The Aging Revolution: Growing old in America becoming more dignified, but with senior population booming, is nation’s health system prepared?

A half-century after renowned gerontologist, psychiatrist and author Dr. Robert Butler ridiculed the nation’s medical establishment for ignoring the suffering of older Americans, Northwell Health today announced the publication of The Aging Revolution: The History of Geriatric Health Care and What Really Matters to Older Adults, which chronicles the significant advancements made in improving the physical and emotional health of the nation’s rapidly aging population.

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The cover of the new book The Aging Revolution: The History of Geriatric Health Care and What Really Matters to Older Adults, (Credit: Northwell Health)

Coauthored by Northwell Health President & CEO Michael Dowling, author Charles Kenney and Maria Torroella Carney, MD, Northwell’s chief of geriatrics and palliative medicine, the book describes the remarkable advocacy efforts of Butler, and other geriatricians and clinicians in recent decades in overcoming longstanding, systemic discriminatory practices against older people that were pervasive within the medical community. The apathy often resulted in inferior care for aging adults who frequently struggled with multiple chronic conditions that were largely ignored by physicians, who saw pain and suffering as inevitable to the aging process.

The book, published by Skyhorse Publishing, analyzes the social action movements since the 1970s that have dramatically improved the quality of life and life expectancy of adults.

While better prepared than it was decades ago, America’s health system is still hampered by shortages of primary care physicians and geriatricians who specialize in the needs of older adults and those with multiple chronic and serious illnesses. Those gaps will continue to challenge the nation’s ability to meet the needs of roughly 62 million adults age 65 and over who now account for 18 percent of the US population – a number that is projected to climb to 84 million by 2054 (23 percent of the population).

If history can serve as a guide for how to meet that challenge, the advancements in geriatric and palliative medical skills and models of care over the past half-century provide a pathway forward. Among the initiatives that turned the tide were:

• A new focus on preventing falls that continue to kill more than 32,000 people age 65 and over every year and injure millions of others.
• The emergence and expansion of palliative care programs to manage patients’ pain and improve quality of life, a specialized medical practice that has spread to nearly every US health system.
• The creation and expansion of “age-friendly health systems” that put a premium on four evidence-based elements of high-quality care – What Matters, Medication, Mentation and Mobility (known as the “4Ms”). Northwell earned an age-friendly designation in 2020, in part because of the exceptional clinical care, research and education programs initiated by the health system’s Division of Geriatrics and Palliative Medicine.
• US Centers for Medicare and Medicaid Services’ (CMS) policy changes that reimburse providers for caring of frail older adults in their homes instead of hospitals or nursing homes.
• New methods for identifying and preventing delirium, a common disorder among seriously ill and hospitalized older adults that adversely impacts patients’ brain functions, causing major confusion, lack of awareness, hallucinations and mood changes.
• New initiatives that train, partially compensate and support millions of family caregivers tending to loved ones in the home.

The Aging Revolution recounts one of the most significant periods of improvement in American medical history, and the policy changes and payment reforms that accompanied it, relying on interviews with some of the pioneering clinicians whose ideas and innovations helped transform care to the fastest-growing demographic in America -- those age 65 and over. They were disciples of Butler, the first director of the National Institute on Aging (now celebrating its 50^th anniversary), who The New York Times described as “the man who saw old age anew.” In his 1975 book, Why Survive: Being Old in America, Butler – who died in 2010 – argued that old age for many people had become “a period of quiet despair. . . and muted rage” and he launched a social movement to mitigate it.

