and (2) studies of medication use and effects that link discoveries in basic biomedicine (e.g., gene delivery systems, specific enzyme-blocking agents, and monoclonal antibodies) to clinical studies, behavioral investigation, and health services research.
Urinary incontinence: Although the degree of urinary incontinence varies widely among individuals, this condition is present in approximately 30 percent of community-dwelling older persons (Diokno et al., 1986); 50 percent of those in nursing homes are incontinent (Ouslander et al., 1982). Urinary incontinence has major consequences in suffering and in costs of care among the older population. Behavioral, neuroanatomic, and neurophysiologic studies are needed to determine the basis of urinary incontinence and the efficacy and risk of currently available treatment modalities.
Delirium: About one-third of hospitalized elderly individuals develop acute confusion, markedly complicating their hospital course and dramatically increasing morbidity and health care costs (Lipowski, 1989). Very little is known about the predisposing factors, natural history, underlying mechanisms, and effective treatment of delirium.
Studies of the interaction of age-dependent physiologic changes and important diseases in old age Research on the interaction between disease and aging is interdisciplinary, drawing on insights provided by research in molecular biology, physiology, nutrition, and behavioral and social science. This research may prove critical for issues of functional capacity, because the major diseases discussed below impose heavy burdens in old age and because better understanding of the linkage between age-related disease and disability may lead to improved independence in older people.
Cardiovascular disorders: Cardiovascular disease is the major cause of death in older persons and is a leading cause of chronic illness and disability. Research should explore genetic and other risk factors as well as the molecular basis of atherosclerosis; the development of standard and recombinant-based drug technologies along with gene therapy approaches and nutritional interventions to treat or prevent hypertension and atherosclerosis; and evaluation over time of therapy for cardiovascular disease to assess cost benefits and effect on quality of life.
Dementia and affective disorders: Dementia after age 75 affects 40 percent of the population (Hagnell et al., 1983) and is the major reason for disability among the very old. Great is the need for studies linking basic and clinical approaches to an understanding of the pathophysiology, cause, prevention, and treatment of Alzheimer's disease and other forms of dementia. These studies should include