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DOCUMENT RESUME ND 215 262 CG 015 995 . AUTHOR Cowell, Daniel D. TITLE [White House Conference on Aging, 1981. Abstracts of the Technical Committee Reports, Mini White House Conference Reports, and State White House Conference Reports.] INSTITUTION White House Conference on Aging, Washington, D.C. MKS AGENCY Department of Health and Human Services, Washington, D.C. 'PUS DATE 81 NOTE 147p.; Papers presented at the White House Conference on Aging (3rd, Washington, DC, November 30-December 3, 1981). For related documents, see CG 015 980-987 and CG 015-990-00 014 022. Best copy available. EDRS PRICE N101/PC66 Plus Postage. DESCRIPTORS Abstracts; *Aging (Individuals); Bibliographies; Employment; Family Role; *Health Needs; *Minority Groups; *Older Adults; Besearchteeds; *Social Integration; *Social Services IDENTIFIERS *White Nouns Conference on Aging ABSTRACT. This. collection of abstracts,, designed to assist White Rouse Conference on Aging delegates involved with research on aging, presents information from 16 Technical'Committee Reports which focus on implications of an age-integrated society, employment, support systems, health issues and services, th4 family, long-term care, elder Americans as a national resource, research, and retirement income. Of the 41 abstracts from the Mini-White Nouse Conference Reports, 10 deal specifically with health care issues: alcoholism, Alzheimer's Disease, vision, hearing impairments, foot care, oral health care, long-term care, mental health, national security, and nursing. Eleven mini-conference abstracts focus on the aging of specific populations, e.g., American Indians, Blacks, Asian Americans, Hispanics, Euro- Americans, women, veterans, rural e lderly, Urban elderly, low income persons, and the institutionalised, e lderly. The remaining ink-conference abstracts dealwith services, ,self-lufficiency, stereotypes, housing, and other issues relevant to aging. Abstracts are also presented from the State White House Conference Reports of all 50 states as well as tne District of Columbia, Guam, the Navajo Nation, the Northern Marianas,-Puerto Rico, and the Virgin Islands. (NRB) www wwwwwwwwwww* Reproductions supplied by !DRS are the best that can be made from the original document. ****tft***************************************************************** BEST COPY AVAILABLE WHITE HOUSE CONFERENCE ON AGING, 1981 Abstracts of the Technical Committee Reports, Mini White House Conference Reports, and State White House Conference Reports Daniel D. Cowell, M.D., F.A.P.A. National Institute on Aging DIAIMMOST Of scoucialoo4 NATIONAL INSTITUTE Of EDUCATION sCNra1,,ONAY. RESOURCE_. .F _ CENTER tERIC Tha AtKammenT has been roprtIttrcor, as -ksterord trorm the pomr-rm UrgaMii14., .....14.4147.9 MW]. ,Ptiltgrri hive tort, mod. To ,tr4X1.1,0. ropmd6cIrr, QuottIV ,Porttsut,mouroptmomstortottrtMmtkwu meat Jo mut mmrew-ortiv represent offt,a, pouts, o p,wv 6 E ine Preface The abstracts in this collection have been taken from the basic materials prepared for the.1981 White House Conference on Aging (WHCoh): Wchnical Committee Reports; Mini White Rouse Conference Repoils; and State White Molise Conference Reports. The abstracts have been prepared by, the National Institute on Aging to assist delegates who are dealing primarily with research on aging issues although other delegates may find them useful', as, for example, the abstracts on Technical Committee Reports. Np attempt has been made to edit the original material; the abstracts, therefore, represent as faithful a rendering of the original Reports as possible. They are designed solely to facilitate the work of delegates who must sift through a large volume of material pertaining to research during the course of their leliberations. The legend which follows is provided.eb assist users-of the abstracts in identifying the abbreviations, notations and symbols which have been used in the interest of brevity. k Daniel D. Cowell, M.0,./, F.A.P.A. Special Assistant to the Director National Institute on Aging Medical Liaison to the 1981 White House Conference on Aging V Area Agencies on Aging AoA - Administration on Aging ANSI - American National Standards Institute CETA - Conprehensive Employment and Training Act FCC - Federal° Comminications CertEfission FCC*, - Federal Council on Aging FL - Food and Drug Administration OHS - U.S. Department of Health and Human Services HCFA Health Care Financing Administration HRA- - Health Resources Administration HUD - U.S. Department of Housing and Urban Development IRS - Internal Revenue Service LTC - Long Term Care liCHS - National Center for Health Statistics NHI - National Health Insurance NIA - National Institute on Aging N1AAA - National Institute on Alcohol Abuse and Alcoholism National Institutes of Health IMMH - National Institute ofllental Health CSI - Old Age and Survivors Insurance VA Veterans Administration WHCoA - White House Conference on ',ling Symbols - female 'crm male 10 - primary or primarily 20 - secondary or secondarily . - support, stimulate, increase or encourage - decrease, diminish RED - research and development Rx- - treatment 6 Age-I White House Conference on Aging. Technical Committees tern Society - implications for the Economy Age-Integrated Society - Implications for Educational; Systems- Age-Integrated Society - implications for Government Structures Age-Integrated-Society - Implications for Societal Institutions Age-Integrated Society - Spiritual Well -Being Creating Age-Integrated Society - Media Employment Family, Social Services and Other Support Systems Hrllth Maintenance and Health promotion. Health Services Implications for the Family Long Term Care Older Americans As a Growing National Resource Physical and Social Environment and Quality of Life Research Retirement Income Principle Technical Committee on Age-Integrated Society - . 4 Implications for the Economy is growdential to current and ture wel -being of elderly (Gains already achieved for the elderly Were made largelyky a productive economy). Hence:* 2. Recommendations o Employment opportunities for elderly should be t. o Government and 'nitre' sector should coopprate to f pe o T income transfer program for poorest elderly is the quickest, significa.': remedy for income inadequacy. o-tdomestic private investment aimed at improved productivity and Iconcnic growth. *And do this without creating intergenerational conflict by utilizing the combined strategy described above - because of heterogeneity of the -elderly group. Technical fi $ 11 fi WHColt Technical Committee on AgeLlatesaltlleq7. Inulications forEducational Systems 1, T life-long learning programs -- older persons' information on knowledge and skills for survival, employment, life enrichment; barriers to education must be 4,; education especially needed in era of rapid social change. Can: reduce isolation. o T understanding of late life and 4 coping skills. o 4 awareness and use of options - - economic opportunities and information. - new roles. - physical well-being. life enrichment. 2. Barriers - $, 4, mobility, handicaps, 4, health, 4, transportation, attitudinal; institutional disinterest. 3. Education an inherent right for all age groups: Recommendations: o Federal government - - T research and research training to 4 scientific knowledge about the 0,-ocess of normal aging, the aging society and the circumstances of the elderly via investigator-initiated and govement-directed kesearch.- all as a way of improving education and service programs. investigate nature and scope of age discrimination in ,U.S. and intervention strategies. T educational-programs for elderly - especiallto &Orme elderly health and social functioning, employment opportunities. - evaluate all relevant Federal educational programs conducted by Federal agencies. T support for educational programs designed to prepare personnel for working with elderly. - J11.1CoA Technical Committee on Age Integrated Society - Implicatirs for Educational Systems o States - - define educational needs of their elderly. - examine educational programs for discriminatory policies. o Educational Institutions and Scientific Organizations - - become 6miliar with changing role of education in our changing society and potential_ exclusionary policies involving the elderly. - consider implications of changing, aging society for-threir memberships, It pub/dc understanding, T service to elderly. o Private - - T accessiblity by elderly to all educational programs they fund/sponsor with T participation by elderly as planners and_ teachers and learners. Key Issues 1. T Educational Opportunities for Older Adults. 2. Education of personnel to serve elderly. 3. Educatibn about aging - inclusion of materials or aging into elementary,. middle, and high schools. - preparation of teachers? - sensitivity to needs of elderly?. role of mass media, telecommunications? - 'P research on education and aging. S .. - 011.W. ; . Ia.. . .1 I ta.. T=1 I - Techrii6a1 Cannittee on Age-IntegratedSociety' Invlications for Government structures a . '1: to develop the role of government vis a vis the elderly and relevant" strategies, to achieve objectives plus structures needed to achieve them.', ,I1 ,2. prevailing mode of dealing with elderly leads to fragementation, piece= 4 meal approach, special-purpose legislation without priorities and with variable implementation. 3. role of government has obscurred effects of non-government structures in meeting needs of elderly - family, private, social institutions, etc. 4. four major issue areas or themes: A. Public policy and policy development o a need for categorical Federal and state agencies for elderly? o need policy priorities and role clarification, e.g,, AoA and FOOA; state vs. Federal government role; removal of disincentives to state initiatives; role and resources of AAA's? o participation by local elected officials? B. Organization and management o need to unify income and health financing within HIES. o T program management - bet national goals and priorities, T flexi- bility of options. by state/local administrators, streamlining of Federal requirements and goals, establish program and performance standards. o analyze need for an impact -of categorical approach to developing services and supports for the elderly. o options 0 - create a Federal Department of Aging? - place AoA and other components (?) in Social SeCurity, Administration? iCVCyiui AUA with gted er dutonacy dad-indETemdence in HHS. - develop Aging Policy Council - key'subcabinet officials who have major responsibility. for elderly? 9 O . ** (S. WHCoA ( . Technioil Committee on Age-Integrated Society - Implications-fcm--(kArernment Structures appOint'Assistant Secretary for/Aging in eadh"Depariment or agency having responsibilities for aging programs? - develop President's Council on Aging - cabinet level officials? tAdMinistrative.relationship between SSI and OASI? C. Federal ism, fragmentation and flexibility use networ k management as a coordination strategy? maximum flexibility in local choice making and conflict resolution regarding implementation of national programs. - designate cities and countries as AAA's? - enhance role of indigenous aging "network" - ethnic and social groups, families, neighborhoods? - 1 role of privatefitructure. D. Advocacy and Advisory Structures - appropriateness of advocacy operationsby Jane agency with ' another? - can part-time FCOA serve demands,of policy advocacy? - White House level counselor as advocate? , - appropriateness of combining planning, services and advocacy in same local, state 'Organizaticni? - efficacy of citizen 'redress programi? - means of citizen input on national programs (OASI and Medicare)? - role and effectiveness and evaluation of citizen advisory bodies? - criteria for membership on advisory bodies. . * 5. Develop specific measurable objectives on'these issues, cost-benefit data, assignment of responsibilities and information feedback mechanisms. O WHCoA o Technical Committee on Age-Integrated Society - Implications for Societal Institutions 1. The phrase "age-integrated society" - taken-as'point of departure fOr ctive-re-lationsirieb involving persons of all aces night, if facilitated by public policy, benefit all Americans, e.g.,,effort to encourage intdrgenerational interact6, status of older AmeriCans, include them in mainstream of society arlp tQ rediscover them as a national resource. - ;2. Consensus that the ideal futuib-will be lirnited,by the realities of old age - but more by our ability to achieve political consensus about social Objectives and ingenuity in implementing them. 3.. Continues social integr4tioninto societal mainstream of younger more functionally capable elderly is eprimary concern with services more emphasized fccolder elderly to counteract increasing-impairment and dependency. * 4. Chronplogical ages only a gross indicator of capacity, behavior and need. 5.. Ageism and negative stereotypes are changing but there remain diffuse- . . mess and confusion about policy objectives. Can social ingenuity and political.skill achieve a society in which a new status for older people will help insure that needs and aspiratipns of all citizens will be served? 6. Three alternative options or "images" of a futuie society vis a'vis the elderly: 6 '0 A. Age irrelevance stressing policies like: o 4, mandatory retirement. o 4, sgoibased privileges, exemptions and programs. o replace FCCIA with Federal Council of Age Equity. B. Updating the Boundary and Social Meaning -of Old Age, e.g. - o change 60 to 75 (i.e$, 75 and older appears still to Warrant special consideration). o prohibit.mandatory retirement before age 75. services to age 65. o 'target special programs on very old. p 0 11 0 iok WTICoA .11p. Technical Committee on Age7IntegrataSoaety Implications for Societal Institutions . Society that recognizes older Persons have a Special status and Special responsibilities o, this was preferred by the Committee. o image of elderly as a concept Of "veteranship" - a new status ("survivorship"?) characterized by liberation, enhanced choice, entitlements, authority and opportunity to woik, retire, education, 4, discrimination, I intergenerational contact, ir social roles that enhance respect for elderly and their continuing contributions. 1.2 a 'tutional religious bodies number 146+-million constituting ty centers of caring and fellowship for older adults - in healing, supportive and educational services. The o uphold dignity of life of elderly and human worth and "wholeness" and the quality of life. o tpmaning of life. o t support for times of stress and conflict, death, dying. -o secularist socie mediate theological, ethical and spiritual values in a pluralistic, stress concept of spiritual well-being as an integral part of the wholistic vier ,,cam the individual. *Spirituality" transcends the 1 religious and includes all intangible non-material needs, aspirations. o can aid in reshapinqsocietal attitudes critical to the achievement of an age-integrated society and in humane policies regarding the elderly. 