Thanks to the advocacy of Butler and others featured in the book, chronic conditions that accompany older age are now far more manageable, allowing individuals to enjoy longer, healthier lives so they can continue their work and professional development, education, leisure, travel and physical activity, while spending quality time with their families and loved ones. Among the contributors to the aging revolution who were interviewed at length for the book are:

• Mary Tinetti, MD, professor of medicine and the Institution for Social and Policy studies at the Yale University School of Medicine, whose groundbreaking research placed a spotlight on the epidemic of falls among older adults and helped identify fall injury risk factors and prevention solutions.
• Sharon Inouye, MD, director of the Aging Brain Center at Hebrew SeniorLife’s Hinda and Arthur Marcus Institute for Aging Research, professor of medicine at Harvard Medical School, and editor in chief of JAMA (Journal of the American Medical Association) Internal Medicine, who brought international attention to the terrible toll of delirium among hospitalized older adults and created a system for early identification and prevention.
• Eric De Jonge, MD, director of geriatrics at MedStar Washington Hospital Center and past president of the American Academy of Home Care Medicine, whose advocacy helped convince Congress and the Obama White House to include home care medicine provisions in the Affordable Care Act, demonstrating the benefits of caring for frail older adults in their homes.
• Kedar Mate, MD, president and CEO of the Institute for Healthcare Improvement (IHI), and Terry Fulmer, PhD, RN, FAAN, president of The John A Hartford Foundation, who helped create and expand the Age-Friendly Health Systems movement.
• Diane Meier, MD, director of the Center to Advance Palliative Care (CAPC) and professor of geriatrics and palliative medicine at the Icahn School of Medicine at Mount Sinai, and Rosemary Gibson, a senior advisor at The Hastings Institute who led national quality and patient safety initiatives at the Robert Wood Johnson Foundation, helped raise awareness of palliative care during its infancy, enabling countless patients to seek relief from pain and other symptoms of serious illness.
• Sharon Reinhard, PhD, RN, head of AARP’s Public Policy Institute, whose advocacy on behalf of family-caregivers helped alert the nation’s policymakers to the burdens facing 40 million Americans caring for ailing family members and the importance of home-based caregivers.
• Donald M. Berwick, MD, president emeritus and senior fellow at IHI, which he co-founded and led for 18 years, and former administrator of the CMS, who is regarded as one of the nation’s leading authorities on health care quality and improvement.

About the Authors:

Michael J. Dowling has been president & CEO of Northwell Health, New York’s largest health care provider and private employer, since 2002 and is recognized by Modern Healthcare magazine as one of the nation’s most influential health care leaders. He previously served in New York State government for 12 years as former Governor Mario Cuomo’s director and deputy secretary of health, education and human services, and commissioner of social services. A native of Limerick, Ireland, he was a professor of social policy and assistant dean at the Fordham University Graduate School of Social Services and director of the Fordham campus in Westchester County.

Charles Kenney is chief journalist at Northwell Health and executive editor of the Northwell Innovation Series. He is the author of many books, including The Best Practice: How the New Quality Movement Is Transforming Medicine, which The New York Times described as “the first large-scale history of the quality movement.” He serves on the faculty of the Institute for Healthcare Improvement in Boston and on the Corporation of the Belmont Hill School in Belmont, Massachusetts.

Maria Torroella Carney, MD, MACP, is chief of geriatrics and palliative medicine, and medical director for continuing care at Northwell Health. She is a professor of medicine at the Zucker School of Medicine at Hofstra/Northwell and previously served as commissioner of the Nassau County (NY) Department of Health. Trained and mentored by Drs. Robert Butler, Christine Cassel and Diane Meier, she was selected as a 2022– 2023 Health and Aging Policy Fellow and is co-chair of the New York State Master Plan on Aging’s Cognitive Health workgroup.

To purchase the book, click here.

About Northwell Health

Northwell Health is New York State’s largest health care provider and private employer, with 21 hospitals, about 900 outpatient facilities and more than 12,000 affiliated physicians. We care for over two million people annually in the New York metro area and beyond, thanks to philanthropic support from our communities. Our 85,000 employees – 18,900 nurses and 4,900 employed doctors, including members of Northwell Health Physician Partners – are working to change health care for the better. We’re making breakthroughs in medicine at the Feinstein Institutes for Medical Research. We're training the next generation of medical professionals at the visionary Donald and Barbara Zucker School of Medicine at Hofstra/Northwell and the Hofstra Northwell School of Nursing and Physician Assistant Studies. For information on our more than 100 medical specialties, visit Northwell.edu and follow us @NorthwellHealth on Facebook, X, Instagram and LinkedIn.

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