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Behavioral and Social Sciences

Recent behavioral and social research has advanced our understanding of the aging process, the health and well-being of older adults, and the experience of growing older in our society. Three conclusions emerge from a review of this research: (1) sociocultural contexts are an important influence on aging processes; (2) significant variability in aging exists among individuals and between social groups; and (3) skills, behavior, and competence can be modified in old age. Increased length of life, which has dramatically altered the age structure of populations, coupled with changes in social policy and family structure, underscores the need to know more about the nature of aging today and its likely effects on future generations.

The primary goal of research in health and aging must be to compress and diminish the duration of morbidity, disability, and suffering during the extra years provided by increased life expectancy and to enhance both productivity and the quality of life during that time. Because of the complexity of life processes, a considerable portion of this research must be multidisciplinary, longitudinal, and cohort sequential, working within existing knowledge, methodology, and resources. For example, behavioral and social studies can contribute to the understanding of the response to clinical interventions or can make clear the factors that influence older persons' access to and participation in health care services. Although the traditional approach to research is featured in this review, long-term payoffs from less-established but promising areas of research should not be neglected.



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Extending Life, Enhancing Life: A National Research Agenda on Aging 4 Behavioral and Social Sciences Recent behavioral and social research has advanced our understanding of the aging process, the health and well-being of older adults, and the experience of growing older in our society. Three conclusions emerge from a review of this research: (1) sociocultural contexts are an important influence on aging processes; (2) significant variability in aging exists among individuals and between social groups; and (3) skills, behavior, and competence can be modified in old age. Increased length of life, which has dramatically altered the age structure of populations, coupled with changes in social policy and family structure, underscores the need to know more about the nature of aging today and its likely effects on future generations. The primary goal of research in health and aging must be to compress and diminish the duration of morbidity, disability, and suffering during the extra years provided by increased life expectancy and to enhance both productivity and the quality of life during that time. Because of the complexity of life processes, a considerable portion of this research must be multidisciplinary, longitudinal, and cohort sequential, working within existing knowledge, methodology, and resources. For example, behavioral and social studies can contribute to the understanding of the response to clinical interventions or can make clear the factors that influence older persons' access to and participation in health care services. Although the traditional approach to research is featured in this review, long-term payoffs from less-established but promising areas of research should not be neglected.

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Extending Life, Enhancing Life: A National Research Agenda on Aging The significance of research discoveries in behavioral and social research on aging can be interpreted in light of three important themes, developed in the next section, bearing on how individuals age, experience aging, and respond to aging: (1) the dynamic interaction of older individuals and sociocultural contexts, (2) differentiation among older individuals and in the aging process itself, and (3) modifiability through interventions to improve the quality of aging. Approaches to the scientific study of sociological and behavioral factors in aging include (1) refinement of measurement and analytic instruments, (2) cooperation and coordination by different disciplines in large-scale investigations using carefully selected, culturally representative panels to be followed longitudinally and cohort sequentially, and (3) application and evaluation of research findings through systematic field studies to test the appropriateness of particular intervention techniques. JUSTIFICATION AND MAJOR THEMES Fundamental advances in the study of aging have resulted from the demonstration that factors in the social and physical environment extrinsic to the individual can dramatically alter the course of aging. Thus, the process of aging is highly mutable and susceptible to interventions of a social and behavioral nature. The committee believes that social and behavioral interventions derived from the research agenda described below will materially improve the functioning and quality of life of older persons. Research also emphasizes the fact that, because aging is a lifelong process, it is useful to study both the multiple determinants of successful aging and the causes and consequences of dysfunction and disability. Finally, research has demonstrated the importance of embedding the study of aging in the broader sociocultural context: race, ethnicity, gender, cultural identity, and the social environment. The Dynamic Interaction of Individuals and Sociocultural Contexts Genetic and other biological forces affect individual health and behavior within specific sociocultural contexts. The effects and mechanisms of these interactions affecting psychosocial aspects of health and aging need to be understood. At least four bodies of research highlight these complex dynamics. These include studies of (1) comparative aging in different societies, cultures, racial/ethnic groups, and other subpopulations; (2) the influences on aging of

