Because the acing frequently fall prey to faise and misleading dains for foods, drugs, and other devices they derive important protection from FDA's regulatory activities. Daring iscal year 1965 FDA approved 30 seizures of drugs. 2 of special dietary foods, and 53 of devices due to false or misleading claims. In addition, the agency recommended one prosecntion and three injuné tions involving drugs, and jae injunction indring derive In May 1955 FDA fensed on the aging during Sealer Citizen's Month with special publications and silde shows, radio and television announcements, and major exhibits in six eines During fiscal year 1967. FDA plans to significantly strengthen its drug progTOLIA to provide consumers particularly the aging with more comprehensive protection in an area of increasing ecocomile and health hazards. OFFICE OF EDUCATION The research and training program has supported 10 studies which deal with the educational problems needs and interests of older people. These studies include such subjects as "Patterns of Information Seeking in Adult Education," "The Infinence of Speed and Prior Knowledge and Experience on Adult Learning." and "Research. Development, and Demonstration in Adult Training and Retraining." In addition. library services provide information and advice on programs oriented to aging conducted by State library agencies; distributes publications on request: maintains liaison with other Federal agencies concerned with aging: assists in conferences of lay and professional leaders concerned with librarysponsored activities for older people: assists training institutions with profes sional preparation of librarians needing skills in meeting the special library needs of older people: and provides grants for the improvement of public library services The Division of Adult Education administers programs for the training of adults in civil defense education, basic education, and communty service and continuing education, and provides consultative services and information regarding these programs. Vocational education and manpower development and training provides training and retraining for persons of all ages in the broad occupational classifications of health. trades and industry, office, distributive and marketing, home economies. and agriculture. These programs, strengthened and enlarged by recent legislation, may be expected to serve older persons in need of new skills, improved old skills, and basic learning skills. Institutions and agencies developing these programs are encouraged to employ older qualified persons as teachers in roentional and manpower development programs. PUBLIC HEALTH SERVICE BUREAU OF STATE SERVICES Three divisions of the Bureau of State Services are primarily concerned with improving the quality and quantity of health services for the aging-the Divisions of Chronic Diseases, Medical Care Administration, and Hospital and Medical Facilities. In addition, the other five divisions pertaining to community health and the four environmental health divisions all are engaged in a broad range of activities related to the health of the aging and aged. In 1965, Public Law 89-109 extended for 1 year the Community Health Services and Facilities Act of 1961. Administered by this Bureau, the act authorized project and formula grants for development and demonstration of improved methods of providing out-of-hospital services to the chronically ill and aged. Programing for the project grants is done by all divisions concerned with community health, while programing for the formula grants is carried out exclusively by the Division of Chronic Diseases. To date, 223 project grants have been awarded to 7 national agencies and to agencies in 39 States, the District of Columbia, Puerto Rico, Guam, and the Virgin Islands. Formula grants have been made to 53 health jurisdictions, including the District of Columbia, Puerto Rico, Guam, and the Virgin Islands. Division of Chronic Diseases Gerontology Branch.—The Public Health Service's first operating program in the field of applied gerontology was established in this Division in January 1963. In addition to serving as the focal point in the Bureau of State Services for all programs, including community and environmental health, relating to the aging and aged, the Gerontology Branch develops and administers a program of preventive and protective health services necessary to maintaining health and minimizing disability for all persons over 45 years of age. This program stresses the importance of individuals obtaining regular health appraisal, and of new patterns for providing community services. In its third year of operation, the Gerontology Branch continued development of activities in four primary areas-community services, professional and public education, training, and research. Projects include: health counseling, referral and followup: comprehensive disease detection, health maintenance counseling. and referral for diagnosis and treatment; training of medical and paramedical personnel in applied public health maintenance; and development of education in health maintenance concepts and procedures for medical and related professionals. Personnel assigned by the Branch to serve in developing distinct programs for the aged in several State and local health departments are continuing their efforts and have succeeded in encouraging better and increased utilization of available funds for programs in health maintenance. Professional education and training in applied gerontology is a high-priority objective of this Branch. Throughout the last 2 years a body of gerontological knowledge was collected and prepared by national experts, under contract, for use in curriculum development. Extensive exploration and demonstration of appropriate methodologies for implementation of the curriculum material is being carried out with universities; medical schools; schools