In 1884 Otto von Bismarck, Chancellor of Germany, made a decision that affected and still affects many lives in the United States to day. He initiated the social, security pension system in Germany, arbitrarily selecting age 65 for receiving benefits. His model has been followed since that time with age 65 designated for retirernent in private, pension plans as well as in, the United States Social Security system. Not only do people at age 65 receive; benefits, they' also receive all the negative implications associated with age in our society, Only the magical number-65-ties these people, together. They do not all age at the same rate and the fact is they do individually experience varying degree of wellness and well-being.
Only recently has Bismarcli's decision for, retirement at age 65 been legislatively challenged. The mandatory retirement age; in the United States is extended from 65 to 70 in private industry and has been eliminated altogether fon federal employees.
As researchers interested in the helath and welfare of our aged population and of "Our Future Selves,"1 as so aptly phrased by Robert N. Butler, we must challenge many of our ideas and stereotypes about the aged. We must question our past research, take a second took at current endeavors, and give new direction for future research.
I will review the history of publications - both nocresearch and and research on the aged; the federal, professional, and educational history that helped develop today's gerontological research; explore some exciting activities currently taking place that could impact on the care of the aged and research on the aged; arid finally, look at some possible future directions for significant research on the aged.
To look at some of the past publications on the aged that. were, generally not research studies, I reviewed the international Nursing Index for three selected lime periods-the years 1971,2 1971,3 and 1976.4 The International Nursing Index is an annual cumulative index of over 150 nursing journals received from all over the world as well as a compilation of nursing articles from non-nursing journals currently indexed in Index Medicus. My review is confined to United States publications only (Table I).
There were a total of 379 articles about the aged published in 1966, 40% of which concerned institutional care, eg, nursing homes and old age homes. Another 38% of articles were grouped under the title "Aged," which largely involved characteristics of the aged and management of the older person in such areas as emotional health and physical disability. Approximately 7% of articles were devoted to geriatrics concerned with problems of chronic illness and rehabilitation. Also in that year, 1966, 7% of published material discussed health insurance. As you recall, Medicare legislation was passed in 1965. Only two publications were listed under the classification of geriatric nursing.
In 1971, with a total of 296 articles, the Index lists 63 publications or 21.3% of total publications for that year under geriatric nursing. Again, our largest percentages include institutional care with the classification "Aged" second with 23%.
Geriatric nursing publications assumed a larger percentage in 1976 with 27% of 416 articles. Publications on institutions again command 42% of the total articles for 1976 with only 9% classified in the "Aged" category. You will note that psychosis including complications, prevention, control, and rehabilitation is becoming a greater concern with 19 articles or 4.5%.
Overall for the three years, the same percentages prevail with publications on institutions assuming the largest proportion - 40%; the "Aged" classification second with 23%; and geriatric nursing articles rising in the three years for the third highest number of articles with 16.4% of the total 1,091 articles.
While classification systems are often difficult to deal with and my analysis is crude, I do think we see an important trend occurring throughout this 10-year period from 1966 to 1976. Nurses are differentiating geriatric nursing as a specific entity clearly enough for classification into the nursing category. There is also the disturbing factor of devoting a great deal of time and effort to institutionalization rather than to exploring new methods of care and alternative care modalities. We have tended to accept the traditional system of care and to seek methods of coping within that system rather than to try to modify or to change the system.
Institutions for the aged are still part of the health care delivery system, and we do need to continue to improve and to monitor the care given to residents, but these persons comprise a minority of the aged. Shanas et al5 in 1968, reported that less than 5% of persons 65 years or older are institutionalized. Lowy and Helphand6 in 1975 claimed that less than 300,000 or 10% of the total three million people eligible for long-term care are in institutions. There has been a deficiency in the amount of time and effort devoted to the 90-95% of aged persons who are not institutionalized. Furthermore, the decision-making process used to determine appropriate placement - institutionalization or home care - has not been clarified. Much has been written about this neglected problem exemplified by the inappropriate or premature placement of many older people in various levels of institutional and home-care programs. Not only does the older person suffer with inappropriate placement, but society pays excessive and unnecessary costs. Objective criteria for appropriate placement has yet to be developed and used and may well lead to better adjustment for the aged if sound rationale is used for decision making. Costs, so important today in health care delivery, make rationale decision making an important issue.