0 services. a le o strengthen the family in aiding their elderly `or, in sore cases, acting as family surrogates.. o serve as places of identity, belonging and refuge. o aid in humanizing bureaucracy and technology. flitamigniatioimt o church and state collaboration needed at all levels to promote education aging, delivery of services and wholistic needd throughout lifespan. o church and synagogue self examination to assure standards conform to traditions revering long life and dignity, human worth and continued growth, 4, ageism and gerontophobia. o use 'Of religious sector instrumentalities to funnel public funds for the elderly. . Page Technical Committee on Age-Integrated Society - Spiritual Well-Being o foster wholeness concept of elderly. o foster education/training for addressing spiritual needs and care of the elderly. o foster services which are wholistic. o t reimbursement of spiritual care services. 14 WHCoA Technical Committee on Creating Age-Integrated Society - Media 1. elderly have negative image, false stereotypes influenced by the media which can also t intergenerational communication, and form and perpetuate cultural values androIe mils;- age discrimination by media in employment. 2. role of oldsters as consumers of media, participants in producing media, 3. impact of new media technology on elderly. 4,--o--little attention paid to portrayal of-elderly-by-media in then programming as well as in key issues of concern to them. o stereotypes abound. r Research o age-not often .a variable in studies (especially for ; and minorities) on impact of media; researth is fragmentary with few forums for such studies; long lag time on publication. 6. Age discrimination in media employment - management, reporters, executives; appearance a factor; few roles written for older actor. . Technol , Elderly not represented among cable subscri -rs. 8. Key Issues - o ,Media portrayal of elderly and dissemination of information about them. o Discrimination in media employment. o New media technology. 9. Recommendations - o Media portrayal and monitoring of programming for elderly; educate media to elderly needs and issues, f FCC inquiry for media stereotyping. o Establish National Council for Mass Media and Older Persons - f research on media portrayal and program activity. - f advocacy. - t elderly programing. - publish magazine on these issues. WHCoA Technical_Comittee on Creating Age-Integrated Society - Media o Research - on process by which attitudes about aging and the elderly are mediated, especially involving women/minorities. Ac04 NIA, and Department of Education encourage research on portrayal of elderly in radio, public broadcast, game, talk show, films, texts, etc. o Discrimination in Media Employment - enforce compliance with Age Discrimination in Employment Act and 1964 Civil Rights Act tot use of older actors, actresses and minorities on TV. o Utilization of Media Technology - consider telecommunications-technology as a useful tool for providing services to elderly. - elderly involvement in cable franchising process. T clearinghouse on telecommunications technology. O 16 Technical Committee on Employment 1.' Sound long-term national economic policy requires a clearly enunciated policy on extended worklife, necessitated by: t, o demographic change. o retired /employed adults. 1 demands on public and private retirement income resources. o vocational educational -and manpower resources, disproportionately directed to younger workers. Recommendations 1) age-neutral hiring, employment and training standards; via collaborative public-private efforts. 2) utilization of skills of all workers efficiently, creatively, effectively, humanely and equitably. 3) it central value of individual's right to work or not work unfettered by arbitrary or intrinsically desirable age constraints, tax policies or retirement benefit formulations, or aging myths." 2. Recarmendations o Federal government with state and local governments should review tax policies to elithinate barriers and disicentives to, employment for elderly. o should be no i O er benrLit contributions based on age (amend Age Discrimination in Employmen o t flexible work arrangements by both management and labor - shared work, part-time jobs, training for second careers; extended worklife should be included as a goal of collective bargaining (National Labor Relations Act). o cm and other publicly supported training and manpower programs -9 equitable help to all age groups; Title V (Older Americans Act) Senior Ccummity Employment Program should be T. o itresearch The Federal government:and private sector should promptly undertake a major research and demonstration effort to: 1; WUCoA 7' Technical Committee on Employment develop and test a utilization strategy for age-neutral occupational performance appraisal tools and personal functional capacity measures for appliclation to a wide range of current and developing occupational categories. - assess value of mature skills, costs and productivity of various age groups in diverse jobs. - 't facts on skills, attitudes and productivity of older workers and disseminate them. o t education and training for new and second careers -- especially in periods -of unemployment or when unemployed. 3. Government, is employer of "last resort" if marketplace doesn't come e-ap with enough jobs. 18 WHCoA Technical Committee on the Family, Social Services and Other Support Systems o Continuum of comprehensive services should be made available which links family, informal and formal support, private and social service programs._ income floor. o in-home an] community based services ant family care and support of older persons. o self ietermination ana choice in decisions affecting services. o /I" ellness programs. o '1 service innovations respite care, day care, congregate living arranclemehts, hospice, etc. WilCoA Technical CoMmittee on Health Maintenance and Health Promotion Research 1. Critical need for new knowledge in geriatric dentistry, including' the physiolojy of aging and information to define optimal oral health for the elderly. 2. Research on elderly minorities has been-negligibl in the past; their numbers and needs have not been, adequately defined. 3.' Special research is needed to define the health probl and needs of older women. 4.- Research is needed in the Area of health maintenance and health prOmotion to more clearly define the elderly population in the U.S., identify the_needs of the elderly with reduced function or chronic disease,and develop pregrams to maintain and enhance the Productivity of the elderly. S. Further research should be oonduated-on the nutrient requirements of older persons in order to plan effective educational approaches. A 20 10/14/81 Report of the Technical Committee on Research on Health Services 1981 White House Conference on Aging (WHCoA) -Summary- The subject report is one of the 16 Technical Committee reports which were prepared under the auspices of the WHCo447". Recommendations of the report are predicated on the conviction that - ePe overriding coal of U.S. health policy for the elderly in this decade should be quality of life emphasizing maximum functional independence (MFI): this is the common theme which links' recommen- eations which have been made. Medicare's essential commitment to the best possible acute care should be preserved, but should be balanced with and linked to cost-effective preventive and lone;- term services: o public and private institutional arranaements should enhance the physical and mental activity and social involvement of older people (e.g.; flexible retirement policies and gradual increase in the normal retirement age, improved functional and performance evaluations, volunteerism, job counselina, task assessments, etc.); o the elderly should have access to a Medicare-approved roster of good primary care practitioners who emphasize-responsible and continuing surveillance, a schedule of periodic Preventive services, referrals as needed,41ong-term'and terminal care and centralized ." medical records; --Medicare should provide for all elderly fixed-amount coverage for drugs and services of major allied health professions' (e.g., dent1stry, vision, hearing, foot care, etc.); o Title XVIII,Medicare reforms are needed (e.g., in the direction of'tupporting primary care, long-term and preventive services and reimbursement of their providers; enhancing benefits for psychiatric care; repealing sections -prohibiting payment far preventive services and custodialNcare; establishing a limit on "cost-sharing; relmburseMent for appropriate long-term care' whether institutional\or home-based; negotiating prospective rates of reimbursement); o a nqw service to coordinate community -based long-term, care should be established in theN$ocial Security,Act, 0 N Pacre 2 o humane terminal care should be an essential aspect of good health care for the elderly ad be confirmed by specific legal, medical and organizational arrangements, including hospice care and "death with digriity" statutes; o professional training in geriatrics and gerontology should be enhanced at all levels of health care training and in the post-graduate and coptinuina education phases; geriatric health services and applied research must have more support; e.g., functional assessment, effectiveness of different configurations of nursing personnel,' cost- benefit prevention research, research on iatrogenic effects of treatment and outcome norms, etc. WHCaik Technical Committee on Implications for the Family o at a time in the evolution of a fast-movingft changing U.S. society and family and sex roles patterns, the family is ircinically still the best and needed support for the elderly but is not being supported by social policy-rai- thing so (i.e., for playing this role). o inflation acts to tighten this situation by making the elderly even more dependent upon their families. -o intergenerational contact and interaction breaking dawn. o government services pitch-ed to an extra-familial focus. o therefore, there is-a need for a new social policy for elders to develop respected new roles for later life: focus on family as basic support unit (not inpiyidual) and support thereof. training community.and education for families and care givers. . lb integenerational research and family research generally (foster grandparents, day care centers); t proximity of elderly to family. . t $ to local social support systems. - end discrimination in social services for elderly. - enri asset tests for SSI. . t home care and innovations therein. . t respite care supportdfor families. co- insurance or dedUctibli concept for long-term care. . -t tax credits for families with elderly, tax abatement, allowances. etc. . t hotlines for Mat abuse. ` . tdemohStration projects for potential of family support of minor o ethnics and low income. q 23 0 Technical Committee on Long -Term Care Reozarnendation.s C." focus is the imlividualpersOn who has functional disabilities anti is in need of assistance. 2. public policy should t capability of the individual and his family via tax incentives, income suppleMents, etc. - a pluralistic system' with full medicaid reimbursement. 3. each pommunitx should have a long-term care system: o case managemeht; assessment; eligibility determination. 'o continuity of care. o data. o control over reimbursement to providers. o mental health. 4 entitlement for all > 75 and for those < 75 who are* disabled. -, o utilize community help and volunteers. 4. define and refine techniques fr quality and appropriateness of care. 5. strengthen all programs which address various aspects of long-term care. 6. Federal funding for emergency situations where gaps must be 4".".` filled. 7. study feasibility of funded social insurance program for long- , term care. a. don't jeopardize well-being of non-impaired spouse by discriminating policies. 9.' develop FedeEalhousstrat to provide social supports, 'foster independence and avoid institutionalization. '10. Make in-home services available,if at same cost as inpatient . wet. 11.' train, recruit professionals and non-professionals for ilong-term-care service. 24 4 Itichnical Committee on Long -arm Care Long-term care really involves a spectrum of social and health services provided in a variet,y of settings - not just institutional. Therefore, a need for an organized and coordinated delivery system.of long-term care that is cognizant of social and_ health needs; must re-balance institutional and non-institutional components,' encouraging not institutionalization but maximum functional independence. Since 80% of care and support available -for elderly'comes frau family or other informal support systems - these Oast be-supported in any long- term -care system. -Long-term cate should be made available to all elderly with functional limitations whdriee&assistance, whether ai-ricae or elsewhere, in a flekible manner, with options and respect for cultural, religious and ethnic preferences with preservation of rights and dignity of the most vulnerable. 0 s 0 25 WHCoA Techmical..Committee on Older Americans As a Growing National Resource Findings 1. Problems created by t retired population, (inflation) t life expectancy --1 t demands an phblic and private retirement income systems and social medical and community services. 2. Talentse'skills and experienciof elders being wasted despite t service needs, because of ageism, negative stereotypes, 4, transportation. 3. Advantages of employing older people - y maternity, reliability, judgement, skills, work orientation, availability. 4. Need option$ for elders to enable them to contribute to society and help themselves. 0, - 5. Inane inadequacy a problem for elderly. 6. Majority of.efderly are physically, mentally and emotionally capable of sustained productive work. 0 Recommendations, 1. Federal Government o 1+ employment opportunities, e.g.: Special Assistant to the Secretary of,Labor for Older and Retiredliorkers. o Similar position for State Employment Offices via the U.S. Employment Service. o U.S. Department of Labor expand training, counseling, placemerit services for older Americans using elderly as trainers, etc. o Include elderly in CETA. . 2. RecommeAdations for Employers (public and private) o 11" positions for older persoins bid take advantage what they can coffer., o Reexamine job descriptions, requirements and personnel policies. o Match functional job requirements with individual abilities and interests - rather than age. o T innovations in work schedules, part-time work, job redesign for elderly where possible. 4b 26 _Technical Committee on Older Americans As a Growing National Resource o Non -discriminatory.policies. o T counseling to elderly. 4' employment of older women. leccamendations for Volunteers Sector o Elderly seen as pcwerfuladvocacy force fott general welfare. T Federal $ (2X) to employ low-income elderly in ccamunity service work - Green Thumb, RSVP, Foster Grandparents, etc.' 4) Expand efforts by volunteer agencies to stimulate volunteerism. o Matrh functional job requirements to individual abilities and 'interests. o Reimburse for travel expenses. 