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*Last Updated January 1, 1999*
BACKGROUND
Elderly persons represent an increasing
proportion of our population and require a major proportion of the
acute and chronic medical care delivered in this country. Gerontological
research has begun to provide a base of scientific knowledge that
is needed to aid health care professionals in providing appropriate
care for the elderly population. Such care includes the treatment
of the psychologically, biologically, and socially-related problems
with the aim of preventing disease and disability and enhancing
the well-being of older persons whenever possible. Research in the
field is still in a developmental state, and many gaps in our knowledge
remain. Research in geriatric medicine covers a broad area and overlaps
considerably with inquiries into social gerontology, biology, clinical
medicine, psychology, health care delivery, health promotion and
disease prevention, and technology assessment.
The American Geriatrics Society has
broad representation among clinicians, researchers, and educators
in the field of geriatric medicine. Given this membership and their
potential for significant interaction with researchers in other
areas of medicine and health care (and its close linkage with the
American Federation for Aging Research), the AGS can--and should
focus attention on the specific areas of research required to improve
the health of our elderly citizens.
POSITIONS
A. Research Training
1. Training in specific research methodologies
must be included in the research component of fellowship training
programs in geriatric medicine. Because of the wide range of appropriate
and important areas of inquiry, the specific content area may
vary. "However, training should include curricula on study
design, biostatistics and critical evaluation of published literature.
In addition, the fellow should be trained in the specific methodologies
pertinent to his/her selected research focus (e.g. basic laboratory
skills, epidemiology). The success of this training will require
a significant sustained commitment to mentoring of trainees by
qualified senior investigators."
2. Research in geriatric medicine
should be encouraged as a significant and highly important area
of endeavor by medical schools, nursing schools, schools of public
health, and other appropriate professional schools. Chairpersons
of departments and other appropriate high level administrative
officers should be encouraged to promote research in geriatric
medicine as an important feature of their program and to indicate
that successful endeavors in this area will be rewarded appropriately.
B. Scope of Research
In order to further the goal of maximizing
the health status of older Americans, research should include or
should be strongly encouraged to include the following areas.
1. Basic biology of the aging process.
Studies of the molecular, cellular, and physiologic aspects of
aging may help answer questions relating to not only the aging
process but many of the diseases of aging.
2. "Basic and clinical research in the
diseases and problems creating functional disability in aging
(e.g., cardiovascular disease, cerebrovascular disease, cancer,
arthritis, Alzheimer's disease, falls, incontinence, osteoporosis,
delirium, nutritional deficiency, etc). In this context, certain
specific areas of inquiry are appropriate."
a. Research into disease etiology
and characteristics as they are manifested in elderly individuals
compared with manifestations in the young.
b. Research into variations in
approach to diagnosis and treatment mandated by older age (e.g.,
test characteristics in older persons, clinical pharmacological
alterations, hospital management, consultation services, post-acute
care, multidisciplinary needs, clinical assessment, technology
utilization, and so on).
c. Research into prevention of
disease and/or complications in the elderly.
3. Research into the most effective methods
and development of new and innovative methods for the delivery
of health care to older persons (e.g., relationship between processes
and outcomes of care, provider-patient communication, role of
social supports on functional outcomes, clinical effectiveness
and cost effectiveness of alternative strategies of care such
as disease-management programs, group visits, efforts led by multidiscilinary
teams).
4. Research on health promotion
and disease prevention for elderly individuals. This will--out
of necessity--overlap with such efforts for younger individuals,
but it is entirely appropriate (given the overall goals of such
research) to establish a factual basis for the use of, or recommendation
for, preventive modalities in all age groups. The specific areas
of inquiry might include cancer prevention, exercise and physical
fitness, diet and nutrition, or general functional maintenance
(e.g., home living).
5. Research on cost, reimbursement,
and technology as applied to elderly persons. This would include
research on the impact of changes in government regulations, public
policy hospital regulations, and other medical economic issues.
6. Research into ethical decisions
of medical care. Because of the growing concern of limited resources
and the urge to maintain the best value for limited dollars, older
persons are at significant risk for adverse actions in this regard.
Inquiries into the rational basis for ethical decision-making
will be of great importance.
7. The most rapidly increasing
portion of our older population is the "oldest old."
Since there is relatively little experience with this component
of the elderly population, investigation into physiological, clinical,
social, and economic characteristics of this population group
is of great importance if we are to anticipate medical care needs
for the future.
8. Mental illness in the elderly
population is clearly a major cause of morbidity and suffering.
Our knowledge of the epidemiology, etiology, pathophysiology,
and treatment of mental illness in older persons is severely limited,
and more research is clearly needed.
C. Funding for Research and Training
1. "The core and critical mass of researchers
in geriatric medicine and relevant areas continues to be inadequate
to advance the field as needed. To overcome this deficiency, strategies
must be developed to attract dedicated researchers to the field
of aging. Important components of these strategies include wider
dissemination of research and training opportunities in geriatrics
to students in the health professions. In addition, increased
funding from the NIH, foundations, and private industry is needed
to support first time investigators, and to sustain promising
new investigators.
2. We recognize the outstanding
contribution of the National Institute on Aging in stimulating
and supporting research in geriatrics and gerontology and in increasing
funding for research through its own efforts and through cooperative
funding for aging-related programs with other institutes.
3. We recognize and commend the
efforts of the Department of Veterans Affairs to fund research
in geriatric medicine through the Geriatric Research, Education,
and Clinical Centers (GRECC) program and other such programs and
urge increased, targeted support for aging and geriatrics research
from this agency.
4. A number of private foundations
and industry sponsors have adopted research in geriatrics as a
pertinent and important area for funding. The need for such support
is increasing, and we encourage other foundations and corporations
to consider the geriatric and gerontological research areas discussed
here as a funding priority.
5. The support given funding for
research on the problems of aging and older persons by a significant
number of members of Congress is recognized and appreciated. It
is extremely important that this support be continued at a time
when cutbacks are under consideration. To achieve this goal, we
recommend that NIH funding to the appropriate institutes be increased
specifically to address the above areas of geriatric and gerontological
research. Consideration should be given for mandating that elderly
persons be included in government-funded research similar to the
NIH requirements related to the inclusion of women, minorities
and, most recently, children.
Developed by the AGS Public Policy Committee and
approved March 1986 by the Board of Directors. Reviewed May 1991.
Reviewed April 1993. Revised in May 1999 by the AGS Research Committee.
The American Geriatrics Society, The Empire State Building, 350
Fifth Avenue, Suite 801, New York, NY 10118, 212-308-1414, Fax:
212-832-8646, info.amger@americangeriatrics.org.
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