The publications we have reviewed from 1966 to 1976 were generally nonresearch articles. Basson,7 in a search of selected gerontological literature from 1955 to 1965, reported 372 out of 438 publications not directly related to research. While our concern today is on research, mention of these fact-finding, descriptive, and empirical publications is important because they did provide the basis and direction for gerontological research to grow.
Formal analysis of most nursing research on the aged begins in the year 1952, significantly the year of the first issue of Nursing Research. An analysis by Drs. Gunter and Miller8 of the 17 studies on the aged, which were published in Nursing Research since its first issue, 1952 to 1976 classified: five as clinical; four as studies of attitudes of nursing personnel and students; and eight as surveys of characteristics and problems of the elderly.
Drs. Gunter and Miller also reviewed 29 psychosocial nursing studies involving the aged for the same 25-year period. Their review of these studies was not purported to be comprehensive and included investigations published in other journals as well as in Nursing Research. The studies were classified by Gunter and Miller into three main areas: nine - studies on the psychosocial characteristics of the elderly; four - studies on the attitudes of caretakers to the psychosocial needs of the elderly; and 16 - studies on intervention and therapy approaches to meet these needs.
NUMBER AND CLASSIFICATION OF PUBLICATIONS* OIN THE AGE IN INTERNATIONAL NURSING INDEX FOR YEARS 1966, 1971 AND 1976
Suggestions by Drs. Gunter and Miller for future gerontological research include the use of similar operational definitions of old age and sampling frames for comparability of studies, more replication studies, improved research designs, and greater dissemination of research results so they may be used in nursing practice. They do report that there is evidence of a developing nursing gerontology. With the relative recent advent of aging as a concern, this statement is encouraging for the future of gerontological nursing and gerontological research.
While some social programs had been established for the elderly such as Social Security in 1935, aging did not become a national concern until 1950. At that time the President, Harry Truman, directed the Federal Security Agency to hold national conferences on aging. Subsequently, White House Conferences on Aging were held in 1961 and 1971. A Research on Aging Act (Public Law 93-296) was passed May 31, 1974. This public law authorized the establishment of a National Institute on Aging (established October 7, 1974) and also required the development of a national comprehensive plan for a research program on aging. This plan was submitted to the Assistant Secretary for Health on January 8, 1975, and the first meeting of the National Advisory Council on Aging was held April 23 and 24, 1975. The Institute on Aging is committed to a multidisciplinary approach to aging. The intramural research program of the Institute is concerned with behavioral changes with aging, the aging processes, age-related deterioration of cells and systems, the physiological control system and genetic transfer. The extramural program will support research on the biological, medical, psychological, and social aspects of aging.
The Research on Aging Act of 1974 also provides for training and instruction by the establishment of traineeships and fellowships, in the Institute and elsewhere, in matters pertaining to the aging process and the special problems and needs of the aged. This training and instruction involves preparation for research and preparation of clinical personnel in the allied health, nursing, and paramedical fields.
Another federal agency has been significant in helping to develop gerontological nursing research. In 1948, the Division of Nursing Resources of the United States Public Health Service was established to carry out research and consultation in nursing. According to Abdellah and Levine this was, "the first organized and continuing effort to do studies of nursing problems on a national basis. . . ." Jessie M. Scott,10 Assistant Surgeon General and Director of the Division of Nursing, reports that:
In lhat year, the Public Health Service began its intramural program of nursing research In 1955 nursing for the first time in its long history received Federal governmentsupported grants for extramural research. In the years that followed the launching of this Public Health Service program, research in nursing was undertaken by institutions throughout the country, with a consequent broadening of the areas being studied, and emergence of greater maturity in both projects and techniques.