4. Recommendations for Local Communities o T utilizaiion of older persons. o tcomaunity councils.which'include elderly to t employment, service opportunities. 5.- Reccuirendations for Education) Institutions o Expand educational programs to assist older workers to reenter or continue in labor' force. o 'P education for elders 'and counseling on educational opportunities. 6. Recommendaticas for Media o_Combat'negative stereotypes and t knowledge about contributions of eldiily and advantages of .hiring them (or as volunteers). Recomiendations for Public/Private/Non-Profit SectLrs o Assesi transportation, safety, access needs of elders as workers or volunteers. 8. Recceinendations for Older Persons Themselves o T involvement in T oppartunitie to work, contribute to coninunity. Technical Committee on Physical and Social Environment and Quality of Life "Quality of life" represents composite of physical, intellectual, social, emotional and spiritual well-being; choices, autonomy; economic and physical security; access to services; exercise of interests and preservation of values, dignity, self worth and positive perception of elderly by society at large. Hence, need for four ;'threshold" recommendations > o Quality of Life for Elderly Impact Statement. o Major concern of policy making at all levels should be totaj, well-being of elderly with concern for interrelationship and coordination of major areas cited below, o Age Discrimination Act of 1973 should be strictly enforced and rights publicized. o t private sector awareness of needs of elderly persons.= Housing o `Suitable, affordable housing seen as entitlement of elderly (from Older Americans Act of 1965); progress has been made but expansion of supply is still needed - especially in rural areas (as well as urban inner cities). Must find ways to help elderly revitalize and preserve own homes as well as provide array of options for those who can't live independently (e.g., congregate family housing assistance). Recommendations .- - National goal of 200,000 units each year and collaboration between relevant Executive departments to find ways of reducing costs of producing and maintaining suitable housing - perhaps by demonstra- tion orolects. - it funding for new and rehabilitated housing for elderly. - T stimulus for housing production foroelderly by pension funds, etc. - All government levels should review housing programs serving elderly to ensure their special needs are being met (in area of special design features for safety, 4/energy, etc.); closest proximity of health and socialoservices; gdod site selection (transportation and safety and shopping); state coordination of planning and funding sources for housing and related services through a single Federal agency; assistance should be provided to elderly homeowners to enable them to maintain and retain homes (help with repairs, tax relief, energy costs, other expenses); help families to'retain oldsters. 28 .WHCoA Technical Committee on Physical and Social Environment and Quality of-Life 2. Transportation Special needs of elderly as *consumers of transportation (as well as drivers, pedestrians): Reoilmendations - National goal of providing adequate, accessible and affordable transportation for elderly -1 $, fare relief, etc. - Improve design and delivery of transportation services for elderly. - /` volunteer services to provide transportation.for elderly (mileage deduction, etc.). - driver's licenses based on ability, not age. - 1' elderly pedestrian and driver safety. 3. Crime Recommendations - All governments should T anti-crime strategies for all; compensa- tion for victims; ombudsman program in long7term care facilities. 4. Legal Services Recommendations Pgauthewi2e regal services Cm*. (LSC) and Older Amcrican Act legal services should be a mandated priority in provision of social services. - $ for legal services by AoA, LSC, private bar and review of structure and operation of the manner in which the- elderly are served, free guardianship visitation rites for grandparents? 23 ss Technical Committee on'Physical and Social Environment and Quality of Life 5. Arts and Humanities Recommendations - Funding of arts and cultural services as a social service (amend Older Americans Act). T demonstration projects (AAA) to test innovative approaches to enhancement of quality of life via arts and humanities. ir funding for employment of elders in cultural activities via cerh. - Integrate cultural services into social service network and t emplcyMent opportunities for elderly artists, -actors, writers and frail elderly should also be included in programs of cultural institutions; oral histories stressing local and cultural heritage. - I research to measure impact that cultural activities have on the physical and mental well-being of older persons and longevity. 6. Creative Use of Time o Quality of life related to quality of leisure. Recommendations - AOA should t pre-retirement planning. - $ for recreation and e-lilbation programs. / awareness of educational, recreational needs of elderly. - 1' physical fitness programs for elderly and standards and Oidelines pertaining thereto. - T programs in long-term care facil' es similar to those outside. 30 Technical Committee on Research I. Introduction New knowledge is needed to meet the challenges of society's fastest growing segment, the aging population;_ Federal support for research is only one-tenth of one percent of expenditures despite the magnitude of those expenditures on health care, p.1 income maintenance and service delivery. Research on aging touches both on factors which make life meaningful as well as possible. The delay and prevention of infirmities and dis- abilities, which often accompany advancing age and their treatment when they do occur, and maximization of independence require knowledge that can be gained only through long-range, painstakingly pursued and dedicated research. p.2 II. Trends A. Diseases and disabilities of human aging are not inevitable and many can be alleviated or eliminated by understanding the biological mechanisms and social processes of aging._ Understanding the basic causes of aging will lead to a greater realization of the span of human potential and the reasons for the increased susceptibility to the diseases of aging. B. We need new knowledge on the variations in social, economic, ethnic, and environmental contexts of aging in order, for example, to expand opportunities for involvement and productivity of older persons as growing national resources. C. The copulation over 65 is growing at a rate of 1,600 persons per day with the greatest gtowth in the number of persons 85 and over, which is expected to double in the next 50 years. III. Key Issues P-3 There are many unanswered questions resear. A. How can the period of healthy and active life for older people( be lengthened? B. Why dowomenioutlive men?. C. What are the special needs of ethnic and minority elderly? D. Why is it that all living cells age but some age more rapidly than others: E. ,How can we improve the health care and service delivery system rather than merely escalating the cost by billions of dollars every year? 3i Technical Committee on Research N. Recaanenditions A. Follow-up activities for the inplatentation of recommendations of the 1981 WHCoA should be authorized and funded by Congress. B. 1. A manpower study should be mandated to determine the manpower needs for research on aging in order to insure that the manpower supply will be available to t the anticipated needs. 2. Adequate resources should be provided to the NIA to imple- ment the Research on Aging Act of 1974, to train a broad spectrum of research investigators needed in gerontology and geriatrics including :research in the social, behavioral, biological and clinical of aging. p.5 3. Sufficient funds should be appropriated to the AoA to support training and research on policy related issues, such-as'evaluationi availability and appropriateness of services. C. Multidisciplinary centers ahould be established for research and training with regard to major problems of aging, e.g., physical and mental health, work, retirement, long-term care, and the development of teaching nursing hones. D. The NIA should be given responsibility for coordination of research on aging in the U.S. with that of other cooperative nations. E. A clearinghouse should be established to coordinate and disseminate its findings of research on aging supported by adequate funding and staff to make research, findings readily available. Lead responsibility &Or this should be undertaken by the NIA through formalization of its Ad Hoc Interagency Committee on Research on Aging. F. Opportunities should be provided by the same Interagency Committee for the exchange of Information-on-lif-e-auPport- systems, communication, environmental regulations, mobility, and health ,services that could be adapted for the benefit of older persons. 32 r . WHCoA p.6 Technical Committee on Research G. A major increase in Federa', funds foi research, research training and denonstrationshould be appropriated immediately to relieve the critical shOrtages in those areas with planning for.increases to a level cOnensurate with industry's invest- . ment in research and development, i.e., 5% of total outlay. H. Private foundations and corprorations should be encouraged by government agencies to invest in research'on aging. Supplementary View bySeymour S. Kety, The retort on research on aging properly emphasizes the magnitude of the national, dhcial and personal problems involved and points out the inadequacy of our national commitment to the acquisition of new knowledge which is the only means by'which these problems will be reduced and ultimately alleviated. The report goes too p.7 far in attempting inadequately to spell cut a comprehensive list of specific needs and a satisfactory and national program of research to address them, i.e., the major weakness of the present report is its lack of comprehensiveness.t In its present form, the report could be mistaken for a complete Statement of research needs and priorities -- which, given the constraints of time upon the committee, it is not. The development of a thoughtful and conpre- hensive program of research on aging should be left to those most knowledgeable and best situated.to do so, i.e., the NIA in concert with other institutes of.the NTH and the NIMH. It is reoommended that the present ad hoc technical committee on research lend its support to their efforts rather than attempting to duplicate them. e Technical Committee on Retirement Income (Majority view) After a lifetime of productivity, the elderly deserve retirement with dignity and independence with the most important ingredient in a secure retirement, other than good health, an adequate income. The committee believes that equity and prudence dictate that the elderly receive a retitment income beyond that needed for just bare subsistence. Social Security has traditionally provided the bulk of basic retirement income for most earners. 1. Principal findings (selected) o Social Security (SS) constitutes the mainstay of the elderly population and provides invaluable, irreplaceable protection to the family at all stages of life; o SS faces snort-term and long-range funding problems that are manageable; . o In 1979, 3.6 million persons over 65 remained in poverty; 29% of single elderly women (1.7 million) live in poverty and 62% of single black elderly women were poor; moreover, sane 25% of the elderly (5.9 million) lived in "near poverty" -- 125% of the poverty measure; o SS accounts for all or nearly all of the retirement income for over half of those age 65 and over; o SS, on the average, actually replaces less than half of former earnings of couples; . o ,Private pension plan coverage is sparse among women, minorities, part-time workers and the non-unionized, among others-,--Drgely-nct-ruir indexed to inflation and covers just under half of even the private work forde; o The funding of many 'state andJocal.government pension plans raises questions as to their future ability to honor tments. 2. Summary of Prinicipal Recommendations lbe.committee supports: o Continuing the role of Social Security as the principal provider of income for those with below average earning, as a source of retirement income for all but the highest earners and continuing full cost-of-living adjustments for Social Security benefits; 34 WHCcit pp.6-7 Technical Committee on Retirement Income o The improvement of spouses' and divorced persons' rights in Social Security and pension schemes based on the principle that marriage is an economic partnership; o Fifteen other spekific recommendation's listed in the Executive Summary on pp.4-5. The committee opposes: o Raising the SS retirement age which would cut benefits to those elderly who are most needy; o Reducing food stamps to the elderly; o Imposing mandatory private pension coverage; o Liberalizing Keogh and IRA maxima contributions. 3. Reassessment of Income Goals o Poverty line -- the committee regards the "poverty" line as arbitrary and inappropriately law even as a minimal measure, yet substantial numbers of elderly persons, especially widows over age 75, receive income below the poverty line. Instead, a "near-poverty" level of 125% of the poverty level is rem:mended; o A better standard for long labor is thepureau of Labor Statistics' "Intermediate Budget." 4. Discussion of Major Reommendations Fuller narrative found on rp.7-12. 5. Supplementary View of Victor E. Hruska, J.D. Inflation is the arch enemy of all people but is especially cruel to the retired who are tied to a fixed income. Older Americans demand all all cut'fight against inflation. He p.13 l'ecommends the IRS follow the lead of states that exempt those over 65 Ypin imam tax for the first $10,000 cl.income from any source. Use of general revenue funds to finance Social Security is opposed. White House Conference on Aging Mini Conferences Aging and Vision Alcoholism and the Aging Alzheimer's Disease and Related Disorders American Indian/Alaskan Native Elderly Arts and Humanities Mack Elderly Challenging Age Stereotypes in the Media Concerns for Lew Income Elderly Consumer Problems of Older Americans -Elderly Hearing Impaired People Energy Equity and the Elderly Environment and Older Americans Euro,Ameriean Elderly 'Foot Care Hispanic Aging Housing Intergenerdtional Relations (Strategies for Linking the Generations). Legal Services Life Long Learning for Self Sufficiency 0 - IL ng-Term Care Mental Health of Older Americans National Health Security New Directions In Funding and Program Priorities for the Aging, The Interrelationship of Government, Private Foundations, Cqrporate Grantmakers and Unions 36 White House Conference on A9ing Mini Conferences Wirsing "Older Veterans Older Women The Oral Health Care Needs of the Elderly Pacific American Territories 'Pcific/Asians: The Wisdom of Age "Public/Voluntary Collaboration: a Partnership in Contributing to Ihdependent Living for the Aged" Recreation, Leisure andillysical Fitness "Rediscovering Governance - Nonservice Approaches to Problems of the Aged" The Rights of the Institutionalized Elderly am the Role of the Volunteer Rural Aging /1 Saving for Retirement Self Help and,Senior Advocacy Senior Centers Simplification Symposium Spiritual and Ethical Value System Concerns Transportation for the Aging Urban Elderly 37 Mini WHCc - Aging and Vision Reconmendations I. Public Education C. Media and environments especially related to information and educational material could be made more useful/helpful to older people with vision problems. - printed publications - guidelines for visibility and intelli- gibility of communications materials should be developed by National Bureau of Standards in conjunction with professional advisory groups and consumers and made available to media. - physical environments - functionally based guidelines should be developed on the particular ways the physidal environment should be modified to meet the needs of older people who are . partially sighted or sensitive to conditions df glare or diminished light. These should be integrated into American National Standards Institute and other standards and used in commerical buildings, residences, etc. - print alterfiatives (radio and recorded matter) for the blind. - removal of barriers to wider use of print alternatives - re: FCC regulations, copyright laws. V. Research A. Recommendations regarding coordination of the research enterprises in vision and aging. o ,government agencies should develop a strategy for coordination -------ae-theireaptt--effortsanLa_contationalreaserch agenda in vision and aging, including joint funding of meritorious proposals. 