July 17, 2010 3:18 am

Pioneering doctor who championed dignity for the elderly

Robert Butler revolutionised western attitudes to old age, coining the word “ageism” to describe what he saw as systematic discrimination against the elderly in modern western society, particularly in his native US. For more than 50 years he fought to overturn what he called “the quiet despair, deprivation, desolation and muted rage that go with growing old” and to replace it with dignity, respect and fulfilment for the ageing.

Butler noted that, during the 20th century, the average life expectancy of Americans had soared by a stunning 30 years – from 47 years in 1900 to 77 in 2000. It was the fastest rise in history. All well and good, he said, except that the structure of society, including our medical services, was in no way prepared for the changes such longevity would bring.

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In his last book, The Longevity Revolution, published in 2008, he pointed out that, in the US, a baby boomer turns 50 every 7.6 seconds, creating a mass demographic shift. “When the baby boomers hit Golden Pond, things are gonna have to change,” he said.

Ageing, he said, was “the neglected stepchild of the human life cycle”, with the elderly often considered useless and shunted off to “warehouse-like” nursing homes staffed by undertrained carers and seen by doctors ignorant of their special needs. He described how, after hurricane Katrina hit New Orleans in 2005, elderly victims had been “invisible” to rescue workers, “left to sit in their own excrement for days while priority was given to saving people’s pets”.

His passionate support for the elderly was rooted in the fact that he was in effect orphaned at the age of 11 months and brought up by his grandparents. During his long career he founded the US National Institute on Aging, set up the nation’s first geriatrics department at the Mount Sinai Medical Center in his native New York City, founded the International Longevity Center and served as adviser on ageing to the last three US presidents and to the World Health Organisation.

It was he who first reached the conclusion that most frailties of the elderly were caused not by age itself but by disease, socioeconomic circumstances or even personality issues. Ageing was a risk factor for senility and Alzheimer’s disease but not the cause. In his books, he talked about “Life Review”, a therapeutic method that says we should encourage older people to reminisce about their lives rather than dismissing their memories as “senile ramblings”.

“Bob” Butler won the coveted Pulitzer prize (non-fiction category) in 1976 for his breakthrough book, Why Survive? Being Old in America, in which he wrote: “We have shaped a society which is extremely harsh to live in when one is old. The tragedy of old age is not the fact that each of us must grow old and die but that the process of doing so has been made unnecessarily and at times excruciatingly painful, humiliating, debilitating and isolating through insensitivity, ignorance and poverty.

In the same year he and his wife, the social worker Myrna Lewis, wrote a sex manual entitled Sex After 60, providing tips on how to continue enjoying lovemaking. At first considered shocking – “Granny having sex? That’s disgusting” was the gist of the initial reaction – it went on to become a best seller and has been reprinted 25 times, latterly with the softer title The New Love and Sex After 60.

Robert Neil Butler was born in Manhattan in 1927, but that same year his parents split up and he was sent to his maternal grandparents’ chicken farm in Vineland, New Jersey. It was his grandfather who gave young Robert his first taste of medical care by letting him tend to sick birds in the chicken shed’s “hospital wing”.

When he was seven, his grandfather died and Robert and his grandmother, almost 60, were forced to live in a seedy hotel room. They lived on government handouts and food during the Great Depression, with his grandmother earning a pittance as a seamstress. When the hotel burnt down, they lost the few possessions they had but Robert had already decided he wanted to become a doctor.

In Why Survive? he wrote: “What I remember even more than the hardships of those years was my grandmother’s triumphant spirit and determination. Experiencing at first hand an older person’s struggle to survive, I was myself helped to survive.”

After a spell with the volunteer US Maritime Service, Butler attended Columbia University, taking an MD in 1953. During postgraduate studies at the University of California and the National Institute of Mental Health in Bethesda, he was appalled by the callous lack of interest and even contempt shown towards the elderly by many of his professors. Older people were often described as “crocks”.

In 1968, residents of his neighbourhood protested against a plan to provide housing for the elderly. “There was no term to explain this prejudice, and so I decided, analogous to the terms sexism and racism, we could use a new useful term, which I called ageism,” he said. He featured prominently in last year’s highly acclaimed international documentary I Remember Better When I Paint, by film-maker Berna Huebner, which examines the positive impact of art on people with Alzheimer’s.

Butler never retired and was working a 60-hour week until three days before he died. “The R-word is a very bad word because if you’re retired, the implication is you’re really no longer a part of society and you’re not a going concern. I do not recommend retirement to anybody. I say they should retire to something.”

He is survived by three daughters from his first marriage, another from his second marriage, to Myrna Lewis, who died in 2005.

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