The list of past research projects funded by the Division of Nursing contains several studies on the aged such as nurse relationships with older patients, the personalization of older patients, attitudes of caretakers, facts on nursing homes, nursing needs of the chronically ill elderly, nursing personnel and dying patients, and nurse awareness and psychosocial function in the aged. The most recent research of direct relevance to the aged funded by the Division of Nursing includes:
1. The effect of illness on family health;
2. Job performance in nursing homes;
3. Living skills of the nursing home resident; and
4. The care-cure problem of dying in teaching hospitals.
Most research proposals on aging now go for funding to the Institute on Aging, although the Division of Nursing's interest from a programmatic view is high. However, findings from other nursing studies completed or in progress with support from the Division of Nursing, Health Resources Administration of the Public Health Service are applicable in the care of the aged.
We can see that the governmental agencies are responding to the population transformation of our society from a young population to an older population that is predicted to reach an "aging boom" between the decade 2010 and 2020.
Nurses have always been a part of the health care delivery system. Probably the first nurses to exclusively give their attention to the care of the aged occurred after the passage of the Social Security Act in 1935. Two provisions of this legislation, Old Age Survivors Insurance and Old Age Assistance, provided financial assistance on a continuing basis. With this cash assistance, the elderly who needed care had the means to seek alternatives other than public institutionalization. There was an increase in the number of boarding homes to accommodate old people. Retired and widowed nurses often converted their homes into living quarters and became the first geriatric nurses with their homes becoming the first nursing homes in the United States. These nurses did not think of themselves as geriatric nurses.
The current development of geriatric nursing or gerontological nursing, as it was later called, owes much of its growth to the professional organization of nursing that has recognized its responsibility and role in the care of the aged. The American Nurses' Association formed a conference group for geriatric nurses in 1961. With reorganization of the Association in 1966, this conference group became one of the five clinical divisions of the ANA. In 1974, in response to the broadened scope of practice, the American Nurses' Association Division on Geriatric Nursing Practice voted to change its name to that of the Division of Gerontological Nursing Practice. One of the first tasks of the Division was the development of standards of practice for geriatric nursing originally published in 1970. A revision, Standards of Gerontological Nursing Practice, was published in September 1976. The ANA also formally recognizes nurses for superior performance in patient care. Their certification program, begun in the late 1960s, first certified geriatric nurses in January 1975, and there are now over 200 such nurses.
The Division of Gerontological Nursing Practice of the ANA also published Guidelines for the Preparation of Geriatric Nurse Practitioners, giving the educational content considered necessary to the nursing care of the aged. The Association has also developed and taught a continuing education curriculum for nursing home registered nurses and submitted a major report to the Senate Subcommittee on Long-Term Care of the Senate Special Committee on Aging. This document remains an. important resource in the field of health services to the aged.
Other documents on nursing published by the ANA have relevance for practice in any area including gerontological nursing practice. For example, Lucille Gress1' mentions the Code for Nurses with interpretive Statements, published by ANA in 1976, when discussing the role and function of the gerontological nurse and quality care for the elderly.
The 1954 House of Delegates of the ANA authorized the incoming Board of Directors to establish a foundation to advance nursing research. With this authorization, the American Nurses' Foundation was established in 1955 with the main objectives of promoting and supporting nursing research and disseminating research findings. Pi tel, J2 a former executive director of the ANF, noted that "it is the only Foundation in the country whose primary and sole purpose is the enhancement of nursing research with the ultimate goal of improvement of health care through research." Twenty years later, at the end of 1974, ANF had awarded approximately 80 grants for research projects totaling a little over one-half million dollars. Twenty-five awards have been made in the past three years at a cost of approximately $120,000. Many of these studies were concerned with the aged, such as: correlates of psychological health and longevity, illness crises in the families of the aged, an interdisciplinary study of care for dying patients and their families, a survey of the literature in long-term illness, interaction between nurses and dying patients, widow bereavement, and bowel and bladder incontinence in geriatric patients. Funds are available in the small grants program from the American Nurses' Foundation. These grants are especially helpful for the novice researcher to begin research studies in a chosen field or for dissertation.
At this time, there are three doctoral programs that offer either an individualized program or a major in gerontologi cal nursing. Approximately 16 universities have some focus on geriatric/gerontological nursing in their master's degree program with an additional six preparing nurses as nurse practitioners.
