Extending Life, Enhancing Life

A National Research Agenda on Aging

Committee on a National Research Agenda on Aging

Edmund T. Lonergan, Editor

Division of Health Promotion and Disease Prevention

INSTITUTE OF MEDICINE

NATIONAL ACADEMY PRESS
Washington, D.C.
1991



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Extending Life, Enhancing Life: A National Research Agenda on Aging Extending Life, Enhancing Life A National Research Agenda on Aging Committee on a National Research Agenda on Aging Edmund T. Lonergan, Editor Division of Health Promotion and Disease Prevention INSTITUTE OF MEDICINE NATIONAL ACADEMY PRESS Washington, D.C. 1991

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Extending Life, Enhancing Life: A National Research Agenda on Aging NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W. Washington, D.C. 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competencies and with regard for appropriate balance. This report has been reviewed by a group other than the authors according to procedures approved by a Report Review Committee appointed by the members of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Support for this study was provided by the Commonwealth Fund (Grant No. 9221) and the Pew Charitable Trusts (Grant No. 86-06646-000). In all cases, the statements made and the views expressed are those of the National Academy of Sciences, Institute of Medicine, and do not reflect those of the Commonwealth Fund or the Pew Charitable Trusts. Library of Congress Cataloging-in-Publication-Data Institute of Medicine (U.S.). Committee on a National Research Agenda on Aging. Extending life, enhancing life : a national research agenda on aging / Committee on a National Research Agenda on Aging, Division of Health Promotion and Disease Prevention, Institute of Medicine : Edmund T. Lonergan, editor. p. cm. Includes bibliographical references and index. ISBN 0-309-04399-9 1. Aging—Research. 2. Aging—Research—Government policy—United States. I. Lonergan, Edmund T. II. Title. QP86.I56 1991 362.1'9897'0072073-dc20 91-2947 CIP This book is printed on acid-free recycled paper. Copyright: © 1991 by the National Academy of Sciences Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The image adopted as a logotype by the Institute of Medicine is based on a relief carving from ancient Greece, now held by the Staatlichemuseen in Berlin.

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Extending Life, Enhancing Life: A National Research Agenda on Aging Committee on a National Research Agenda on Aging *JULIUS R. KREVANS (Chair), Chancellor, University of California, San Francisco *JOHN E. AFFELDT, Medical Advisor, Beverly Enterprises, Rancho Santa Fe, California PATRICIA ARCHBOLD, Professor and Chair, Department of Family Nursing, Oregon Health Sciences University, Portland *BEN D. BARKER, Professor and Dean, School of Dentistry, University of North Carolina, Chapel Hill STANLEY J. BRODY, Emeritus Professor of Physical Medicine and Rehabilitation in Psychiatry, University of Pennsylvania Medical Center, Philadelphia ANTHONY CERAMI, Professor and Head, Laboratory of Medical Biochemistry, Rockefeller University, New York, New York VINCENT J. CRISTOFALO, Audrey Meyer Mars Professor and Director, Center for Gerontological Research, The Medical College of Pennsylvania, Philadelphia *CARROLL L. ESTES, Professor and Chair, Department of Social and Behavioral Sciences, Director, Institute of Health and Aging, University of California, San Francisco CALEB FINCH, Arco/William S. Kieschnick Professor in the Neurobiology of Aging, University of Southern California, Los Angeles