1 O o' mechanisms should be explored fo; fostering closermorking.relation- ships among the professions ,and scientific.disciglines in, research on vision and aging; might include the development of, renters, combining research and diagnosis ce e very integrative training programs and use of existing journalk and symposia to familiarize a broader population of professionals' with i v the problems of vision and aging. B. The need for research to be performance (task) Oriented., o spedial attention must be given to supporting and funding of performance-oriented research to better identify and evaluate the vision characteristics of the elderly ar4 to rectify or ameliorate functional disabilities. 33 .Mini WiroA - Aging and Vision 0 C. The need for social policy analyses and improved population data on vision and aging. o population -based data collection is. needed on a' national scope to conductlaolicy relevant'analyes such as: - needs assessments for services, research and technological development in aging and vision. - epidemiological studies, - cost-benefit analyses of services anStbstcontrol service delivery. - evaluation studies of programs and technology. of - better research on tonsumer protection and related consumer issues regarding vision care and prosthetics. - deployment strategies (getting devices into the hands,of. users and attendant problems). VI. Finance and Legislation B. Policy and financing ceresearch in vision impairment and related high technology.. o increased funding should be made available for research in vision impairment!, including high technology; Natidnal Eye Institute, National Institute on Handicapped Research, and private sector. n remaearch ranabra ahem' 1 d he esrahli shdair nr earl argeri to combi nab liige client populations and toisearchers iemaltiple disciplines. III. Low Vision and Policy' C. Research and technology fordow vision and policy.. 4 o fundinflow vision research-s6culd be encouraged ',related to aging in both public and,private sectors, be problem-oriented and clinically based in the following area's: c - epidgmiologic studies of high -risk ethnic papylations concerning visual impairments. a Mini WHCoA Aging and Vision - lag vision rehabilitation canters to develop a voblem- solving approach to functional vision difficulties and develop connections between lab research, clinical practice and rehabilitation services. - T psychcphy*ical investigatirs of methods.of vision evaluation related to function and performance. 40' t Mini MiCati - Alcoholism and the Aging Reccemendations 1. Research and Development 3 1. national task force to coordinate research on the effects of alcohol and aged, e.g., the National Academy of Sciences, e.g. -: - identification of cases; - differential Rx; - rehabilitation; -- continuity of care; - metabolic/physiological aspect of alcoholism iniaged; - nature and kinds of alcohol abuse seen in elderly; 0 - treatment models and effectiveness; interacticAl of alcoholism, psychological and socioeconomic and life change factors; q - Federal government - fund and monitor research and evaluation. o establish research priorities and funding to evaluate treatment models - May 1982; series of "best practice seminars" to disseminate findings April 1983; development of a mechanism for incorporating effective Rx models into a e:Jtem for practitioners training by April 1984. 2. Sducaticti and Traininq a public information and curricula for professional staff and trainees, e.g., NIA, NIAAA, HRA, AoA, develop a contract for the development of curriculum guidelines by June 1982. 3. Increasing Utilization of Existing Services 4. 14 Effectiveness of Rx NIA, NIAM, Am% develdp guidelines for quality and scope of Rx for aging alcoholic and of followup and support groups. o need high quality, low -cost model prograzof comprehensive service to,elderly alcoholic: NIAM, AoA (with help of NIA and HCFA) should lead in including such a model in their authorizing` legislation. Mini*WHCoA - Alcoholism .and the Aging S. Increasing Availability and Accessibility of Services 6: Protection'of Patients' Rights Problems 42 Mini WHCoA - Alzheimer's' Disease and Related Disorders * We are spending $1,000 on maintenance for every $1.00 spent on research for the disorder! Recommendations 1. research support is needed as well as efforts to attract additional investigators: - natural history. - etiology (pharmacology, genetics, virology, toxins, vascular, immunology, biochemistry) . - pathology and pathophysiology. - animal models. - cause and range of phenomenology. - objective measures of brain function. 2. Need specialized centers for realistic clinical management. 3. la responsive social support' system. 4. 1" education. * Prevention should have primary emphasis with the priority of prevention, cure, Rx, assistance and care. 43 Mini WHCaA - American Indiah/Alaskan Native Elderly "We are Indian People. Let us be who we are." (maintain tribal cultures) pp.12-13 Recommendations 1. Family Based and Age-Integrated Programs 2. Social Services - Direct Funding to Tribes 3. Guaranteed Annual Income 4. Long-Term Care 5. Availability and Appropriateness of Social Services for Indian Elders Issues Research: o '1' demographic research - specific for Indian elderly - disease rates; - life expectancy; - nutritional needs, patterns. o T biomedical, social and behavioral research. o need for improvement of the relevance, quality and sensitivity of such research that has been done. o Indian-relevant research must be c,ne on Indians in context of their own culture which takes tribal diArsity into account. o research on significant life experiences (20to Federal policies (Indian Reorganization Act of 1934, etc.). o research on Indian elderly is such that it does not benefit the Indian community. o need more Indian people to carry out research on Indians. Mini WHCoA - Arts and Humanities The value of the arts and humanities to the lives of older people and their contributions to the cultural vitality of the nation are commonly appreciated but seldom understood and documented through research findilils: Recommendation 1. Research o 14 the actual and applied research using public and private support exploring all aspects of the arts and humanities related to acing and older people, e.g.: - correlations and variations in creativity over the life span and particularly in later life. - implications of different cultural definitions of creativity in later life. - myths and stereotypes concerning creativity in later life. - effects of involvement in the arts and humanities on the physical and mental health of older people. 0 - NIA expansion of its new interest in the creativity of older adults. - encourage a variety of research methodologies - scientific techniques as well as'approaches drawn from the arts and humanities. o a resource center should be developed (government, non-profit organization or university) to gather and disseminate information and data about the arts, humanities and aging. - bibliographies on arts and humanities and aging. - national directory of artists and humanities scholars involved with older adults and gerontology. - publish a periodical on the arts, humanities and aging; disseminating research findings and programmatic activities. - Convene a co-sponsor workshop, seminars, and conferences on issues relating to the arts, humanities, gerontology and older persons. 43 Mini varok - Arts and Humanities o the fornulation of public policy relating to aging issues should take advantage of the multiple perspectives offered by the humanities. - utilize scholars (history, ethics, philosophy and jurisprudence) to help pose and clarify issues in health care, work and leisure, social security and private pensions, life-long learning, etc. - encourage humanities scholars to undertake and fund sources to support policy-oriented research concerning culture and aging. 46 Mini WHCoA - Black Elderly 1. Income 2. Crime 3. Employment, o 14 research (government and private) and dissemination effort to accomplish by 1985 - develcpnent end testing of age-neutral performance appraisal tools and personal functional capacity measures. - gather and disseminate information to employees and general public concerning skills, experience and productivity of middle-aged and older workers. 4. Education . 5. Research o ' coat-benefit analyses to determine most effective way to improve economic well=being of older Blacks. o t research on extent to which urban areas are becming centers for Blacks and other elderly poor) t research $ for evaluation of the impact of these demographic trends on urban social service delivery. o it research as possible impact of revising medicare for all Americans and establishing a comprehensive tIII. o research on elderly Blacks' belief in folk medicine and their use of home health and other services. 6. Housing 7., Long-Term Care 8. Mental Health o T $ for research on mental health needs of elderly Blacks. 9. Rural Elderly 10. Caiuunity Support Systems 4 Mini.WHCoA Challenging Abe Stereotypes in the Media Workshops 1. Develop an ongoing Media Center - positive and realistic images and people, etc. o do research work based on data 2. Cable TV: Future Visions 3. commercials: Bane or Blessing 4. Print Media: The Potential 5. Innovation:' Ni Program Ideas 6. Discrimination in Media Employment 7. Public Service Announcements: SW to Write 8. Radio: How to Have Your Ownftogram 9. Monitoring and Media Activism to educate the media to present combat stereotyping of older received from media monitoring. 4 413 alb and Get Then on the Air MiniAHCoh - Concerns for Low Income Elderly Issues 1. Retirement Income 2. Health Services 3. Lon9-Term Care 4. Nutrition 5. ,Energy 6. Transportation 7. EMployment and the Work Ethic 8. Housing 9. Urban and Rural Service Deliver G 43 C a Mini WHC0A - Consumer Problems of Older Americans Recommendations 1.' Consumer Education o new partnerships should be established between the research and educational communities to accelerate and facilitate effective application of relevant research findings. 2. Need for Food and Nutrition Research, Development and Surveillance of Health and Disease Problems, e.g.: o relationship between diet and degenerative chronic diseases. o specific nutrient needs in presence of decreased caloric intakes.; o -improved understanding of the dietary patterns and nutritional- status of both well and chronically ill older individuals. o 't understanding of interaction between foods, nutrients, diets - drugs, environmental contaminants and food additives. o itt food and nutrition research, development and surveillance concerned with maintaining health and reducing disease must be at all levels of the scientific community. o T support for grant, contract and intramural research of agencies like NIH, FDA, USDA, etc., as well as by private sector, state- , supported universities with medical and allied health schools; . implementation of the national nutritional status monitoring system recently submitted to the Congress. 3. Social and Emotional Aspects of Eating with Respect to Physical Health o additional research should be undertaken.in this area. JO . Mini ififiCoA - Elderly Hearing Inpaired People Recommendations 1. Research - needed on: o genetic basis on elderly hearing loss; o 1' studies of inner ear; o noise-induced hearing loss; o relationship of hearing loss-isolation-and onset of terminal disease; relationship between noise-stress - violence in maltigenerational families; roved hearing aids - better quality at J1 $; o t logical services other than hearing aids. 2. Training 3. Health-Relaied Institutions 4. Self-Help Orga nizations 5. Hearing Health Care Costs 6. Communications Access 7. Public Information/Awareness/Education Discussion and Conclusions - Research o ?empathy research; o hearing loss counseling; o "denial syndrome." Mini WHCoh - Energy Fruity ands the Elderly Recommendations 1. Health Research and Service Programs Federal agencies should be regulred to: o disseminate information to elderly and their families on healthful energy conservation. o it demographic and medical research into impact of curtailed energy use on health, comfort and well-being of the elderly. o get out information to health professionals on: - effect of heat and cold and reduced energy consumption on the elderly. - recognize and treat health-related problems in the elderly attributable to temperature extremes and energy limitations. - enable providers to prescribe and disseminate information that will prevent hypo- and hyperthermia-related illnesses and injuries. a 52 c Mini tAINCoA - Environment and Older Americans Recommendations 1. Health Impact o reduction oof exposu're to environmental hazards. - hazards should be identified and the public's exposure regulated by Federal aed state laws. - current standards of chroniclow-dose radiation should be reexamined periodically and appropriate research conducted, particularly with regard to fission products and their effects upon older people. o Use of National Death Index - Data sets, such as NDI and those from HCFA, Social Security and IRS, should be used to access the relitionshiptetween lifelong environmental exposure arid cause of death (with safeguards to protect individual privacy). - an appropriate agency should have access to key data sets, and working with other agencies, should exercise surveillance of acute and continuous hazards that impact on disease, discomfort and quality of life. o Emergeney Procedures in Environmental Alerts - appropriate public agencies should identify in a systematic way, the'range of life- or health-threatening conditions, particularly with reference to more vulnerable population groups. - the most appropriate procedures in response thereto should be tested and standardized. o Research on Environmental Factors that Influence Aging - concerned Federal agencies, including EPA and NIH and pharma- ceutival industry should 1' suOport for research on the cause and progression of aging and on controllable environmental factors that can improve the health and longevity of older persons. - support for research in genetics, biochemistry, toxicology and epidemiology should be expanded. o Minority Report: Use of Environmental Planning 'and Design . to Foster the Elderlys' Independence - a national panel, should be established to develop broad guidelines regarding the design of environments that promote independence. Page-2 Mini WHCoA - Environment and Older -Americans 2. Employment and Volunteer Opportunities o new options for the elderly in the enviromental field, Federal government and other public and private resources should study and experimentyith: .146 - innovative on-the-job environmental training activities. - ,creative intergenerational environmental support programs, job sharing, pre-retirement training for transition to environmental jobs, use of elderly in public information programs, enployer awareness programs showing benefits of hiring elderly, expenses-paid voluntary programs in environ- mental fields, development of jobs whose risks could be borne by elderly. 