ADDRESS

BY

C, EVERETT KOOP, M,D,
   SURGEON GENERAL
U,S, PUBLIC HEALTH SERVICE

         AND

DEPUTY ASSISTANT SECRETARY FOR HEALTH
US, DEPARTMENT OF HEALTH AND HUMAN SERVICES

PRESENTED TO THE WORKSHOP ON GERIATRIC DRUG USE
   OF THE DRUG INFORMATION ASSOCIATION
        WASHINGTON, DL
        FEBRUARY 27, 1984


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(GREETINGS TO HOSTS, GUESTS, FRIENDS, ETC,)

  I'M DELIGHTED TO BE HERE THIS MORNING TO HELP OPEN THIS WORKSHOP
ON DRUG USAGE AMONG THE ELDERLY,  I WOULD BE HARD PRESSED TO THINK OF
A MORE TIMELY SUBJECT THAN THIS ONE TO BE ADDRESSED BY THE DRUG
INDUSTRY AND THE PHARMACY AND PHARMACOLOGY PROFESSIONS,

  ALL THE DEMOGRAPHIC AND SOCIAL AND POLITICAL AND BIOMEDICAL
INDICATORS TELL US THAT THE SINGLE MOST SIGNIFICANT CHANGE IN THE
CHARACTER OF AMERICAN SOCIETY IS THE GROWTH OF THAT SEGMENT OF OUR
POPULATION THAT IS OVER THE AGE OF 65, SO LET ME EXTEND TO THE D,I,A,
A WORD OF CONGRATULATIONS FOR PUTTING THIS WORKSHOP TOGETHER,

  THE PROGRAM FOR THIS MEETING OFFERS AN EXCELLENT BALANCE OF
CONCERNS IN THE AREAS OF SOCIAL POLICY, PATIENT CARE, BIOMEDICAL
RESEARCH, AND GOVERNMENT-INDUSTRY RELATIONS, A NUMBER OF MY
COLLEAGUES REPRESENTING THESE MANY CONCERNS IN THE DEPARTMENT OF
HEALTH AND HUMAN SERVICES WILL BE FOLLOWING ME TO THIS MICROPHONE,


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  AND I SHOULD ADD RIGHT HERE THAT, IN THE THREE YEARS I'VE BEEN
YOUR SURGEON GENERAL, I`VE BEEN IMPRESSED OVER AND OVER AGAIN WITH THE
QUALITY OF LEADERSHIP THAT IS AVAILABLE TO HELP ATTEND TO THE SOCIAL,
PHYSICAL, AND MENTAL HEALTH OF OUR SOCIETY, GOOD PEOPLE ARE FOUND
THROUGHOUT THE US, PUBLIC HEALTH SERVICE AND, INDEED, THROUGHOUT THE
DEPARTMENT OF HEALTH AND HUMAN SERVICES ITSELF,

   ALSO, I'VE BEEN PLEASED TO SEE THE DEGREE TO WHICH THE PRIVATE
SECTOR HAS PUT FORWARD ITS SHARE OF THOUGHTFUL, KNOWLEDGEABLE, AND
CARING PEOPLE WHO ARE ALSO DEEPLY CONCERNED ABOUT THE FUTURE COURSE OF
OUR SOCIETY, I KNOW THERE ARE MANY QUESTIONS IN WHICH GOVERNMENT AND
THE PRIVATE SECTOR MAY DISAGREE, AND FOR MUCH OF THE TIME THAT'S JUST
THE WAY IT SHOULD BE,

  BUT I WOULD SAY THAT WHERE THE ISSUES ARE OF CONSEQUENCE TO THE
HEALTH STATUS OF OUR PEOPLE, THE PUBLIC AND THE PRIVATE SECTORS ARE
NOT ADVERSARIES, RATHER, THEY TEND TO PUT FORWARD THEIR BEST PEOPLE
TO WORK TOGETHER FOR WHAT IS GOOD FOR OUR COUNTRY, OUR PREFERENCE IS
CLEARLY COLLABORATION AND CONSENSUS, WHEN IT COMES TO THE PUBLIC
HEALTH,