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Extending Life, Enhancing Life: A National Research Agenda on Aging * DeWITT S. GOODMAN, Director, Institute of Human Nutrition, and Professor of Medicine, Columbia University College of Physicians and Surgeons, New York, New York * WILLIAM N. KELLEY, Executive Vice President and Dean, University of Pennsylvania Medical Center, Philadelphia GEOFFREY PLACE, Vice President, Research and Development, Procter and Gamble Company, Cincinnati, Ohio THOMAS D. POLLARD, Professor of Cell Biology and Anatomy, Johns Hopkins University School of Medicine, Baltimore, Maryland JOHN E. ROBSON, Deputy Secretary, Department of the Treasury, Washington, D.C. * JOHN W. ROWE, President, Mount Sinai School of Medicine, and President, Mount Sinai Hospital, New York, New York * JUDITH RODIN, Philip R. Allen Professor of Psychology; Chair, Department of Psychology; and Professor of Medicine and Psychiatry, Yale University, New Haven, Connecticut ROBERT J. RUBIN, President, Health and Sciences Incorporated, Washington, D.C. * FRANK A. SLOAN, Centennial Professor of Economics and Chairman, Department of Economics, Vanderbilt University, Nashville, Tennessee Chief Consultant to the Committee and Coordinator, Liaison Teams LESTER SMITH, Associate Professor of Medicine, Department of Medicine, Section on Geriatrics/Gerontology, Howard University College of Medicine, Washington, D.C. Institute of Medicine GARY B. ELLIS, Director, Division of Health Promotion and Disease Prevention ** EDMUND T. LONERGAN, Study Director JOSEPH S. CASSELLS, Senior Staff Officer *   IOM member. **   Affiliation: Associate Chief of Staff for Geriatrics and Chief, Geriatric Section, Department of Veterans Affairs Medical Center; Clinical Professor of Medicine, University of California, San Francisco.

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Extending Life, Enhancing Life: A National Research Agenda on Aging LINDA A. DePUGH, Administrative Assistant *** RICHARD WILLIAMS, Program Assistant THEODORA FINE, Contract Editor Advisers to the Committee ROBERT N. BUTLER, Brookdale Professor and Chairman, Department of Geriatrics and Adult Development, Mount Sinai Medical Center, New York, New York DOROTHY P. RICE, Professor in Residence, University of California School of Nursing, San Francisco ALEXANDER RICH, Sedgwick Professor of Biophysics, Massachusetts Institute of Technology, Cambridge T. FRANKLIN WILLIAMS, Director, National Institute on Aging, National Institutes of Health, Bethesda, Maryland ROSALYN S. YALOW, Solomon Berson Distinguished Professor at Large, Mount Sinai Medical Center, and Senior Medical Investigator, Department of Veterans Affairs Medical Center, Bronx, New York Consultants SUSAN COZZENS, Department of Scientific and Technological Studies, Rensselaer Polytechnic Institute, Troy, New York JACOB J. FELDMAN, Associate Director for Analysis and Epidemiology, National Center for Health Statistics, Hyattsville, Maryland GAIL JACOBY, Chief, Office of Planning, Technological Information, and Research, National Institute on Aging, Bethesda, Maryland KATHRYN HYER, Associate Director, Health Care Policy Unit, Ritter Department of Geriatrics, Mount Sinai Medical Center, New York, New York TIM MEYER, Market Analyst in Pharmaceutical Research and Development, Procter and Gamble Company, Cincinnati, Ohio GARY MIRANDA, Technical Writer/Editor, Kaiser Permanente Health Research, Portland, Oregon SUSAN PHILLIPS, Research Associate, San Francisco, California ***   Affiliation: Department of Veterans Affairs Medical Center, San Francisco, California.

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Extending Life, Enhancing Life: A National Research Agenda on Aging Preface In 1988, with generous support from The Commonwealth Fund and The Pew Charitable Trusts, the Institute of Medicine (IOM) convened a committee of 18 national authorities on health care to develop priorities on age-related research for the next 20 years, and to estimate the resources required to carry out the new research agenda. The IOM also asked the committee to identify research that would enhance the understanding of basic processes of aging and maximize function in older persons; to alert scientists to promising but neglected areas of research on aging; and to bring the importance of age-related research to the attention of government, academic institutions, industry, and the public. Impetus for this study was provided by two major themes: (1) the opportunity furnished by the potential of science to improve the quality of life and independence of our older citizens and (2) the need to respond to the growing numbers of dependent and demented persons 65 years of age and over. The committee was aided by 63 outstanding scientists comprising 4 liaison teams—basic biomedical research, clinical research, behavioral and social research, and health services delivery research—and by 2 experts in biomedical ethics (see Appendix A). Further guidance was provided by 5 senior advisors to the committee and by input from more than 60 leaders in the field of health care and aging. Liaison teams and the experts on biomedical ethics prepared docu-