3. Advocacy and Consumer Participation o dissemination of existing data on environmental hazards and the elderly. t. NIA, etc., shOuld compile a summary of principal environmental health hazards affecting the elderly - in laypersons' terms and data gaps should be identified. o HUD and AoA should sponsor research that evaluates public and private 'housing for the elderly in-terms of protection from environmental' health hazards and the quality of life. Funds should be made available for both recommendations. 54 Mini WHCoket - Euro American Elderly 1. Increasing Ethnic and Cultural Sensitivity in Government Programs 2. Improving Health of Elderly Euro Americans 3. Strengthening Family Life of Elderly 4. Enhancing Mediating Structures and Neighborhoods 0 5. Addressing the Language Barrier 6. Economic Security for Elderly Euro Americans clt 7. Empowerment and Volunteerism' 6 6 5') 6 11 Mini WHCah - Foot Care March 7-8, 1981 No specific inclusion of research issues: cR 5 fi Mini WHCoA - Hispanic Aging Recommendations 1. Research o T 4 Hispanic researchers in field of Hispanic gerontology; o research on chronological vs. functional age in Hispanics - building data base as basis for programs; o study of barriers to greater service utilization by Hispanic elderly; o demographic analysis using 1980 Census - as basis for services; o all government entities = $ for minority research on aging; o research on informal support systems of elderly Gispanics and their non-institutional supports should be 1". 2. Long-Term Care 3. Economics 4. Employment 5. Physical and Mental Health 6. AgingNetwork/tegislation 7. Cultural and Spiritual Well-Being 57 Recommendations 1. Owner-Occupied Housing Mini WHCoA - Housing 2. Rental Housing 3. Coordination' of COMmunity Resources Approaches to coordination tnclude: o T experiments inliving arrangements: p.6 - "house-sharing" by private homeowners., - other shared living arrangements using an agency locator and screening service, cooperative living arrangements involving the purchase or rental of apartments or residences for group living, and small group congregate residences with high levels of support. 4. Research on Housing - Related Topics o living space needs of older people (65-75) should be analyzed in p.7 terms of safety, needed redesign and cost effectiveness with respect to providing living space for them as they become older and frail. o research on potential housing problemr; and service needs of older p.7 people in areas where they will be more concent_ated4during the next decade, i.e., inner cities, retirement areas, suburbs. o study is required of how counseling and other supports can assist p.8 older people in making housing decisions and taking actions such as selling, buying, moving, remcdeling, repairing, etc. o new knowledge is needed,abou',. the qualities of effective management p.8- in planned housing, particularly how the goals of sensitive personal relations, optional service planning and effective financial manage- ment can be achieved simultaneously. 5. Education and Personnel Needs Mini WHCoA - Intergenerational Relations (Strategies fdr Linking the Generations) 1. Elementary and Secondary Education 6 national action - research to examine effects of intergenerational activities and for the development of effective approaches to intergenerational programs. 2. Higher Education 3. Social Services 4. Transportation 5. Housing and Neighborhood 6. Crime Prevention 7. Religious and Spiritual Well-Being 8. Physical and Mental Health 6.4' research (NIA) toward better understanding of the processes and mechanisms that either bind the generations together or keep them apart. 9. Employment jimmigzuQuipowar,-s...trzr No recommendations on Research. .i '^ . . . . ... , . ... 4 . , a . . .Go _ . - . _ .. , I. Mini itiCah - Life Long Learning for Self Sufficiency (Strategies for strenghtening life-long learning for self sufficiency) Recommendations Themes - 1. Surviving - Learning for Economic Sufficiency 2. Coping - Learning for Practical Life Skills o research needed on structural barriers which impede older person's educational opportunities such as inappropriate curricula, scheduling and teaching methods. o generalized coping skills - develop new knowledge about generalized coping skills, e.g., decision-making, problem solving, etc. 3. Giving -1 Learning for Community Contribution o attitudinal research to identify successful approaches to creating a more positive image of the potential role of the elderly should be encouraged. 4. Growing: Learning and Lifespan Development research and debonstrations should be undertaken which will indicate the tangible benefit of self-actualization activities for older persons. o results of basic and applied research and demonstration projects on adult lifespan development and aging should be disseminated at national and local levels. Mini WHCoA - Long-Term Care 1. Planning and Evaluation o Effective mechanisms should be devised to collect and disseminate research and evaluation data for the assistance of planning, reimbursement and other other long-term care policymakers; o greatly increased social and technical research should be stimulated;` o because much long-term care research is fragmented and specializ4d, a long-term care research and evaluation agenda should be devised which focuses on large-scale, integrative, cumulative undertakings; o existing systems of long-term care delivery are frequently redundant or inadequate; t data in terms of its commonality, timeliness and relationship to decision making; $ for collecting population data based on the need for services and the supply, organization anl distribution of services. 2. Program and Case Management 3. Organization 4. Human Resources o biomedical research on the aging process should be promoted. 5. Financing Mini WHCoA Mental Health of Older Americans 1. Research o areas that require further emphasis and exploration = alcohol abuse and alcoholism; misuse and abuse of prescription and non-prescription medication; effectiveness of various therapeutic modalities; success of alternative community living situations; needs and assets of families in supporting and coping with mentally ill older persons; clinical syndromes such as Alzheimer's disease, depression and psychosis. Should be relevant to public policy and service delivery and easily available. Research, demo. and knowledge dissemination programs of NIMH, AoA, and NIA should be expanded. o 11' research on social and psychological factors that affect mental health and illness of elderly.= - late life transitions (role of families, support quality of life system). - comparative studies of different types of living arrangements pertaining to quality of life. 4 - impact of institutionalization on the elderly, their families and the interactions between them. o research on delivery of services and alternative ways of meeting service needs iminstitutions and in communities. = - effectiveness /cost effectiveness of alternative service delivery organizations. - NCHS should collect more data relevant to elderly. - information on clinical outcomes, comprehensiveness r ervices and costs of services delivered-by different, types and k AS of providers and provider arrangements, should be examined. - the development of various models for the integration of health, mental health and social services should be encouraged and studied for efficacy, cost effectiveness, accessibility and utilization of services. NIMH, NIA, AoA and'VA should organize and fund research centers - 20 - engage in multidisciplinary research ("to some extent") - balance between biomedical, psychological, sociological and epidemiological approaches with 1/2 reflecting a "psychosocial and/or systems orientation." Research funding and staffing patterns should have a biological/psychological/sociological balance. Mini WHCoA - Mental Health of Older Americans Also 2. Public Information on Mental Health and Aging o NIA, AoA, NIMH, etc. should support programs to translate the current scientific information on all aspects of normal and abnormal processes of aging into forms usable by the pUblic,- role of family, needs of minority aged, etc.; also present aging stereotypes to media for eradication. o NIMH and NIA should support demonstration projects with strong research components on mental health promotion and illness prevention. ,t4 Mini WHCoh - National Health Security 1. Declaration of the Mini Conference 2. Conference,Resolution 6' ,-4101.4it Mini WHCoA - New Directions In Funding and Program Priorities for the Aging, The Interrelationship of'Grvernmentt Private Foundations, Corporate Grantmakers and Unions Recommendations 1. it employmentopporbinities (flex time, job sharing, retraining, etc.); 2. it political participation of older citizens; 3. it one-stop information and referral services; 4. Tself-help and mutual aid group4; 5. f housing options and innovative financing; 6. elders as stabilizing influences in "fragile" neighborhoods; 7. / home health care programs; 8. review and streamlining of regulations; 9. integration and coordination of public programs-at all levels of government and various agencies; 10. / $ for administrative staff as well as for program activities; 11. I options for use of leisure; 12. compensation for participation of elders in service activities; 13. T $ from voluntary and corporate foundations for aging field; 14. attack on ageism; 15. development of clearly articulated public values and ethics (caring and compassion) to guide those working in the field of aging. 6G Mini WHCoh - Nursing March 27-29, 1981 , 1. The government and private sector should give priority to and provide support for nursing research which would address the p.2 major health issues of older adults. P.3 o nursing, research conducted in an experimental teaching nursing home would provide new knowledge in the treatment of acute and chronic illness, decubitus ulcers, arthritis, staff patterns, incontinence, confusion, Alzheimer's Disease and other senile dementias; also research in hospice care services; long-term care; primary health care, both in the facility and in the community, and "nursing homes without walls." o nursing research o n self care, health maintenance, quality of life in chronic illness, and assistance to family support networks. p.20 o le financial support for nurses seeking doctoral preparation; encouraging nurses to, focus on research activities on older adults and health services delivery to this population. o Federal and local government could encourage investigations p.20 relating to older adults and their families by earmarking a percentage of reimbursement for their health care services to go toward gerontological nursing research. Ow, Recommendations 1. Research 4 Mini WHCoA - Older Veterans A - o Geriatric Research Education and Clinical Centers 6 Li Mini WHCoA Older Women 1. Insuring Adequate Income 2. Health Concerns o sensitivity of medical researchers and educators to neglected areas of concern: - health promotioin, disease prevention. - 'self help, mutual help. o alcohol and drug abuse. combat over-prescription of drugs based on ageist and sexist conceptions of-older women. l programs for older female alcoholic and-drug abusers. 3. Quality of Life o demographics of aging - differentiate f from ocin data and cross-classify it (age, sex, race, income, geography, marital status) and separate older from younger women. - aggregate data should be collected in forms which bring older women out of invisibility. 6) Mini WECoA - The Oral Health Care Needs of the Elderly Issue Papers (no specific recanmendations made) 1. Research on Oral Ptysiolasy and Aging o research needed on oral physiology of aging; o need epidemiologic data to judge meaning of purported age - related changes; o distinguish between oral aging changes and changes 2° to pathology; o role of systemic pathology and oral environment; o research on the aging process, both in general and in particular,' as related to oral health, must be continued and expanded. 7() Mini WRCoA - Pacific American Territories March 18-19, 1981 Research - no recameniations. Mini WHCoA - Pacific/Asians: The Wisdom of Age Recommendations 1. Research and Demonstration o $ in both areas to information base on the Pacific/Asian elderly population - utilizing P/A researchers in a P/A community. o T Long-Term Care demonstration efforts for P/A community. 2. Health Care 3. Economic Security 4. Social Security 5. Nutrition 6. Housing 72 Mini WHCoA - "Public/Voluntary Collaboration: a Partnership in Contributing to Independent Living for the Aged" by NVOILA Recommendations 1. Research o coordination of programs among voluntary organizations and public agencies including: -- research on needs identification, methods of service delivery and evaluation. 2. Health Promotion/Disease Prevention, Health Maintenance o need a national policy on this as a component of the continuum of services-system, including:_ - social, behavioral and biomedical research and a clearinghouse of research information. Mini WHCoA - Recreation, Leisure and Physical Fitness 1. Research and Training o 1 Federal $ for research, training and demonstration in areas of recreation, leisure and physical fitness relating to the aging. o evaluation and assessment should be undertaken to determine most cost-efficient, effective leisure, recreation and physical fitneSs approaches for older Americans and to promote such programs through national public information sources. o T Federal $ for research for determining effectiveness of media, publicity, news and information referral systems concerning older Americans. o 't research on recreation and leisure behavior of older Americans' needs should be undertaken using longitudinal methods to determine better control for life stage and cohort or generational effects. o T NIA's information system to include all known aging resources. research on the disincentives to greater remunerative and voluntary work of elderly which may impede participation in leisure experiences. o / research on ways of modifying recreation and leisure activities, facilities and equipment to make them more age appropriate for elderly. 