Nurses with RN licensure, but not necessarily a BSN in all instances, who are interested in working with the aged can be awarded a certificate as a geriatric nurse practitioner from at least six nursing programs across the country. These programs are nine months to one year and usually require a perceptor sponsor.*
The nursing educational system is moving to prepare more knowledgeable professional nurses to deliver total care to the aged. Most health professionals have not been as well prepared to evaluate the needs of older people for various types of long-term services nor to assist them in obtaining the services appropriate to their needs. Nevertheless, Dr. Myrtle K. Aydelotte13 has pointed out a deficiency in our educational system for all health professionals. She says,
Failure to provide students with the rationale for and examples of interprofessional collaboration is a weakness of our educational system. The majority of preparatory courses fail to acquaint the health professional with the interrelationships of the various health care roles and the need to coordinate activities in order to provide a system of comprehensive care.
In the absence of any orientation to the collaborative role concept, health professionals develop an extremely limited perspective of the health care system. They tend to concentrate solely on their sphere of responsibilities, giving little consideration to the impact of specific activities on the total system. Such territorial mentality does not foster collaboration.
Nowhere is the collaborative effort more important than in the care of and research on the aged where solutions to problems encompass many disciplines. Much has been conceived in the preparation of nurses for the care of the aged and their role in a health care team. However, little has been written about how to develop multidisciplinary health teams. Several hospitals and clinics, especially in pediatrics and psychiatry, have incorporated this concept in the objectives of their programs. Unfortunately, evaluative research of these programs is not available to any extent. As we move in this direction, each discipline and each team member must assess their knowledge and their limitations.
The professional nurse can assume or share responsibility for team leadership and/or coordination of activities directed toward maximizing the potential state of health of the aged person. The entire effort of the team should be directed toward increasing effectiveness in the delivery of health care. A recurrent concern of health team members is that nurses are not aware of the "fit" of other disciplines in a health team and nurses are concerned that other disciplines are not always aware of their "fit" into the total health care delivery system. Nursing function and educational experience have expanded during the past several years and this is true in other fields as well. Roles become blurred and there is an overlap into other fields. Programs designed to educate people in the care and research of the aged should consider collaborative educational experiences for relevant disciplines so that "fit" and communication is more easily accomplished.
What are some current activities that could impact on the care of the aged and on gerontological research? One of the most significant is the demographic change with over 10% of the population aged 65 and overin the United States. With the increased numbers of older persons, they become visible and more powerful. As the cover story of Time14 magazine for October 10, 1977 states:
The 1960s was the decade of aroused youth; the 1970s may well belong to their grandparents. Some 23 million Americans, about 10 per cent of the population, are 65 or over. Numbers alone give them political clout, because they vote more consistently than younger groups. In addition, they have begun to organize with all the skill and determination of other embattled minorities. Such burgeoning pressure groups as the Gray Panthers, the National Council on the Aging, the National Association of Retired Federal Employees and the National Council of Senior Citizens have given their political representatives little respite. Foremost among their goals has been the right to work.
You are aware of the outcome of that goal. I refer you back to the number of articles that appeared in 1966 after the passage of Medicare in 1965. Here again is legislation that can trigger a vast amount of research. We need hard data on the number of workers who will remain in the job field and the types of jobs they will hold. What difference will this make on our economy and for providing jobs for young members of our society? Should persons past age 65 work full-time or part-time? The December 1978, issue of Nursing Outlookls reports on a study of a European approach to retirement where workers of retirement age are phased out slowly. Adjustment problems are less and workers stay healthier. There are other alternatives to an abrupt cessation from the work force, but findings from research are necessary to determine the most effective alternative. Studies are needed also on the work history, adjustment, and health of those persons who elect to stay in the work world past age 65 compared to those who do not.
