we having then no need to fear either falls or heart attacks. Taking short walks, or long ones — hiking to the young — is still possible for us, as has been pointed out in a previous section, and so too just sitting outdoors in summer weather and letting our eyes and ears be active while our bodies rest in the shade or bask in the sun. Taking trips no longer means a "century run" on a bicycle, or, except in rare instances, walking what in these days seem incredibly great distances for anything but riding. But we can pleasurably substitute rides about the countryside, and as Dorothy Canfield Fisher pointed out in her sketch of what life holds for the elderly, a jeep can afford us much leisurely sightseeing if we can still drive it ourselves or secure a not too impatient driver. Traveling is increasingly possible for the elderly, since it is generally made so comfortable as not to overtax even those a bit frail. This is true even of traveling by car, because of the motels which offer comfortable quarters for a night's or day's rest. This mode of traveling and sightseeing can also be enjoyed at a low cost for those fortunate enough to have sons or daughters or other relatives who are willing to "take the old folks along" on a planned vacation trip. In this way many of us are at long last seeing the famous places and scenes which we have through life heard of and longed to visit. And to enjoy these opportunities in the company of those who enjoy our pleasure and are willing and eager to make our travel entirely enjoyable and likewise anxious to safeguard us from accidents and too great fatigue even when we are intent on missing nothing, is an experience to long enjoy also in retrospect. Other forms of travel, a trip to Europe or Asia or Africa, or even Australia, is possible for those of us who have the means and the strength to undertake it. But for most of us, seeing the great sights of our own beloved U.S.A., and those of our good neighbors, Canada and Mexico, will suffice. And it may well be added that for those of us who for one reason or another cannot hope to ever go far from home, there 265

Aging in Minnesota is still the National Geographic magazine, which affords a panorama of all the wonderful sights of near and far, in this and every other continent, on the earth and over it and under it, and is a marvelous substitute for travel that we can enjoy without ever leaving our homes, our couches, or even our wheelchairs. Work, we have already said, helps us to feel independent and of use in the world, while it also provides the exercise needed for our health. It is of course also a means to keep us from boredom, from feeling that time passes too slowly for us. It can also be said that work can be and should be a form of enjoyment. To what extent it is enjoyable depends upon several things: its adaptability for us, how freely it is chosen or accepted, how much it is in line with our skills, and first and last and most importantly, how interested we are in it and how much we can lose ourselves in it. Continued interest in and enjoyment of some form of work is the best possible antidote for that worn-out, onthe-shelf, good-for-nothing-more feeling that may otherwise threaten to make our later years an endurance test in continuing to exist. Men, especially, have been much urged to begin cultivating a hobby at least in middle age which can be continued into old age. For those who are lucky enough to have a hobby, one that has real interest for them, retirement becomes really enjoyable in that it offers more time for devoting to the hobby. Do-it-yourself projects, as has already been said, should not be undertaken without due consideration of strength, skill, expense involved, and the general likelihood of success. Nothing can be more discouraging to an elderly person than something so unwisely attempted that it is almost certain to end in failure. Like children, elderly people need the fillip of success in what they undertake. For women, as has also already been pointed out, housekeeping, or rather homekeeping, is a lasting form of occupation, provided health and strength, and above all, interest, continue to make such work possible and satisfying. It is well known, and certainly well advertised, that for American women housework is no longer drudgery, and even only partial acceptance and use of modern conveniences and gadgets will make housework possible for even the very elderly woman. But here again, interest is the prime factor in making housekeeping enjoyable. If interest has waned with the boredom of doing the same things over and over, daily, weekly, yearly, or with the changed setup in the home, due to the shrinking size of the family, the absence of need for 266

We Who Are Elderly regularity, and the loss of the sense of accomplishment — then even what has once been enjoyable in spite of its hardships can become a boring routine too long continued, a mere going through the motions for want of something else to do or from a sense of duty; thus all enjoyment is lost. For the woman whose home has again become one for just two or even for herself alone, there is needed the tonic of taking stock of the home and its possibilities, planning improvements or at least the addition of something new to increase usefulness or beauty, finding new ways to deal with old problems, setting a goal for continued or added comfort and well-being for whatever remains of her household. Showing a visiting granddaughter how grandma does things can often do more for grandma herself than for granddaughter. And if granddaughter surprises grandmother with some new skills and possibilities in housekeeping, that can often add to renewed interest in what had become too well known to retain any interest. As a general rule, the desire for cleanliness, for comfort, and for attractiveness can keep even a very elderly homemaker both busy and interested. Shopping is a perennial interest and enjoyment for nearly all women, one that few women ever entirely outgrow. The delight of selecting, choosing, acquiring something new for herself, for her family, or for the home itself, usually lasts as long as life itself, or at least as long as any measure of strength and energy and means remain. Closely associated with acquiring new things is taking stock, making an inventory of the old. When time allows, looking over one's possessions, putting them in order, discarding or putting back into use what has long lain idle, gives most homekeepers a real satisfaction. Rummaging is one of the really interesting undertakings that women periodically — and men too — can enjoy. With us who are elderly, however, rummaging should not be allowed to become the cause of too vividly bringing back the past, especially if we are inclined to melancholy. When we find ourselves becoming more and more depressed with every article we handle, it is time to get out of the attic and back down into the living room. With children and the still young a rainy day is right for rummaging in the attic; with us who are elderly, it had better be a sunny day, and not only because it affords more light in the dim corners. Most of us also enjoy occasionally looking over, caring for, and rearranging our prized possessions — for women, silver, linens, china, 267

Aging in Minnesota and various knickknacks; for men, favorite pipes, guns, fishing paraphernalia; and for both sexes odd bits of jewelry, papers and letters, photographs, and souvenirs of this and that important occasion. Unless we are very detached from such possessions it is well not to part with them too soon, for they often serve as friendly little anchors to keep us from feeling too much adrift upon the tides of time and change. For the very detached, however, it is often a satisfaction to get rid of all such reminders of the past, since they like to feel themselves even in old age "footloose and fancy free" and forward-looking in all things. Collecting has become an interesting and enjoyable hobby for many elderly people, and of things to collect there is no end, nor is there seemingly any end to the number of specimens, once we have decided on our particular field. Yet the enthusiasm of the true collector never wanes, not even when space for the collection becomes an almost unsolvable problem. The ardent collector should, however, beware of expecting to find great appreciation of his own collection in the eyes of other collectors, and still more of finding even comprehension from non-collectors. For both men and women among those of us who are still able to be active, gardening has become more and more a chosen and recommended form of light work that provides exercise and fresh air, a growing interest — in two senses — and also a means of adding to one's stock of food and of beauty. It can also be highly endorsed as a form of enjoyment. Given a suitable plot of ground on or near our own property, many of us who have never known it in our younger days find it fairly easy to attain the necessary skill to make gardening both profitable and pleasurable. True, there are the difficulties and frustrations owing to unfavorable soil or weather or both; the incursions of pests of many sorts, from gophers and moles to flying, hopping, crawling insects; weeds that never stay disposed of; to say nothing of the raids of dogs, cats, and rabbits. All of these can certainly cause so much discouragement through the growing season that we vow we will never try gardening again; but in one way or another we learn to cope with practically all of them. And come the near-spring months and the seed catalogs, our enthusiasm revives; we gird ourselves with plans and anticipations of what is to be, this time, a really successful and enjoyable gardening season. And in its way it will be. Even a very small flower or vegetable garden yields enough beauty 268

We Who Are Elderly or fresh food to make the work and outlay worth while, to say nothing of the enjoyment of watching things sprout, grow, bloom, and ripen under our ministrations. In many ways, gardening is the most enjoyable occupation or hobby, for it is really a creative form of work and gives a sense of pride in a real accomplishment. Many elderly men and women enjoy producing especially fine products that can be displayed at fairs and possibly win prizes there or in garden displays or contests. They can even, if they have or acquire the skill and patience, become the creators of new species or variations of well-known garden products. There is also the duty and pleasure of keeping our surroundings neat and attractive as far as it lies in our power to do so. To some of us this duty is not a pleasure but an arduous task, especially with crabgrass and weeds of other sorts, and, again, all the animal and insect pests. However, modern aids for all the most arduous forms of this work, such as power mowers, weed killers, sprays, fertilizers, and automatic sprinklers, can generally keep us from too great discouragement and exhaustion. And there also, when spring calls us we are generally ready to begin striving again for that lovely lawn, the envy of all our neighbors, so glibly promised us by the seed and nursery companies. It is best, though, in all work with growing things, not to expect perfection, and also for beginners not to be too ambitious and attempt to grow flowers and vegetables that require too much skill and care, or to lay out generous garden plots that will supply friends and neighbors as well as themselves. Small plots and easy-to-grow plants are usually most productive of success and enjoyment; though a bit of experimenting now and then is not amiss, if we can afford the time, energy, and expense and the possible disappointment. Gardening is especially suitable in villages, suburbs, or outskirts of cities, but even backyards within cities can be used. For those who have access to open country, and the strength and energy for it, bird-watching is becoming a popular form of outdoor enjoyment. The study of the different species of birds and their habits and habitats is in itself fascinating; and it can be combined with the study of wild animals peculiar to one's region, and even the study of wild flowers. Being able to recognize and name species of birds, animals, and flowers when they are encountered is a satisfaction to many, and it can also lead to much interesting and informative reading. An 269

Aging in Minnesota even easier hobby is to learn to recognize and name trees, generally by their leaves and general appearance. Too many of us have gone through life without any real acquaintance with even the most common trees of our environment; nor have we known that all trees bear flowers, and that leaf buds are formed in the fall, not in the spring. To those interested in woodcarving, the kind of wood to be obtained from each kind of tree is of course of special interest. Many of the seed forms, really the fruits of the trees not generally regarded as fruitbearing, are of great beauty, and one can spend many a pleasant hour studying the special means of spreading the seeds employed by various trees. The loneliness of elderly people is often cause for commiseration, and intense loneliness can make nearly everything tasteless and impossible to enjoy. Mention has already been made of the loneliness due to loss of families and old friends or removal to unfamiliar environments. Yet with a little encouragement and a little effort on our own part, those of us who seem sunk in utter loneliness can generally be brought into relations that will relieve our worst distress. Those who have long belonged and still do belong to a church will of course be spared the type of loneliness that comes from isolation. Belonging to and attending a church is indeed a form of real enjoyment, even though it may not appeal to all to so classify it. To listen to the presentation of what are to us accepted truths of supreme importance, by someone whom we consider an authority, is certainly one of the keenest of pleasures; and to be closely and habitually associated with the likeminded also affords great satisfaction and pleasure. There are, besides, the many social activities enjoyed in most church congregations, the forms varying according to the creeds and established customs of each, and all of them generally enjoyable to the members because they bring a sense of fellowship and often have to do with a project interesting to all. Those who have for many years belonged to lodges and their auxiliaries, to clubs, fraternities and sororities, and hundreds of other organizations of various kinds, purposes, and activities, also find many of the same enjoyments as do church members. In general it may be said that those who can be considered "joiners" should be able through life to find associations and enjoyments that will preclude loneliness. Those who have always been and still prefer to be non-joiners are like270

We Who Are Elderly ly to have found long ago qualities within themselves that give them compensating satisfactions and help them to find mere casual relationships to replace the more intimate, and friends and forms of recreation to suit their tastes. There is also for us the possibility of forgetting our own loneliness and finding happiness in giving comfort and service to others of our age, notably in visiting the ill and disabled or the merely isolated. For we know that because of the understanding and experience that age always brings, we are more likely to bring comfort to those of our own age group than can younger people, however willing. Remembering the old adage that no one is ever too old to learn, we can also seek enjoyment in the acquiring of new skills, learning or perfecting ourselves in a foreign language or re-learning what skill we once had in music or painting or other handiwork. Many of us, especially the foreign-born, are finding new enjoyment in reviving their interest and skill in weaving, knitting, and various forms of embroidery and fancy work, and in teaching such skills to younger women. In the same way, elderly men who learned wood-carving, cabinet-making, and other hand skills in the old country can gain considerable acclaim and even profit in producing things both useful and beautiful. The above-mentioned skills can also be put to use in giving great pleasure to others, especially children. It is heartening to read of the middle-aged and older men and women who spend many hours making or repairing toys for underprivileged children, the men working with wooden and metal toys and the women repairing and dressing dolls and making stuffed cloth animals and the like. A joint venture in a doll and toy hospital to which children could bring cherished toys to have them restored to health at little or no cost would fill many otherwise empty or lonely hours and give joy to the children and double joy to the giver of happiness. It need hardly be pointed out that we find great comfort in keeping in touch with such old friends and acquaintances as are still spared to us, even if contact is possible only through correspondence. The daily mail can be and often is of great solace and pleasure to the elderly, and a letter now and then from an old friend can brighten a whole day or more for us. And the writing of a reply can also be most satisfactory in that communicating with one's contemporaries is "talking" to those who understand what we mean even if we use old "codes" and expressions of our own. When a common background and atmos271

