percent) to one in two. In addition to the dollars for research activities, funds are needed to support a minimum of 140 additional predoctoral and postdoctoral fellowships per year for training in health services research careers, for specific infrastructure needs, and for construction costs. Health services research also will participate in the added funds for support of programs of geriatric and gerontological research that are located within current medical centers (administrative locus, as compared with geographically established centers).

CROSS-DISCIPLINARY AND CROSSCUTTING ISSUES

Most of the research priorities identified in this chapter cross disciplinary lines, focusing on issues that benefit from clinical, behavioral, and social science as well as health services research. Beyond that, four key crosscutting issues must be addressed directly.

First, an understanding of the effects of gender, class, and ethnicity is salient to every priority area listed in this chapter. Second, ethical issues that must be thoughtfully analyzed and researched are embedded in each priority. Third, save in specific areas, health services research in the area of health promotion/disease prevention cannot proceed until clinical research provides clear mechanisms for risk reduction in the older age groups. This need has been identified by Lipton and Lee (1988) who state with respect to drug use research:

Despite the existence of a great deal of information regarding drug therapy and older patients (especially information gathered in recent years), there is a need for more research. Areas requiring further study include the nature of age-related biological, physiological and pathological changes; ways in which these changes affect the elderly person's response to drugs; and the kinds of drug prescribing, dispensing, and administration appropriate to deal with these changes. An area that has remained virtually unexamined involves the psychological changes (e.g., depression) and social changes (e.g., loss of spouse) that accompany aging and the way they affect the older person's need for, use of, and response to drugs. Drug epidemiology studies—large-scale studies of drug use and its relationship to clinical outcomes—are urgently needed in elderly populations, especially with regard to psychotropic agents. Private foundations and federal funding agencies (particularly the National Institutes of Health and the Alcohol, Drug Abuse and Mental Health Administration) should give these areas high priority on their agendas.

Fourth, the dynamic nature of both the aging process and the health care delivery system means that there is a great need for longitudinal research. Most of the research areas in this section can best be



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