cluding those in health services delivery) is far short of the goals to provide care for dependent and chronically ill older persons and to meet future needs (National Institute on Aging, 1987). This deficiency will be compounded further by the loss of informal supports as more and more women join the labor force, therefore making them less available to provide care for older relatives.

Three trends are likely to influence health policy and health services for older persons in the 1990s: (1) the continuing problem of rising health care costs, (2) the growing concern with quality of care and cost-benefit ratios, and (3) the continuing rapid structural change of the health care service delivery system (Gilford, 1988).

Health services research focuses on broadening the knowledge base required to understand and influence the organization, delivery, and financing of health services to older persons. This research area cuts across the other four agenda areas in this report, relying heavily on knowledge from basic research in the biological and psychosocial arenas and linking with clinical research in studies designed to test delivery strategies for proven interventions in a variety of settings. By studying and making more effective the factors that influence delivery of health care to older individuals, research in health services delivery can contribute to decreasing disability and chronic illness, and to improving the quality of life of the older generation.

The following issues in health services delivery were identified by the committee as having greatest relevance to the research priorities listed in the next section:

  • long-term care and continuity of care for older persons;

  • financing health care for older persons;

  • drug use and mental health services for older persons; and

  • disability/disease prevention and health promotion services for older persons.

Implicit in research involving these areas are questions regarding (1) the extent to which functional status and/or quality of life for older persons is improved with various treatment options and (2) the efficacy and cost of care. This focus on effectiveness, outcome, and functional independence fits well with the new direction being taken by federal research centers.

An extended discussion of the issues related to health services research in aging appears in the Health Services Delivery Research Liaison Team report (see Appendix B).

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