of public health, nursing, and social work; official and voluntary agencies; and professional societies. With support and consultation from the Branch, a university program was developed for clinical psychologists to provide course training and related clinical experience in dealing with aged patients. These examples are aspects of a nationwide program to maintain the health of the aging by improving the quality of health services available to them. The education program involves both professional and public education, emphasizing the importance of health maintenance. To further both aspects, the Branch has developed and/or purchased publications, films and exhibits directed to professional and general audiences. Among the materials completed during 1965 is a film, "The Critical Decades." which was premiered at the American Medical Association clinical session and has generated significant interest. Research being conducted or supported by the Gerontology Branch is of an applied nature, designed to gather information which can be used in providing technical consultation on community services for the aging, or in developing and implementing approaches to health problems of the aging. Currently, studies are being directed toward investigation of the patterns of utilization and provision of health and related services for the aged in urban, semi-rural, and rural areas, with particular attention to personal factors influencing these patterns. Another example, a project of special importance, is in the planning state-a longitudinal study of a specific aging population to assess social, psychological, and economic aspects of the aging process. A rehabilitation unit, created in 1964, is responsible for developing programs in the area of prevention and control of medical disability. Specifically, the unit is concerned with all areas of medical rehabilitation-services, publie information, and professional education--with the objective of improving the fune tional level of the aging population disabled by disease and illness. Under direc tion of this unit, a bureauwide staff study of present and projected activities relates to medical rehabilitation was completed in 1965. Other activities in gerontology The activities of the Geronotology Branch are augmented in the Division of Chronic Diseases by the Office of Preventive Services and the categorical programs for cancer, diabetes and arthritis, heart, neurological, and sensory diseases, and renal disease. At this time, units are being established for chronic respiratory diseases and on smoking and health. The newest unit in the Division of Chronic Diseases is the Kidney Disease Branch. At present the program emphasis is on the establishment of kidney dialysis centers. These centers will provide services for persons up to 50 years of age. Plans call for an expansion of the Branch's activities to include other services of more direct benefit to the aging and aged, including those for the prevention and detection of urinary tract infections. The development of projects for automating multiple screening as part of periodic health appraisal and for validating screening tests are being supported and directed by the Office of Preventive Services. Studies are being directed to ward testing the effectiveness of early detection. In addition, a handbook on the screening procedures for chronic diseases is being developed by this Office. While the program of the Cancer Control Branch is not directed to any one age group, benefits will accure to all persons, including the aging and aged. The research activities related to detection and prevention supported by this Branch should have marked effects on persons in the upper age groups. Tests and equipment to be used for cancer detection are being developed; and in the area of prevention, the Branch is supporting the development of a method to determine high-risk groups. Also being made is a study of physicians' attitudes and practices concerning cancer. Services to develop and demonstrate various aspects of therapeutic control of cancer are being provided target populations, including the aging and aged. Eighty-three percent of all diabetes and 85 percent of all arthritis is found in persons over 45 years of age. Many research activities and studies supported by the Diabetes and Arthritis Branch stem from the health problems associated with these two diseases. Some of the projects are directed toward the perfecting and evaluating of equipment and techniques for detection and diagnosis. Also, through the loan of equipment and supplies or the assignment of personnel, diabetes casefinding is being supported by the Branch in more than three-fifths of the States. Consultation to provide for the improvement, expansion, or development of diabetes and arthritis programs is available to all States and communities. Professional and patient education are included in the activities of the Diabetes and Arthritis Branch. By providing professional, technical, and financial assistance to States and other agencies, the most effective methods of prevention, diagnosis, and treatment of cardiovascular diseases most prevalent among the aging and aged are made available by the Heart Disease Control Branch through six of its eight programs: Cardiopulmonary diseases, congestive heart failure, coronary heart disease, hypertension, peripheral vascular diseases, and stroke. Research, services, training and education are important elements in each of these programs. Metabolic and etiologic studies, projects for the development of intensive-care units, and studies to predict the hospital course of disease and the likelihood of recovery for patients with coronary heart disease are among the special interests of this Branch. The Neurological and Sensory Disease Service Branch has primary responsibility for program efforts to provide for the detection and control of glaucoma, a