Aging in Minnesota phere have been shared for many years, there is much that needs no explanation, that can be read between the lines and said without words. And having come to know what the loss of old friends and acquaintances means, we are all the more anxious to cherish those remaining to us, to share our feelings and comfort us and to be in turn understood and comforted by us. Thoughts may not flow so freely, fingers may be stiffened, and for some of us not used to much writing, the task of beginning a letter may seem forbidding. But once begun, the letter may carry us on of itself, and the satisfaction of having expressed ourselves and tried to brighten the day for the recipient of the letter will compensate for all the difficulties that had made us feel like postponing the writing. Letters to old friends will always be worth the writing — even with increased postage rates. While we do not propose to take too seriously the admonition of the song, that "It's later than you think" and to "enjoy ourselves" on the eat-drink-and-be-merry-for-tomorrow-you-may-die principle, we can heed the admonition enough to prevent postponing of this and that normal pleasure and the many "I have always wanted to —" projects. We can use our leisure much as we have always been accustomed to using our working time, doing what should be done, and could be done when it should be done, taking full advantage of opportunities that may not come again. The habit of postponing is never more easily yielded to than when there is much leisure; and we who for perhaps the first time in our lives have much leisure, have to strike a good balance between enjoying the sense of freedom from enforced activities on the one hand, and avoiding stagnation through complete inactivity on the other. And when all else temporarily fails, when we are weary of all forms of activity, when we are plain tired, just resting — enjoying our leisure for itself, feeling the relief of being out of harness, freed of taxing chores and responsibilities — may well be a temporary pleasure, at least as long as it remains free from boredom and loneliness. Many of us find President Eisenhower's once-expressed idea of a desirable retirement, "I'd like to take a rocking chair out on the porch and just sit in it for six months — and then begin to rock very slowly," very pleasing. Many of us returning from a long trip much enjoyed in sightseeing may come to feel that what we most want to do is to sit on our own porches and let the world come by to look at us. 272

We Who Are Elderly Much, very much of what we find to enjoy in our old age depends upon the outlook that life and living have given us or that we have consciously cultivated. For while it is not entirely true that life is what we make it, or that we can be happy if we only determine to be so, it does make considerable difference in our outlook on life what sort of attitude and temperament we have developed as the result of both outward and inward influences. And if we are bent upon making the best of the years that remain to us and we find ourselves hampered and discouraged by unwholesome ways of thinking, we can now use our leisure and opportunity for reading and listening to lectures, and so on, to learn to change our attitudes at least enough to give us greater peace of mind and pleasure in living; again, it is never too late to learn. Not that it is wise to lose sight of reality in accepting admonitions to be happy, or believe that we can change outward circumstances by merely wishing and thinking them different. For mental well-being is just as much, and often more, dependent upon outward circumstances as is the physical; and no one, old or young, can be fully "well" in either respect in very unfavorable circumstances. The effort in such case should be to change the circumstances, or, that failing, to cultivate fortitude. But if the cause of our lack of peace of mind and serenity is really in ourselves and we are not willing to so concede, then we can at least avoid making others unhappy also. For misery not only loves company; it often commandeers it. And this we need to remember, for our own good, in choosing our associates also. For many of the things that can give us enjoyment, adequate funds are needed, spare funds that we can feel free to use without a sense of being foolish or reckless and depriving ourselves of necessities. Something has already been said, and more will be said later, about the need for an adequate income, especially in these days of inflation. But it can be said here that no income, whatever its source — our own savings, or Social Security, or pensions, or Old Age Assistance — is to be considered adequate unless it affords means for various forms of enjoyment, over and above the necessities of life: the means of enjoying a bit of luxury in food now and then, of something new in clothes that we crave (true especially of women, of course) even though it is not absolutely needed; of buying a much desired book, picture, or piece of music; of attending a lecture or some form of entertainment; of purchasing a gift for a friend; of taking a short trip or making a contribu273

Aging in Minnesota tion to a cause to which we gave both time and money in the past. There is little danger that we who are elderly will go on a spending spree or provide lavish entertainment for guests in order to impress them, or spend money because it burns holes in our pockets. We have been too long and too thoroughly conditioned toward thrift throughout all our lives not to think more than twice before we spend money for any purpose, and we are, by and large, still inclined to be too saving. And in this connection something should be said about a form of enjoyment that is neither wise nor conducive to well-being for the elderly, namely hoarding. It is not hard to understand the feelings of those to whom the lack of money has long since made the possession of it in itself the greatest pleasure. Nor is it hard to understand how the fear of want in one's extreme old age can bring about the refusal to use the means at hand to avoid that very want. But understandable as it is, nothing is more tragic and pitiful than the so often encountered cases of elderly people who have lived the last years of their lives in discomfort and deprivation, often enough in actual misery and want, only to leave behind them money hoarded and never used. We who are elderly should remind ourselves that youth and middle age are the times for saving as well as earning money, old age the time for using it. For though we can also understand the attitude of the elderly woman of whom it was said relative to the old saying that "You can't take it with you," that "If she can't take it with her, she won't go," we can and should see the folly of depriving ourselves and others we might have helped, only to leave behind funds that often cause strife among the inheritors and wasting by those who are not in any sense frugal. "Money can't buy everything" and "The best things in life are free" are true to some extent, as much as all such general pronouncements ever are. But of what we have earned in one way or another, and what is rightfully ours, let us spend not too niggardly for what we want and can enjoy as well as for what we need and must have. Count us in, not out. No doubt what is best known and most written and said about us who are elderly has to do with the unprecedented increase of our numbers. Until the turn of the century those over sixty-five had been an insignificant number, and practically the only problem of the aged ever spoken of in either fiction or non-fiction was that of the retired farmers, who, as we have already mentioned, 274

We Who Are Elderly retired to the country villages and were looked upon as derelicts who had lost all interest in active life and merely dragged out their days in aimless sitting about and listening for the mill whistle to tell them when it was time for meals. Whatever truth there was in this picture, it certainly did not take on any aspect of being a problem for general consideration. The increase of our numbers did not really come to general notice until the census of 1940 showed that the number of those over sixtyfive had increased to very nearly three times that of 1900, the percentage having risen to 6.8 of the entire population, as compared with the 4.1 of 1900. The census of 1950 showed an even more significant rise in our numbers; the total number, 12,271,178, being more than four times that of 1900, and the percentage within one tenth of exactly twice that of 1900. The 1960 census places our number at 16,560,000, or 9.2 per cent of the entire population. Estimates for future growth of our numbers place the total for 1970 at 20,040,000, with a total population of 213,547,000, the percentage of those over sixty-five becoming then 9.4, thus approaching ten per cent of the entire population. It must be remembered that these figures are for those of us over sixty-five; the number seventy or over will, of course, be considerably smaller. So much for figures and what they are likely to mean to the general reader. The greatest significance is naturally in our voting strength, where our numbers can and should count very nearly one hundred per cent of our total number, there being no upper limit to the voting age. Our voting strength is therefore of first consideration to those particularly interested in the political status and trends of our nation. So long as there is no particular trend seen in the voting results owing to the increase of our numbers, except in some cases of community affairs, our steadily increasing voting strength is probably not regarded as particularly significant. But should we ever have reason to pool our strength to bring about some desired and needed changes, our voting strength would indeed become significant. This has of course long been realized in connection with old age organizations and movements relating to the need for improvement of our status, principally as to financial matters, but also regarding our social status and our general welfare. The situation regarding our voting strength and what it could accomplish were it ever united for the furtherance of a cause is very simi275

Aging in Minnesota lar to that of the voting strength of labor, though very likely it will always remain much less significant. Those of the laboring class were always reminding themselves and being reminded by those having concern for their welfare that if their voting strength were merged into a united effort, they possessed the strongest voting power in the nation because of their numbers. This has long since come to pass, as we now well know. But the voting strength of even a minority can become very significant if pooled. Therefore this is one, though as yet a minor reason for counting us in. City, township, village, and county candidates for office have indeed 'already begun to realize that concerning many measures, particularly those having to do with social welfare and the abolishment of social evils, account had better be taken of the stand of "the old folks." Nor can there be any reasonable doubt that as we who are elderly become more and more conscious of ourselves as a group with group interests, and as our ranks continue to be replenished by those who are much better informed, more practiced in political matters, and much more articulate and aggressive than the oldsters of the past, our voting will become of constantly increasing significance. The buying power of us who are elderly is probably not great, since the great majority of us are living on limited incomes which are shrunk still further by inflationary prices. But with our steadily increasing numbers, the constantly growing needs for replacement of durable goods, and the also increasing demand for the better things of which we do not intend to be entirely deprived, our buying power should not be entirely ignored. We do to a large extent have our own decided tastes, and we are not much given to following the styles in dress or furnishings or to demanding the very latest in electrical appliances and gadgets of various sorts; in short, we are inclined to be conservative and unwilling to give up the old and tested for what is newer but not better in our eyes. This unreadiness to follow current styles and accept without reservations what is newest often discourages us from buying, because we are unable to get what we want and what best suits our needs and satisfies our judgment. This is particularly true in women's clothes and has been more than ever true in recent years because style changes have been so radical and extreme. The sudden return to the waistless dresses would not have seemed so impossible to us elderly women, since we had worn 276

We Who Are Elderly them in the twenties and had never taken too seriously the ridiculing of them for several years until they were suddenly back in style. But this time there were new features added which made them virtually impossible for us to consider, and furthermore we felt certain they would soon be out of style. Present-day dresses are less extreme except in regard to the exaggerated fullness of the bust, a pouter-pigeon effect which many of us regard as distinctly ugly as well as in ridiculously bad taste. At the same time the size system for women's clothes has been so changed that there is nothing to fit those of us who are neither half-size nor stouts. We are irritated also to find that all really attractive dresses are sold only in misses' or half sizes, for though we are conservative, we are not lacking in taste for what is attractive in cut and color. What seems to be really needed is an older women's department in dress shops and department stores, and there appears little or no reason why there should not be such to accommodate us. The old notion that elderly women are so indisposed toward anything that has to do with their age that they would shun such a department holds less and less true as a more rational attitude toward aging develops. It is part of our being our age that we accept with genuine appreciation anything which especially caters to us. To stock such a department an older woman should do the buying and elderly prospective buyers be consulted. It is not too wild a guess that in a short time such a department would become popular and would be patronized also by women not in the elderly bracket; for many younger women prefer garments conservative in cut and free from such extreme features as plunging necklines, sheath skirts, and the aforementioned pouter-pigeon bustlines. Women's hats, the traditional object of mirth for men, are now of so many shapes and sizes that the elderly woman finds little difficulty in buying a hat that confers reasonable dignity as well as being becoming. But this may not always continue to be so, and the time may come again when women's hats, too, become extreme in style, so that there would be a ready welcome for a hat department where elderly women could find something suitable. Men's clothing has so far been less subject to sudden and violent changes in style, and all men's clothing stores make it possible to find a well-fitting and suitable hat and suit for the elderly man, who gen277

Aging in Minnesota erally knows what he wants and will buy nothing else. In regard to men's hats, however, the reappearance of derbies may signal more radical changes not acceptable to elderly men, particularly since they have too often laughed at their wives' hats to want to invite retaliation. Regarding furniture, there are new styles that so definitely add to comfort that we who are elderly are very ready to accept them. Many new fabrics are so easy to clean and keep clean that we are eager to secure them; this is especially true of curtains and draperies, and applies also to clothing. Durability, however, is not always what it should be and what we have always expected it to be in good furniture; and present prices are very often prohibitive for replacing what after lasting for almost the proverbial lifetime is beginning to wear out or become unsightly. In this field, therefore, furniture of good lines, good material, and reasonable prices would be very welcome to those of us who feel a need to refurnish our homes but are deferring from season to season to do so. Stocking durable furnishings and advertising them as being likely to appeal to the taste of the elderly might very likely prove profitable. Very heavy furniture is not preferred by the elderly for obvious reasons. Darker finishes are generally, though not always, preferred. Extremes in design and finish, such as are attractive to younger generations, are seldom favored by us who are elderly. As has already been pointed out, elderly housewives are generally ready to avail themselves of the convenient forms in which foods can now be bought. Few of us, however, do not at some time or other long for some old-fashioned dishes which we enjoyed in our childhood and youth, such food being often made from recipes brought from this and that "old country" and now no longer known to even our generation. To procure such remembered and longed-for foods many of us, both men and women, would take considerable trouble and pay considerable prices, which suggests that eating places, catering establishments, bakeries, and the like which would provide or take orders for such specialties would stand to attract considerable patronage among us elderly people. And again many of the younger generations are not averse to trying such foods and often develop a taste for them. There are of course already eating places that provide "old country" dishes, but generally such places serve only the specialties of some one nationality, and they do not provide specialties not already on their menus. Given 278

