• Disorders of metabolism and homeostasis: Disorders of metabolism and homeostasis may precede and almost always influence the emergence and severity of the conditions described previously. The committee recommends studies on the pathophysiology and molecular genetics of conditions such as diabetes mellitus, altered muscle metabolism, altered bone and mineral metabolism, and altered lipid metabolism in old age.

These include:

• investigation of the molecular biology, pathophysiology, prevention, and treatment of common sensory deficiencies of old age, especially impairment of hearing and vision;

• examination of the factors associated with oral and dental problems of old age, including periodontal disease, disorders of salivation, and oral-facial pain;

• study of common skin conditions of elderly persons, such as dry skin, itching, and predisposition to cancers of the skin; and

• study of the interaction between nutrition and normal aging and between nutrition and age-associated diseases.

The support required for an effective research program in the priority research areas involves added funds, phased in over 5 years, most importantly an increase in the funding rate of NIH-approved investigator-initiated research grants on aging from one in four to one in two; provision of education and support for an additional 200 to 300 fellows and postdoctoral students and 100 to 150 junior faculty per year, coupled with necessary continued support for midlevel investigators new to the fields of geriatrics and gerontology; expansion of current infrastructure supports; and the addition of at least 10 new Claude Pepper Centers, as described more fully in the section on funding.

Fundamental advances in the study of aging have shown that psychological and behavioral variables, along with factors in the social and physical environment, can alter the course of aging dramatically. Thus, the process of aging is highly responsive to social and behavioral interventions. Studies employing such interventions as training in cognitive skills or increasing the sense of competence