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Extending Life, Enhancing Life: A National Research Agenda on Aging different environments (including geographic, workplace, and treat-ment environments), living arrangements, and other forms of mate-rial and social support; (3) the effects on behavioral and health outcomes of older persons’ individual characteristics coupled with the varying opportunities and constraints of different social milieus; and (4) the brain/behavior relationship. Medical research can no longer be separated artificially from sociological, economic, or psychological research. The social contexts in which individuals develop and age influence the length of their lives, their health, their ability to make decisions or cope with the demands of their conditions, their functional capacities, and the way they feel. Indeed, each of these factors influences the others. The natural laboratory provided by differences among subpopulations and subcultures in our own society, between our society and others, and between those who grew up at one time in history and those who grew up at another evidences the fact that growing up and growing old varies, for example, if one is a member of a developing society; if one is black, female, or poor; or if one is of a particular birth cohort. Contemporary social and behavioral research in aging displays an increasingly sophisticated view of the dynamic effects of culture, social setting, and context on individual behavior (Featherman and Lerner, 1985; Maddox, and Campbell, 1985; Campbell and O/Rand, 1988; Riley, 1988; Spenner, 1988). One example of such research [Moos, 1974, 1980) illustrates efforts to measure and examine the varied settings in terms of environmental and individual character-istics and the interactions between the two. Several important conclusions have been suggested. First, the characteristics of the setting-whether structural or interpersonal factors-affect outcome. Second, personal characteristics, such as the individual capacity for cognitive appraisal and coping can, to a degree, compensate for repressive controlling environments. Third, the “fit” between personal characteristics and independence-enhancing environments predicts a beneficial health outcome. Last, the social processes that route individuals toward beneficial milieus are as important as providing a beneficial environment in the first instance. Differentiation Both within and across societies, the older population is ex-tremely heterogeneous; moreover, aging has varied substantially over historical time. People arrive at the end of life by different routes, and societies influence these routes in varied but consequen-tial ways. Social and psychological factors affect both how individu-

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Extending Life, Enhancing Life: A National Research Agenda on Aging als and the broader society age and experience aging. This variability is the best evidence for modifiability in later life. Aging is dependent on gender and ethnic, economic, political, and educational circumstances. Lifestyle, risks of illness and dependency, and functional ability also affect how one ages. Research by sociologists, economists, historians, and anthropologists has documented why references to “elderly persons, ” the “minority elderly persons,” or “the older woman” are necessarily inaccurate and misleading (Clark and Spengler, 1980; Keith, 1985; Verbrugge, 1985; Maddox, 1987b). Although observed variation in aging surely has a biological component, the list of explanatory factors must include those that are predominantly social and behavioral. Research has demonstrated that sanitation, food, and clean water, as well as adequate income, education, and housing, have powerful effects on life expectancy, health, and functioning. In the most impoverished developing countries, for example, average life expectancy is about half of that in developed societies (Torrey et al., 1987). To be poor or black in the United States costs an individual, on average, 5 or 6 years of life expectancy. Poor people, who typically are also undereducated, tend to be underinsured, to use health care facilities less effectively, and to be less likely to adopt healthful lifestyles (Berkman, 1988). In our society the differential allocation of resources—jobs or related income—by gender or ethnicity increases the risk of poverty, illness, and premature death in later life. Chronological age is only a crude predictor of behavior or health. Although the risk of functional impairment increases with age (Manton, 1988), people in their 80s have a 50 percent chance of continuing sufficiently free of disability, so as to be capable of self-care (Katz et al., 1983), although this figure decreases as one approaches the late 80s. Older individuals differ in their sense of self-control (Rodin et al., 1985; Rodin, 1986), in their capacity to cope with illness or other life challenges (Siegler and Costa, 1985), and in their risk of mental disability (Blazer and Meador, 1988; George, 1989). Such differences are dependent on social, behavioral, psychological, lifestyle, and cohort characteristics. Modifiability From this knowledge of differential approaches to old age stems the concept of the modifiability of aging. Improvements in socioeconomic circumstances can simultaneously improve health and well-being in the young and old. Recent research shows that many aspects of the course and outcome of the aging process are plastic—that is, open to intervention. For example, investigators have devel-

