Psychology of Aging in the 21st Century.

You won't hear about it during the election, but one great achievement of our government will soon change the lives of thousands of elderly Americans. Early this century, years of federally sponsored research into Alzheimer's and related dementias will produce widely available treatments that can really make a difference in disease progression.

The national effort to study Alzheimer's combines government and private-sector funding, with research priorities largely established by the National Institute on Aging and the National Institute on Mental Health. The government's leadership has been essential, in part because the search for the causes of dementia involved research at the molecular and genetic levels using equipment that didn't exist 20 years ago. Perhaps more importantly, only consistent federal funding could have created the consensus that dementia is a preventable condition rather than an unavoidable result of old age.

One problem for nursing homes is that the extensive publicity on biologic advances in Alzheimer's suggests that drugs and gene therapy are the only things that matter. The role of caregivers and long-term care facilities in improving the quality of mental life of the elderly often appears neglected, while researchers ally with pharmaceutical companies to develop better medical solutions to dementia.

As the decades-long, bipartisan effort to investigate Alzheimer's achieves breakthroughs, the field of geriatric psychology searches new topics for its focus. The annual meeting of the American Psychological Association in Washington in August provided some clues on funding and research priorities for the next 10 or 20 years. Speakers from the National Institute on Aging and institutions funded by federal grants offered several possible directions, all related to nonmedical approaches to improving the quality of life of older Americans.

Steven Zarit, PhD, of the Gerontology Center at Penn State University argued in a symposium on "Psychology of Aging-Envisioning the Future" that advances in care of the "oldest old" have created a much more optimistic view of aging. It's unclear, however, whether this optimism is justified. On the one hand, we hope that science will make it possible for "more of our life to be healthier, fuller, more active." On the other hand, it is possible that "we are headed toward expansion of morbidity," in which medicine extends lives beset by chronic illnesses and deterioration. The difference lies in better understanding of the onset of disability and the maintenance of independence.

Zarit noted that Americans 75 years and older who live alone are most likely to experience unmet needs for Activities of Daily Living, implying that residence "in the community" might not be the best answer for aging if it results in isolation. The best approach, Zarit said, is to prepare for old age early by meeting and keeping good friends, deciding what values are important in life and taking care of financial needs.

Several speakers emphasized that the focus on the biology of Alzheimer's obscures the need for applying nonbiologic psychology to the elderly. Howard Levinthal, PhD, of Rutgers University said, "There is, in fact, a psychology on top of the biology of aging that is just as complicated as the biology...except that psychologists don't want to talk about it." The problem, according to Levinthal, is that changes that can be observed with scientific instruments are most easily communicated. Nonbiologic factors, such as the influence of relationships on health, also need to be addressed convincingly. This is difficult because "the private experience of age and illness" occurs in "conceptual space" rather than in measurable terms.

Neil Charness, PhD, of Florida State University, addressing the same symposium, emphasized that future support for nonbiologic aging research lies in making psychological science more useful to the elderly. He jokingly suggested that the focus of research is to produce findings that benefit publishing companies, grant-funding agencies and academic departments, "and, incidentally, keeps researchers employed." The most important need is to "scale up" experimental findings to the real world.

Charness offered several suggestions as to how research on the psychology of aging can move from the laboratory to society. Psychologists should focus, in part, on becoming useful to long-term care practitioners and caregivers, especially in providing guidelines that will improve the mental and emotional lives of the elderly. Equipment designers and companies employing the elderly also can benefit from cognitive research, so that older people who choose to work can continue to do so. A related area for applied geriatric psychology is to support court decisions and legislation that affect age cutoffs and age bias in employment.

To accomplish this transformation of nonbiologic psychology, Charness argued that "we need better venues for knowledge transfer." He suggested that researchers should be required to translate journal articles for nonacademic readers, perhaps through changes in federal grants. He further urged that more money be devoted to training opportunities that make science accessible to caregivers. "Continued support of cognitive research on aging may not be viable in the long term," he warned, "until it proves of value to seniors.

Other presentations at the American Psychological Association showed that these suggestions for new directions in the psychology of aging are already bearing fruit. Psychology faculty and students at the University of Colorado, Colorado Springs, for example, offered presentations on suicidal thoughts among the elderly and the process of family involvement before nursing home admission. Another interesting project presented by Ayn Welleford, PhD, and Myra Owens of Virginia Commonwealth University was based on in-depth interviews among older African-American volunteers. Welleford and Owens found that a positive perception of the role of the "elder," a sense of involvement in purposeful activities, "connectedness" and personal control were themes that repeatedly emerged among volunteers who are aging "successfully." Physical well-being, attractiveness, wisdom and personal development also were important to successful aging. As one of their subjects said, "I can't run as fast as I used to but I can walk. There ar e people who can't do that. Look how blessed I am!"

Studies such as Welleford and Owens's interviews lack the drama of laboratory experiments that are conquering the biology of dementia, but bringing the whole person back into studies of aging appears to be a trend in federally sponsored research that will be welcomed by the long-term care field.