fer approaches should be particularly valuable in this area. Interactions between environmental (e.g., carcinogens and nutritional factors) and genetic factors in the cause and prevention of cancer warrant intensive study.

Disorders of Metabolism and Homeostasis

Strong epidemiologic evidence indicates that metabolic dysfunctions have significant impact on the pathogenesis of numerous disorders affecting the health of older individuals. Metabolic problems may precede the development of clinical manifestations of disease, accelerating the progression of atherosclerosis, hypertension, neuropathy, and musculoskeletal disease. Disorders of metabolism and homeostasis influence the onset and severity of most of the alterations described elsewhere in this report. The metabolic disorders considered in generating these recommendations include diabetes mellitus, altered muscle metabolism, altered bone mineral metabolism, and lipid disorders. Intensive studies should be undertaken to clarify the pathophysiology and genetic basis and to elucidate the long-term complications of these disorders in elderly individuals. Research on relationships among genetic, pathogenic, and nutritional factors will be of great value.

ADDITIONAL RESEARCH OPPORTUNITIES

Although the committee emphasizes the foregoing areas of research for priority consideration, other areas should not be neglected in the research agenda on aging. These additional opportunities include dental and oral problems in aging, especially the prevention and treatment of periodontal disease, cancer of the mouth, and orofacial pain; diagnosis and treatment of neurogenic dysphagia; investigation of hearing impairment, its prevention, and its treatment; study of conditions (particularly glaucoma, cataracts, and macular degeneration) contributing to loss of vision in the aged; and various skin conditions associated with aging (keratomas, skin cancer, and dry skin).

While each of the foregoing research areas leads to detailed specific secondary research objectives, each area also represents the interface of several disciplines. Major opportunities in clinical geriatric research exist in interfaces between physician-scientists and colleagues from the social and behavioral sciences. Increasingly, productive interaction between basic and clinical scientists is resulting in research strategies and protocols that provide the opportunity for application of



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