disease common primarily to persons over 45. Testing is being evaluated, and statewide programs for screening are being supported. A number of studies are seeking to determine the types and extent of visual defects among nursing-home residents, the social and functional effect of correction on the individual patient, and the cost of providing the services required. Programs in speech rehabilitation are being supported in seven States, with two of the projects specifically directed to stroke-asphasia patients. At the present time, the Neurological and Sensory Disease Service Branch is funding several training projects in areas of importance to older people (e.g., instruction of physicians in the use of tonometers for glaucoma detection and the training of audiologists and paramedical personnel in the area of communicative disorders). Division of Medical Care Administration The Division of Medical Care Administration was created in August 1965, and assigned the Public Health Service's responsibilities for the health insurance for the aged program. This new Division will provide the focus in the Service for medical care administration activities in general, and for the administration of the professional health aspects of the legislation in particular. In line with this mission, the division will administer operational and grant programs for the development, expansion, and improvement of medical care systems, services, and resources. It will administer the professional health aspects of the health insurance for the aged program in such areas as standards, State, and local agency activities, training, evaluation, studies, utilization review and relationships with the National Medical Review Committee. Studies will be conducted and supported relating to the health insurance program and to the advancement of knowledge and understanding in the field of medical care administration generally. Consultation and technical assistances will be provided to other related programs of the Department of Health, Education, and Welfare and to official, voluntary, and professional agencies and organizations. The new division will have responsibility for evaluating the impact of new and existing medical care systems, financial mechanisms, and services on the health services and resources of the country. A nucleus for this operation was provided by the transfer of programs from two divisions in the Bureau of State Services. These were the Medical Care Administration Branch and the Health Economics Branch of the Division of Community Health Services, and the Nursing Homes and Related Facilities Branch and the Office of Care Services of the Division of Chronic Diseases. In addition to duties under the health insurance benefit programs, these four units will continue to carry out former functions. From the two branches formerly in the Division of Community Health Services, this includes the continuation of studies on financing and utilization of medical care services. Specifically, these are studies on drug utilization and cost, utilization and cost of health insurance plans, medical utilization patterns in an aged population with medical-surgical insurance, health insurance for retired military personnel and dependents, utilization of medical care by Spanish-American War Veterans, cost of cancer in the United States, local health department activities in medical care administration, and patient-physician communications. The branch is also supporting or conducting research studies on new methods to provide ambulatory patient care, administrative controls in old-age assistance hospitalization; and international survey data on social and economic factors in relation to the physical functioning of older people, their health status and retirement patterns. In addition, support is being given for a national study on the social well-being of noninstitutionalized older people. an evaluation of public health programs for the aging, and an analysis of social and economic differentials in mortality. Studies on the health service needs of middle income retired people living in a cooperatively owned apartment project. and physicians' attitudes toward home care programs are being continued. Cost studies on rural hospitals based on comprehensive medical services, and a hospital records study to determine insurance coverage of the aged are in progress. Several demonstration projects are receiving support. Included are demonstrations relating to the following subject areas: the development of a central medical social service bureau; a program of hospital planning for patient posthospital care; a personalized service bureau for homebound chronically ill and aged; a neighborhood health-aid program; a health care program in a public housing community; a screening and referral service program; and a program of comprehensive medical care for the medically indigent. Through technical and financial support, the Home Health and Related Services Branch, formerly the Office of Care Services, will continue to place emphasis on home health services with stimulation of their development in both urban and rural communities. Surveys and development of guidelines have been carried out on home health services in general, including special studies on coordinated home care, home delivered meals, and personal care aspects on homemaker-home health aid programs. In addition, because of the growing importance of coordination and provision of continuity of care for the older patient, special stress has been given and will continue to be given to patterns of coordination of services, primarily represented in communities by programs of information, referral, and counseling. An inventory of these services is being conducted. Continued and increased interest in training of professional personnel is evidenced by the support of several training centers throughout the country. These centers provide