Low funding rates for research grants diminish opportunities for developing careers in age-related studies and may contribute to undersubscription to training programs in geriatrics (IOM, 1987).

In 1990 support for research on aging from all sources (NIH + Department of Veterans Affairs + other federal departments and agencies + foundations), described further in Chapter 7, amounted to an estimated $601 million, or less than 0.5 percent of the estimated 1987 (the most recent year for which figures are available) $162 billion cost of care for disability and illness in older patients (Waldo et al., 1989). This small national commitment to research in aging is a wasteful strategy in light of the potential contribution of research to improve the status of older persons and to reduce the enormous and expanding costs of their care.

A growing sense of urgency is accompanied by the recognition that the time is right to bridge the gap between the needs of an aging society and the scientific knowledge base. The nation now needs a comprehensive plan for research on aging. By identifying research priorities and the resources to support research on aging, it is the committee's intent to respond to that need.

The Aging Society: Current Costs for Health Care of Older Persons

Most older persons are vigorous and have lives of good quality, and more than 50 percent of those 80 years and over are independent in self-care. Although mortality rates have fallen in the. older generation, with increasing life expectancy, chronic diseases have become a major cause of death and disability. For instance, Rice reported that 40 percent of persons 75 and over had two or more chronic illnesses and that the proportion of the aged population reporting multiple chronic conditions had risen in recent years (Rice, 1989).

Of the 10 leading causes of death among older persons, only 2—heart disease and diabetes mellitus—are listed among the 10 leading chronic geriatric conditions (National Center for Health Statistics, 1989). Most of the leading chronic conditions involve disability and prolonged decline. Disability here is defined as any restriction on or impairment in performing an activity in the manner or within the range considered normal for a human being (World Health Organization, 1982).

Chronic conditions contributing to disability include arthritis, heart disease, strokes, disorders of vision and hearing, nutritional deficiencies, and oral-dental problems (in up to 40 percent of older persons; Baum, 1988). Dementia (especially Alzheimer's disease),



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