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develop more information on long-teri care issues, asking for systematic studies of the benefits of specialized care units on dementia patients, family members, and health care administrators and practitioners.

These and other new developments in Alzheimer's disease research are

among those highlighted in the recently released second report of the

Congressionally appointed Advisory Panel on Alzheimer's Disease.

The panel

has emphasized the need and opportunity for further progress In understanding and treating Alzheimer's disease-- progress that can come from a significant

research effort on this dread disorder.

Older persons must also face the consequences of possible physical frailty. A najor goal of the NIA is to develop Interventions to minimize loss of function and to maintain independence at the maximum level possible. The costs of physical frailty are comparable to those imposed by dementia-

estimates range from $54 billion to over $80 billion per year, including $24

billion for health-related services alone. Frailty can extract such costs

through fall-related injuries, including hip fracture, and through the

consequential loss of one's ability to live independently.

As with dementia, the prevalence of affliction is especially concentrated

among the oldest old,

But it is increasingly evident that people are never

"too old" for prevention or reduction of physical frailty.

It is a

particularly fruitful research focus because frailty interventions, such as

leg strengthening exercises, balance training, and modification of medication

dosage, have either been tested or are now ready for testing.

As reported in

June 1990, a notable NIA-supported study of muscle strengthening exercises in

frail 90 year-old persons showed remarkable improvement in muscle strength,

muscle mass, and the ability to walk.

Such an approach is at the heart of

geriatric care; NIA shares this philosophy on comprehensive rehabilitation

with the new National Center for Medical Rehabilitation Research.

A series of clinical trials to gather definitive information regarding

prevention or reversal of frailty was initiated in 1990 and will continue

through 1993, including a special initiative on frailty in minority

populations.

At this point we will choose the most successful elements from

the trials to develop a comprehensive strategy for reducing frailty, falls,

and other injuries.

Another important step toward better integrated geriatric

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 18. 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

genes.

Disruption of this balance leads to ani inability to reproduce --which

occurs in aging cells.-or to uncontrolled proliferation--as seen in cancer

cells.

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. Further research, including hearing studies, should enable the development of other

interventions to ameliorate loss of function and independence.

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

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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 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.

A new

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 long

range 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

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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
Aging. NIH, 1983, J.Lowell Orbison Alumni Distinguished Service
Professor; 1982-1983, Director of the Geriatric Unit, Monroe Community
Hospital, Rochester, N.Y.; 1980-1983, Co-Director, Center on Aging,
University of Rochester Medical Center; 1968-present, Professor of
Medicine and of Preventive, Family and Rehabilitation Medicine,
University of Rochester; 1968-1982, Medical Director, Monroe Community
Hospital, Rochester, N.Y.; 1977, L.S. Mcleod Visiting Professor of
Geriatric Medicine, University of Adelaide and South Australia
Postgraduate Medical Education Association; 1956-1968, Instructor to
Professor of Medicine and of Preventive Medicine, University of North
Carolina; 1954-1956, Fellow in Medicine, University of North Carolina;
1953-1954, Assistant in Medicine, Boston University; 1953-1954, Senior
Resident Physician, Boston Veterans Administration Hospital; 1950-1953,
Intern and Assistant Resident Physician, John Hopkins Hospital; 1942-
1943, Assistant in Chemistry, Columbia University.

Military Service: 1983 to present, Assistant Surgeon General, U.S.
Public Health Service; 1943-1946, Communication Officer, U.S. Naval
Reserve, active duty.

Societies and Associations: American Association for the Advancement
of Science (Fellow); American College of Physicians (Fellow); American
Federation for clinical Research; American Public Health Association
(Fellow); American Society of Human Genetics; American Geriatrics
Society; American Diabetes Association; Society for Experimental
Biology and Medicine Rochester Academy of Medicine; New York and Monroe

County Medical Societies; Gerontological Society of America; New York
State Public Health Association; Association of American Physicians;
Institute of Medicine, National Academy of Sciences; The Royal Society
of Medicine; and Academia Medicorum Litteratorum,

Honors and Awards: Phi Beta Kappa; Alpha Omega; Sigma Xi; Member,
Institute of Medicine; Diplomate, American Board of Internal Medicine;
Diplomate, National Board of Medical Exaniners; Markle Scholar in the
Medical Sciences; Special Fellow, Department of Physiocoloy, Vanderbilt
University: Honorary Member, American Academy of Orthopedic Surgeons ;
and Honorary Doctor of Science, Medical College of Ohio.

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:)

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