More attention has been given recently to studies of persons in the middle years of life, although research in this area is still meager, having begun only in the mid1950s. If development is continuous through the life cycle, gerontologists have suggested that understanding old age is possible with an understanding of middle age. Dr. Dolores Borland16 in an August 1978, issue of the Gerontologist makes the suggestion that "studies which focus on the middle-age years would develop a variety of data which would provide the 'missing link' between the data already available on aging in the pre-middle-age years and old age." Dr. Borland gives an assessment of research on middle age including characteristics of the past research and implications for future research on middle age. Nurses interested in gerontological research need to continue to be aware of findings from research on the middleaged population and how these findings impact on gerontological practice and studies.
Let me go back even further in the life cycle and discuss a project being conducted through the sponsorship of the American Nurses' Foundation under the direction of Evelan Holder.17 The total program, "Know Your Body," was developed in the years 1975 through 1978 by health and nutrition educators, researchers, and community health practitioners at the American Health Foundation in New York. The local "Know Your Body" project is funded by the Victor E. Speas Foundation and is a health screening, health education, health intervention program for seventh, eighth, and ninth graders in four school districts in the greater Kansas City area. The students take a written pretest to define the baseline of their health knowledge of nutrition, blood pressure, and smoking. Current and stimulating curriculum materials are taught by classroom teachers in the disease control section of life science or health education for a period of six to ten weeks. Then the posttest scores on health knowledge are compared with pretest scores. The students may also, if they choose, be measured on a battery of tests provided by registered nurses and lab technicians during a health screening lab at their school. These tests include height, weight, skin-fold measurement, blood pressure, modified Harvard step test for cardiac response, and blood test for cholesterol, sugar, and hematocrit. They also complete an adolescent health habits survey and a family health survey. Students then have their own test results, whether within normal limits or not, and participate in classroom discussions of risk factors to heart disease, lung cancer, and stroke, the "Know Your Body" target diseases for control. Students with high risks such as overweight, high cholesterol or poor physical fitness have an opportunity to participate in an after school club that encourages behavioral change and peer-group support.
Findings reveal that among these young adolescents 21.2% have at least one risk factor for cancer/cardiovascular disease, 8% have two risks; 14.5% have serum cholesterol at or about 180 mg percent; 17.6% are overweight as defined by 20% greater than average weight for height. There are two important reasons for discussing this project on adolescents at a gerontological conference. First, life style change may be possible in this age group that could promote longevity and/or the quality of life for these students as they grow older. To quote Dr. Madeleine Leininger,1 "as more knowledge accumulates about wellness behavior, we can predict that there will be less need for practitioners for the ill and more need for 'wellness' practitioner s- a shift from our present directions." Perhaps we will be nearer to this goal when these youngsters reach old age. Second, the screenings, health education, and intervention could be expanded to include persons in middle-age and older age so that maintenance of health status and prevention of disease at those ages could be experienced. In addition, mechanisms are provided for consumer-provider dialogue and the responsibility for good health habits is given to the person who can best control diet, weight, smoking, and exercise. With persons monitoring their own wellness care, dependency on the health professional is reduced.
Another group of studies relevant to research on the aged is research on women in our society. With greater life expectancy for women than for men, we can conclude that a greater number of the aged are and will be female. Several current changes become important: women are marrying later and choosing to remain single more often; having no children or fewer children; divorcing more frequently; going back to school or changing careers in mid-years; and entering the labor force in greater numbers. With greater independence, women are maintaining their own Social Security and retirement plans. What will be their needs and retirement status, socially, economically, and psychologically? Female-headed households and women, both young and old, living alone are more common. Are these females more self-reliant in old age? Women generally assume major responsibility for care of aged parents and others who are chronically ill in the home. If more programs become available for home care, what does that do to career patterns of women and their view of old age? Demographic trends that help distinguish changes in female roles, and consequently male roles, provide direction for future research on the aged.
To look to the future, it is not too difficult to predict that gerontological research will increase when current population projections indicate that almost 20% of our population will be elderly by the year 2030. 19 Also, research on the aged will have an expanding focus. The National Institute on Aging is now conducting research on the psychological and social issues relevant to aging, but is seeking proposals on sociocul turai factors that impact on aging of minorities.20 Research in this area is sparse. The National Institute on Aging is concerned that lack of baseline data on minorities and minority aged restricts the ability to document the impact on these groups of historic and cultural changes within the last few decades.