We Who Are Elderly reasonable accessibility, pleasant though not lavish interiors, and a quiet and pleasant atmosphere, with the availability of a wide range of specialties and favorite dishes, any eating place advertising a special welcome for the elderly should become eminently successful. Since we tire easily, we who formerly made use of them miss the resting places provided in all the larger department stores in the past. Often these were no more than a row of comfortable chairs conveniently placed where we who needed it could find a moment's rest. Modern women's lounges are comfortable and attractive, but generally they are situated where it is necessary to walk some distance and ascend to upper floors to reach them, and this extra effort is not always, or even often, possible for the elderly woman on a hurried shopping trip, with bus schedules to meet. For men no resting places are provided, so that the elderly husband who is waiting for his wife to make her purchase and does not feel equal to standing about inside or out, has perforce to take refuge in the shoe department to find a place where he can sit down! We miss too the conveniently located parcel-check rooms where we could be relieved of heavy or troublesome packages and parcels and find them quickly available when called for. We understand that such conveniences and comforts are considered too old-fashioned and nonstreamlined to be tolerated in a modern establishment, but by us they would be recognized as a concession to our needs and make us feel kindly toward the establishment that would provide them; and supposedly the need for the customer good will is never quite to be dispensed with. To the shops and stores that still provide elevator service we feel grateful, since many of us find it difficult or inadvisable to use escalators. The fact that the elevators are well filled and often crowded testifies to the continued need for them. All in all, it may not be so absurd as at first thought it may seem, to suggest that the forward-looking seller of wares of any kind should not entirely disregard the buying power and potentialities of the growing numbers of us who are elderly, and that it might become decidedly profitable to count us in, not out. Much has been made of the remarkable increase in longevity, especially in our nation, and much credit has rightfully been given to science for its discovery of medical means to counteract diseases which had hitherto been considered fatal to elderly patients. Much credit has 279

Aging in Minnesota also been accorded to the inventions that have decreased the drudgery which had lowered the resistance power of the worn bodies of the elderly and so made them easier victims to old-age afflictions and which in itself contributed to early aging and death. And, finally, much praise has been given to the improved standards of living in our country — the better diet, better housing, more medical aid. That all these have contributed to greater longevity is undeniable, and so far as longevity in itself is to be considered a human good the credit given is certainly due. However, it is beginning to be recognized that living long is not always an unmixed blessing to either the individual or to society. Most of us have known oldsters who bewailed living so long and who welcomed the release that death would bring. This attitude toward long life comes from those who are ill and suffering pain or discomfort, and those who have lost interest in life because they have been practically shunted out of it and deprived of all that had given savor to their earlier life, leaving them to aimless living in which all purposefulness, activity, and pleasure has been turned to apathy. Still others have become so embittered and frustrated that all forward-looking has been lost and only the sense of weariness and futility left to them. Still others have so deteriorated in body or mind that they have become wards of society to spend their last years in institutions where even with the best of care life has become mere existence. That we do not believe that such a dark picture of old age is either the prevailing one or the inevitable one we have made adequately clear in foregoing sections of this chapter. We have clearly pointed out that often the individual elderly person can save him or herself from such a tragic ending of life, and that the effort of each and every one of us should be directed toward making life worth living to the very end of our lives. But we have also pointed out that our own efforts cannot always succeed and that we have needs that we cannot well supply ourselves and for which we need the understanding and assistance of society at large. Since, as we have also pointed out, this seems to be the age of greater and greater awakening of the social conscience, it would seem not too impossible that we who are elderly should also profit from this awakening to an extent hitherto considered unthinkable. That the intensified concern for children, for the handicapped, for the mentally ill, 280

We Who Are Elderly and for all those who in one way or another have become unequal to the struggles of life, unaided, should, so to speak, also rub off on us who because of the weight of years have lost the ability we once had of meeting all life's problems and hardships with reliance on only ourselves or those close to us, no longer seems incredible. We have already placed reasonable good health as the first requisite of continued enjoyment of life in old age; we have also mentioned the comparatively new sciences of gerontology and geriatrics. Now that we are stressing our claim to be counted in, it is time to deal with what these two sciences can and should do to prevent old age from becoming a tragedy for the individual and a detriment and burden for society at large. All medical practice now stresses the value and common sense of making prevention a greater aim than cure. This theory already so prominent in pediatrics is now also a proposed theory and method in dealing with the ailments of old age. For just as the assumption that childhood diseases were inevitable and inescapable so long remained unquestioned, so there are many ailments of old age, both physical and mental, that have far too long been accepted as inevitable accompaniments of the aging process. But as this is also outstandingly the age of discrediting mere assumption and replacing it with scientific investigation, all of the ills of old age should have that reviewing that has brought about such remarkable and desirable results in other fields of medicine. In other words, what is needed is the opening of a new field of investigation, treatment, and prevention of the ills of aging. Gerontology and geriatrics must become as well established branches of medicine and surgery as pediatrics now is. For just as it was discovered that children are not merely cut-down men and women, so it must be recognized that the aged are not merely worn-out adults, and that, like children, they need special understanding and special treatment, both of these having in view the preventing of otherwise impending ills or, at the very least, preventing the worsening of such. For incredible as it may seem to many of us, it is already deemed possible that such physical ills as hardening of the arteries, high blood pressure, apoplexy, arthritis, degeneration of joints and muscles, and even to a large degree loss of vision and hearing; and such mental ills as loss of memory, depression and apathy, and numerous neuroses, 281

Aging in Minnesota such as abnormal anxiety and compulsions, can actually be prevented by medical advice and aid plus re-education of those who are entering what is in many ways a new phase of life — old age. To this end the sciences of gerontology and geriatrics need to become much better known and accepted as an important branch of all medical training. Departments of gerontology and geriatrics must be established in all medical schools, and the opportunity to specialize in these new branches offered and adequately presented. The present conviction on the part of some heads of medical schools that it is unthinkable that any students should be interested in specializing in these fields must be promptly discarded. In providing facilities for the study of treatment and care of the elderly there is much more that is desirable besides knowledge of the prevention and cure of ailments. Elderly people often need considerable special attention and consideration, just as do children, and in general the greater the age and the severer the ailments or tendency toward them, the greater this need. It should first of all be recognized that the energy and resistance of the elderly is greatly lessened and that, therefore, their ability to endure long waiting, long examinations, and long drawn-out treatments at one time cause inadvisable depletion of strength and resistance and often counteract the intended benefits. Prolonged anxiety is also a serious drain on the strength of an elderly patient, thus also reducing his hopefulness and his cooperation. There is no more tragic sight in the waiting room of a large clinic than that of an ill and very anxious elderly patient whose already waning strength is being depleted by long periods of waiting. Unfortunately the elderly patient cannot be distracted as can the ailing child, and little relief of any kind can be offered him or her. If the elderly were, as are the children, segregated from the great numbers of those who are younger, and so given attention much more promptly, much greater benefits would result from medical care. Special clinics for the elderly must of course eventually be provided. The need for special hospitals is also great, for the elderly need to be sheltered from noises and disturbances to a far greater degree than even children, and they also need special understanding and care. Special doctors and nurses trained in the new sciences of gerontology and geriatrics, in charge of such a hospital, could work wonders. The personality and attitude of all those caring for elderly patients play a 282

We Who Are Elderly very large part in improvements or the lack of it. Often the elderly patient is already lacking any determined will to live or is so near to that state that injudicious and unsympathetic treatment by those upon whom he is dependent can easily push him over into listlessness and weariness and finally complete loss of the will to live. If this is allowed to happen, medical treatment will be wasted and the patient might as well have been allowed to die without it. Nurses and all others who are to be entrusted with the care of the elderly should be chosen with regard to their special fitness for this work and should then be specially trained for it. This would hardly be possible without special hospitals for the aged, or, at least until such can be provided, special wards in general hospitals. Again it will be realized that this is only duplicating what is already recognized as indispensable in the care of sick children. If all this seems too great a demand for benefits for tlie elderly, consider what efforts are made, what sums spent for the betterment of this and that far less worthy cause. If only childhood and middle age are worthy of attention and outlay, then why the great acclaim for longevity? Only in very primitive societies where there is no appreciable lasting contribution made by any generation can it be considered ethical that the elderly, who have made their contribution, should be regarded as less worthy of consideration than the young, who have yet to make theirs. Besides, if prevention of old age's ailments becomes as stressed and successful as is hoped, the time should come when the elderly will require less and less special care. Though the new insight into the situation of us older citizens is as yet slow in growing, there is already enough evidence of it to warrant the prophecy that within the next ten years the medical care here spoken of will have an assured beginning. And those of any age group who expect to be elderly should not fail to realize that whatever better things accrue to us will also be assured to them. The matter of desirable housing for the elderly has already been widely taken into account; much improvement has already been made and much more is being planned for. As we have already pointed out, remaining in their own homes or in rented quarters which they have long occupied is practically always best for the elderly. But this will always prove impossible for many of us; and since living with children or grandchildren is no longer considered the best and almost only 283

Aging in Minnesota means for providing us with homes, as was the case for so many generations, other means of housing are being provided. Old people's homes, rest homes, nursing homes, and the like have already progressed far beyond the poorhouse of the past and even the county homes of more recent times. But such homes are still only in part what is needed and should be provided for, even with state supervision, the living standards and the comforts and proper conditions depend in a very large part upon the intelligence and good will of the owners or managers, and most of all upon their qualifications for housing and caring for the elderly. It is not to be expected that dealing with considerable numbers of elderly persons in various stages of ailments and with various temperaments will be found by any young or middle-aged person an ideal occupation, but some degree of devotion to such an undertaking there must be; for if the whole purpose concerns itself with the profits to be made, it stands to reason that nothing will be offered above and beyond legal requirements, even if these are always lived up to. The milk of human kindness is always indispensable in dealing with the elderly, exactly as it is with children, and the difference between kindly and patient care and actual coddling and "spoiling" is much the same in both cases. This is not meant to imply that all elderly persons are childish, but all elderly persons have lost some of the hardihood that in earlier years made it possible for them to withstand an atmosphere of neglect and disregard. For though many of us are still staunchly independent and bent on remaining so, we are more vulnerable in many respects, and fortitude costs us more than in our more robust days. That there are already homes that are as nearly ideal homes for the elderly as can be expected or needed, many who have spent years in such homes will readily testify. When cleanliness, warmth, good food, such care as is needed, some few means of recreation, and, above all, a pleasant and kindly atmosphere, are provided, there are not likely to be peevish complaints on the part of reasonably well-disposed occupants. There is, however, one practice in establishing homes for the elderly that should long since have been abandoned — should, in fact, never have been allowed to exist. That is the practice of using very old buildings which have been repaired and modernized to fulfill minimum re284

We Who Are Elderly quirements but which are still far from being even safe for the housing of old people. This fact has been attested tragically often in the past two or three years, when in case after case such old buildings have burned and many of the elderly inmates, especially those ill or crippled, have been burned to death, suffocated by smoke, or fatally injured in trying to escape. It is of course part of the generally lessened regard for life that has kept public protest against such occurrences from becoming so strong that all such buildings have been abandoned. No doubt there are those who do not regard the death of an elderly person as particularly lamentable, but it would be hard to believe that any normal person would sanction the placing of the elderly in hazardous situations where they are easily victimized. It is hardly plausible that the ordinary American shares the attitude of more primitive peoples that the elderly are not only expendable but to be got out of the way whenever practicable. Plans for housing in smaller units for those still able to care for themselves in homes made especially convenient have already been discussed, and these plans too are under consideration and to some extent in operation. It should again be noted that such housing gives the elderly the opportunity for continued activity and interest in work, so important to their health and well-being. It should be pointed out that "occupational therapy" should also be a feature of the institutional homes, which is now seldom true of even the best of these. Some part of the day should have its regular duties in some useful form of work, even for those not in good health. The value of occupational therapy has not yet been sufficiently recognized and stressed. It is also very desirable that every elderly person have some daily exercise in the open air, except of course in weathers or climates which forbid this at times. Those able to do so should walk about outdoors for a certain length of time, and those not so able should at least be taken for a short ride in the open. When possible, the able can enjoy their exercise more if they aid the less able in this respect. To women, even the extremely elderly, the care of their own rooms or possessions is generally a pleasant duty if not beyond their strength. A vegetative existence is never a wholesome one even when found tempting by some. It cannot be stressed too much that longevity is not in itself a supreme good or an unmixed blessing for either the individual or society. 285

Aging in Minnesota Nor is it enough to hail with great acclaim the feat of living beyond the hundred-year mark. If increased life expectancy and longevity are to be hailed as actual advances in our land, then these must mean not mere lengthened existence but actual living, with reasonable health, security, comfort, continued interest, activity, and accomplishment which means some degree of usefulness. To make this possible for us we ask the aid of those who expect presently to take our places. Mention has already been made of the complaints of many employed persons, both men and women, that they are being discriminated against because of age, this particularly after age sixty-five, though in some cases as early as age forty. Women who were eagerly welcomed into jobs in factories, stores, and offices and have given their best in services for ten, fifteen, or more years are now finding themselves replaced or denied advancement in favor of younger women. Various reasons are being given, where any are given at all. They have to do with supposed public preferences, with the preferences of managers and fellow workers, and with vague references to "policies." What is particularly galling to women so ousted or passed over is that the younger women are not only inexperienced but also generally far more easy-going and less conscientious, and that they often start at wage levels that the elder worker reached only after years of painstaking efforts to make themselves more efficient. As to the preference for the young women on the part of the public, this is hard to credit, since younger salesladies, for instance, are far less accommodating as well as far less experienced in giving the customer what he or she wants. Managers may indeed find the younger woman more pliant and less inclined to voice her opinions, but unless the elder employee assumes too much authority, it would seem that her experience would be regarded as having some weight in decisions, unless the man or woman manager is the type who will not yield a point no matter what the evidence. Whether it is absolutely necessary or not for the older employee to continue working should not enter into the question. It can be assumed that the woman who works does so because she finds it advisable to do so; and in the case of the older woman home duties are probably not being neglected, this being much more likely to be true in the case of the younger woman. Many older women prefer to stay on the job until they become eligible for social security payments, or for an increase in the size of them, or until they have accumulated 286