2. Physical and Mental Health 3. Older Americans in a Changing Economy 4. Retirement 5. Older Americans as a Growing National Resource 6. Housing and Physical Environment 7. Social and Health Aspects of Long -Term Care , S. Family Social Services and Other Supportive Systems 9. Governmental Structures for the Aging 10. Special Issues Facing Minorities' Issue Agendas forreseardh,Oevelopment and programming should closely examine physical fitness'of older adults, the means used to attain physical fitness, the value of physical fitness, its-impact on functional independence, its cost effectiveness in terms of y health care costs, etc. 74 Mini %MCA - "Rediscovering Governance - Nonservice Approaches to Problems of the Aged" 1. State and Local Governments 2. Private and Non- Profit Sectors 3." Mutual Support Sector o conduct further research on the utility and cost-shifting effects of non-service approaches to the needs of the aged through public interest associations and research institutions. Encourage sharing of policy research findings by state and local governments in their own efforts. 75 Mini WHCoA - The Rights of the Institutionalized Elderly and the Role of the Volunteer Recommendations 1. Right to Long-Term Care 2. *Right to Quality Care 3. Right to Participate in the Life of the Community 4. Right to Access to the Community 5. Right to Protection and Enforcement of Rights 6. Community Education and Training Programs Mini WHCoA - Rural Agin Recommendations 1. Mental and Physical Health and Long-Term Care 2. Social and Spiritual Well-Being 3. Social Service Delivery and Outreaching/Older Americans as a Growing Resource o if $ for research and development of educational materials programs, outreach and referral systems-for alcohol and drug abuse. 4. Legal Services 5. Retirement Income/Economic Well-Being 6. Energy 7. Nutrition 8. Housing 9. Employment 10. Transportation Mini WHCoA = Saving for Retirement 1. Profile of the Financial Condition of the Elderly 2. Improving the Living Standards of the Elderly 3. Providing an Expanding Economic Base to Support a Growing_ elderly Population 4. Increasing National Saving 5. Investing National Saving in Most Needed Capital Resources 1. Mini WBCoA - Self Help and Senior Advocacy Health Care curricula in medical schools, care facilities and incentives the study of geriatrics more rewarding; o HHS sftould 1 geriatric medicine including internships in long-term to medical students to make o long-term care. 2. Energy 3. Legal Aid 4. Housing 5. Crime Prevention o research. 6. Transportation 7. Income Maintenance Mini tilicoA - Senior Centers January 26-27, 1981 No specific reference to research issues. [i A Mini WHCoA - Simplification Symposium (American Bar Association Commission on Legal Problems of the BlderlY), - Rec&rmendations 1. development of a single application form for the elderly for a number of benefit progiams. 2. develop common definitions. 3. develop a focal point, where there can be a comprehensive evaluation of the individual's needs, while decentralizing the delivery of services. 4. hearings and appeals orocedures of the various benefit programs should be made as similar as possible with possible provision for government payment of rea7;-)nabi attorney's fees or expanded legal services capacity for representation of the elderly in such matters. 14, 8 4 amrammr- Mini *Calk - Spiritual and Ethical Value System Concerns Recommendations 1. Spiritual Well-Being o research on the quality of life, health and life satisfaction should . include spiritual components, e.g., effect on aging persons of a ,belief in religion or vice versa; religion and policy and religion and.gerontophobia. 2. 'Universal Ethics for an Aging Society o f research in preventive medicine - keep-well health assessment clinics uiE5-53IIStic health principles. 3. Role of Religious-Institutionsin an Aging Society 4. Church-State Relationships in an Aging Society 5. Attitutes of Society toward Aging t. Contributions of Older Persons to Society 7. Age Vs. Need as a Basis for National Policy o f research on the pros and-cons of age vs. need as basis for policy. 8 Recommendations wrjWr. Mini WHCoh - Transportation for the Aging 1. Funding and Subsidies 2. 3. Coordination Accessibility .4. Pura/ and Small Towns 5. Minorities 6. Future..Service Planning 7. riguipment and Facilities Design Mobility Issues. 9. System Operations 10. Research and Development o establish trends in the future availability of volunteers and what will occur if availability of volunteers changes; o research in developing special needs transportation during emergency and natural disaster situations; o research on multiple use vehicles; o 1 transportation research agenda; research on assisting people with communication difficulties in the transportation environment (visual/speech/hearing) - innovative methods of communication; .0 research utilization to develop a network of communication Ld completed research and experience from demonstrations. 11. Fnerzt and Inflation 12: Elderly 10 Transportation Service Advocacy 13. MatiPersonalartTronandPedestrianism o 1` professional/medical advisory group -4 basic screening criteria It for drivers - physical limitations, road skills, knowledge of traffi;" laws and the nature of the exam itself. 40 83 Mini WHCoA , Transportation for the Aging 14. Public 15. Paratransit Services 16. Interagency Coordination at the Federal Level, Mini WRCoA - Urban Elderly Recommendations o government, private sector,- unions = t research, basic and applied in field of gerontology - process of aging anu conditions of elderly - serve as basis for supportive services. 2. Problems /Other Issues Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia New Jersey White House Conference on Aging States Minnesota Mississippi Missouri Montana Navajo Nation Nebraska Nevada New Hampshire Florida New Mexico Georgia New York Guam North Carolina Hawaii North Dakota Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Northern Marianas -Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washi ,ton West Virginia Wisconsin Wyoming White House Conference on Aging States 87 State WHCoA - Alabama March 12-13, 1981 1. Research p.3 o seek to identify cost containment strategies on the part of providers, consumers, regulatory bodies and the government both locally and nationally. t State WHCoA - Alaska Recommendations V-D 1. Research data on aging within minority groups be more fully implemented in program planning by all agencies involved in formulation of policy. V-A 2. o Provision be made for gerontological research within the State of Alaska. o T research of the impact on older Alaskans of anticipated rapid developmental change both in rural and urban Ala§ka. o Research and data development are needed to provide the information for the implementation of issues related to economic security, social well-being, health and an integrated society. State WHCoA - Arizona March 4, 1981 1. Research o Increased funding should be made available for basic research in geriatric medicine; o The NIA and other research institutions around the country should be funded to do basic research on the process of aging; o Educational programs based upon current research should be -established to arrest the misconceptions about the capacities of the elderly; o Religious institutions should be at the forefront of the effort to gain research on the ways and means to assist the and on the process of aging in general. State WHCoA - Arkansas 1. Research o funds should be approprirated to the NIA to continue producing information for health Oibfess4-3nals on geriatric patients. o t funds for research into physical and psychological aspects of the aging process. o a portion of funding for aging programs under the Older-Americans Act should be maintained to fund practical research into the most accurate methods of assessing the needs of older persons and in developing services to meet those needs in the most efficient and cost effective manner. o t study on public benefits (e.g., SS, Medicare, Medicaid) to determine their effectiveness and the revisions needed in the programs. o gerontological studies are needed on a continuing basis to increase general knowledge of the aging population:and its impact on society. 44, p.11 1 State WHCoA- California April 27-29, 1981 Research 1. it funds for basic and applied research'and physical, psychological and social aspects of aging with provisions for program evaluations and for additional funding through innovative tax incentives for the private sector. 2. research should be undertaken on social, physical, emotional changes and human development, enhancing the quality and independehce of life, income maintenance and health care systems, including problems of older women, ethnic and cultUral minorities with recruitment, of women and minority researchers. 3. continued research should be underetaken to assess and evaluate the changing eduLat,ion, trains and personnel needs for professionals and para-professionals in the fields of gerontology and geriatrics. 92 State WHCoA - Colorado October 9-11, 1981 1. Research p.10 o Congress should provide funds for research and demonstration projects on unique and effective outreach and treatment strategic., for minority, rural, frail and handicapped elderly, and nursing home residents. 9:3 Research State WHCoh - Connecticut March 25, 1981 Resolve that specific. programs and services be made available to facilitate family interaction such as law family air fares, insurance coverage for ( family therapy, amistanceto families with handicapped or dying members, . creative. employment programs for students to serve as respite caregivers, ,playracms and private visiting rooms in long term care settings, and support Zf behavioral science research and training on intergenerational interaction. A J p.3 o funds be earmarked for applied research on the medical, social and economic impact of rising energy costs on the vulnerable,elderly. p.6 o a national research initiative on Alzheimer's Diszase be undertaken with funding equivalent to that for cancer or heart disease research. 45.10 o research on the quality of life, health and life satisfaction should include spiritpal components. P.9 State WHCoA - District of Columbia May 1-2, 15, 1981 Research 1. Resolve that there be a continuation of basic and applied research in the biomedical and social science fields; 2. Resolve that research which enhances the direct provision of services be encouraged. 96 S State WHCoA - Florida 1. Research p.4 o recommend utilization of elderly as oonsultanti, resource people. . 0 p.11 State WHCoA - Georgia March 2-5, 1981 Research Resolve that: 1. Continued emphasis be given to the study of organic brain syndrome, focusing on causep,.differential diagnosis, pre- vention and treatment programs; 2. Further research be conducted to identify variables -that help people stay healthy in old age; 3. National research be conducted to determine the qualitative effectiveness of existing services to the elderly including education and training programs. The enabling and disabling _aspects should be identified; 4. Emphasis will be placed on collaborative research between the National Institutes of Health and private organizations, particularly in the areas of arthritis, hearing and vision; 5. Federal support-will continue for research in viable alternatives to long-tern care and in-hcine, health care in rural and urban areas; 6. Criteria, other than age, for voluntary and involuntary retirement be researched and developed. 9a State WHCaN - Hot -di December 4-5, 1980 Research - no specific recanmendations. d a 100 State WHCotk - Idaho 1. Research o Su t research into needs and attitudes of elderly living in rural areas. Into thods of rowi and e ing-the delivery of health, social, long-term and other services at the local level. o Support basic research in biomedical areas of cellular biology and neurochemistry. a i a 10; State WHCaN - Illinois Research . 1. t funding for high quality basic, applied and policy research within the field of aging, including support for biomedical, pp.3-4 psycho-social, ecommic and humanistic aspects'of aging and the linkages among them. . 2. support should be targeted on research which analyzes alternative ways of educating and communicating the basic core of knowledge about the aging process to those who work in the field and to the general public, including especially der persons; better mechanisms are needed for effective dissemination of research findings and knowledge about the acing process. 3. research should be supported on the'conditions,under-which people retire between the ages of 55 and 70 and their situation- after retirement.- particularly in terms of nature of employment, economic status and health. State WHCoA - Indiana. October 20-22, 1980 Reccemenclations p.11 : Research 1. Recognizes importance of encouraging broadly based research on the aging process with funding at mord''substantial Federal and state leVels with stability of funding over longer periods for purposed of continuity of research. The recommendation is made: Appropriate research should be funded to develop future career, clinical and research personnel in the field of aging with greater emphasis placed on research and edu- cation dealing with physical fitness, health maintenance and preventive medicine as well as acute illness. Preparing .for An Increasing Nuntir of Older Americans Creating an Age-Integrated Society as 1. Legislation, through funding appropriations, should encourage institutions of higher edUcation to implement, improve or expand p.9 professional preparation for career opportunities in gerontology and geriatrics and that education, research and continuing education opportunities be supported by appropriate-funding allocations for the benefit of the aging and aged. 2. The Federal' government should urge . . . universities and medical schools be contacted ai'id urged to increase basic and clinical p.10 research in geriatrics (e.g., senile dementia, osteoporosis, Witite disease with existing research monies inadequate to the task ahead .103 O 41, State WHCoA - Kansas , May 19-21,, 1981 0 1. 