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  AND THE PROGRAM FOR THIS WORKSHOP IS A GOOD ILLUSTRATION OF
THAT, THE PEOPLE WHO WILL COME TO THIS MICROPHONE FOR THE REST OF
TODAY AND TOMORROW ARE TOP-NOTCH, AND I SAY THAT NOT ONLY BECAUSE OF
THE INFORMATION THEY POSSESS -- WHICH IS CONSIDERABLE -- BUT ALSO FOR
THE COMMITMENT THEY'VE MADE TO PUT THEIR KNOWLEDGE AND EXPERIENCE TO
WORK FOR THE BENEFIT OF OUR CITIZENS,,,ESPECIALLY THE MOST VULNERABLE

OF OUR CITIZENS, THE AGING AND THE AGED INFIRM,

  SO I ENCOURAGE EACH OF YOU WHO HAVE REGISTERED FOR THIS WORKSHOP
TO EXPLOIT THE TWO DAYS YOU HAVE HERE, TAKE ADVANTAGE OF THE
COLLECTIVE WISDOM AND EXPERIENCE PRESENTED BY THIS PROGRAM AND COMMIT
IT ALL TO YOUR NOTEBOOKS OR - BETTER YET -- TO YOUR MEMORIES,

  FRANKLY, WITH THE ARRAY OF TALENT HERE, MY ROLE AS KEYNOTE
SPEAKER IS NOT AN EASY ONE, NEVERTHELESS, I DO WANT TO LEAVE A
MESSAGE WITH YOU, SOMETHING THAT MAY LEND A LARGER PUBLIC HEALTH
PERSPECTIVE -- OR A CONTEXT, IF YOU WILL -- TO THE DELIBERATIONS TODAY

AND TOMORROW,


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  I MENTIONED THE WORD "DEMOGRAPHY," BUT I DOUBT THAT THERE'S A

MORE SOPHISTICATED AUDIENCE IN THIS CITY THEN THE ONE HERE TODAY, WHEN
IT COMES TO PROJECTING THE OVER-65 POPULATION FOR THE UNITED STATES,
BUT SHEER NUMBERS, AS YOU WELL KNOW, DO NOT TELL THE WHOLE STORY,  IF

ANYTHING, THE GROSS STATISTICS -- "ONE IN FIVE AMERICANS," THAT SORT

OF THING -- MAY SCREEN OFF MANY SIGNIFICANT DEMOGRAPHIC SUB-SETS,

   FOR EXAMPLE, MY GOOD FRIEND, DR, DONALD CUSTIS, THE CHIEF MEDICAL

DIRECTOR OF THE VETERANS ADMINISTRATION, HAS BEEN WARNING US THAT BY

1990 ABOUT 60 PERCENT OF ALL MEN OVER THE AGE OF 65 WILL BE
VETERANS, IF, AT THAT TIME, VETERANS SEEK VA, HEALTH CARE AT THE

RATE THEY ARE NOW SEEKING IT, THEN, SAYS DR, CUSTIS, ABOUT 1,8 MILLION

VETERANS WILL BE LOOKING FOR VA, CARE IN 1990,

   BUT 10 YEARS AFTER THAT, IN THE YEAR 2000, THE FIGURE WILL HAVE

CLIMBED TO 2,2 MILLION VETERANS SEEKING VA, CARE, THEY WILL BE AMONG

THE ESTIMATED 9 MILLION VETERANS WHO WILL BE AMONG US BY THE TURN OF

THE CENTURY,


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  EACH SUCCEEDING AGE COHORT IS MORE LITERATE AND BETTER EDUCATED

THAN THE PREVIOUS AGE COHORT, ALL SIGNS INDICATE THAT BY THE YEAR
2000, OUR POPULATION OF PERSONS OVER AGE 65 WILL BE MORE SELF-
SUFFICIENT AND MORE REACHABLE -- IN TERMS OF PATIENT EDUCATION -- THAN
ANY PREVIOUS GROUP,

  TODAY WE ARE EXHORTING EVERY AMERICAN TO TAKE MORE PERSONAL
RESPONSIBILITY FOR HIS OR HER HEALTH STATUS, WE'RE MAKING SOME
HEADWAY, BUT WE'D LIKE TO BE MAKING MORE, AND WE WILL, AS THE YEARS
PASS AND THE PERCENTAGE GROWS OF AMERICANS WHO HAVE THE EDUCATION AND
TRAINING TO HANDLE MORE PERSONAL HEALTH RESPONSIBILITY,

