Extending Life, Enhancing Life A National Research Agenda on Aging (1991) / Chapter Skim
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3. Clinical Research
3. Clinical Research
Pages 57-70
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From page 57... ...
studies of age-depenclent physiologic change and specific pathologic entities. Recommendations for specific studies within these two major topic areas overlap significantly, reflecting both the multifactorial nature of disease ant!
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From page 58... ...
RESEARCH PRIORITIES · The first priority is research into the causes, prevention, management, and rehabilitation of functional disability in elderly persons. The overwhelming importance of functional capacity as a determinant of older persons' needs dictates a special focus on factors that limit the independence of elderly individuals.
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From page 59... ...
Although substantial data on the relationship of traditional cardiovascular risk factors to the subsequent incidence of cardiovascular disease in older men and women are emerging from the aging Framingham cohorts, few data are available to indicate whether intervention in these risk factors affects subsequent rates of cardiovascular disease, including stroke, heart attacks, and congestive heart failure. Some limited data exist in the area of diastolic hypertension, ant!
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From page 60... ...
Failure to Thrive (InanitionJ This is a syndrome of weight loss, decreased appetite and poor nutrition, and inactivity, often accompanied by clehyciration, depressive symptoms, impaired immune function, and low cholesterol. Occurring in both acute and chronic forms, failure to thrive leacds to impaired functional status, morbidity from infection, pressure sores, and, ultimately, increased mortality.
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From page 61... ...
Urinary Incontinence Urinary incontinence, although it varies in intensity and in the degree to which its victims are clisablecl, is a highly prevalent, costly, morbid, and seriously neglected problem in elderly persons. The prevalence of urinary incontinence is approximately 30 percent in community-c~welling older persons ;Diokno et al., 1986~ and reaches 50 percent for those in nursing homes tOuslander et al., 19871.
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From page 62... ...
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.
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From page 63... ...
This development, plus the extension to actual gene therapy of current techniques to introduce cells carrying engineered genes, may allow us to prevent, cure, or otherwise substantially modify many of these diseases. Cardiovascular Disease Cardiovascular disorders are a major target, for cardiac disease is the number one cause of death in persons over the age of 65 and cerebral vascular disease is the third most common cause of death in elderly persons (National Center for Health Statistics, 19891.
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From page 64... ...
Excellent opportunities are available for basic molecular and cell biologic studies to determine the mechanisms and causes of central nervous system cell death in the aged, particularly the role of growth factors in central nervous system changes associated with both normal aging and injury. These studies should include assessment of cellular and molecular markers and new approaches to imaging and neurotransmitter mapping of the nervous system.
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From page 65... ...
Neop;lasia Cancer and its related complications are the number two cause of death in persons over the age of 65 National Center for Health Statistics, 1989~; for elderly persons death due to cancer is the second leading cause of lost years of life. The basis for the age-associatec]
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From page 66... ...
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.
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From page 67... ...
There would be little delay in the development of excellent research proposals in these areas since the National Institute on Aging (NIA) and other federal agencies already have a substantial number of approved but unfunded research proposals with excellent priority scores.
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A moderate amount of core support should be provided to these centers for continuity of key research personnel and ongoing efforts; however, such centers would be expected to compete for additional research funds on a continuing basis to ensure that their work remains current and is peer reviewed. The primary goal of these centers would be to produce substantial numbers of very welltrained, clinical-research-oriented investigators.
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From page 69... ...
Report of the Committee on Leadership for Academic Geriatric Medicine. Journal of the American Geriatrics Society 35:773-791.
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From page 70... ...
1982. Urinary incontinence in elderly nursing home patients.
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