Social support and continued involvement in useful activities have been shown to foster positive effects on health and longevity. In contrast, studies have associated the lack of social connectedness with significant increased risk for poor health and death. Being part of an active network also increases the opportunity for productive activities, whether paid or volunteer. For most older men and women, a substantial amount of productive work and contributions continue throughout life. Identification of valued roles and continued social integration have been associated with positive health outcomes and self-assessed well being. Similarly, other aspects of health behaviors and lifestyles have been associated with important health outcomes.
Close links have been established between lifestyles and health outcomes. We hope to learn how to ensure that people will initiate beneficial behavior changes and also sustain these choices during the long term. This effort is especially important for older individuals who are at increased risk for multiple pathologies, disability, and functional limitations, which may keep them from fully engaging in the world around them.
Improvements in acute and long-term health care for older people are essential, including strategies to ease the burdens of caregivers and enhance quality of care at home and in different long-term care settings. These initiatives should result in more effective strategies for prevention, treatment, and rehabilitation.
Objectives
Identify Ways for Older People To Retain Valued Roles and Maintain Independence
Despite negative stereotypes, millions of older people contribute to keeping our society functioning and loathe the thought of being a burden. Most older men and women are now participating in the following:
- Working in paid jobs
- Performing essential volunteer work
- Maintaining a household
- Supporting children and grandchildren.
For example, according to one source, if family caregivers had to be replaced, an estimated three million paid workers would have to be recruited. Research is helping to optimize the unique resources that elderly citizens represent. Investigators are seeking and applying technological, social, and behavioral findings to extend older people's ability to remain independent, active, and productive in later life.
Enhance Family Functioning
Intergenerational family support accounts for the way the family assembles and allocates its resources—money, skills, and time—to care for all its members. Research is needed to:
- Monitor these relationships over time
- Understand both their effects on the health and well-being of older people
- Gain insight into the caregiving, emotional support, and economic transfers provided by older people.
More research is needed to address the important issues of increased demands faced by the family's caregivers in light of the changing patterns of work and family demographics, including such characteristics as gender, marital status, income, wealth, education, race, and ethnicity.
Reduce Elder Neglect and Abuse
Although isolated studies have documented the devastating long-term consequences of elder mistreatment, research on elder abuse and neglect is seen as inadequate, as noted by a recent study by the Institute of Medicine, National Academy of Sciences. Substantial research is needed on: (1) the prevalence of elder abuse, (2) reliable measurement tools for assessing elder abuse by health care professionals, and (3) interventions to reduce the incidence of elder abuse.
Improve Health Care and Long-Term Care
There is a pressing need to define organizational mechanisms that will assure quality, affordable health care for the elderly. Attaining this goal will require examining component parts of health care delivery systems and their impact on medical, social, functional, and cost outcomes. An important research focus will involve coordination of care to promote attention to patient and family preferences, smooth transitions between care settings, and maximize independence.
For long-term care, most often provided in a home setting, research can be helpful in reducing the burdens of caregivers, with an emphasis on the unique challenges faced by dementia caregivers. Studies are planned to fill gaps in our understanding of caregiving patterns and the effectiveness of different strategies for helping families manage care needs of physically frail elders. For both informal and formal long-term care settings, specific guidance is being developed on caregiving skills, environmental modifications, and technological supports.
Improve End-of-Life Care
There is a critical lack of empirically generated knowledge on how to maximize quality of life at the end of life. Medical culture is oriented primarily to patient care and not to addressing the multifaceted needs of dying individuals and their families. Future research should focus on the impact of health care organizations and provider interactions on the quality of life for dying individuals. Special attention should be given to developing strategies that enhance support of the older person, the family, and medical care providers who are attempting to provide humane and life-affirming services at the end of life. Additional research is needed to improve older people's experience at the end of life, such as research on: (1) the transitions among end-of-life care settings such as the home, hospital, nursing home, and hospice; (2) better measures of the quality of life at the end of life for both the patient and his or her family; and (3) the social and economic context of caring for a dying elder.