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Extending Life, Enhancing Life: A National Research Agenda on Aging oped ways in which to restore and enhance learning and memory apparently lost in very old individuals (Schaie and Willis, 1986) and to enhance self-esteem, thus enabling previously passive, institutionalized elders to take better care of themselves (Rodin et al., 1985, 1990). Because studies documenting the potential modifiability of aging have tended to focus on reducing age-related decrements in the health of individuals, research is needed to define more broadly the areas and limits of the modifiability of aging, particularly in terms of enhancing existing skills and learning in later life. RESEARCH PRIORITIES Three major research priorities flow from these themes. The first priority is investigation of the basic social and psychological processes of aging and the specific mechanisms underlying the interrelationships among social, psychological, behavioral, and biological aging functions. The second priority is research that addresses issues of population dynamics, including the question of whether morbidity is being postponed commensurate with increases in longevity. The third priority is research that examines how social structures and changes in those structures affect aging. These priorities should be seen as the cognitive precursors to specific research questions that will examine issues related to health and functioning—the primary focus of this report. In formulating the research priorities, and in discussing the priorities listed below, the committee has not examined needed research addressing the full array of societal and specific behavioral issues and questions posed by an aging society, such as economic and political implications. The latter, however, represent an equally crucial research agenda. Investigation of the basic social and psychological processes of aging and the specific mechanisms underlying the interrelationships among social, psychological, behavioral, and biological aging functions should be undertaken. A search for the mechanisms of the interrelationships among hitherto separate disciplines would include studies of (1) the social, psychological, and behavioral variables that predict health, longevity, functional ability, and well-being in individuals and (2) the most effective techniques for maintaining and improving general physical and mental health, and functioning. Once such mechanisms are identified, different intervention models need to be compared.

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Extending Life, Enhancing Life: A National Research Agenda on Aging Biologists have emphasized the inevitability and unidirectionality of decline (Rockstein and Sussman, 1979; Finch and Schneider, 1985). Psychologists, however, have found that some behavioral capacities are multidirectional: some improve over the life course, some remain stable, and others decline (Woodruff-Pak, 1988). Further, because individuals are adaptive in their behavioral adjustment to biological decline in aging, behavioral decline often is minimal. Moreover, understanding the range of limits of physiological decline and its consequence for behavior is an important priority for future research. One of the most exciting frontiers involves the examination of the interaction among behavior, central nervous system structure and function, and neuroendocrines and other hormonal factors. Examples include investigation of the relationship between memory function and such central nervous system structures as the hippocampus and cerebellum (Berger et al., 1986) and research on stress-related environmental, psychological, and hormonal factors that lead to anatomic changes in the brain (see cerebral atrophy under extreme stress: Jensen et al., 1982; Finch, 1987). Although extensive descriptive literature exists on both physiological and psychological changes in advancing age, only limited information is available on specific behavioral correlates of specific biological changes. Data on specific interactions between biological and psychosocial factors are even more sparse. It is suspected, for example, that adverse changes in the synchrony between the autonomic and central nervous systems in advancing age may affect intellectual performance, particularly in jobs or tasks requiring complex decision making. Despite the recognition that the major health problems of older people are chronic, little attention has been paid to behavioral and social interventions to reduce excessive disability and provide new treatment and management strategies. Some key issues for researchers include rehabilitative strategies to maintain or restore function, treatment of the social or emotional barriers to rehabilitation, and compliance with medical regimens. A variety of behavioral interventions—biofeedback in hypertension, for example—appear promising (Zarit, in press). Behavioral interventions also can be used to enhance performance of older people (Rodin, 1986). The movement from work to retirement is one of the most important life-course decisions facing middle-aged and older workers. It has significant public policy implications, deriving from federal regulations, personnel policies, and decisions of workers. New social and economic surveys need to link business characteristics, such as pension plans and retiree health insurance, with individual career and retirement decisions. It is important to examine the age-

