Serving on the National Institute on Aging Advisory Council as a scientific member was a challenge and an exciting and enlightening experience. I remember arriving early the night before my first session and meeting with Dr. Robert Butler, the first NIA Director. His vision and commitment to the elderly served the agency well during its early years. Serving on the council has given me diverse opportunities, such as helping to write parts of the national plan for the aging, suggesting areas of future research, and strongly supporting training programs in geriatrics for the future. Training programs for the care of the elderly are sorely needed in basic as well as clinical research.
One of my most rewarding experiences was serving on the council of the National Institute on Aging teaching nursing home, where, for the first time in the history of the National Institute of Health, a school of medicine and a school of nursing were required to participate. In my travels around the country, I was encouraged by the spirit of cooperation between two schools to provide the groundwork for future care of the elderly through teaching, research and clinical service. There was plenty of opportunity to argue with fellow advisory council members, fortunately always with the full knowledge that the discussion would conclude with our decisions being more careful and more wise than if the spirited debates had not taken place.
Like the council members, the NIA staff members gave their time and energy selflessly to move the young institute ahead. Now that Dr. Franklin Williams has taken over the leadership of the Institute, the National Institute of Health can look with pride on the National Institute on Aging, I believe nursing must be even more rigorously involved in all aspects of the care of the aging, as principal investigators, as peer reviewers and as council members. The best and most appropriate way to do so is by submitting grant applications with the frequency and quality to be within the fundable range. Doctorally prepared nurses are receiving excellent research preparation now, and in-depth postdoctoral experienee is a must in postdoctoral positions or as faculty members in university schools of nursing.
The papers submitted for this special issue of the Journal cf Gerontological Nursing were written expressly for this journal at the request of NIA and provide a breakthrough approach to understanding the work being done there.
To reflect on the articles in this issue, McCormick and Burgio stress the real possibility of nursing controlling, not just managing, incontinence. The article goes on to identify major ways of controlling incontinence such as habit training, biofeedback, pelvic floor exercises and contingency management. I fully agree that the control of incontinence may be within the scope of nursing. I urge all of us to make sure that our interventions are powerful enough to make a difference. We need to report investigations in clinical interventions in greater detail so as to refute any suggestion that listening to tape recordings is sufficient!
In the article by White, Farmer and Brody on hip fractures, their observations that increased weight seems to protect against the risk of hip fracture. They also note that physiologic knowledge that the strength of a bone reflects stresses that have been placed on it, has implications for nursing. Prevention of hip fractures is an important goal for all of us who work with the elderly.
Ory's paper shares much of the current thinking on health promotion and carefully notes the research that is being encouraged on how psychosocial processes interact with biological processes to influence health and effective functioning in the middle and later years. All research that is being encouraged is in the domain of nursing. Nursing must plan an ever-increasing role in the National Institutes of Health, and society needs to learn the scientific underpinnings of nursing.
The fascinating data shared in these papers by the researchers at the National Institute on Aging are put into focus by Dr. CowelTs article. "Promising evidence from numerous studies indicates that the current high rates of morbidity and institutionalization can be significantly reduced and that gradual deterioration, decreased physical and mental functioning and eventual institutionalization are not inevitable consequences of growing old."
Since in all aspects of health care, nursing, and the elderly are working together, this journal issue may be another step along the way to improvement in care for society's needs. Nursing has come a long way and there is still a long road ahead. I am proud of nursing and of having had the privilege of providing nursing input to the National Institute on Aging Advisory Council for the past three years.