clinical studies to determine the neuroanatomic and neurophysiologic basis of urinary incontinence and the efficacy and risk of treatment (e.g., drugs, surgery, training, and elimination of risk factors). Finally, there is an urgent need to develop new, effective, and safe treatments—preventive, ameliorative, or curative—for incontinence.


Delirium, the development of acute confusional states, is a global disturbance of cognitive function accompanied by an alteration, and often fluctuation, in the level of attentiveness and, usually, consciousness. Delirium frequently is overlooked or misdiagnosed, and often mistaken for dementia. Approximately one-third of hospitalized elderly individuals develop an acute confusional state, markedly complicating their hospital course and dramatically increasing not only morbidity but also health care costs (Lipowski, 1989). Despite its high prevalence and tremendous morbidity and costs, little is known about the underlying mechanisms of or effective interventions for delirium.

  • The second research priority involves studies of the interaction of age-dependent physiological changes and important diseases in old age.

The scientific and medical community needs to evaluate the interaction of age-related physiologic changes with diseases that either occur predominantly in aged populations or present different symptoms, course, or sequelae when occurring in the aged. This area of research is largely interdisciplinary since a number of lifestyle and socioenvironmental factors have an important influence on the emergence of disease in aging populations. Research on the interaction of aging and disease processes provides a critical link to issues of functional capacity since each major disease category mentioned in this report imposes a large burden on the aging population; prevention of or more effective intervention into these disorders might well reduce the onset of disability.

To effect the study of the interaction of aging in disease, research knowledge of biologic and physiologic processes from many levels must be integrated. Crucial to this effort is the appreciation that research gains in the areas of both normal and disease states act synergistically to increase our understanding of pathophysiologic mechanisms. This approach has been particularly well demonstrated

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