In the first priorities list for selection of possible projects for study ranked in order and developed by the Office of Technology Assessment or OTA,21 Implications of Increased Longevity ranks as number 16 out of 30 selected priorities. Toset these priorities, OTAasked 5,000 people to consider the critical technological issues that they thought were of special importance to the United States and the world and to submit their top choices. OTA received 1,530 suggested topics for study with another 2,875 items extracted from published literature. Among the assessments by OTA on Implications of Increased Longevity will be studies on the economics of an aging society, implications of increased longevity for the health care system, alternative roles for the elderly in American society and others. These assessments will provide members of Congress with information to focus on long-term and comprehensive issues.
These two examples illustrate that the need for expanding and increasing gerontological study is acknowledged in order to cope with age changes that are occurring and will continue to occur in our population. To significantly impact on future gerontological research, nurses interested in the field must also expand and increase their activities in at least four areas.
1. They must continue to be politically aware and politically involved. The President's budget request for fiscal year 1980 provides no funds for nursing research projects. Furthermore, a rescission (removal or reduction of appropriated funds) is expected and a hold back of funds already has been in process for nursing research. No awards are being made for continuing projects although funds were appropriated. Additionally, only continuing fellows under the National Research Service Awards legislation are being funded. The National Research Service Award legislation was extended for one year and signed by the President on November 9, 1978. To date, no new fellowship awards have been made although there are several approved and unfunded. Nursing gerontological research can add immeasurably to the data necessary for the social, psychological, and physiological well-being of the aged and consequently of society. To do this, however, we need funding for research and funding for training of new investigators.
Research data is needed for impending political issues and future issues relative to the aged. For example, HEW is moving toward a standard of numerical staffing by the ratio of RNs to patients in both acute and long-term care settings. In the care of the aging, a policy is needed in establishing standards in relation to patient needs rather than on nurse-patient ratio, but documentation is needed for policy guidance. Another issue is the greater use of RNs in skilled nursing facilities for direct patient care. It is unlikely that the effort will be encouraged without the supporting data for this change.
2. Based on those facts, the second area where gerontological nurse researchers need greater awareness and involvement is in observing trends for the future in the social system and in the health care system, especially trends concerning the aged. With research geared toward trends, there is the possibility of having relevant data to support change. Furthermore, by looking to the íuture and preparing necessary data, we may be able not only to support and follow change but to make changes in the policies and the care of the aged population. To conduct research in this broad social perspective of aging, Undings from research outside of the strictly gerontological field are relevant, eg, studies on women.
3. Also, gerontological nurse researchers do need to expand their capabilities into a third area which is the use of multi-disciplinary gerontological research teams. In view of the increasing number of aging persons there is need to promote standards of care that add meaning to the living experience. Basic human needs, growth and development, socialization, self-esteem, and selfactualization do extend through the life cycle until death. Guidelines for effective multidisciplinary practice need to be developed to assure that these needs that do extend through the life cycle are recognized and met. These guidelines can only be developed by exploration, demonstration, and research.
4. Finally, a very important area for attention is the development of methods for greater use of research findings in nursing practice. O'Connell and Duffy,22 analyzing the status of nursing research in practice, state that ". . .research in nursing has not appreciably changed the behavior of nurses." Reasons for this charge by the authors are that not enough research has been conducted and lack of replicated studies has not insured the reliability of findings. I think that the dissonance that exists between research and practice in nursing generally also exists in gerontological nursing. Some efforts are being made to solve this problem. Intradisciplinary as well as interdisciplinary research teams would also be helpful for greater communication.
To summarize, the review of past gerontological research and its evolution demonstrates how much can be accomplished in a short period of time. Currently, knowledge of the aged is being expanded and accelerated in all areas - cultural, social, psychological as well as physiological. Three articles out of the total ten in the January- February 1979, issue of Nursing Research23 are on the elderly. Nurse researchers in the gerontological field can further expand the knowledge in the future by greater political involvement, astute observation of trends, collaboration with other disciplines, and insuring the access and use of research findings in clinical practice.