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Extending Life, Enhancing Life: A National Research Agenda on Aging ments for the committee's use, and the committee met 4 times over a 2-year period to create the current report. The present work can be seen as an extension of earlier studies by the National Institute on Aging: Our Future Selves, in 1978,1 and Toward an Independent Old Age: A National Plan for Research on Aging , in 1982.2 These reports described the promise of science to meet the burdens posed by a growing population of disabled older persons and presented an extensive list of research opportunities in the study of aging. The current study offers a limited number of general research priorities for the coming decades. To carry out this program the committee recommends a significant increase in the funding of approved research grants on aging, expansion of training of faculty in age-related studies, widening of the scientific infrastructure base, and additions to present centers for the study of aging. More than 150 health care professionals contributed to this report. The committee wishes to express its gratitude to Samuel O. Thier, president of the IOM, for his steadfast support of this complex project. The study initially went forward with support from Enriqueta C. Bond, the IOM executive officer, and was continued and brought to conclusion with the assistance of Gary B. Ellis, director of the IOM's Division of Health Promotion and Disease Prevention. This report is restricted to the committee's description of the opportunities and advantages of increased research on aging. Given that resources are available, the committee would suggest that expenditures on research related to aging be increased as recommended in the report. The report does not, however, consider the effects of a large increase in spending on aging research on other U.S. health and human welfare-related research, and the committee realizes that resources are not unlimited. In addition, the committee does not comment on the desirability of increasing expenditures on research on aging versus expenditures on research on children, cancer, AIDS, contraception, the brain, or other major areas of investigation involving health care of younger adults. This report should not be used to determine priorities in the general area of health research, nor is it intended to set priorities for all health-related research. 1   National Institute on Aging, Our Future Selves (Bethesda, Md.: U.S. Government Printing Office, 1978). 2   National Institute on Aging, Toward an Independent Old Age: A National Plan for Research on Aging (Bethesda, Md.: U.S. Government Printing Office, 1982).

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Extending Life, Enhancing Life: A National Research Agenda on Aging In closing, it should be noted that the dictionary defines “agenda” as “a list of things to be done,” and it is in this sense of the word that the current work is presented. The program outlined in the following pages states the committee 's commitment to the concept that increased fundamental research on aging holds the most promise to improve the lives of an ever-increasing number of older Americans. It is now the task of the leaders of this country—in government, foundations, industry, education, and science —to join with an informed public to evaluate and implement this program. Julius R. Krevans, Chairman Committee on a National Research Agenda on Aging

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Extending Life, Enhancing Life: A National Research Agenda on Aging Contents     Executive Summary and Recommendations for Funding   1      Background,   4      A National Research Agenda on Aging,   9      Crosscutting Issues,   24      Recommendations for Funding the Research Agenda on Aging,   26      Implications for Funding Agencies,   35      Concluding Comments,   37  1   Introduction   40  2   Basic Biomedical Research   47      Research Priorities,   49      Additional Research Opportunities,   50      Resource Recommendations,   52      Crosscutting Issues,   55  3   Clinical Research   57      Research Priorities,   58      Additional Research Opportunities,   66      Resource Recommendations,   67      Crosscutting Issues,   68

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Extending Life, Enhancing Life: A National Research Agenda on Aging  4   Behavioral and Social Sciences   71      Justification and Major Themes,   72      Research Priorities,   75      Additional Research Opportunities,   80      Methodological Needs,   81      Resource Recommendations,   82      Cross-Disciplinary and Crosscutting Issues,   83  5   Health Services Delivery Research   88      Long-Term Care and Continuity of Care for Older Persons,   90      Financing of Health Care for Older Persons,   95      Drug Use,   96      Mental Health Services,   99      Disability/Disese Prevention and Health Promotion Services,   100      Research Priorities,   101      Additional Research Opportunities,   102      Resources Required,   102      Cross-Disciplinary and Crosscutting Issues,   103  6   Research in Biomedical Ethics   107      Research Priorities,   107      Additional Research Opportunities,   115      Conclusions and Resource Recommendations,   115  7   Review of Resources Committed to Research on Aging   119      Funding Support for Research on Aging,   119      Institutions Engaged in Research on Aging,   123      Publications on Research in Aging,   125      Personnel Engaged in the Study of Aging,   127     Appendixes       A  Acknowledgments   135      Liaison Teams,   135      Experts Providing Information to the Committee,   140      Directors, DVA Geriatric Research, Education, and Clinical Centers,   142      Directors, Pharmaceutical Company Research,   143     B  Background Documents   144     Index   145