short-term training and orientation for professional per sons at service, consultative, and administrative levels and will give particular emphasis to the relationship of home health services to medicare. Finally, the activities of the program are being expanded in the development of methods of evaluation of patient need for care service as a crucial part of all community planning and programing. The Nursing Homes and Related Facilities Branch will continue to provide opportunities for training of administrators and other personnel emploved in nursing homes and for training of students in professional schools, including medicine, social work, and nursing. It will continue the development of demonstration projects and research studies to improve services, Included are studies on the effectiveness of foster family placement for preventing premature and inappropriate placement in nstitutions and in preventing premature mental and physical deterioration; he usefulness of a multidisciplinary mobile team to provide patient care in ursing homes; the provision of social services for nursing home residents; the restoration and conservation of the social health of patients: the role of the nursing home in provision of care; a classification of patients for long-term care: nursing home counseling and referral services: the extent to which patients are being transferred from mental institutions to nursing homes and the effect on the patient: the value of utilizing organized health resources. training and consultation for personnel, and of utilizing patient self-help in care in nursing homes and related facilities; and manpower studies of physical thereapists and dietitians in nursing homes. Other projects are now being developed to meet the demand for techniques in the implementation of the medical care legislation. This includes a project to develop transfer and working agreements between hospitals and nursing homes. To promote a continuing relationship of the Branch with State health departments, State licensing agencies are being encouraged to form a group that can serve as a discussion and planning organization. This group will focus its attention on change in responsibility-from exclusively regulatory to inclusion of training and education for the improvement of patient care in nursing homes. The Branch will continue its distribution of audiovisual materials pertaining to the management of nursing homes and the provisions of services in these facilities. Films currently in circulation include the following subject areas: hospital-nursing home affiliations; how to select a nursing home; environmental health in nursing homes: safety and fire protection in nursing homes; and laundry service in nursing homes. Individual exhibits are available in the areas of food service, environmental health, activities programs, and nursing services in nursing homes. Branch publications include an annotated reading list; a series of 21 publications on environmental health factors in nursing homes; a food service manual; guides on standards, social services, health records for long-term care facilities; and an instructor's guide for the use of “How To Be a Nursing Aid in a Nursing Home." Division of Hospital and Medical Facilities A primary objective of the Division of Hospital and Medical Facilities is to stimulate the construction of facilities needed to build up an efficient, well-coordinated services network for the acute care, long-term care, and rehabilitation of all persons, including the aged and aging. Since the enactment of the HillBurton program, the Division has provided assistance for the construction of 54,000 long-term-care beds in chronic disease and nursing home facilities. The hospital and medical facilities amendments of 1964 provided for an extension and increase in these efforts. The amendments specifically authorize an annual appropriation of $70 million for each of 5 years for "long-term care facilities," which combines the previously separated grants programs for chronie disease hospitals and nursing homes. The aging and aged will benefit also from the other provisions of this legislation, which include a 5-year extension for construction of hospitals and public health centers, diagnostic, and treatment centers, and rehabilitation facilities. There are further provisions for the modernization or replacement of public and nonprofit hospitals and other health facilities, particularly those located in more densely populated areas. Planning funds are available also. A demonstration project is being supported which is intended to show that an effective program of geriatric rehabilitation can be implemented in a rehabilitation unit employing skills available to typical community hospitals. Two pertinent training projects are being supported also. One is a curriculum planning project to provide a course of study at the undergraduate level for the potential social worker and nursing home administrator; the other is for rehabilitation training for county hospital personnel. Other Divisions At the present time the Division of Accident Prevention is supporting several research projects basic to the health and well-being of older people. Included are a study which provides for the screening of women for osteoporosis and evaluation of a new diagnostic device used to measure osteoporotic change, and several other studies which relate to safety in nursing homes. One of the studies on nursing home safety is directed to determining means to reduce fire hazards and to provide safeguards for preventing accidents. The other study is concerned with the testing the durability of flame retardancy of fabrics after normal usage; these are fabrics used for wearing apparel, bed clothing, and decorating. The Division of Accident Prevention gives consultation to State health departments, other Federal agencies, and other public and voluntary groups con |