We Who Are Elderly enough savings to insure reasonable financial security for their old age. In some cases the dismissal of older men clearly has to do with avoidance of old-age pension payments. In other cases a younger man may be available at a lower salary than the elderly man has worked up to. Also in many cases younger workers can be speeded up much better than the elderly, and where the processes are routine, as on an assembly line, speed, of course, counts in profits. In all cases the younger worker should take some thought about replacing an elderly worker who is being forced out; for nothing is more certain than that youth will turn into age, in what often seems a very short tune, so that here again self-interest should suggest the need of establishing fairer practices in regard to elderly workers. All in all, it would seem that this is a matter in which the now powerful labor unions might well take action to secure fairer practices regarding tenure for the elderly worker who wishes it and who can still give satisfactory service. That for the elderly worker some adjustments are advisable as to working hours, difficulty of the work, slowing up to save him from undue strain, and sparing him from having to compete with much younger workers, has long been conceded. Nor should such adjustments be begrudged, for the elderly worker often makes up, by careful and efficient service, for special consideration. Here and there a farsighted and fainninded employer has already established a system of keeping elderly workers under conditions that do not overtax them. That such an employer is to be highly commended, and most often is, goes without saying. But such still-rare instances offer no solution for the great mass of elderly workers unwilling or unable to retire. Nor does a compulsory pension plan solve the problem, since, as has been pointed out, it often results in the dismissal of the worker before the pension is due. Some sort of tenure, such as obtains in some of the professions and in the civil service, would seem to be what is needed. In everything that has to do with making old age a time of living, not merely existing, the matter of an assured and adequate income ranks next to that of health, and indeed often conditions health. Perhaps the worker forced to retire and deprived of his earning power would still feel it possible in the manners we have already discussed in an earlier section to find interests and occupations in new ways and 287

Aging in Minnesota so remain a reasonably satisfied person, healthy in body and mind, if he had an assured adequate income. Such an income must now, however, be considerably greater than what would have sufficed in the days when many of us were carefully saving for old age, since as we have said, savings which would have then been ample for some ten or twenty years will now be exhausted in a fourth of that time, unless replenished by additional income. For this situation there is no help for those of us who are no longer earners, unless inflation is stopped or added income supplied us. And nowhere does inflation make itself felt more grievously for those living on savings with too little added income than in the inflated costs of medical services and hospitalization. The consequence of this is that the elderly couple owning their house and reasonably well fixed financially can, in the event of the serious illness of either of them, be plunged into acute worry about their ability, or more often inability, to pay for medical services needed. Far too often such services are foregone or are limited to what is too evidently absolutely necessary, so that ailments not at first serious become so for lack of remedying, and always there is further damage to health through acute worry and resentment. The much-debated KingAnderson bill should give needed aid to those of us under social security. Social security payments, gradually increased and extended to greater numbers, are in many ways an amelioration. But they are still usually too meager to provide adequate income, and need to be supplemented by savings or incomes from other sources. Were inflation eliminated and social security payments substantially increased, the matter of adequate income would be solved for many of us. But there are still great numbers of us who were born too soon to be eligible for the benefits of social security, though we certainly worked enough and earned enough to be entitled to them. If, in addition, we were also born too soon to be included in pension systems such as now prevail in many professions, there is for us, when our savings are exhausted, no alternative except Old Age Assistance. Fortunately, once the reluctance to accept this means, especially where the stigma of charity itself attaches to it, is overcome, the allowance made is in most states sufficient to keep the elderly recipients in reasonable comfort. Fortunately too, the attitude of welfare boards and their workers has been considerably changed in recent years so that there 288

We Who Are Elderly is no begrudging the payment of such funds as are available and allowable to those in need of them. There is, on the other hand, evidence of begrudging and unwillingness to take an enlightened attitude regarding assistance payments among many state legislators. This is clearly demonstrated when legislators, generally those from rural sections, insist on maintaining the lien law, which is a form of mortgage placed on the homes of those who own their houses but are in need of an income, the only difference between this and an ordinary mortgage being that this mortgage does not fall due until after the death of the owner and there are no interest payments. The refusal of legislators to repeal lien laws in states where they exist is by their own declaration based largely on the contention that children who would normally inherit the house should be compelled to support their parents. Efforts to remind such legislators that their contention is in direct opposition to the accepted principle which largely activated the establishment of Old Age Assistance, namely that parents should not be forced to be dependent upon their children for subsistence in old age, is brushed aside. Some legislators also cling to the old argument that those who know that it will involve the mortgaging of their homes will abstain from asking for the assistance, thus saving the county and state considerable amounts of money. It need hardly be pointed out that this argument is a survival of the unenlightened attitude of the past that any and all who were not able to live on their own means were paupers and that it was right and proper for the community to take any means to avoid the expense of caring for them. Certainly both of these arguments bear little resemblance to the announced noble purpose of Old Age Assistance as declaimed at its establishment, that of giving to the elderly independence and freedom from want as a payment due them for their years of serving society in one capacity or another. It is ironic that those who declaimed the loudest about the honor and concern due the elderly because of their services to the state and the nation were in some instances the first to sanction the lien law and will in all probability be the last to allow its repeal. What should in all fairness have been done at the establishment of social security should of course have been to include in its benefits all those whose earning power was then already lost, and so remove one 289

Aging in Minnesota disadvantage of our having been born too soon. Finally, it is something to think about and wonder at that the United States with all its wealth cannot afford to do what little Sweden does — pay every citizen over sixty-five an old-age pension, with no strings attached. As we have already mentioned, one of the difficulties encountered by those of us who live in our own homes is that of securing needed services for improvements and repairs, where because of our incapacities or/and the new complexities of things we use, we are unable to conform to the modern do-it-yourself practices. When need arises for skilled services we are, indeed, confronted with two difficulties, that of securing a man, or sometimes a woman, who will take time for the small service we may be needing and that of the excessive charge we must expect to meet if service is obtained. Thus we must, in some localities, expect to pay the union-fixed minimum charge of $6.40 to have a leaking faucet repaired, a job requiring some fifteen minutes of work and a small new part, costing, we are told, two dollars. Much the same is true when relatively unskilled labor is needed and must be paid for by the hour. We who recall the days when a semi-skilled and experienced carpenter worked at building a house at a daily wage less than that now asked by the unskilled laborer for one hour's work, cannot but rebel against inflation and what it does to our limited funds. But since now there are numbers of both skilled and unskilled elderly workers who have been forced out of their jobs or have willingly retired but are still interested in part-time work which would give them something to do and also add to their income, why should it not be possible to make one good out of two evils? Why should it not be possible to establish centers in cities and towns and even suburbs and rural communities where those wanting part-time jobs could be reached by those of us needing their services? Such labor pools should not interfere perceptibly with regular union labor, or if they did, why should they be prohibited for that reason? After all, monopolies which become inimical to the general good are supposed to be illegal. Labor pools could be formed for both men and women workers no longer regularly employed, with not much more than mere registration required. Contacts and agreements could then be made between those needing specific services and those willing to give them at charges determined by the nature of the job. To know where we could get the help of women in times of stress, for temporary nursing or household 290

We Who Are Elderly help or cooking or sewing or even temporary baby-sitting with elderly invalids, would relieve many of us of undue hardships and anxieties. And those of us who take pride in our homes would be happy to have improvements made if we could afford the cost. Incidentally, even with inflation, the cost of materials is far less to be dreaded than the cost of labor. Regarding recreation for us who are elderly much has been and is being done. Younger people are generally greatly impressed by what they feel must be the dreadful dullness of old age. Most of us can remember when we shared this feeling. Fortunately, many of us are so well occupied with various forms of busy-ness that we have no time to feel bored. Not that we are immune to loneliness, especially such as afflicts us when we recall the many gone who were once so much a part of our lives. And for the bedridden and shut-in much cheer is always needed. Luckily there are now many organizations, as well as individuals, who make it a large part of their concern to provide such cheer. For all of us, regardless of the number of our years or the state of our health, some recreation outside of our homes is generally needed, and it is a good sign of the energy and resourcefulness of our generation that so many organizations have been formed by us ourselves to provide the recreation we need and can enjoy, for such organizations allow of participation in programs as well as mere passive enjoyment of them. In the extreme East and West these organizations seem very numerous and constantly more so; the Central states seem to be lagging behind somewhat. When it comes to such formal entertainments as plays, concerts, and exhibitions of various sorts, many of us find attendance impossible because of lack of transportation, especially when the distances are considerable and bus service not very convenient. The late hours at which such entertainments are available is also a deterrent to many of us. Afternoon entertainments, with some special means of transportation, would solve this problem for us. For all elderly people, home entertainment must always constitute a great part of needed recreation, and for this radio and television were long ago hailed as affording the ideal solution. But as I have said, this ideal has never been realized. Dissatisfaction with programs such as they are has recently been voiced by officials of radio and television themselves. But as yet, programs that have seemed promising have 291

Aging in Minnesota generally proved to contain the same undesirable features — crude sex allure, horror, violence, crime, with, in all forms of drama, murder apparently the sine qua non. Nor have we seen any attempt, as yet, to provide programs especially adapted for the listening and viewing pleasure of the elderly. Evidently we are not likely to be counted in by either local stations or the networks as long as the wishes of the heavy advertisers remain of first concern. True, there may be some local stations and minor networks that do provide better programs. On the other hand, local stations seem to be particularly ready to discontinue, always without any forewarning or explanation, just such network programs as we elderly listeners and viewers have come to enjoy. An encouraging sign of the changing attitude toward us who are elderly and the desire to count us in is the number of educational courses that are being offered especially for us. Many colleges and universities, this again especially in the East, are offering courses which have to do with aging itself and the problems it poses. They deal with the changes to be expected and how to meet them so as to best avoid or ameliorate the various ailments and deteriorations, and how to adjust to old age in general. Many also offer instruction in various skills suitable for the elderly and of former or newly awakened interest to them. Besides the education they afford, such courses give opportunity for increased intercourse with those our own age and with those who share our interests, and they also foster renewed interest in life. Most of these courses are free; some are paid for with scholarships given the elderly. The chief drawback is that they are generally accessible only to those who live near enough to attend them. One college, however, offers dormitory rooms and other means of living on the campus for a very moderate fee. Courses offered during the summer months are particularly attractive to the elderly. There are also great numbers of pamphlets and brochures about the problems of aging which can be secured upon request. Inquiry addressed to one's nearest college or university will bring information as to what is available of such literature, and also information regarding courses given or about to be given. Since it is already pretty well established that the elderly are as able to learn and to benefit by learning as are those in lower age brackets, the chief problem is to interest us who are elderly in continued efforts to learn; usually we can be 292

We Who Are Elderly more easily persuaded if we can attend classes composed entirely of our own age group, though there are many instances of elderly people attending regular classes and finishing both high school and college courses which, perchance, they began in earlier years but did not finish. Discussion groups are also often a stressed feature of courses offered the elderly, and such groups can sometimes be organized in one's own community, given enough of the elderly who would be interested in such a project. Anent the new view of the ability of elderly people to learn and be educated or to educate themselves, there is an amusing new twist to the old adage about teaching an old dog — namely that it is entirely possible to teach an old dog new tricks, provided that one can interest the old dog, and provided that one knows more than he does. Having now clarified and emphasized our needs and our hopes for aids, often going immensely beyond anything thus far granted us or even conceived as necessary or possible to be granted, it is time that we forestall any conclusion that what we are asking for is such care and protection as will free us from all further effort and concern about our own welfare and security. Should any such impression have been created, it is necessary only to recall that we have at every point emphasized that what we mean by being counted in is that we be considered worthy of aid to retain or regain health, mental and physical, and to conserve our self-respect and self-confidence, and our interest in life — all to the end that we may continue to contribute to society and save ourselves from becoming helpless burdens upon it. For the rest that means complete cessation of effort and concern, most of us are willing to wait for that in store for us at the end of our lives; however different our conceptions of eternity, we all must agree that it is a long enough time to afford us all the rest we shall need, even if that requires, as Kipling has phrased it, "an eon or two." True, we have now and then mentioned our contributions made in our more robust years, but never in the sense that all we now propose to do is to cash in on what is due us. But at no point have we asserted that we still possess the physical strength and endurance of the young and the middle-aged and are prepared to compete with our juniors on even terms. At every point we have confessed that even though we may still possess reasonable good health, we have not escaped the burden of the weight of the 293