Research, education, and service have all been discussed. They are each bound to the other to form a continuous circle. The interdependence of each of these was succintly described by Jack Masuer,24 Conceiver, Designer, and First Clinical Director, Clinical Center of the National Institute of Health when he said, ". . .traditions of excellence have demonstrated abundantly that research enhances the vitality of teaching, teaching lifts the standards of service, and service opens new avenues of investigation."
- 1. HEW Public Health Service, National Institutes of Health, National Institute on Aging with the advice of the National Advisory Council on Aging: Our Future Selves A Research Plan Toward Understanding Aging. Washington, DC, US Government Printing Office, 1977.
- 2. International Nursing Index, vol 1. New York, American Journal of Nursing Company, 1966.
- 3. International Nursing Index, vol 6. New York, American Journal of Nursing Company, 1971.
- 4. International Nursing Index, vol II. New York, American Journal of Nursing Company, 1976.
- 5. Shanas E, Townsend P, Wedderburn D, et al (eds): Old People in Three Industrial Societies. New York, Atherton Press, 1968.
- 6. Lowy L, Helphand M: Matching community resources and patient needs. In Sherwood S (ed): Long-Term Care: A Handbook for Researchers, Planners, and Providers. Holliswood, New York, Spectrum Publications, Ine, 1975, pp 349-389.
- 7. Basson PH: The gerontological nursing literature search, study and results. Nurs Res 16(3):267-272, Summer 1967.
- 8. Gunter LM, Miller JC: Toward a nursing gerontology. Nurs Res 26(3):208-221, May-June 1977.
- 9. Abdellah GG, Levine E: Better Patient Care Through Nursing Research. New York, Macmillan Company, 1965, ? 3.
- 10. HEW Public Health Service, National Institutes of Health, Division of Nursing: Research in Nursing: 1955- 1968, Research Grants. Washington, DC, US Government Printing Office, Revised 1969, forward, ? iii.
- 11. Gress L: Aging and gerontological nursing. Dialogue 4(4):8-10, Spring 1978.
- 12. Pitel M: New directions for the american nurses" foundation. Presented at the Ninth Nursing Research Conference in San Antonio, Texas, March 21-23, 1973.
- 13. Aydelotte MK: Conceptualization of die role of nursing service administrator. Paper presented at die Invitational Conference on the Role, Functions, and Qualifications of the Nursing Service Administrator, sponsored by the American Hospital Association, October 5, 1978, ? 10.
- 14. Now, the revolt of theold (cover story): Time October 10, 1977, ? 18.
- 15. In brief. . .from other journals. Nursing Outlook 26(12):744, December 1978.
- 16. Borland, DC: Research on middle age: An assessment. Gerontol 18(4):379-386, August 1978.
- 17. Holder ER: Adolescent risks to cancer and cardiovascular disease, a "close encounter" with reality. Presented at the ANA Hearings, Special Committee on Youth Health Needs, Chicago, Illinois, October 31, 1978.
- 18. Leininger MM: An open health care system model, hi Spradley B (ed): Contemporary Community Nursing. Boston, Little, Brown and Company, 1975, ? 18.
- 19. Office of Technology Assessment, Congress of the United States: OTA Priorities 1979, Washington, DC, ? 16.
- 20. US Department of HEW: NIH Guide for Grants and Contracts 7(19): 19-22, December 15. 1978.
- 21. Office of Technology Assessment, Congress of the United Stales: OTA Priorities 1979, Washington. DC.
- 22. O'Connell KA, Duffey M: Research in nursing practice: Its present scope. In Chaska NL (ed): The Nursing Profession: View through the Mist. New York, McGraw Hill, 1978, ? 170.
- 23. Nursing Research 28(1): January February 1979.
- 24. Masuer J: 1908-1969, engraved in stone at National Institutes of Health, Bethesda, Maryland.
NUMBER AND CLASSIFICATION OF PUBLICATIONS* OIN THE AGE IN INTERNATIONAL NURSING INDEX FOR YEARS 1966, 1971 AND 1976