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Extending Life, Enhancing Life: A National Research Agenda on Aging productivity relationship in different settings (IOM, 1981; Sterns and Alexander, 1987; Spenner, 1988) so as to identify matches and mismatches between productive capacity of older workers and the personnel preferences and policies of business firms. Adopting a life-course perspective that views today's younger adults as tomorrow's older adults should be paired with monitoring social change and the changing sociodemographic and health characteristics of populations. To the extent that children and younger adults at risk can be identified and helped, the elder population of the future will enjoy better health and well-being. Research should be designed to provide a clearer understanding of individual differences in sensory, cognitive, and behavioral aging, particularly as these differences reflect relationships between brain and behavior, environment and behavior, and society and behavior. Applied and clinical research can translate into practice what is known about the modifiability of risk factors, skills, learning, and memory. Evaluation procedures need to be improved and effective interventions devised. Research that addresses issues of population dynamics, including the question of whether morbidity is being postponed commensurate with increases in longevity, is a further high priority. Descriptive demography and epidemiology and techniques of population estimation have improved substantially in recent years (Hogan, 1985; Myers, 1985; Torrey et al., 1987; Guilford, 1988). Apart from the significance of immigration, two high priorities for research include (1) improved and continued forecasts of the future number of older persons, both in developed and developing nations, and (2) estimates of the proportion of those people who will be able or unable to function independently. Important work on forecasting is now under way in several research sites and is in continuing need of support. For the United States, sophisticated forecasts are now suggesting that, given a degree of control over well-known risk factors for heart disease, the size of the older population in the twenty-first century would exceed even the current high estimates (Manton, 1988). Unquestionably, the society will be confronted with unprecedented numbers of both healthy and disabled older people, and it is of critical importance that more be known about the interaction of factors—behavioral, social, and biological—that influence the time of onset of morbidity and disability as life expectancy continues to increase. Comparative studies, such as epidemiological studies of cardiovascular disease among Japanese in different locations, are suggested

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Extending Life, Enhancing Life: A National Research Agenda on Aging as timely and useful in helping us to understand the dynamics of adaptive life transitions in varied groups. Identifying factors that enhance active life expectancy of ethnic minorities is an essential step in developing effective policy to assist minority elderly persons. Research on population dynamics needs to give special attention to at-risk populations—in particular, those subpopulations at high risk for poverty, social isolation, underemployment, inadequate education, illness, and inaccessibility to health care. Higher-priority attention should be given to such subpopulations as the poor, women, and minorities. The physical and mental health of men and women in the United States differ in significant but paradoxical ways. Women have a higher incidence of transitory illness and a higher prevalence of nonfatal chronic diseases, they report more symptoms of illness, and they are major consumers of health care services. Women under age 65 experience more injuries, bed disability, and restricted activity days than men; this gender difference becomes even more pronounced at age 65 (Minkler and Stone, 1983). Maddox (1987a) found that women were more likely to be impaired and to be impaired earlier than men; when socioeconomic status was equalized, however, this difference disappeared. Yet, on average, women live 8 years longer than men (Verbrugge, 1985, 1988). These differences provide an obvious opportunity for cohort-sequential longitudinal research to document whether observed gender differences in morbidity and well-being are persisting or changing over time. It is important that research also strives to identify and explain psychological variables both as predictors of health, longevity, and functional disability and as ends in themselves. Psychological and behavioral variables may not only contribute to biological aging, but may also be the behavioral representation of physiological dysfunction. In addition, certain psychological states need to be identified as conditions that must be managed in the aging process. Equally, this research necessitates detailed analyses of existing databases and the creation of new databases that contain information on health histories and psychological functioning to allow testing of the reciprocal effects of illness, lifestyles, personality variables, and psychological competence. Research should be undertaken to study the manner in which social structures and changes in those structures affect aging. Just as individuals change, so too do social structures; observations of old age today show neither what old age was like in the past nor what it will be like in the future (Bengtson et al., 1985; Riley et