   HOWEVER, WE ARE FACED WITH SO MANY UNKNOWNS IN THE FIELD OF
HEALTH FOR THE AGING THAT WE MUST BE CAREFUL NOT TO GENERALIZE TOO
QUICKLY OR TOO OFTEN, ALL OUR PROJECTIONS ARE BASED UPON LIFE AS
WE'VE KNOWN IT SO FAR,, aNOT LIFE AS IT WILL BE IN THE FUTURE,
                    LET ME
GIVE JUST ONE SMALL EXAMPLE,


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  OVER THE PAST 15 YEARS OR SO, THERE HAS BEEN A VIRTUAL REVOLUTION
IN EYE CARE AND VISION HEALTH AMONG YOUNG ADULTS AND OLDER WORKING
ADULTS, AS A RESULT OF THIS NEW CONCERN WITH VISION -- THAT IS, AS A
RESULT OF THE MANY EFFECTIVE WAYS WE TREAT DISEASES OF THE EYE TODAY
AND THE MANY WAYS WE PREVENT EYE DISEASE AND INJURY FROM OCCURRING-- I
BELIEVE WE OUGHT TO RE-THINK MANY OF OUR PROGRAMS OF VISION HEALTH,  I
THINK WE WILL SOON BE ABLE TO DO MUCH MORE WITH THE SAME RESOURCES WE
NOW HAVE,

  AND OTHER AREAS OF PUBLIC HEALTH FOR THE AGING ARE JUST NOW
CAPTURING OUR ATTENTION, FOR EXAMPLE, ONE MAJOR PROBLEM AMONG THE
ELDERLY IS URINARY INCONTINENCE, SOME PRELIMINARY US, DATA SEEM TO
INDICATE THAT ABOUT HALF OF ALL PATIENTS IN NURSING HOMES SUFFER FROM
URINARY INCONTINENCE, AND IF SOME BRITISH DATA ARE ANYWHERE NEAR THE
MARK, ANOTHER HALF MILLION OR SO ELDERLY SUFFER FROM URINARY
INCONTINENCE BUT ARE STILL LIVING AT HOME,

  INCONTINENCE CAN BE A CRITICAL CONDITION FOR TENS OF THOUSANDS OF
OLDER PEOPLE, IT REDUCES THEIR ABILITY TO LIVE INDEPENDENT LIVES,,,IT
REDUCES THEIR MOBILITY,,,IT IS A HUMILIATING CONDITION AND INCREASES
THE POTENTIAL FOR PHYSICAL AND SOCIAL ISOLATION, AND INCONTINENCE CAN
PRODUCE, OF ITSELF, OTHER DISEASE OR DISABLING CONDITIONS, SUCH AS
SERIOUS INFECTIONS AMONG CATHETERIZED PATIENTS,


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  URINARY INCONTINENCE CAN SOMETIMES BE A SIDE EFFECT FROM A
PRESCRIPTION DRUG BEING TAKEN FOR QUITE ANOTHER PURPOSE, A CHANGE OF

PRESCRIPTION, WHERE POSSIBLE, CAN SOLVE THE PROBLEM, OR THE CONDITION
MAY BE RELIEVED OR EVEN REVERSED THROUGH SURGERY, BUT IN OTHER
INSTANCES, THE SOLUTION MAY BE IN A COMBINATION OF SURGERY, A DRUG,
AND NEW LEARNED BEHAVIOR, FOR INSTANCE, AT THE UNIVERSITY OF MICHIGAN
WE ARE SUPPORTING RESEARCH IN COMBINATION BEHAVIOR-AND-DRUG THERAPY IN
CLINICAL TRIALS EMPLOYING PHENYLPROPANOLAMINE AND OXYBUTYNIN,

  BEHAVIOR THERAPIES MAY HOLD OUT A GREAT DEAL OF HOPE FOR THE
INCONTINENT ELDERLY, AS YET, HOWEVER, WE DON'T HAVE A TESTED, CLEAR
IDEA OF WHICH THERAPIES WORK AND WHICH ONES DON'T, TO HELP GET THAT
PROBLEM RESOLVED, THE NATIONAL INSTITUTE ON AGING, TOGETHER WITH THE
N,I,H, DIVISION OF NURSING, WILL SOON BE ADVERTISING A NEW ROUND OF
GRANT PROPOSALS FOR BEHAVIORAL THERAPIES TO REVERSE URINARY
INCONTINENCE,


