46 THE FIVE-YEAR OUTLOOK 



trolled. That will require continued and concerted re- 

 search into the causes and courses of the diseases that af- 

 flict the elderly (NRC-Obs.: NRC-2; HEALTH). 



There is also increasing evidence to show that in older 

 people the body handles drugs differently than it does in 

 younger people. Since the elderly often suffer from multi- 

 ple chronic diseases and, therefore, follow complicated 

 drug regimens, they are unusually susceptible to the un- 

 toward and debilitating effects of drug interactions. 

 Therefore, additional information will be needed about 

 drug metabolism and drug interactions in the elderly so 

 that less debilitating and less dangerous drug regimens 

 can be instituted.' 



The second set of factors reducing the functional capac- 

 ity of the elderly is concerned with social and behavioral 

 patterns. Lifestyles and behavior patterns have long been 

 suggested to affect longevity and health in later life. 

 However, there is not yet a clear understanding of that 

 relationship. In addition, there is increasing evidence that 

 nursing practices can significantly affect the functional 

 capacity of the elderly (SSRC^). Furthermore, the social 

 stresses to which the elderly are subjected, such as 

 changes in family circumstances and in their economic 

 status, can have major debilitating effects. Although some 

 progress has been made in counteracting those stresses, - 

 additional efforts will be needed in the coming years. 



ASSESSING AND REDESIGNING HEALTH AND SOCIAL 

 SERVICES TO ACCOMMODATE THE HEALTH NEEDS OF 

 THE AGED 



Public health workers and physicians agree that care of the 

 elderly should be designed to maintain the functional and 

 social independence of people as much as possible. Possi- 

 ble strategies for approaching that goal include ( 1 ) provid- 

 ing for better detection of emerging illnesses before they 

 advance and the provision of assistance prior to the de- 

 cline of functioning; (2) improving health care facilities to 

 deter further institutionalization and enhance the ability ot 

 people to return to community living; and (3) increasing 

 the availability of intensive services to treat and rehabili- 

 tate the elderly and chronically ill so that they may main- 

 tain the highest possible level of functioning (NRC-1; 

 SSRC^). 



Science and technology can play an important role in 

 all three strategies. Through improving methods for iden- 

 tifying high-risk cases and through preadmission cer- 

 tification services, alternative living and health care 

 arrangements may be provided to limit unnecessary in- 

 stitutionalization. Through research advances, the quality 

 of care provided in outpatient units, nursing homes, and 

 intermediate care facilities may be enhanced. Similarly, 

 advances in medicine are leading to higher quality and 

 more appropriate care for the chronically and acutely ill. 

 New drugs, for instance, may permit significant numbers 

 of patients to be shifted from surgical to medical care and 

 from institutions to community settings (SSRC^). 



DEALING WITH THE PROBLEMS OF ADDICTION 

 Substance abuse is one of the health problems causing 

 greatest concern in recent years. Alcoholism, drug abuse, 

 and cigarette smoking have all been related to both a wide 

 variety of diseases and numerous social problems 

 (HEALTH; Outlook /). For example, of all of the oppor- 

 tunities for preventing such diseases as cancer and ar- 

 teriosclerosis, one of the most important is the reduction 

 of cigarette smoking {Outlook I). However, while more 

 than 30 million Americans have stopped smoking since 

 the Surgeon General's Report, Smoking and Health, was 

 published in 1964, there are still over 50 million smokers 

 in the United States today (SSRC-2). Ftirthermore, smok- 

 ing rates have been rising more rapidly among adolescents 

 than in any other segment of the population, and, there- 

 fore, reduction in this habit must be a critical focus of 

 efforts if we are to be successful at all in slowing the onset 

 of life-threatening diseases. 



Alcohol and drug-related addictions remain major 

 problems for American society. Although there is no 

 accurate estimate of the total incidence or prevalence of 

 alcohol abuse, it has been estimated that over 10 million 

 American adults are either alcoholics or problem drink- 

 ers. That is roughly 7 percent of the population 18 years of 

 age or older Although the number of heroin addicts is 

 estimated to have dropped below one-half million by 

 1980, the abuse and misuse of most other psychoactive 

 drugs appear to be rising. In economic terms, the costs of 

 alcohol and drug abuse have been very high. They were 

 estimated in 1975 at $43 billion for alcohol abuse and $10 

 billion for drug abuse, and they seem to have been escalat- 

 ing since then.' There are also the widely acknowledged 

 social problems the addictive behaviors present. 



Science and technology can help with the problems of 

 addiction in a variety of general ways: by determining the 

 neural and physiological bases of addiction and addictive 

 behaviors, by increasing understanding of the barriers to 

 changing behavior, by increasing understanding of the 

 causal relationships between addictive behaviors and ill- 

 ness, and by better understanding the relationship be- 

 tween childrearing practices and the presence of addictive 

 behaviors later in life (SSRC-2; HEALTH). Two fre- 

 quently cited kinds of actions that can be taken to facilitate 

 the application of scientific and technological advances to 

 the problems of addictive behaviors are: (1) increasing the 

 knowledge base about the causes of addictive behaviors, 

 so that more effective prevention and treatment regimens 

 can be developed; and (2) increasing efforts to translate 

 basic behavioral research findings into biomedical prac- 

 tice (SSRC-2; HEALTH; Outlook I). 



INCREASING THE KNOWLEDGE BASE ABOUT THE CAUSES 

 OF ADDICTION 



Any attempts to increase efforts either to prevent the 

 development of or to control addiction once developed 

 will have to be based on information about its causes. 



