care occurred with the 1990 amendment of the Public Health Service Act authorizing creation of Claude D. Pepper Older Americans Independence Centers. Because independence is the central focus of the centers, these studies will consider the full range of older persons' physical and mental functional abilities, not just the effects of treatment on a particular disease. These centers also provide an excellent environment for imparting to health care professionals strategies for how to put these various frailty interventions to use. NIA plans to fund up to four of these Centers in FY 1991. Early retirement is one more issue that we must face as a society as it is now costing the nation an estimated $15-20 billion annually in lost earnings, lost taxes, reduction in saving rates, and other related costs. This continuing trend toward younger retirement has enormous social and fiscal implications. As directed by Congress, the NIA has initiated and with other Federal agencies will continue to support the Health and Retirement Survey. This survey is designed to provide current data upon which to project possible social and fiscal impact from changing demographics and other factors on issues such as the Social Security earnings test, the age for eligibility for Social Security and Medicare benefits, and the design of private pension plans. Already, the NIA has compiled a substantial body of findings on the positive effect of continued work activity on productivity, health, and intellectual functioning. Another priority area for NIA is sponsorship of cardiovascular research, particularly how both "normal" aging as well as disease states in the older population affect changes in the cardiovascular system. Because the onset of cardiovascular disease in adults can be delayed into later years through present prevention interventions, it is imperative that we develop additional knowledge on cardiovascular disease within older persons. While we have made some advances in this area, a better understanding of vascular aging and its relationship to vascular disease should lead to answers to why arteries become stiff and more prone to atherosclerotic disease with advancing age. Ultimately this could lead to the development of "age-adjusted" therapy for hypertension and atherosclerosis. The NIA will continue to emphasize aging research on issues particularly relevant to women's health such as osteoporosis, post-menopausal estrogen replacement therapy, and urinary stress incontinence. As requested, a report concerning research on women's health has been prepared and will be available to the Committees. Studies of other subgroups of older Americans, including rural populations and ethnic minority populations, will continue to receive special attention by the National Institute on Aging. For example, it is important to be able to recognize that differences exist in the use of health care services among populations, and how such differences affect health care delivery systems. Basic research studies into the biological and behavioral mechanisms of the aging process will continue into 1992. An understanding of these basic mechanisms will aid in identifying appropriate interventions to prevent disease and disability, as well as learn what ideally could be expected for "normal" aging. For example, we have learned that within each cell, a balance exists between genes that "turn on" cell reproduction, called proliferative genes, and those that "turn off" reproduction referred to as antiproliferative Disruption of this balance leads to an inability to reproduce--which occurs in aging cells--or to uncontrolled proliferation--as seen in cancer celis. genes. Scientists supported by the NIA are studying genes that block cell proliferation in senescent cells. Knowledge gained from these studies of senescent cells will be of enormous value in our understanding aging processes and age-related diseases, including cancer. Regarding behavioral research, studies have shown that reduction in the visual field of vision is actually amenable to training. Poor performance in the field of vision test is strongly associated with older adults involved in driving accidents, especially at intersections. Through development of training interventions, there is now optimism that accidents can be reduced in older drivers, thus enabling older adults more years of safe driving. research, including hearing studies, should enable the development of other interventions to ameliorate loss of function and independence. Further The NIA is actively supporting research on aging and sleep, and provides key support for the Congressionally created National Commission on Sleep Disorders Research. Because so many older persons have disturbances in sleep patterns, it is commonly assumed that loss of sleep patterns is simply part of normal aging. But, much of what we have already learned tells us that many sleep disturbances are caused by conditions sometimes as easy to reverse as a simple adjustment of medication. A new A continuing priority