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Extending Life, Enhancing Life: A National Research Agenda on Aging al., 1987; Riley, 1988). It is necessary to identify stability and change in social structures and to show how stability or change affects the performance, productivity, health, and well-being of older adults. Special attention should be paid to such traditional subpopulations as ethnic and racial minorities and older women for whom social status and change entail increased risk to health. Although family structure and function continue to change, research points to a continuation of intergenerational contact and support, even when families are separated geographically (Sussman, 1985). Kinship ties still bond generations (Bengtson et al., 1985), and families continue to be the dominant source of social support in all societies (Horowitz, 1985; Hagestad, 1987). Because of the social changes experienced in recent decades in the United States, further research is required on stability and change in living arrangements and exchange relationships. The changing structure of families and the implications of these changes for social support and caregiving demand special attention (Oppenheimer, 1982). The work force, the labor market, and the family responsibilities of women, for example, have been characterized by considerable change, but the effects of these changes have not been monitored adequately in research. The knowledge that family and labor force composition have changed does not give us the needed evidence for sound estimates of how these changes will affect the availability of social support for dependent older persons in the future. There has been little study, for example, of the implications of four-generation families, the conditions under which outside support services may affect informal family care, or how family support can be supplemented effectively by community services. In the past decade sociologists, psychologists, and economists have looked at the relationships among work, retirement, and productivity. As our nation confronts a critical shortage of workers, increasing numbers of able older persons are spending two to three decades of their lives in retirement. Research is needed to specify what changes in social structure could provide productive opportunities for these older people and to examine how current trends in work, retirement, and productivity are experienced by aging individuals; how they affect physical and psychosocial functioning; and how they may result in loss of productivity. Studies that contribute to the better understanding and design of assessment techniques for evaluating work capacity and prolonging work careers of older adults clearly are needed. Additional studies are needed as well to understand the effects of the policies and decisions of business leadership on the hiring and retirement of older workers, and behavioral research is

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Extending Life, Enhancing Life: A National Research Agenda on Aging needed to discover the mechanisms that link changes in social structures (education, job experience, income patterns, and family constellations) to individual differences in maintenance of psychological competence, well-being, and adaptive capacity as people age (Schooler and Schaie, 1987; Schaie and Schooler, 1989). Whereas the dynamics of poverty among adults are increasingly understood (Duncan, 1984), fewer data are available about the dynamics of moving into and out of poverty. Lifetime earnings, personal savings, and pension coverage provide the resources for retirement, but income and wealth can be depleted during retirement by the death of a spouse, health crises, and/or adverse financial events (Burkhauser et al., 1988). The economic status of older people has been little studied; more research on this subject is needed to untangle the complex interrelationships among aging, economics, gender, racial/ethnic status, and health as measured by mortality, disability, chronic illness, and institutionalization. Contextual variables are known to exert significant influence on behavior and performance. The mechanisms through which specific changes, events, or length of exposure to certain milieus influence behavioral outcome, such as role performance, health, and sense of well-being, are less clear. They must be addressed from a variety of perspectives, and caution is indicated in extrapolating from one cohort to another, particularly concerning expectations, attitudes, and preferences among older people. How social structure may affect psychological and biological aging may be explicated as well by study of the impact of social factors upon control processes that influence an individual 's sense of effectiveness over the life course (Rodin et al., 1985; Rodin et al., in press). ADDITIONAL RESEARCH OPPORTUNITIES These include the following: Social research: (1) Study the characteristics of employment, workplaces, and older individuals who are associated with continued productive activity in lifelong jobs or in new careers; (2) study how actual performance and expectations about performance of older people are affected by changing technology and examine the efforts of firms to use training and job respecification to make technological changes as age neutral as possible; and (3) develop and apply a multidimensional quality of life index to identify contributing fac-

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Extending Life, Enhancing Life: A National Research Agenda on Aging tors among subpopulations for whom the index is low (e.g., the very old or minorities). Behavioral research: (1) Study the psychological concomitants of illness and how these affect self-care and response to formal care; (2) study the comparative effectiveness of different modalities in the treatment of chronic mental disorders; and (3) examine the effect of behavioral and social intervention on the outcome of long-term illness. METHODOLOGICAL NEEDS The committee suggests that three methodological approaches be used to carry out the new research agenda in behavioral and social investigation. These are as follows: (1) refined measurement and analytic instruments such as tests, scales, and models for forecasting or analysis; (2) cooperative multidisciplinary large-scale investigations utilizing multicultural, diverse populations studied over time and cohort sequentially; and (3) studies of intervention techniques utilizing the findings of the foregoing research. Tests and Instruments Examples of new and improved measurements include (1) measures of functioning that build on current activities of living scales; (2) psychological and other behavioral assessment techniques that are age fair and culturally fair, such as tests of skills, abilities, knowledge, and capacities appropriate for older people and people in different population subgroups; (3) measures of social contexts such as home, workplace, and community; (4) more accurate ways to measure behavioral and social components of illnesses such as Alzheimer 's disease; (5) improved techniques for longitudinal and cohort analysis; and (6) modeling techniques to facilitate trend prediction. Coordination of Large-Scale Research Although multidisciplinary research is difficult and costly, it is the only way to address many of the central issues of interrelationships and interactions among the variables and processes discussed above. These issues include demographic and epidemiological matters related to the postponement of morbidity, antecedents and consequences of health differences and sequencing among different groups, dimensions of caregiving (including effectiveness, duration,