Aging in Minnesota years. What we have tried to make clear in every particular is that in order to make longevity mean actual living and not merely extended existence, we must depend on concessions such as are indispensable for our well-being and our ability to cope with tasks that we are ready and willing to undertake if only they are modified and geared to our lessened strength and endurance. And let us say now that if such concessions are deemed impossible and the demand for them ridiculous because of the ever-increasing pace of material progress, which demands the full time and energy of the younger generations and which renders greater consideration of and for the elderly a mere waste of time and means, then longevity can only become more and more a tragedy for both individuals and society, and efforts should then be directed toward preventing rather than promoting it. Whatever our sense of awe before the tremendous strides of progress, we still maintain that not all progress is worth all that it costs. And we invite reconsideration of progress that costs neglect of human welfare — not to mention often the very lives of those far younger than we who are actively engaged in promoting it. Even in lesser matters, complete devotion to progress often causes complete disregard for the loss of what is invaluable and irreplaceable. We have already touched upon the matter of the value of acquired skills which have steadily been made more valuable by practice and experience. We have remarked especially upon the skills, manual and mechanical, of those born and trained in other lands, skills so ingrained and perfected that nothing but severe loss of faculties or absolute frustration can destroy them or render them useless. That such skills are allowed to go to waste through far too early discharge or retirement of elderly workers is already costing our nation dear. Many of those so skilled can still teach others even when no longer able to achieve themselves the ideal of perfection so well taught and preserved through many years. Such valuable skills are not limited to the foreign-born. Practically every worker who has been proficient in a certain kind of work for a number of years has acquired a knowhow and judgment that can be acquired in no other way. This is likewise true in the professions and the arts. Though it is true that genius can transcend the ordinary need of time and experience and arrive in a miraculously short time at a perfection unattainable by the most prolonged and painstaking effort, yet for the ordi2M

We Who Are Elderly nary man and woman it takes long and conscientious practice to achieve what is sometimes called a sixth sense, that unerring capacity for knowing the right way to produce the wanted effect. Thus, as has long been recognized, the elderly doctor may lack information about the newest methods in this and that treatment, but his store of accumulated wisdom — his sixth sense — may enable him to divine and choose the right method. That this is as true of the humblest household task as of the marvelous creations of the elderly painter, sculptor, musician, the skilled performer in any art, is known to every elderly housekeeper. In primitive societies the conserving of skills probably never went much beyond the father-to-son teaching and learning; but in civilized society the sum total of skills needs always to contain a large amount of the old to avoid costly losses through errors and misjudgments in using the new. Therefore to discard the elderly worker because he is elderly is as foolish and wasteful as old-time practices of refusing ever to trust the young. Should then the determination of retirement become not a matter of arbitrary age limits but of the desires and capacities of the elderly workers, and should it also be found wise and profitable to make the needed concessions regarding work practices, many of us in the seventy, eighty, and even ninety age brackets would choose to continue working, as do many of the self-employed. And productive labor is generally conceded to be a contribution to society, unless at some time in the future all human labor becomes, as is sometimes prophesied, a drug on the market. But if this comes to pass, the adjustment needed will certainly be far greater than that of merely making room for the elderly in the present economy. Another contribution that can be expected from us who are elderly is that of mature judgment. We have already pointed out that the young lack judgment because they have not lived long enough to acquire perspective. Intelligence is of course a necessary element in forming judgments, but intelligence is only a potential until it has been developed through exercise in scrutinizing and analyzing facts and experiences, and this is also the method by which perspective is acquired. Experience is costly in time and money and often in much more than that; therefore what it can contribute even in small degree is too valuable to waste. It has been conceded that the conservatism 295

Aging in Minnesota of the elderly is often the needed brake upon questionable ventures, not merely the drag upon progress that it is sometimes called by the too impatient. We are told that the adolescent are instinctively antagonized by the advice of their elders and their attempted control, because this is the rebellion against authority required for maturing. But it is also possible for the mature to become too impatient to concede to experience its real worth. There is a quaint Swedish adage, not translatable literally into English because of the difference in idiom, but which essentially means that the aged have lived the longest, a neat and canny reminder of the value of experience. We who are elderly can also contribute the element of continuity which links both eras and generations together. We Americans are just beginning to celebrate this and that anniversary occurring and recurring in our comparatively short history; at such times we feel the urgent need of accurate recall of the past, and nothing can so well supply this as, where still it is possible, appeal to the memories of the elderly. For records can err or be misinterpreted, but the spoken recall of the reliable elderly person who was there is authentic and living. It is not necessary to list the well-known names of the elderly statesmen and women, the discoverers and inventors, the scientists, the geniuses of mechanical and manual skills, the poets, the historians, the painters, the sculptors, the musicians, the doctors, lawyers, educators, philosophers, writers, those in high office, those who have served us in time of crisis, all of these — those happily still living and achieving and the tragically many who in recent years have, all too soon, been counted out by death — who have by their outstanding achievements conferred such honor upon age itself that the attitude toward it has changed to a very considerable degree, from disregard and even disdain to wonder and admiration. They have made old age not only respectable but, yes, glamorous. They have, moreover, given us of the rank and file of the elderly new hope and renewed self-confidence. They have made us see that to admit our age does not need to mean to bewail it; that indeed, "Though much is taken, much abides," and, finally, that our claim to be counted in is not absurd. Let us, then, who have achieved it, declare again that longevity, though certainly to be appreciated and cherished, is not in itself enough — not enough for us to be noted merely because of our age, and 296

We Who Are Elderly to receive congratulations from those in high office on our hundredth anniversary, pleasant though that may be; not enough to be interviewed in traditional fashion and asked the secret of our living so long, by a tongue-in-cheek young reporter who has not the least real interest in or respect for whatever answer we may conjure up. In short, we do not aspire to become museum pieces or antique displays. And having all of us, native-born or foreign-born, spent a required number of years to achieve all the rights and privileges of first-class citizenship, we cannot accept the dictum that by having lived an additional much greater number of years we have automatically relegated ourselves to second-class citizenship. Finally, to add to our own a professional and much more authoritative analysis of the present problems and the future possibilities of longevity, we cannot do better than to quote a part of the final paragraph of Dr. Edward J. Stieglitz's chapter, "Orientation of the Problems" in the symposium, Mental Disorders in Later Life: Tremendously increased longevity is here. It will certainly increase further. Lengthening of the life span may become either a curse or a blessing, depending upon whether longevity is associated with disabling illness or with health. The present rate at which hospitals for mental disease are admitting older patients is cause for real alarm. Chronic disablement from progressive physical disorders of later years is already a heavy social burden. But the future is not all dark. Science has explored far into the physical world about us. Application of our new knowledge has exploited many wondrous potentialities for our benefit. It is the future task of science to explore the potentialities of man himself. The full capacities of man will not be revealed until senescence is more fully understood. If medical and psychiatric guidance can make the later years of life ones of continuing maturation, the future of man should be bright indeed. The time has come at last when men are living long enough to have time to think.* Meanwhile, it is heartening indeed that every day that passes brings further news of efforts in Congress and in the country at large to aid the elderly to get the medical services so necessary for them. And while the proposed aid is for cure or amelioration and not yet for prevention of the ills of old age, the hope grows ever stronger that in but a relatively short time it will become the latter, for arguments against such measures steadily melt away before the sure sense of the informed mind and the aroused conscience that what is under*Used by special permission of the author, Dr. Edward J. Stieglitz.

297

Aging in Minnesota taken for human welfare is never unwise. It is, of course, still true that but for the ever-continuing inflation, most of us who are elderly would have been able to take care of our own welfare with the funds we had accumulated for that purpose, and we should certainly have greatly preferred to do so. Let those, then, who, far from seeking to curb inflation, are in fact increasing it by greater and greater demands for high pay and profits, be chary of crying down and opposing public expenditures to aid those who are the victims of inflation, as well as of the earlier lack of security for their savings. As for those who somewhat pridefully announce that they will manage to pay for their parents' medical needs instead of letting it become necessary for the general public to pay with increased taxes, let them remember that we did the same in our day, when it was indeed the only means of providing for our parents' needs. Pride is often a praiseworthy quality, but never when it obscures a sense of justice. Heartening, too, are the intensified and increasingly successful efforts to bring about social justice and equality of civil rights for all races, in keeping with the promises so long unkept. The future is indeed not all dark for either minorities who have long sought relief from discriminations, or for a newly recognized minority, the rapidly enlarging group of the elderly, whose problems, whether due to age itself or to present circumstances for which they have not been able to prepare themselves, need prompt solution. Not all dark either for those who must undertake the solution for their own sake as well as for the earned and merited welfare of the elderly. Even the world situation, dark as it still is, seems to many of us elderly, for whom nuclear warfare would mean if not death, at best such dislocations as would mean the end of living such as we have known it, seems now less dark. For we, still remembering our history lessons, are convinced that our country must stand its ground and regain its initiative and that its recent show of determination to that end has already had its effects. And when it comes to courage to support our country and uphold its principles, let there be no doubt that we should be counted in as first-class citizens. As for this chapter, it may be said to have served its intended purpose if it has to some degree succeeded in interpreting us, the elderly, to others and revealing us to ourselves. 298

Aging in the Future A R N O L D M. ROSE AND B E R N A R D E. N A S H

The final chapter of this book goes beyond the facts into predictions and recommendations. The predictions grow out of the studies; the recommendations are taken from among those formulated by the hundreds of persons who contributed to Minnesota's Recommendations for Action to the White House Conference on Aging. No doubt other writers would make other predictions and recommendations, but the authors could not close this volume without offering their own consideration of the future.

THIS volume has thus far presented the facts about older people in Minnesota — their characteristics, the conditions under which they live, their views of themselves and their problems, and what has been done to solve these problems. In this last brief chapter, we turn somewhat from the facts to speculate about the future of older people in the state and their needs. This speculation arises partly out of our knowledge of trends, but also partly out of our evaluation of needs. If the projection of trends into the future is hazardous, evaluating them is even more so, and thus there is room for differences of opinion regarding the contents of this last chapter. Still, we would not be giving a complete picture of the elderly in Minnesota unless we hazarded this interpretation of what is going on and what is likely to happen. The economic future: a goal. A goal to which Minnesota aspires is the fulfillment of every citizen's constitutional guarantee of freedom, independence, and equality of opportunity. In today's society, the older citizen finds this goal increasingly more elusive. The critical economic challenge is three-fold: to stimulate employment opportunities that will make possible earning sufficient income; to protect the purchasing power of the individual; and to provide financial as299

Aging in Minnesota sistance to citizens whose resources are inadequate for the maintenance of minimum standards of decency and health. Meeting these challenges requires a continuous appraisal of the trends, changes, and social forces which combine to create the problem. Population trends. Minnesota, third among the states in life expectancy, can expect a 20 per cent increase in the sixty-five-plus age group in the next twenty years. With nearly 10 per cent in this segment of the population now, Minnesota can expect over four hundred thousand elderly by 1980. This trend has serious economic implications for the future stability and vitality of our population. Intensifying the problem is the increased movement of youth from the rural areas, creating a disproportionate increase in the percentage of older persons in these areas. Another important population shift is the movement of the younger population from cities to suburbs and the related movement of older people from suburbs to cities, causing older people to constitute an ever-increasing proportion in the city centers. Thus the tax burden to keep up the city services is falling more heavily on the elderly and on the decreasing proportion of those in the productive ages; the burden is becoming so heavy that there is a danger that city services will be cut. The increasing proportion of older people in the total population, their greater longevity, their concentration in rural villages and city centers, will all tend to create new economic and social problems for the individual citizen, the city fathers, and the social planners. Income maintenance trends. An increasing number of older people are available to continue working past sixty-five. The willingness of employers to hire them is growing, too, but the jobs available are not increasing as fast as the need. The problem is accentuated by decreasing opportunities in farming and self-employment and by the displacement caused by automation. Social security, pension benefits, and individual retirement planning are raising the income of the retired, and continuation of these trends will depend on government policy, on the employers, and on the efforts of the aging themselves. Whether inflation will nullify all efforts to raise the real income level of the aging, as well as reduce the purchasing power of those on fixed incomes, will depend largely on the federal govenment's general economic policy. Government, both federal and state, also has it within its power to reduce the relative tax burden on the elderly. 300

Aging in the Future Health considerations for the future. With improvements in medical science, which have all but wiped out the acute infectious diseases (mainly pneumonia and tuberculosis) as causes of death, the health problems of the aging and aged have more and more become the chronic illnesses (cancers, heart diseases, and arthritis-rheumatism) and the physical and mental infirmities of advanced age. This is not to say that there has been a real increase in the chronic illnesses and infirmities, but merely that longer life and the control of the acute diseases now allow some old people to develop chronic illnesses and infirmities which they would never have lived to manifest before. The chronic illnesses incapacitate their victims for longer periods of time than did the acute infectious diseases, and their requirements for longer medical care make them much more costly. Older people today are more likely to be incapacitated by disease than were their counterparts in past generations, who simply died off more quickly. Incapacity and infirmity bring the need for more medical service. Thus far, efforts to control chronic diseases have been successful primarily in the area of early detection, prevention, and public education. Whether science will discover surer cures for chronic diseases cannot be said, but research has been greatly increased in this field. Geriatric research has continuously increased the possible span of life, and not merely the actual length of life. The problems, of course, are to assure that longevity doesn't simply give old people a longer period of incapacity and to provide proper care for those who are incapacitated. Restorative and rehabilitative services are improving and are now more available. But the expansion of these services thus far has been limited by cost and lack of trained personnel. Whether they will continue to increase to meet the growing needs of the entire aged population will depend on various factors, but principally those affecting the income available to the elderly. Most directly relevant here is the possibility of expanding health insurance to cover these costs. There is some evidence that the population as a whole is becoming somewhat more aware of their personal needs for health insurance. But this does not include those who are already retired with modest incomes, nor will it ever cover a certain proportion of the population which does not purchase adequate health insurance voluntarily. Even more serious is the fact that most private health insurance companies 301