for NIA is training for research and academic leadership in aging and geriatric medicine, including particular emphasis on bringing more persons from minority backgrounds into these fields. initiative we will continue into 1992 is support for minority Ph.D. candidates for dissertation studies. We need to provide more encouragement and support for developing scientists at every level of education. All programs fostered by the National Institute on Aging have the longrange goal of ensuring that we Americans can look forward to a healthier and more productive life into our older years, and in the process, alleviate the tremendous health care costs that threaten to burden the older individual and society as a whole. Mr. Chairman, the FY 1992 budget request for the National Institute on Aging is $348,558,000. I will be happy to answer any questions. BIOGRAPHICAL SKETCH OF DR. T. FRANKLIN WILLIAMS Birthdate: November 26, 1921 - Belmont, North Carolina Education: B.S., University of North Carolina, 1942; M.A., Columbia University, 1943; M.D., (Cum Laude) Harvard Medical School, 1950 Professional History: 1983 to present, Director, National Institute on Military Service: 1983 to present, Assistant Surgeon General, U.S. Societies and Associations: American Association for the Advancement County Medical Societies; Gerontological Society of America; New York Honors and Awards: Phi Beta Kappa; Alpha Omega; Sigma Xi; Member, Publications: Author of over 131 publications in journals and books. QUESTIONS SUBMITTED BY THE SUBCOMMITTEE Senator HARKIN. Dr. Williams, we will submit some questions to you in writing. I had some on life expectancy and a science article last fall that I wanted to talk to you about. I have a vote, and I only have about 5 minutes left to go make it. So, we will just dismiss this panel, and the next panel can come forward. I will be back in about 10 minutes or so, something like that. [A brief recess was taken.] [The following questions were not asked at the hearing, but were submitted to the Department for response subsequent to the hearing:] QUESTIONS SUBMITTED BY THE SUBCOMMITTEE ALZHEIMER'S Question. Last year the Committee provided a significant increase for Alzheimer's with funding for all of the several Institutes at NIH approaching $200 million total and almost $156 million at the National Institute on Aging. This is up from the $78 million the Institute spent on Alzheimer's in FY 1989 and the $91 million the Institute spent on Alzheimer's in FY 1990. In spite of these increases, I understand that the professional judgement of the Alzheimer's community is that the NIA budget for Alzheimer's should be set at $290 million in FY 1992. Tell the Committee what we are learning about the causes and the possible cures for Alzheimer's. Do there continue to be scientific opportunities in the Alzheimer's field that should be pursued beyond the 1992 funding levels? Answer. Research beyond that planned for FY 1992 could be pursued in many aspects of Alzheimer's disease research--basic biological studies into its etiology, means to improve upon early diagnosis, and the development of treatment approaches. There are basically two approaches to the treatment of Alzheimer's disease. The first involves slowing, stopping, or reversing the biological processes that lead to the decreased functioning of nerve cells by compounds, such as nerve growth factor, that target the neurodegenerative process itself. Only very recently has information become available which indicates that we may be close to understanding some of the processes leading to cell death in Alzheimer's disease. Thus, it may take some time to develop compounds which are directed to these processes. The other approach attempts to increase the functioning of Alzheimer's disease patients and ameliorate both the cognitive and non-cognitive behavioral symptoms. This may be through drugs or other compounds which facilitate the neural functioning of remaining neurons or which bypass the compromised systems, or by behavioral methods which help the patient use his or her available faculties to the fullest. NIA is encouraging and supporting the discovery, development, and testing of new pharmacological treatments and behavioral procedures directed toward relieving the symptoms of the disease and increasing the functioning of the patient. One area in Alzheimer's disease treatment research to receive immediate emphasis would be preclinical drug studies. Once a potential drug is developed, it must be carefully tested under laboratory conditions, often using animal systems, to determine its efficacy before moving the drug to clinical trial studies in patients. Determination of toxicity after the biological activity of the compound has been assessed is also necessary. Toxicological tests must determine that there are not likely to be immediate or major deleterious effects on organ systems before the compound can be given to humans. The development of these resources would facilitate screening compounds in animal models |