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Extending Life, Enhancing Life: A National Research Agenda on Aging and outcome), effects of different strategies on financing long-term care, and the relation between age productivity and retirement, among others. Field Intervention Studies Large-scale behavioral field trials are needed to test hypotheses and evaluate recommendations for interventions based on the findings from the studies described above. These need to be systematic and of sufficient duration to observe long-term consequences and should include strategies to maintain and improve such health and cognitive functions as memory, new learning, and adaptations, as well as designs for home and workplace that would allow older people to maintain and prolong productivity and independent living. Although large-scale longitudinal research projects are necessary to implement the research agenda, the importance of small-sample studies to enhance in-depth understanding about the processes of aging must not be ignored. These studies are less costly to implement, often provide information on a relatively short-term basis, and can, for example, gather data on individual performance that are “averaged out” in larger studies. RESOURCE RECOMMENDATIONS Significant additional resources will be necessary to undertake the needed behavioral and social science research agenda in aging in the major priority areas. The funds to acquire these resources are described in detail in the Executive Summary and Recommendations for Funding. Despite large growth in the federal commitment to health research in the past decades, the social and behavioral sciences actually have lost ground relative to other areas of research—a trend that must be stopped if the potential of this research agenda is to be realized. Supports for behavioral and social research on aging in 1989 were estimated at $80–$100 million from the federal government and $10 – $15 million from nonfederal sources such as foundations (Behavioral and Social Research Program, NIA). Based on the calculation of the dollars committed to behavioral and social research on aging, an estimate of the capacity for high-quality research, and the additional monies necessary to develop the new initiatives identified here, the total budget for age-related behavioral and social research should be increased by more than 100 percent over current expenditures, with the additional funds to be phased in over a 5-year period. The

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Extending Life, Enhancing Life: A National Research Agenda on Aging recommended distribution of additional funds for the research initiatives should support studies of social, psychological, behavioral, and biological interrelationships; “at-risk” populations; population dynamics; and changing social structures. These resources involve (1) increasing the funding rate of NIA and other NIH approved research program grants (RPGs) on aging from one in four (24 percent) to one in two; (2) providing training for an additional 200 investigators per year in behavioral and social science; and (3) a one-time cost for construction. New resources will include a share in ten multidisciplinary research and training centers added to the current three centers (Claude Pepper Centers) supported by the NIA and participation in an expanded scientific infrastructure (laboratories, computer support, long-range population studies, and increased linkage to such existing databases as the Health Care Financing Administration Medicare data tapes). The increasing isolation of older persons (one-third live alone), the burden of psychologically disabled older persons on families, and the presence of serious affective disorders (older white males have the highest suicide rate) among elderly persons point up the urgent need for research that leads to better management of social and behavioral problems in the older population. CROSS-DISCIPLINARY AND CROSSCUTTING ISSUES Basic biomedical and clinical researchers have only recently begun to examine the influence of gender, race, culture, ethnicity, and social class on biological processes and clinical presentations. These and other social and behavioral issues cut across the disciplines and offer opportunities for further investigation and understanding in the field of aging. Gender The difference in life expectancy at birth between the sexes was small for those born in 1900, but it has widened considerably over the century. Much of this difference can be ascribed to changes in child-bearing practice and other lifestyle factors as well as to tobacco-related deaths and heart disease. Social and behavioral gender differences in morbidity, particularly as related to chronic conditions, suggest many promising research areas, such as the gender-specific response to social isolation and psychological disorders; differences in the relation of social supports to functional status; the differential effects of gender in pension income, social role expectations, labor