'Institutions,ot post-secondary and higher education should be required to include geriatric and gerontology training and p.I6. research as an.integral`component of'programs for-all medical, health-related and social service:professionals: -----21~Ntwrrox-research that contributes to a better quality of°1ife foreoldertidulth and contribilles to general knooledge about the aging process and Joncjevity. p.17 C o hoh funds for research should be Ahintained and research supports to institutions of higher education should be continued at no less thari the current level; o The National Cancer' Institute shodld-be directed to create programs of clinical research specifically directed to the elderly; ; o Research should be directed to focus on reducing or eliminating pathological, physical and, social conditions that lead to premature aging and dependency o Funding should be directed to local and national research pruoects with the intent of determining whether service p:-Igrams for the elderly ,should be-age-integrated or age- segregated; o Research emphasigin all national institutes should include geriatric and gerontological research. State WHCOA - Kentudcy .. May 19-21, 1981 Research . No specific recomnendations on research. :1 6 O 10G ---....,. 4 c Q AS cs . o . 0 . c S State WHCaA - Louisiana April 3, 1981 1. Research - Two types needed: 1) aging and chronic illness; ,2) inprovement of services both relevant,and related to perceived needs. p.8 o need for need-relevAnt research; research should be done on s9cial/econamic needs prior to eliminating programs. o research should be employed to determine the most effective and cost effective means of meeting those needs. o research needed on UTC, abuse, home care, housing, mental/spiritual health and their interrelationships.in order to determine optimum means of service provision and care for the elderly. o research should be coordinated and use :lade of cross-national data in solving the problems of,the elderly. o previous research on family ccamunication should be implemented. o research should be done to develop options for the elderly in, terms of life styles and service provision. 11, p.7 .o do more geriatric training and research, especially on medications for the elderly. 0 a. -0 10; 0 a tact r 7-8, 0 t 4 State WHCok - Maryland December 1980 Recommendations Reteareh- p.8 1. o develop mechanisms for evaluating the effectiveness, responsiveness and availability of programs involved. in the network of aging services. 'these should include institutlonal, community and family services. 2. o conduct research into the theoretical process of aging and develop better measures of aging-than chronological age to assess physiologic, psyellogic and functional status. 13-9. 3. o assess the factors affecting mental well-being-in aging, e.g., isolation, loneliness, depression; need for affection; study the'acceptanceirejection of aging by individuals and the impact o these attitudes on mental health and well-being. 4. Examine'the developmerit of stereotypes -'give specific attention to the role oftschools/media in fostering/reflecting attitudes regarding haw society perceives the aged and how individuals perceive themselves as they age.' 5. T research on the effects on caretakers of earing for the functionally disabled elderly; determine how to attract care- givers, *methods of support, rewards and ways to prevent physical and aental strain on caregivers. .0" State WHCoA - Massachusetts May 19, 1981 Research 1. Adequate funds needed to support research which sets the direction for social policy and service planning shall be made available, particularly in the area of preventative health,with-arphasis-on the special needs of aged women and minorities. 2. The Federal government shall continue its support of research on the problem of elder abuse and intervention stategies. *p.13 p.14 3. Greater research on aging shall be fostered through increased and stable Federal funding with special emphasis on financial incentives to participating institutions. 4, Linkages shall be established between long-term care facilities and community resources including researh opportunities while safeguarding patient/resident rights and privacy. 5. Research on the aging process shall include studies on successful aging including health habits and responsibilities for one's own health. 6. There sha1be substantial increases in funding for basic biomedical; clinical, behavioral and interdisciplinary research en aging. 110 State WHCoA - Michigan April 29, 1981 There is a severe shortage of social research data in the field rsZ gerontology. The lack of quantifiable, reliable and valid social research data has made it difficult for both policy makers and program planners-to-direet-services_ta_that specific segment of the older population who have need of them. The metho66-16jids cabled for in the following resolutions stress the critical importance of: correct assessment techniques, appropriate minority sampling in surveys, and the appropriate use of minority professionals in design. Policy Recommendations: 1. That a national ad hoc committee be established, preferably within the National Institute on Aging, for the purpose of developing a master plan for research on the impact of minority status and ethnicity on the adaptation to old age. 2. That federal and state policy decisions regarding innovative service interventions should be based upon results derived from the use of longitudinal, evaluative experiments designed to measure their reliability and validity. 3. That precise and reasonable monitoring systems should be developed by federal and state governments to measure the implementation of service interventions. 1 4. Research should be directed at the contribution of-the primary physician and of the health care team to the care' of the elderly. 5. That research be undertaken at the community, state and national levels for the purpose of determining appropriate and beneficial models of mental health support systems which would be most responsive to the needs of the elderly. 6. That the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Drug Abuse, the,National Institute of Mental Health, the Administration on Aging, the National Institute on, Aging, and other concerned agencies place a high priority on research activities dealing with detection, treatment, and prevention of alcohol and drug problems among older Americans. 7. That research be done on a long-term care reimbursement system that reflects the medical/health and social services model which will also determine the professional levels needed for care assessment. ' 111 State WHCoA - Michigan 8. The general authority granted by the Public Health Service Act be retained as the sole basiS for National Institutes of Health appropriations. 9. A President's Council for the Health Sciences be established by the Congress, its primary function to provide for the continuing examination of the performance and planning of National Institutes of Health programs. 10. Itois recommended that specific techniques be established for effectively differentiating between senility and reversible brain -syndrome, 11. That investigation be done on the following: a. The incidence and extent of abuse of the older population as research subjects. b. The feasibility of instituting protective policies for the older persons in the event that abuse is identified. c. The legal and social inplication of a guardian or consent giver for research participation of older persons who may be incapable of making such decision. 12. That federal and state governments should make every effort to reassess the housing needs of the elderly and rural local govern- ments' abilities to meet these needs by means of surveys,, then proceed to plan for the future housing needs. 13. That the federal and state governments initiate research which would document the most effective rehabilitation design for independent living programs for the elderly. 14. That federal and state governments, in coordination with the regional commissions on aging, should make every possible effort to determine the most effective medium which can be used to inform the elderly of the availability of the various assistance, rograms. 15. That the social and psychological antecedents of leisure behavior of the aged be determined. 16. That research be conducted on the area- of abuse of the elderly. 17. That research be designed that brings about awareness of the diverse needs of those experiencing aloneness. 18. Thatthepeaning of aging in various age groups of the American society'be explored with the purpose of changing perspectives to improve the quality of living for the aged. 112 State WHCoA - Minnesota May 27-28, 1981 Research pp.4-5 1. Recommendation: :To include a sound research/evaluation/ dissemination- nt in all government funded programs for the aging; to encourage such a omponent in privately sponsored p ams; to require the determination of the effectivene of federal and state laws regarding the. aging; and encourage the technological development and increased valuation of consumer products benefiting the aging. 2. Recommendation:, To study the causes, effects and treatments --of-dementia -oc-curring_across the lifespan using biomedical, psychological and other appropriate techaques. 3. -Recommendation: To study varieties of grouped housing arrangemened and their advantages and disadvantages in local communities in comparison with the advantages and disadvantages for older people maintaining their own homes. 4. Recommendation: To iden4fy optimal means for effective dissemination of research findings to targeted gropps such as the handicapped, including the involvement ofaging persons in such dissemination; education of researchers concerning ways to present their work in formats which non-researchers can 'understand and useCeducation of policy - makers and others to enable them to become intelligent interpreters of research findings; and tne development of standards by which all interested persons can determine whether research for policy purposes ht been adequately conducted. 5. Recommendation: To evaluate the economic and functional feasibility of establishing and utilizing innovative health providers; home health and emergency care services; and to study procedures and feasibility of hospice care, at the patient's own home or in a special facility or unit, as a service extension-of long-term care facilities. 6. Recommendation: To determine the adequacy of the focus, organization category, location, number and type of professional organizations and personnel that provide mental health services and legal services specifically designed for older adults in Minnesota. Pave 2 State WHCoA - Minnesota 7. Recommendation: To study the economic, societal and personal consequences of retirements that begin at various ages including demographic projection of dependency ratio changes; the-causes_and consequences of permanent and seasonal migra- tion; the feasibility of public and private-incerne-maintenance_ during lengthening'periods of life expectancy; incentives for older persons to continue working; and roles, contributions, and needs of older persons-in their families and communities. 8. Recommendation: Investigate the admission criteriai the staffing patterns, the registered nurse's role,-the degree of family involvement, and the possibility of over-medication that exists in long-term care facilities to determine whether the placement of older adults in such facilities is in their own best interest. Itkihvolve_older_mmle themselves in doing research on programs in their local areas (both rural anT----------- urban), and in developing innovative strategies for coordination of services. 10. Recommendation: To study the unique'needs and develop special programs for each of the following; the rural elderly, the racial minority elderly, and the handicapped elderly. p.13 o It is recommended that cammunicatioh be researched in all areas (e.g., consumer, health care, psychosocial, the media) that apply to the aged and their specific needs. 114 State WHCoh - Mississippi May 18-20, 1981 Research - need for a centralized mechanism for education and research. p.3 o encourage institutions of higher learning to become involved in aging research; o a consortium and Center on Aging (in Mississippi) should be established by legislative mandate; o moreostate and Federal funding should be made available for research in gerontology; p.4 o more research should be conducted in the areas of resident care in long term care institutions; p.5 o research efforts directed toward rehabilitation and disability assessment of older adults should be expanded. State WHCoA - Missouri May 11-13, 1981 Research 1. Further research in physical and mental health, nutrition, education in the use or misuse of drags in geriatric care p.3 and the continuing education of the health care providers in the overall treatment of the Older American should be considered as an optimum program for the benefit of the older individual; 2. While taking into account programs already available, research should be done in order to assist the elderly p.6 individual to maintain his/her independence and dignity and to establish the most effective ways to meet their needs; 3. Efforts should be made toward securing continued funding of research and that the findings of such-research be p.9 widely distributed in understandable lay terms. State WHCaA - Montana April 11, 1981 1. Research No recomendations made. N. 117 s StateiffiCa - Navajo Nation March 24-26, 1981. Research - No specific recommendations. 116 9 lV a, State VTACoA Nebraska April 27-28, 1981 Research - no recommendations. 0 11a State WHCoA - Nevada June 19, 26, 1981 Research - No specific recomnendations. 1Z " State WHCoh'- New Hampshire May 16, 1981 Research / 1. The NationM Institute on Aging should expand and intensify its efforts' to impact on media through its research efforts. 4. -4 P. *I.. 44...N.M. State Met* - Not Jersey March 24, 1981 Research Federally supported research mast help society anticipate the p.5 coming problems related to the increasing numbers and proportions of older pecple in our society and provide some directions to control them. 1. Incmase Federal funding for research into the individual's' ment41 and physical health in the later yews; 2. Increase research and development of an effective information systemon the interaction and interrelation. of drug use, and potential abuse, by the elderly and those involved in the care of the elderly; Develqp,,on the-Federal level, effective evaluation methods to measure the *pact of social servicxt and haw to construct the most efficient mix of services to the individual. /As 122 1.1 ,3 a a State WHCoA - New Mexico 4May 7-8, 1981 Research 1. Additional emphasis (policy and funding) should be placed p.4 on research and training in the area of nutrition and the elderly; 2. Congress should provide substantial financial support for researcht education and training in gerontology. In addition, matching funds should be allocated to states for local determination of research projects. .t 0 123 mamma. Adir.ftlilllai A A Research 1. Congress should include in its final recommendations on the 1981 Older Americans Act Amendments full authorizations at p.12 no less than current (1981) levels for training, research, and demonstration programs (45.5 million). State WHCoA - New York May 10-12, 1981 12 4. StateWHCoA - North Carolina March 13, 1981 1. Research o T support for basic and applied research and research training in the field of aging and the aged via It funding to the Division of Aging. - small grants program to develop basic and applied research projects. pp.19-20 - graduate school training for research careers. - second career training in aging research for established professionals. o Policy Recommendations: 1. Rending support should be made available for basic and applied research and research training in the field of aging and the aged, Such funds should be made available through increased funding to the Division of Aging. a. small grants program to develop basic and applied research projects. b. graduate school training for research careers. `c. "second career" training in aging research for established professionals. o Policy Recomnendations: ----1--That funds from the State be allocatcd to the Division of Aging to develop its research capabilities. 