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develop more information on long-term 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 major 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
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. 1 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 an inability to reproduce--which occurs in aging cells--or to uncontrolled proliferation--as seen in cancer celis.
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.
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 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.
BIOGRAPHICAL SKETCH OF DR. T. FRANKLIN WILLIAMS
Birthdate: November 26, 1921
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:]