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Extending Life, Enhancing Life: A National Research Agenda on Aging force participation, and responsibilities for caregiving; interactions among neuroendocrine and other hormones; and cognitive and psychological status. Potentially significant are the many connections of this research with work in clinical science and health services delivery research as it relates to alterability of risk factors, appropriateness and effectiveness of interventions, utilization, service delivery, and many other areas. Race and Ethnicity, Socioeconomic Status, and Other Cultural Factors As is the case with gender, the cultural factors associated with race and ethnicity present important variables across and among the disciplines of aging. For example, racial and ethnic differences in metabolizing certain drugs and substances are confounded by cultural variables in the use of these substances, definition and presentation of symptoms, other illness behaviors, and acceptance of treatment regimens. In addition, an understanding of the effects of racial and ethnic-cultural differences in resource allocation is critical in explaining clinical, social, and psychological differences in aging and in health care service utilization. Moreover, race and ethnicity may well be contributing factors to underlying basic biological processes or their manifestations in old age. Population Dynamics Issues of population dynamics include accurate estimation and prediction of population trends in longevity, mortality, morbidity, and functional status. These dynamics also have major linkages with health services delivery concerns about access, availability of services, financing, system design, and policy formation. However, these issues, particularly as they concern estimates of the health and functional problems most likely to face large numbers of elderly people in the coming decades, also have connections to basic biomedical and clinical research in terms of predicting problems and defining important areas of research. Brain, Environment, Society, and Behavior Some of the age-related deficits in memory performance and cognitive function are amenable to understanding at the neurobiological level. But the question of the extent of memory deficit due to deterioration of basic storage mechanisms in the brain in contrast to

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Extending Life, Enhancing Life: A National Research Agenda on Aging those due to altered modulatory processes also requires a better understanding of the related psychological and psychosocial processes. Moreover, the interaction of the brain with aspects of the environment —physiological, physical, and social—is also poorly understood (Finch, 1987). For example, environmental stress can influence sleep patterns, which can then reflect on brain activity and the mental and emotional sequelae. Such interactions demand both crosscutting and cross-disciplinary approaches to further our essential knowledge and understanding. REFERENCES Bengtson, V., N. Cutler, D. Mangen, and V. Marshall. 1985. Generations, cohorts and relations between age groups. Pp. 304-338 in Handbook of Aging and the Social Sciences, R. Binstock and E. Shanas, eds. New York: Van Nostrand Reinhold. Berger, T. W., S. D. Berry, and R. F. Thompson. 1986. Role of the hippocampus in classical conditioning of aversive and appetitive behaviors. Pp. 203-239 in The Hippocampus, vol. 4, R. L. Isaacson and K. H. Pribam, eds. New York: Plenum. Berkman, L. 1988. The changing and heterogeneous nature of aging and longevity: A social and biomedical perspective. Pp. 37-70 in Varieties of Aging: Annual Review of Gerontology and Geriatrics, vol. 8, G. Maddox and P. Lawton, eds. New York: Springer Publishing. Blazer, D., and K. Meador. 1988. The social psychiatry of later life. Pp. 283-294 in Handbook of Social Psychiatry, A. Henderson and D. Burrows, eds. New York: Elsevier. Burkhauser, R., K. Holden, and D. Feaster. 1988. Incidence, timing and events associated with poverty: A dynamic view on poverty in retirement. Journal of Gerontology 43: 546-552. Campbell, R. T., and A. O'Rand. 1988. Settings and sequence: The heuristics of aging research. Pp. 58-82 in Emergent Theories of Aging, J. Birren and V. Bengtson, eds. New York: Springer Publishing. Clark, R., and J. Spengler. 1980. The Economics of Individual and Population Aging. New York: Cambridge University Press. Duncan, G. 1984. Years of Poverty, Years of Plenty. Ann Arbor: Institute for Social Research, University of Michigan. Featherman, D., and R. Lerner. 1985. Ontogenesis and sociogenesis: Problematics for theory and research about development and socialization over the lifespan. American Sociological Review 50: 659-676. Finch, C. 1987. Environmental influences on the aging brain. Pp. 77-91 in Perspectives in Behavioral Medicine, M. W. Riley, J. Matarazzo, and A. Baum, eds. Hillsdale, N.J.: Lawrence Erlbaum Associates. Finch, C., and E.L. Schneider. 1985. Handbook of the Biology of Aging, 2nd ed. New York: Van Nostrand Reinhold. George, L. K. 1989. Social and economic factors in geriatric psychiatry. Pp. 203-234in Geriatric Psychiatry, E. Busse and D. Blazer, eds. Washington, D.C.: American Psychiatric Press.

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