2. That a, consortium be established, with members selected from among the public and private universties and colleges of the State which are engaging in research in aging, from the Division of Aging, and, from other agencies whose missions importantly involve the elderly, to link research and data, resources to the needs of practice, policy, and planning. g4Y 3. that the University-State A Consortium serve as a Research Advisory Committee *Ile Division of Aging to help set Statewide priorities for research and provide impetus for securing the funds needed for research development. 0111.IbINSM11. State WHCoA - North Carolina 4. That there be established and funded, within the Division 'of Aging, a Statewide capability for: a. conducting continuing surveys to ascertain unmet needs of the aged; b. continued program demonstration/evaluation; c. the development of a continuing data base concerning the elderly, to guide policy and program development; d. the communication of the above data/information to local Councils on Aging: highlighting unmet needs and targeting groups and problems needing special attention; 1 e. initiation of research projects in areas where findings would have a special value for planning. o At both the state and Federal levels, encouragement should be given to, and funding provided for, researdi on abuse of older persons so that corrective measures may be devised and imple- mented; such research should focus on physical, social and economic abuse cf older persons by their adult children, relatives and/or caretakers. 12 State WHCa - North Dakota May 11-12, 1981 Research -No specific recommendations made. 127 A,,,lomitommiAlx4411AmmWM State WHColk - Northern Marianas April 24, 1981, Research - No specific recommendations. 12a State WEICoA - Ohio April 22-24, 1981 1. Research p.10 o focus research on Alzheimer's Disease and other chronic diseases encountered by older persons. :7 pp.10-11 o develop a comprehensive and coordinated national research agenda in aging involving a national consortium of founda- tions, professions, government, institutions, organizations, etc. o the agenda should include investigations into the use and effect of drugs on older persons; the so-Cio.;environmental- behavioral aspects of the lives of older persons and the disabling diseases encountered by them. o results of research should be disseminated to service pro- viders by all state units on aging and area agencies on aging. o research results should be incorporated into pro fessional education curricula. 123 State WHCoA - Oklahoma April 20, 1981 1. Research o Studies should be undertaken to investigate the impact of social, economic, environmental and biomedical factors on the well-being of older people, including minority groups. Included in this study should be housing,- sociology, economics, religion, long-term care, intergenerational relationships, education, (formal and in- service). State and private support bust supplement waning Federal support for these areas - to support longitudinal as well as cross-sectional research. pp.11-12 2. Research into the origih and possible improvement of attitudes and behavioral characteristics of health and service providers and their recipient populations should be undertaken; states should mandate the inclusion of training in gerontology and/or geriatrics into educational programs of all health and social services providers. 3. Periodic evaluation and assessment of the success and cost of each program (especially those aimed at improving the quality of life of older people) should be undertaken. Dissemination, as well as publication in non-technical terms, should be made of the findings and used as a base for the development of new alternatives and options. 4. A greater investment must be made in the production of knowledge about the aged and the aging processes. While service expenditures must not be reduced, there must be increased appropriations for research into the care and medical needs of our older population. 130 State" WHCoA - Oregon 6 1. Research pp.6-7 o emphasize wellness-death with dignity, the focus of the implementation of research findings, involve multidis- ciplinary teams to increase adu't independence through a maximum utilization of family and community supports. o educate seniors to use research findings for self-help purposes; utilize local senior groups to ;monitor, analyze and facilitate dissemination of research findings. 'b place research emphasis on survival needs and quality of life of older Americans. o establish a clearinghouse of information, facilitate use of information by elderly,-moitor and evaluate information and make use of telephone hot lines and news media: o place emphasis on development of quality of life indicators in R&D projects; apply cost efficiency and effectiveness criteria to these indicators. o distribute 1980 census tract data to all counties and local communities as a basis for research planning. o set up demonstration projects and find ways to demonStrate the use of a personally owned health record. o promote internships in nursing homes and alternative institutions to upgrade the quality of training, curriculum and research_in health and health-related educational programs. o determine ways to include older persons in the full research process to produce a better product, promote individuai dignity and utilize his/her experience. 13; State WHCoh - Pennsylvania March 22-25, 1981 1. Research pp.3-4 resolve that full recognition and research be provided for the development and delivery of high quality yet cost-effective long-term care health and social services; it is recaarended that continued research to address the aging process and conditions relevant to the physical and mental well-being of the'aging population be provided. p.9 o resolve that advocacy effort be made toward the-development of a team of gerontologists and directors of agencies serving the elderly to conduct research which will examine the changing role of the elderly in the areas of human values, basic needs, educational opportunities, self reliance and decision making; this research -should address the impact of the issues and their relationship to regional differences. 132 State WHCoA - Puerto Rico I. Research p.4 o universities must-provide degrees and proMote research in the area of gerontology. o _current social changes affecting the family within society and elderly members within the family must be studied in order to obtain an adequate comprehension of their overall meaning and their implications for attitude formation. p.6 o a nation -wide research program in gerontology should be established. o a compulsory data collection system should be developed and implemented to determine the needs of the elderly - and used as a resource for research and other activities in the field of gerontology. o leaders in the field of gerontology must participate in the creation of the intellectual environment that will promote research in gerontology. 0 133 State Vitra - Rhoda Island. 1. Research o Resolve that funds be allocated for education, prevention and research in the field of mental health for the elderly. 134 State WHCcA - South Carolina May 14-15, 1981 Research -ono specific,recompiendations. a t O S 135 trIrta.raok---.- 1101. State WHCah - South Dakota 4 April 7-8, 1981 Research o The Federal government should do research on the inequities in the placement of the elderly in institutions in regard to the type of have and state residence; o The Federal governMent should do research on the inequities in reimbursement for private pay versus medicaid; o A research and demonstration project should be developed to discover ways-to prevent moving the elderly in need of extensive health care away from their friends and community. o Expansion of medical research should be focused on the normal age- related changes and associated chronic conditions, both physical and pcychosocial; o Research-and demonstration projects should be developed to find ways to keep the elderly in their homes and active in their coMmunity. 136 P. mar ti State WHCoA - Tennessee May 11-12, 1981 Research No specific recommendations made, 0 137 State WHCoA - Texas March 29-31, 1981 Research - Research into practice; 1. train service providers as pararesearchers to use data to set policies; 2. research findings with implications for policy and service program development should receive the widest possible distribution. 138 State WHCoiN - Utah (April 1981) Recommendations Research (VI) 1. Coordination p.10 o researchers in the field of aging should coordinate their -efforts to select projects that meet critical needs, avoid duplications and with service providers. o findings should be communicated through existing organizational resources furnishing. the elderly and those working with them, usable information. o Congress continue to fund NIA and increase funds as necessary to implement positive findings and defray increased research costs. o private organizations should be solicited and urged to contribute research monies to increase knowledge in the aging field. 2. Biomedical p.11 o 1 research emphasis toward understanding the aging process with the results utilized in medical, education and practice. o T research on chemical substance abuse among elderly. o t research on over-the-counter and prescribed drugs for the elderly to determine the correct dosage and regulatory requirements. p.11 3. Behavioral and Social Sciences o T research on reduction, and prevention of dependency in later life. o research on meaningful ways to better utilize the time and talents of the "young-old." o T research on need of "old-old" (e.g., supportive and restorative health and social services). -1).12 o 4' research on specific personality, social, cultural, and environmental factors producing social competency and personal satisfaction. 13a State WHCoA - Utah p.12 o special research attention should be given to the older person's relationships in the intergenerational family. o I' research transculiuial research (family, religious, community, etc.) should be done_to determine positive concepts applicable to improving conditions of our aged. 4. Human Service and Delivery p.1, o k research on service systems to determine most effective Organization to furnish services which have optimum content, quality and cost. 5. Research Training p.12 o researcherg need training in the field of aging before conducting research in aging. J State ViliCoA - Vermont November 19, 1981 Reoomendations 1. Research p.9 There is a need for more knowledge about the biological and social effects of aging and how this knowledge can be trans- lated into public policy: Policy Reccamendation o I funding to implement the National Aging Research Plan with emphasis on issues relating to long-term care services. Action Recomendations o Fund research to understand the basic processes of aging, e.g., cellular changes in brain tissue. o Fund research to understand and control clinical manifestations of aging, e.g., senile dementia, behavioral management in nursing homes, bladder control programs. p.10 o Fund research to understani the interaction - between older people and a dynamic society, e.g., family dynamics, retirement problems, income and health benefit programs, intergenerational ccmunication and balancing of services/benefits between young and old. o Fund research to investigate how oportunities can be increased for older people to contribute more fully; retirement and employment; sexuality; effects of mass-media on self-perception; special problems of older women; alcoholism; volunteering; working; effects of public housing on quantity of life. 2. Older Americans as a Growing National Resource p.8 o Research should be funded to identify the value and contributions of older Americans. 141 StabeiffiCoh - Virgin Islands May 4-5, 1981 Research No specific reccomendations: 142 A F State WHCoA - Virginia October 16-17, 1981 Research No specific recommendations made. 143 State WHCoA - Washington Reccumendat ions 1. Research o tsupport for NIA to undertake comprehensive, systematic and intensive studies of the biomedical, behavioral and social aspects of aging, with special emphasis on the mental health needs of older persons for the purpose of promoting the well-being of older persons. o Federal research and model projects should focus on the minority elderly, rural elderly, disabled elderly and older women. 14 ,, State WHCcik - West Virginia March 24-25, 1981 Research No specific recommendations on research. 145 pp.5-6 State.WHCoA - Wisconsin May 5, 1981 Research - o Congress shall ensure that adequtellnidtmig-shall-be-allocated __ to health and human services research efforts of importance to older citizens; o 1 private enterprise and foundations to allocate funds for pure and applied research in aging; o older citizens shall participate in identifying research issues and the dissemination of research findings; o research on natural support systems for the care of the elderly - family and other natural caretakers - in order to provide the least restrictive and most humane care consistentwith the optional quality of- life; o research shall investigate the impact and interrelationships of taxation, retirement' benefits and other pertinent fiscal policies on the economic well-being and equity of older persons - particularly with regard to Work opportunities in later life; o research should address as pribrity issues: - life span education - maintenance of health - disabilities and long-term illness polypharmacy and drug use - nutrition - traininVedu, Aional goals in gerontology of all health- related professionals and occupations o the results of gerontological research and the development of new km/ledge shall be disseminated and applied in the formation of public policy and the conduct of activities of the institutions, programs and services in order to benefit the health and well-being of all persons; p.5 o research and training in the many conditions which produce senile dementia shall be publicly supported and promoted. 14L State WHColk - Wyaning June 4, 1981 Research No specific recommendations on research. . -1, 14 -1-