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  WE'RE TALKING ABOUT DOING SOMETHING TO HELP A MILLION OR MORE

OLDER PERSONS WHO ARE INCONTINENT,  IT MAY NOT BE AS COMPLICATED OR AS
DRAMATIC A PROBLEM AS HEART DISEASE, BUT IT CERTAINLY AFFECTS THE

LIVES OF AT LEAST AS MANY PEOPLE,

  THE OFFICE OF THE SURGEON GENERAL HAS TAKEN A SPECIAL INTEREST IN
THIS PROBLEM AND IN ONE OTHER, ALSO A WIDESPREAD BUT POORLY UNDERSTOOD
PROBLEM OF THE ELDERLYwAND THAT IS, OSTEOPOROSIS, OR THE LOSS OF

BONE STRENGTH,

   AS WITH SO MANY PROBLEMS THAT AFFECT THE HEALTH OF OLDER PEOPLE,
WE HAVE SUSPICIONS ABOUT HOW IMPORTANT AND FAR-REACHING THE PROBLEM OF

OSTEOPOROSIS MAY BE, n ,BUT WE HAVE VERY LITTLE RELIABLE, HARD DATA TO
GO ON, SOME EXPERTS SAY THAT AS MANY AS 15 MILLION AMERICANS SUFFER

FROM OSTEOPOROSIS, BUT -- ABSENT A TIGHT AND GENERALLY ACCEPTABLE

DEFINITION OF "OSTEOPOROSIS" -- SUCH NUMBERS ARE NOT RELIABLE,

   THE DISEASE ITSELF IS NOT THOROUGHLY UNDERSTOOD,   WE ARE TRYING
TO LEARN MORE, AND I AM HOPEFUL THAT SOME NEW INFORMATION MAY APPEAR

DURING THE N,I,H, CONSENSUS CONFERENCE ON OSTEOPOROSIS, TO BE HELD IN
BETHESDA, APRIL 3 AND 4, WE STILL HAVE NO ACCEPTED, SAFE AND EFFECTIVE

TREATMENT FOR OSTEOPOROSIS, NEVERTHELESS, AS LITTLE AS WE MAY KNOW,

WE STILL KNOW ENOUGH TO FEEL WE MUST MOVE AHEAD AND DO WHAT WE CAN,


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  THE SECOND ISSUE I WOULD CALL TO YOUR ATTENTION IS HIP
FRACTURES, AN ESTIMATED 200,000 HIP FRACTURES OCCUR EACH YEAR AMONG
PERSONS OF ALL AGES, OF COURSE, THE GREAT MAJORITY OF FRACTURES OCCUR
AMONG THE ELDERLY: THE TYPICAL AGE AMONG PERSONS REPORTED TO HAVE HAD
A HIP FRACTURE IS IN THE MID TO LATE 70s

  BUT THE NATURE OF THE EVENT IS NOT CLEAR, DOES A PERSON FALL
DOWN AND FRACTURE THE HIP -- WHICH IS THE COMMON NOTION -- OR DOES A
PERSON FRACTURE A HIP AND THEN FALL DOWN, WHICH IS THE SEQUENCE I
BELIEVE IS MORE TYPICAL? AS YET, WE DON'T KNOW THE ANSWER, IS IT
IMPORTANT? VERY MUCH SO,

  AT LEAST ONE OF EVERY FOUR HIP FRACTURES CAUSES IN SOME WAY THE
DEATH OF THE PERSON WITH THAT FRACTURE, USUALLY WITHIN ONE YEAR,  IT
IS A CONTRIBUTING FACTOR TO THE DEATHS OF MANY MORE PERSONS, CURRENT
ESTIMATES PUT THE TOTAL AT ABOUT 35,000 PREMATURE DEATHS EACH YEAR, A
CONSIDE.RABLE NUMBER, ACCORDING TO OTHER DATA, ALMOST AS MANY VICTIMS
-- ANOTHER 26,000 -- GO ON LIVING BUT CAN NO LONGER WALK, THEY
REPRESENT AN ENORMOUS BURDEN TO THEIR FAMILIES, THEIR COMMUNITIES, AND
TO THEMSELVES,