Aging in Minnesota find that they have to pay a very disproportionate share of their benefits to those over sixty-five and that they have to increase the premiums charged of younger persons to a point where it might not be worth while for those under fifty to take out health insurance. The question is now being publicly raised whether private health insurance plans can meet the growing requirements for medical and personal services caused by the chronic and incapacitating diseases. The answer seems to be in a combination of compulsory health insurance and government subsidy, and this has become a political issue to be solved, or not solved, by political means. Social services. With industrial development, people meet new challenges to their rights, dignity, and individuality. Most of these challenges can be met through individual initiative, whereas others are most efficiently resolved through collective action. It is the collective action — the social institutions created by man for fellow man — that concerns us here. Most of us acknowledge that social progress too frequently lags behind technological progress and that it is the result of an aroused social conscience in regard to problems created by technological progress and economic fluctuation. Unfortunately this conscience is not universally aroused, because of such restrictions as inadequacies in cultural background, lack of native ability, or events in a person's life which limit his opportunity to attain the good life within our society. It has been observed that the revered "All men are created equal" is true only as an expression of the right to equality in life, liberty, and the pursuit of happiness. Society is responsible for the creation of these equal opportunities and does so through its institutions. From these premises it follows that the goal of social services is not only to satisfy the common human needs of the underprivileged, but also to create opportunities for all people to maximize their potential. Many existing programs and services are based upon an emotion that regards older persons as dependent, deficient, and despondent. We hope that our future society will emphasize their potential, respect their pride, and protect their principles. They must not be viewed as a minority group requiring unique services, but as a group whose usefulness has been hampered by external influences and whom society has overlooked in both social and physical planning. This implies several mandates for future action: 302

Aging in the Future 1. Communities should be urged to recognize the special needs of older people. Insofar as possible these needs should be met by existing agencies serving the total population. Agencies must examine and, if necessary, improve the adequacy and availability of then* services for older people. Older persons should be brought into the total process of community education and the development of necessary programs. 2. Local agencies should help families to make the best of their own resources, encouraging them to sustain the normal relations between aged parents and adult children, and planning on the basis of the over-all needs of each family and all its members. 3. Any community service that enables older people to remain in their own homes should be supported. Each community and county should recognize the growing demand for as well as the economic and psychological advantages of developing housekeeper services, domestic aid services, meals on wheels, and visiting health service to help older people to stay in their own homes longer. 4. There should be more adult foster homes for those who are no longer able to live in their own homes but do not require the special care offered by institutions. By foster homes we mean residential settings for one or two non-related persons who are accepted as part of the foster family. The residents receive personal service, but not service ordinarily given by such trained personnel as registered nurses. 5. A friendly visiting program should be developed, as appropriate, in each community of the state. All studies of the needs of older persons have stressed that a substantial number are tragically lonely and isolated, hungering for at least a minimum of personal and human association. For these, the customary links with friends and family have fallen away or eroded with disuse. 6. We should have a concerted effort on all fronts — mass communication and all levels of education — to provide facts which will change attitudes toward aging. Like everyone else, older people need affection, respect, status, security, and independence. In our society, which emphasizes youth, materialism, and productivity, these needs are not being met. The problem of housing. It is most often desirable to help older persons to live in their own homes or in close association with the fam303

Aging in Minnesota Hies of their adult children. Several sets of circumstances, however, can make this impractical or undesirable: The home of the older person or couple may be too large, too old-fashioned, too deteriorated, or too poorly located for wholesome living. The home of adult offspring may be so far away from the original residence of the older person that moving there would cut off most social contacts for the elderly parent. The family of the adult offspring, or their relation with the older person, may be so disrupted or so charged with conflict that it would benefit neither the parent nor the offspring to live together. When older people choose to move or are obliged to move from a family residence, the new housing should be especially adapted to their needs. A great deal is now known about the kind of housing best suited to the needs of older people, but thus far very few examples of such housing are available in most communities. Much more construction of good housing — financed partly or wholly by government, by philanthropic foundations, by churches, by unions, by fraternal organizations, by cooperative associations, or by the older people themselves— is necessary before the current needs can be met. The best informed sources of knowledge should be consulted before such housing is constructed. The new housing should have at least the following: a location near shopping, health, and recreational centers or near public transportation leading to them; a neighborhood containing persons of all ages, but with a somewhat greater number of older people in it; a residence as part of a project in which there are common meeting rooms and common recreation facilities; housing which does not depend on stairs for access, which accommodates wheelchairs, which provides special safety features (for example, grab bars, no slippery floors, emergency alarms), which is just large enough to meet the needs of the older person or couple and not so large that it becomes a burden to keep up, which is furnished with the treasured items from the person's previous household but supplemented with modern equipment. Social services should be planned along with the housing: housekeeper service, domestic aid services, meals on wheels, visiting health services. None of the above applies to that minority among the elderly (about 5 per cent in Minnesota at the present, but likely to grow) who are not physically able to live by themselves or in the homes of relatives. Their housing may be hospitals (including mental hospitals), 304

Aging in the Future nursing homes, boarding homes, or homes for the aged. Physical and social standards for these are also well known to the experts, although they are not always met in practice. It is true today that some of the elderly are living in institutions which have more medical facilities than are really required and hence are unduly expensive. For example, a large number are in general or mental hospitals who could just as well be living in suitable nursing homes. "Halfway houses" should be established for the partly rehabilitated mentally ill as stepping stones from the greatly protected environment of the state institution back into the community. In these places they would have some supervision in their living and working in the community and/or sheltered workshop. Special wings could be attached to hospitals for the care of the chronically ill who do not need the intensive treatment designed for short-time patients. All congregate housing for the aging should have facilities for physical and mental rehabilitation. It is sometimes erroneously assumed that ill or incapacitated older persons cannot be rehabilitated, whereas the fact is that they often can be, with consequent lower costs for maintenance as well as increased happiness for the patient. Education. Education is a fundamental tool in all programs concerned with aging and the aged. It is basic to knowing and understanding the process of and the adjustment to aging. It illuminates the role and needs of aging in society today. It helps younger persons to prepare for a happy and satisfying old age. It serves as a vital tool in the development of positive attitudes toward aging and the understanding and appreciation of the aged. It is necessary for training specialized personnel to serve the needs of the aging. Successful preparation for aging begins in the early years with training in reading, communication, art appreciation, vocational skills, arts and crafts, hobbies, health, foreign languages, and so on. The means of providing this education are varied, and should be selected with a view to the subject matter being taught. Certainly public schools, colleges, universities, libraries, mass media, and specially organized educational and propaganda programs should all be involved. The training and recruitment of specialized personnel needs emphasis at a time when the number of the elderly is increasing and there is a sharp upturn in public awareness of the problems of the aging and what can be done about these problems. 305

Aging in Minnesota Free-time activities. Elderly people have a surfeit of free time and little knowledge of how to use it. The future is not likely to see a reduction of free time, since any lessening of discrimination against older people in hiring is likely to be compensated for by a displacement of factory workers because of automation. The economy, the state of technology, geriatric practice, and basic cultural attitudes will determine the amount of free time available to older people. Clearly, the problem of older people's free time can be solved only by preparing them to take advantage of facilities for its wholesome use and by making these facilities available when demanded. Having free time is a privilege of a rich industrial society. Having free time in the later years, with the health to enjoy it, moreover, is a privilege of living in a society with the medical knowledge and the sanitary practices to keep most elderly people physically vigorous. Because the conditions creating free time for most elderly people are of fairly recent origin and because public awareness of the special problems of the aging is also new, society is just beginning to provide special facilities for their leisure, and much more needs to be done by both public and private groups. One of the simplest but probably most important things that can be done is to draw older people into the regular community organizations and activities. Most of these have never discriminated against the elderly, but most elderly people discriminated against them in the sense that they would not take part, even when younger, and hence do not know how to go about beginning to take part now that they are older. Organizational leaders, however, can do something to help: they can provide free rides to meetings, give assignments that can be handled at home (such as telephoning, and addressing and stuffing envelopes), make special efforts to introduce shy or proud older people to the other participants, and avoid language which might offend the puritanical among the elderly. Special recreational or educational groups for older citizens can seldom be formed by older people themselves, for the simple reason that few among them have experience in organizing and these few usually feel the least need for such special programs. Cities around the country — including Minneapolis and St. Paul — have recently created a special job requiring a skilled person to stimulate and organize recreational and educational groups for the elderly, as well as to aid them in other ways. This is usually under the sponsorship of 306

Aging in the Future the local Community Chest or equivalent private organization. Such organizations seldom exist in small cities or rural areas, and some agency of the government must take the initiative there. Minnesota has pioneered in creating such a position in its rural areas through the Five-County Community Organization Demonstration Project (fathered by the authors of this chapter). The favorable response to this experiment, from both older people and community organizations and leaders, is evidence of its usefulness and potentialities. Our funds came, without indication that they should be used for this specific purpose, from the federal government, and will continue for an additional period to come from a national private philanthropic foundation. But if the program is to be carried out on a mass basis, it appears that it must be sponsored by government — federal, state, or local, or some combination of them. The government should provide only the organizer; he should work through the existing local agencies, private and public, to stimulate the concrete programs for enjoyable and effective living in the later years. The best of these programs in cities around the country are thus far attracting only a small minority of the older people, even though the benefit to this minority may be enormous. New techniques for reaching additional persons obviously need to be developed, and this requires new ways of changing the attitudes of older people and their families. Too many old people still see themselves, and their families see them, as useless and incapable of the pleasures of recreation, community service, education, or sociability. The psychology of old age as a period of sitting in the house, waiting for death, and diverting oneself with nothing more than housework or baby-sitting needs to be changed. One category of old person for whom next to nothing has been done is the lower-class pensioned widowers, who — in their search for inexpensive lodgings and for sociability with their own kind — live in skid-row areas of the large cities. They are often confused with the disorganized and the alcoholic who live in the same areas, and middle-class people who are otherwise concerned with the problems of the aging will have nothing to do with them. Only the Salvation Army and some other fundamentalist religious organizations are willing to give them any attention. A great variety of successful activities have been organized for older 307

Aging in Minnesota people, and a great variety of successful techniques for organizing them has been worked out, although only relatively seldom have they been adequately written down so as to be useful for other potential organizers. The activities include daytime meeting places with reading matter and facilities for table games, day centers with diversified programs, neighborhood self-help groups, organized trips, classes, hobbies and their display, participation in political and civic organizations, part-time work for pay. We have mentioned the role of the community organizer in stimulating and helping to organize such programs. The techniques are not so difficult, however, or so requiring of special skills that any well-motivated and intelligent layman could not learn them in a reasonably short period of time. One kind of layman, in this sense, who should be especially interested in providing the stimulus and leadership for such activities on a local basis, is the clergy. And the church is an ideal sponsoring organization. Spiritual values can be effectively maintained in church-sponsored social and educational activities which satisfy the emotional needs of man. Clergymen are just beginning to be aware of the possibilities in community organization for the aging and in social orientation toward aging. Techniques: research and organization. Throughout this discussion we have referred to the need to develop new knowledge, test techniques, measure consequences, and to organize existing knowledge to make it generally available. Basic research — biological, psychological, and sociological — is continually needed, as is research in practical techniques. The accumulating knowledge and its dissemination will make it increasingly possible to use national policies and procedures for the attainment of social goals. On the other hand, as a result of the studies reported in this volume and other studies made throughout the country in preparation for the White House Conference on Aging, survey knowledge suggesting the scope of the problems of aging and the specific characteristics and needs of the elderly is already available. Any further calls for such general survey research during, say, the next ten years (during which time conditions may be expected to change gradually so that at its end more up-to-date surveys will become necessary) may serve only to delay social action and to avoid discharging responsibilities to the aging. Research is necessary and desirable, but it has too often been used as 308

