needed to elucidate the interactive processes among disability, disease, mental health, the environment, and the cost of health services. Such a holistic approach should lead to a better understanding of the panoply of services needed by older persons. Finally, research is required to elucidate the cost and outcomes of various patterns of mental health care. How well, for example, do community mental health centers meet the needs of older persons? These data should be related to the reimbursement system that currently does not pay for many types of mental health services.
Although some work has been undertaken in the area of disease prevention through risk reduction,*there is still a crucial need for clinical research in this area. Lacking is consistent evidence regarding the effects of risk reduction on the presence of disease conditions; no systematic research has been undertaken on risk reduction in late adulthood. Lifestyle prescriptions for older populations are now based on research done on younger populations.
Several clinical research questions need to be answered before health services research can proceed:
Are accepted risk factors for disease the same in direction and magnitude for older persons as they are for younger persons?
What are the prevalence estimates for specific risk factors by demographics within the older population?
Are interventions known to be effective with younger persons equally effective and acceptable in reducing risk in older people?
Does the reduction of risk factors make any difference in the health status of older persons?
What is the relationship between disease and disability?
If research does support the need for intervention, then demonstrations designed to deliver preventive services to older persons should be developed. Research also is needed to identify risk factors for disability; risk-reduction programs can then be developed and evaluated.
See the Institute of Medicine's 1990 report, The Second Fifty Years: Promoting Health and Preventing Disability (Washington, D.C.: National Academy Press).