of the 1.3 million hip fractures that occur annually. Hip fractures, in turn, often result in premature death or increased dependence. A number of age-related factors have been implicated in injuries among the elderly: poor eyesight and hearing, arthritis, neurological diseases, and poor coordination and balance. In addition, medications and preoccupation with personal problems may result in distractions or drowsiness that leads to injury. Environmental factors such as poor lighting, uneven floor surfaces, and lack of safety equipment also increase the risk of injury. Most of these risk factors can be reduced by modifying the home environment, monitoring drug usage, and training people to compensate for physical limitations.

Oral health is a neglected area of care for the elderly, even though loss of teeth and oral disease are among the most common impairments in late adulthood. The impact of these impairments on personal health and on psychological and social well-being often goes unappreciated. Difficulty in eating and speech limitations are two examples of how dental impairments can exacerbate existing physical and mental conditions. The importance of preventive dental care for the elderly warrants much greater consideration from service planners.

Although about two-thirds of nursing home residents have a mental disorder (National Center for Health Statistics, 1989b), the role that mental impairment plays in the occurrence of disability among the elderly, as well as among younger segments of the population, is an important area for continued investigation (box follows). The research conducted thus far suggests a strong correlation between physically disabling conditions and mental illness, especially depression. Wells and colleagues (1989) found that, compared with patients with physical disorders only, depressed patients reported greater bodily pain, had a lower perception of their health status, and performed more poorly in physical and social activities. Poor functioning attributed solely to depressive symptoms was comparable to the level of functioning associated with cancer, cardiovascular disease, and six other major chronic conditions. Given that the likelihood of depression is high among elderly people who have a physical illness, these findings underscore the potential health benefits that are likely to result from the provision of appropriate mental health services. Research strongly indicates that depressed older adults are very responsive to interventions, especially those that focus on fostering socially supportive contacts and activities (U.S. Department of Health and Human Services, 1988b).

As mentioned above and discussed in a recent IOM report (1990b), social isolation is considered an important risk factor in the development of disease and disability. A consideration of social isolation usually occurs in the context of social support, and both concepts are often used interchangeably.

Clearly, many simple interventions can have a broad, positive impact on the health of the elderly. Yet despite advances made in clinical research



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