Aging in the Future a conservative device to hinder efforts to solve social problems. Of course, the results of existing research need to be better disseminated. In speaking of organization here we do not refer to the techniques of community organization, the importance of which has already been mentioned, but of the organization of social institutions to work on the problems of aging. Currently there is a dispute between those who would use private and voluntary organizations exclusively and those who prefer solutions by government action. At least since the founding in 1956 of the Governor's Citizens Council on Aging, most Minnesotans active in the field of aging have regarded this as a foolish controversy, although some of those motivated by private or political interest insist on taking one position or the other. Both kinds of organization have their role, and sometimes one will do little or nothing unless the other stimulates it. In general, with some exceptions, private organizations are best equipped to start or experiment with new activities or to carry on activities that require a good deal of local variation, whereas government is best equipped to make tested programs available on a mass basis. Expensive programs, designed to reach a large proportion of people, are usually expected to be financed by government. The problem of income maintenance for the elderly — through social security or old age assistance — is now widely accepted as belonging in the sphere of government, although private pensions are recognized as desirable supplements. Reducing discrimination against hiring the aging can often best be done by private groups, including employers' associations, if they ever realize their opportunity; but some states have found it necessary to use statutes or education and persuasion by the executive branch (Minnesota is effectively using the latter). As suggested in the section on health, the problems of costs of medical care for the bulk of our older citizens will increasingly have to be solved through government. The organization of medical care itself can conceivably be handled by private groups of physicians, nurses, and hospitals; but if they continue to prove unable or unwilling to provide to the elderly, particularly in rural areas, services such as home care, rehabilitation, and health and nutrition education, government will sooner or later step into this field also. Providing social services, housing, and education for the elderly should continue to be the function of both private and public organ309

Aging in Minnesota izations, each performing different specific duties within their special competence. The current division of labor within these fields is a healthy one, with the only needed addition being that private groups and governments should prod each other to perform their separate tasks. Providing free-time activities is probably most often best handled by private organizations. But, as we have seen particularly with regard to rural areas, stimulation by a government-paid community organizer is often necessary if the job is to be done at all. A major measure of the success of efforts of both private and governmental organizations is the extent to which older people themselves and tlieir families take the initiative in solving their problems. This is impossible in some areas, such as maintaining income and organizing group recreational activities, but elsewhere the individual older person or his family can help a great deal. There is one problem area for the older person in our society in which all successful efforts must work through the older person himself and his family: namely, keeping up the prestige of the aging person and creating a healthy attitude toward the process of aging. Research and education on the social psychology of aging are essential here, and the principal function of private and public organizations is to make the findings of research available, through education, to the general public. It has been the task of this concluding chapter, in the light of the facts about the characteristics and conditions of Minnesota's aging and about the history of efforts to ameliorate the conditions presented in the preceding chapters, to predict the future of the aging in Minnesota and to prescribe for a happier future. Specific recommendations are contained in the pamphlet, Minnesota's Recommendations for Action, prepared as one of the publications of the Minnesota Planning Committee for the White House Conference on Aging, and in publications prepared by the federal staff for the White House Conference. The very existence of this volume and of other activities in connection with the White House Conference suggests the rapidly growing public awareness of the problems of the aging and the public's intention to do something effective about them.

310

APPENDIX AND INDEX

This page intentionally left blank

Appendix THE FIVE-COUNTY DEMONSTRATION PROJECT MATERIALS DISTRIBUTED TO LOCAL GROUPS

A. COMMUNITY COMMITTEES Purpose. The committee's job is to explore the economic, demographic, and sociological factors bearing upon the lives of older citizens in the community. In those areas of community activity in which opportunities for meaningful and enriched living are lacking, the committee's responsibility is to stimulate action on the part of existing agencies to supply the lack. Where no agency has appropriate jurisdiction, the committee's responsibility is to seek action in developing solutions. The committee's work is to be defined in terms of people, and hence studies are necessarily continuous, in keeping with the effects of changing environmental, legislative, and economic factors which influence community and individual adjustments. Finally, the committee serves as a coordinating body through which community programs designed to improve life for the aging are kept in balance, so that they meet the problems as completely as possible at the community level and eliminate duplication of services to promote the most efficient expenditure of time and funds. Simply stated, the role of the committee is study, community education and stimulation, direction of program development, and coordination of services. The committee should not engage in direct services to individuals nor should its studies include pure research. Its ultimate goal should be to incorporate its functions into an over-all council of social services which represents the community conscience for providing opportunities to satisfy the common human needs of all age groups. Procedure. Effectiveness is dependent upon conviction and the efficiency of the committee organization. Conviction stems from knowledge and knowledge from study and personal experience. Efficiency calls for clear definition of sub-committee responsibility, willingness to fulfill assignments, and the recognition of the need to study before acting. The appointment of members is the first step. Since the interest and support of all citizens and organizations will provide great assurance of success, the membership might include recreational director, health officer, superintendent of schools, welfare director, librarian, clergy, senior citizens, visiting nurse, social agencies, civic leaders, labor and industry, social security and employment, security offices, insurance agency, and housing representative. The next step is establishment of priorities and organization of sub-committees. Specify the charge to each. These should be sub-committees on health, housing, education, employment, leisure time, welfare, publicity, and public information. Survey existing resources and programs. Conduct forums for self-education; provide opportunities for citizens to express needs and make recommendations. All this is usually done by sub-committees. Involve as many as possible in decision-making. B. QUESTIONNAIRE ABOUT LOCAL SERVICES FOR THE AGING Employment. Do you have part-time jobs for people over 65; training for jobs for people over 45; special job counselors for older people; vocational rehabilitation for the handicapped older adult? Education. Do you have older-adult education courses (typing, political discussion,

313

Aging in Minnesota home budgeting, home crafts) in schools, libraries, or churches; preretirement counseling by industry, labor, or farm groups; courses in preparation for later life? Family life. Do you have counseling on family problems involving an aged person; services such as housekeeping to keep families together or to keep a person in his own home? Housing. Do you have publicly owned apartments for single older persons; single dwellings for older people with modest incomes; an adequate number of boarding homes; a sufficient number of homes for the aged; supervised foster homes for the aged? Health. Do you have desirable nursing homes; an adequate number of nursing homes; a health education program for all adults, on a regular, sustained basis; adequate facilities for the physical and social rehabilitation of the chronically ill; appropriate psychiatric assistance for the mentally ill older adult? Recreation. Do you have senior citizens' clubs for older adults; hobby shows; camping opportunities; year-round sales outlets for craft work; organized recreation within homes for the aged; an all-day community center for older people; supervised volunteer visiting of older people within their own homes and nursing homes and homes for the aged? C. OFFICERS AND COMMITTEES OF SENIOR CITIZENS' CLUBS AND THEIR DUTIES The suggested officers for a senior citizens' group are chairman, co-chairman, and secretary-treasurer. Each committee in turn also has a chairman. Program. Arrange for monthly programs. These will have to be changed as you find out the kind of entertainment that is accepted and the kind that is not. Plan with and through other community groups, such as churches who are willing to sponsor a program. Arrange in advance for the following month's meeting place. Attempt to gradually interest more of the senior citizens themselves to take part in the program. Include members of the senior age group on the committee itself as their aptitudes become known. It is imperative that programs, sponsoring groups, place of meeting, and timing of programs be arranged several months in advance. Membership. Get and maintain an up-to-date list of names of senior citizens, thenaddresses, and their telephone numbers. Get the names of prospective members from all available sources — churches, lodges, welfare offices, social security office, rest homes, physicians. Assist and encourage the addition of new members and ascertain, if possible, the reason or reasons for loss of members who previously showed an interest. Transportation. Make transportation available for members who could not otherwise attend. Assume duties usually assigned to sergeant-at-arms in other groups: arrange for seating plan, microphone equipment when needed, stage paraphernalia, and other physical properties necessary for the program. Social. Greet, introduce, and seat senior citizens at the meetings. Arrange for name cards which will probably be used at the first few meetings. Impart a feeling of as much friendliness and informality as possible, especially during the first few meetings. This committee will have a continuous function and responsibility even when other groups are presenting the program. Refreshment. Arrange for serving lunch at each meeting. When the program is taken over by an outside group, it is this committee's responsibility to make sure that that group accepts the duty of serving lunch; the committee should be notified as to when lunch will be served during the meeting so that the program can progress on schedule. Publicity. Notify the senior citizens of time and place of meetings through the local papers and radio or via mimeographed notices. Secure publicity in your local papers to influence shy old people to join and attend the meetings. D. SOME GUIDES TO THE ORGANIZATION OF SENIOR CITIZENS* CLUBS Determine the object you seek. Do you know the need for such a program in your community? Do you know the interest in such a program on the part of senior citizens?

314

Appendix Do you know the support you can expect from other groups in the community in conducting programs, sharing costs, providing transportation, providing facilities, getting publicity? This information can be secured from church groups, welfare office, social security office, nursing and rest homes, and/or through a survey of retired citizens. Use newspapers, radio, and personal contacts. Accept the jact that once you start a program you cannot withdraw without providing a substitute sponsor. Don't rely on the older people to take over responsibility for planning. Involve as many organizations as possible in sponsoring and planning. Plan and advertise programs quite a while ahead, not just between meetings. Share publicity and other honors with all groups concerned. Use publicity to the best advantage. Be cautious: don't advertise the club as one for older persons. It is more acceptable to potential members to learn that this is a group for mature or retired persons. Point out that the purposes are to make new friends, broaden horizons, and develop outside interests. Appoint a special publicity committee; publicity is as important as the program itself. Make contact with newspaper, churches, welfare offices, social security office, farm organizations, county extension office, public health nurse, veterans service officer, doctors, nursing and rest homes, etc. Have the high school art class make posters. Send notices home with schoolchildren to be given to their grandparents and other elderly relatives. Obtain free spot announcements on radio and television stations. Write the story or notice for newspapers and church bulletins. You will be more likely to get it published if the copy is already prepared. Plan good programs. Set the programs up three to six months in advance. The program committee should have elderly people among its members. The program should have group approval (be something they are familiar with or interested in) and a degree of ritual or repetition which gives continuity. It should have activities which are somewhat challenging, but provide the potential for satisfaction — in other words, get the members involved in activity; something new in which there is an uncertainty of the outcome, thus offering stimulation and challenge; variety — though not necessarily a large variety at each meeting. Some programs should provide the opportunity for recreation, some for socialization, some for education, and some for service. Resource materials for programs can be obtained from library (films, speakers, book reviews, and so on), recreation departments or school recreation directors, senior citizens themselves, community groups (garden clubs; youth groups; art, music, and theater groups), speakers (doctors, lawyers, public officials, schoolteachers). Arrange jor several types of program. Educational programs can include talks by doctors on health; nutritionists on health and diet; lawyers on wills, transfer of property, and so on; police on pedestrian safety; fire chief on fire safety; home economist on cooking, buying, home management; public officials on knowing one's local government and on current events; social security and welfare directors on resources available and other benefits. Special classes should be established for any group of ten or more desiring it such as in art, writing, civics, languages, music. Service programs should include making cancer bandages for the Red Cross; making scrapbooks for children in institutions; repairing toys and clothing for the needy; helping to maintain church or public grounds. Socialization programs should include monthly birthday parties, oldtime dances, games, trips and outings with other groups, visiting sick members. Programs can have a variety of things going on at one time to hold the interest of all members. Usually no one activity should last more than thirty minutes, unless it is a special-interest event such as a craft or class group. Use care in planning meetings. Meetings should be held near transportation, with as few stairs to climb as possible. Afternoons are preferred; older persons have more energy then, and they don't like to be out after dark. Moreover, time hangs more heavily in the afternoon. The space provided should be cheerfully decorated, large enough to accommodate dancing and games, have kitchen facilities, and offer privacy for individual interest groups.

315

Aging in Minnesota Establish rules for membership. Have a membership committee to make up a list of potential members and maintain it and handle mailings and hostessing (registration). Potential members should be personally contacted by someone familiar to them, if possible— clergymen, other elderly persons, welfare workers. Members absent more than twice should be contacted to determine the reason. It is best not to set minimum age; many persons in their fifties might wish to take part. Dues need not always be charged; a cup at the refreshment table often covers expenses. Notices of meetings must include time; place; program; expenses, if any; telephone number of person to get in touch with if additional information or transportation is needed. Hostesses should be at the door to greet each new arrival, prepare a name tag for him, introduce him to others. The meeting should start with an icebreaker. Many clever games can be found for this in books on recreation and party ideas. Have the executive or steering committee oversee the major items. It should handle arrangements (place, decorations, equipment, and sponsor); transportation (securing cars and drivers to pick up members requiring aid in getting to the meeting and home again); program; refreshments; and publicity. Remember, your attitude is contagious. Don't be overly solicitous or patronizing. Don't "do for" or "talk down to" unless necessary. Don't forget, frustrations will happen. E. PLANNING A SENIOR CITIZENS' PARTY

Form a committee. Elect a chairman. Appoint committees and chairman for arrangements, hostess, transportation, program, refreshments, publicity. Determine place, date, time. Program should include music, group participation, games, talk, movie, food. Have the date set for the next program so it can be announced at this party. Use a questionnaire to get program suggestions. Try a display and demonstration of hobbies. Advertise through churches, clubs, and posters in stores. Give prizes to oldest man and woman, the one who has traveled furthest, one with the most children, the one who has lived in the county the longest, and a door prize (not much — perhaps a silver dollar each) to one man and one woman. Have registration at door. Get name, address, birthday. Print the name in big letters on a card and pin it to dress or suit. Have a transportation committee. Advertise a telephone number to call to get a ride. Have central pick-up points such as churches, if you use buses. Make a special effort to draw shut-ins and residents of nursing homes. Pay special attention to greeting, welcoming, seating, and introducing to others. They will feel uncertain. Help them feel wanted and important.

316

Index Accident proneness, 212-14 Activities of the aged: plans for after retirement, 154, 156; facilities needed or desired, 156-62, 172-75; facilities and services provided, 157; driving, 161-62. See also Clubs; Needs of the aged; Recreation Adjustment: of the aged, 162-67; sex differences in, 167; self-concept of health as a factor in, 167-68 Adult education, 144-45 Aging process, 193-205 Aitkin County, 23, 30, 32, 52, 54, 57, 58 American Association of University Women, 75 Anoka County, 37, 38, 39, 47, 63, 64, 65, 67 Attitude toward aging, 22, 162-63, 182-90 Atwater, Althea, 15n, 16, 18 Barber, Eddice, 16, 73 Barr, Dr. Robert N., 4 Becker County, 70 Beltrami County, 71 Benton County, 23, 32, 39, 71 Big Stone County, 39, 46 Bloedow, Gerald, 17, 20-33 Board of Corrections and Charities, 2 Bond, Betty, 15n, 16 Brown County, 46, 47, 51, 53, 54, 55, 56, 59,66 Carlton County, 53, 55, 57, 60, 71 Cass County, 55, 57, 63 Characteristics of the aged: perspective, 214-15; complacency, 216; self-centeredness, 219-20; moodiness, 220; brooding, 221; garrulousness, 222-23, 252; carping, 223; intolerance, 223-24; obsessions and compulsions, 224-25; curiosity, 226; mellowing, 226-27. See also Friends Chippewa County, 53, 59 Chisago County, 37, 53, 59, 64 Church attendance, 172 Church programs: club organization, 4, 253; education for problems of aged, 6; factors in success of, 28; need for, 308

Citizens League of Minneapolis and Hennepin County, 8 Clay County, 39, 53, 60 Clearwater County, 39, 53, 55, 57, 58, 59 Clothing of aged, 276-78 Clubs: educational opportunities in, 31; social service of, 81; recreation programs in, 31, 36; social, 32, 132-33, 137-38, 270-71; activities of, 32-33, 134-35; membership in, 132-36; desire to join, 134-35. See also Church programs; Recreation Cook County, 37, 39, 42, 43, 51, 53, 54, 57, 58, 60, 66, 67, 69 Cottonwood County, 53, 71 Council of Jewish Women (Minneapolis), 6 County by County Statistical Report, 17,72 County committees on aging: selection of members, 23-25; selection of specific project by, 26-27; relation to welfare boards, 27 Dakota County, 38, 39, 55, 56, 63, 66, 67 Death, 216-19 Demonstration project on aging: 21-33, 301; selection of counties, 22-23; selection of director, 23; objectives, 26-27; results, 30-33 Depression, 233-35 Diet, 195, 238-40, 278-79 Doctors, relation of aged to, 190-91 Dodge County, 42, 53, 58, 59, 71 Douglas County, 54, 57 Downtown Foundation, 5 Duluth: 75, 76; program for aging, 4, S; proportion of aging, 37 Economic goals of the aged, 299-300 Economy, relation of the aged to, 36 Education: about the problems of the aged, 6, 8-9, 140; of the elderly, 140-47, 292-93; future needs in, 305 Employment: and retirement, 105-16, 250, 287; tenure, 105-16, 250, 287; attitudes toward, 115-16, 266-67; part time, 290; labor pools, 290-91

317

Aging in Minnesota Employment Security, Minnesota Department of, 8, 34n Factbook Sub-committee, 48-49, 62 Faith healers, 204, 206-7 Family and Children's Service agency (Minneapolis), 4 Family relationships, 125-32,170-71, 242-44 Faribault County, 47, 59, 60 Fillmore County, 40, 71 Financial security. See Income; Needs of the aged Five-county community organization demonstration project. See Demonstration project on aging Ford Foundation, 18 Fraud, 225-26 Freeborn County, 39, 52, 54, 56, 71 Freeman, Orville L., vii, 7, 15, 17 Friendship and aging, 136-38, 171-72, 220, 252-53, 271-72 Future of the aged: 175-78; research and, 180-81, 192, 308-10

Hoffman, Isaac L., vi, 34-72 Homes for the aged. See Housing; Needs of the aged Hospitals, special, for the aged, 282-83 Housing, 65-67, 283-85, 303-5. See also Living arrangements Housing, federal project, 232 Hubbard County, 39, 52, 54, 55, 57 Hursh, Morris, 15 Income: levels of, 47-58; comparison of aged with general population, 50, 58-61; breakdown by county of residence, 58-61; sources of, 61-65, 97, 168-69; maintenance of, 93-105, 300; residents in the community and institutions compared, 97; amount needed by aged, 273-74; security offered, 287-88. See also Needs of the aged Industrial Relations Center survey, 8 Inflation, 235-36, 298, 290 Inter-County Statistical Supplement, 34, 72 Isanti County, 54, 57 Itasca County, 39, 47, 52, 54, 56, 67, 69

Geriatrics, 192, 281-82 Geriatrics, 5 Gerontology, 192, 193, 281-82 Gethsemane Episcopal Church, 5 Golden Age Club, 30 Goodhue County, 59, 60 Governor's Conference on Aging (1956), 8, 9 Grant County, 39, 52, 53, 59, 66, 71 Gustavus Adolphus conferences, 14, 16 Halfway houses, 305 Hansen, Gary D., 73-181 Health: care of, 67-72; attitudes toward, 82-85; self-concept of, 167-68; care desired, 173; mental, 197-99, 204-5; physical deterioration of the aged, 199-203, 204, 237-40; future considerations, 301-2 Health and medical care: community services, 86-90; cost, 90-93, 168, 196-97; insurance, 90-93, 301-2 Health, Minnesota Board of, 2, 3 Health, Minnesota Department of, 4, 5, 6, 7 Hennepin County, 37, 39, 44, 45, 46, 52, 54, 55, 56, 64, 66, 67, 70, 71 Hennepin County Committee for Older People, 6 Hennepin County Community Chest and Council, 4 Hennepin County Welfare Board, 4 Hobbies, 153-54, 155

Jackson County, 47, 55, 56, 59, 60 Kanabec County, 46, 51, 53, 55, 57, 60, 67 Kandiyohi County, 40, 63 Kaplan, Jerome, 4, 5, 6, 7 Keep on Living! A Guidebook to Community Resources for the Senior Citizens in Minnesota, 17 King-Anderson bill, 288 Kittson County, 39 Komarek, Mrs. E. R., 16 Koochiching County, 54, 56, 64, 66 Lake County, 39, 63, 66 Lake of the Woods County, 37, 54, 57, 58, 59, 60, 64, 71 Lac qui Parle County, 53, 59 Law and Your Rights, The, 19 Legislation, 5, 7, 8 Le Sueur County, 71 Library service, 143-44 Liebman, Rabbi Joshua, 217 Lien law, 289 Life insurance, 168 Lincoln County, 53, 54, 56, 58, 59 Living arrangements, 116-25, 169-70. See also Housing Lutheran Brotherhood insurance company, 14

318

Index McClure, Ethel, 1-11 Mahnomen County, 52, 53, 59 Marital status of the aging, 127-28 Marshall County, 71 Martin County, 55, 56 Mayhood law, 5 Medicine, preventive, 281-82 Memory impairment of the aged, 204-5 Mental Disorders in Later Life (symposium), 297 Mille Lacs County, 52, 55, 57, 64, 71 Minneapolis City Council, 11 Minneapolis Council of Church Women, 4 Minneapolis Volunteer Service Bureau, 5 Minnesota Governor's Citizens Council on Aging, vi, 7, 9, 10-15, 181 Minnesota Planning Committee, 310 Minnesota's Aging Citizens, 34 Minnesota's Recommendations jor Action (pamphlet), vi, 310 Minnesota Welfare Conference, 5 Mobility of aged, 118-20 Mondale, Walter R, 19 Morale: 162-67; sex differences in, 167, 174-75 Morrison County, 23, 33, 60, 61 Mower County, 39, 52, 54, 56 Murray County, 39 Nash, Bernard E., vii, 1-11, 15, 19, 20-33, 299-310 Needs of the aged: general discussion of, 79-178, 237-53, 276-93; peace of mind, 217; security, 229-36, 287-88; health, 237-40; diet, 238-40; exercise and rest, 240; affection, understanding, 242—46; loyalty, 244; respect and pity, 246; clothing, 276-78; furniture, 278; food, 278-79; social services, 302-3. See also Housing; Income Neuman, Richard, 16 New Ulm, 67 Nicollet County, 55, 56, 59, 60, 63, 65 Nobles County, 53, 60, 61 Norman County, 53, 59 Old Age and Survivors' Insurance, 62-65, 97 Old Age Assistance: history of in Minnesota, 3-11; local organizations, 21-22; rural programs, 22-25, 28-29; as income source, 61-64, 97, 236, 288-89; health care of recipients, 67-72 Old age pension, Swedish, 290 Olmsted County, 39, 43, 52, 55, 56, 63, 67

Organizations to study aging, public vs. private, 309 Otter Tail County, 40, 64 Pine County, 52, 54, 57, 67 Planning for the future. See Income maintenance Plus-65 Committee, 6 Polk County, 53, 60 Poorhouses, 2, 3 Population of the aged: distribution in Minnesota, 35-36; comparison of Minnesota with other states, 37; percentage of total population, 38-40, 275; trends, 40, 300; age ranges, 40-42; sex ratio, 42-44 Preventive medicine, 281-82 Problem groups among the aged: farmers, 248-49; town and city dwellers, 249-50; professionals and those in the arts, 250; elderly women, 250-51; homeowners, 251 Public Welfare, Minnesota Department of, 6, 7, 8, 25, 34n, 181 Purchasing power of the aged, 276 Ramsey County, 37, 38, 39, 44, 45, 46, 47, 52, 54, 55, 56, 64, 66, 67, 71 Rang, Frank, Jr., 17 Recreation: 81-82, 147-54, 178-79, 253-74, 291-92, 306-8; free-time activities, 14754; what can be enjoyed, 150, 253-54, 271-72; activities not desired by aged, 152; hobbies, 153, 268; program-planning, 178-79; reading, 254-59; poetry, 257-58; drama, 259-60; music, 260-61; radio and television, 261-62; art, 262-63; dancing, 264; games, 264-65; travel, 265; housekeeping and other work, 266-67; shopping, 267; gardening, 268-69; bird-watching, 269-70; acquiring new skills, 271; future goals, 306-8. See also Activities of the aged; Church programs; Clubs Red Lake County, 37, 52, 54, 57, 64 Redwood County, 53, 59 Regional conferences on aging, 14-16, 18 Religion, 133, 138-40, 218-19 Religion and aging, background paper on, 139 Religion, church-sponsored social activities. See Church programs Research, future needs and possibilities, 180-81, 192, 308-10 Residence, urban-rural distribution, 44-47 Retired Teachers Association, 16

319

Aging in Minnesota Retirement and employment, 105-16, 250, 287. See also Employment Rock County, 39, 63 Rose, Arnold M., v-vii, 12-20, 73, 299-310 Roseau County, 52 St. Joseph's Hospital (St. Paul), 2 St. Louis County, 37, 52, 60, 61, 66, 67 St. Louis County Welfare Board, 6 St. Paul Fire and Marine insurance company, 16 Schooling. See Education Scott County, 63 Sherburne County, 23, 32, 55, 57, 58, 60, 61 Social Activities. See Recreation Social change and aging, 126 Social Security, v, 3, 86, 97, 100-5, 235-36, 288-89 Social Security, hospital coverage under, 86 Social services, 302-3 Special Consultant on Aging, 21-22 Special Staff on Aging, U.S. Department of Health, Education and Welfare, 21 Stamats, Esther, 19 Statistical Supplement (county data), 72 Stearns County, 23, 32, 39, 53, 60 Stevens County, 39, 47, 63 Stieglitz, Dr. Edward J., 297 Structure of project, 24 Swedish old age pension, 290 Swenson, Wendell, 16 Swift County, 53, 59 Swindlers. See Fraud Taves, Marvin, vi, 17, 73-181

Taxation, Department of, 34n Thomason, Aldena Carlson, 182-298 Tibbitts, Clark, 19 Todd County, 52, 53, 55, 57, 58, 59 Townsend, Francis, v Traits of the aged. See Characteristics of the aged University of Minnesota: school of social work, 4; hospitals, 5; center for continuation study, 6; industrial relations center, 8; extension division, 9 Variety Club of Minneapolis, 5 Volunteers, 25, 29-30 Voting strength of the aged, 275-76 Wabasha County, 59, 60 Wadena County, 54, 55, 57, 60, 61, 64, 71 Walker, Mrs. Walter W., 15n, 16 Washington County, 38, 39, 52, 53, 60, 61 Watonwan County, 60, 61 White House Conference, Background Paper on Religion and Aging, 139 White House Conference on Aging (1960), Minnesota's preparation for, v, 12-15, 310 White House Conference on Aging (1961), 1, 34, 308 White House Conference on Aging, Minnesota Planning Committee, 15-20, 25 Wilkin County, 39, 46, 54, 55, 56 Winona County, 52, 60, 61 Work. See Employment

320