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   IT SEEMS QUITE CLEAR -- IN JUST THESE TWO AREAS ALONE, URINARY
INCONTINENCE AND OSTEOPOROSIS --  THAT WE CAN SAVE MANY THOUSANDS OF
LIVES AND MANY MILLIONS OF DOLLARS WITH WELL-PLACED INVESTMENTS OF
TIME, INTEREST, AND MONEY, AND THOSE ARE THE KINDS OF INVESTMENTS WE
ARE MAKING,

  I HAVE CONCENTRATED ON THESE TWO AREAS BECAUSE THEY PRESENT NOT
ONLY THE POSSIBILITIES OF OUR GAINING NEW BIOMEDICAL KNOWLEDGE, BUT
THEY ALSO ARE AMONG THE COSTLIEST CONDITIONS AFFECTING THE NATION'S
ELDERLY: INCONTINENCE AND HIP FRACTURES COST MEDICARE ALONE IN EXCESS
OF TWO BILLION DOLLARS EACH YEAR,

  THERE IS SO MUCH PUBLIC DISTRESS AT THE HIGH COST OF CARE FOR THE
ELDERLY THAT I AM TRULY CONCERNED ABOUT OUR COUNTRY MAINTAINING ITS
POLITICAL WILL TO SUPPORT THIS KIND OF INSURANCE, A GREAT DEAL OF
THOUGHT AND EFFORT IS GOING INTO RESEARCH AND DEMONSTRATION PROGRAMS
THAT TINKER WITH THE FUNDING AND THE REIMBURSEMENT MECHANISMS,


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  AND ALL THAT IS IMPORTANT, TO BE SURE, BUT TO MY WAY OF
THINKING, THE REAL SOLUTION WILL COME WHEN WE HAVE THE MEANS TO
CONTROL, REVERSE, OR PREVENT THE MAJOR, MORE COSTLY DISEASE AND
DISABILITY CONDITIONS OF OLDER PEOPLE,

  LATER IN THIS WORKSHOP YOU WILL BE HEARING FROM DR, T, FRANKLIN
WILLIAMS, THE DIRECTOR OF THE N,I,A, AND A STRONG SUPPORTER OF ALL THE
RESEARCH INITIATIVES THAT HOLD OUT HOPE FOR THE AGING, HIS AGENDA, OF
COURSE, IS CENTRAL TO MANY OF YOUR INDIVIDUAL INTERESTS, I AM SURE, I
HAVE GREAT RESPECT FOR HIM AND HIS STAFF AND I AM SURE YOU WILL FEEL
AS ENCOURAGED AS I DO, ONCE YOU HAVE HEARD HIS MESSAGE AT LUNCHEON

TODAY,

  BUT LET ME OFFER THIS WORD OF CAUTION TO THOSE OF YOU WHO WOULD
FOCUS ON THE DISEASE CONDITIONS OF THE ELDERLY TO THE EXCLUSION E THE
HEALTH CONCERNS OF ALL OTHER AGE GROUPS: YOU CAN'T DO IT,, a IT JUST
DOESN'T WORK,


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  WE HAVE BECOME SO SPECIALIZED IN MEDICINE, AS IN SO MANY OTHER
THINGS, THAT WE SOMETIMES TRULY BELIEVE THAT HUMAN GROWTH MOVES FROM
ONE NEAT LITTLE CATEGORY TO THE NEXT:

  ONE DAY WE ARE KNOWN AS "INFANTS",, ,THE NEXT, WE ARE IN EARLY
CHILDHOOD,, ,THEN, PRE-PUBESCENCE I SUPPOSE, FOLLOWED BY ADOLESCENCE
AND YOUNG ADULTHOOD,

  THEN WE ARE "WORKING ADULTS," AS OPPOSED TO THE OTHER KIND, WHO
ARE FORTUNATE ENOUGH NOT TO HAVE A CATEGORY OF THEIR OWN,

AND THEN, OF COURSE, WE BECOME "OLDER PEOPLE" AND THE "AGED,"

  IT IS CERTAINLY A HANDY WAY TO DEAL WITH THE NORMAL LIFE-SPAN,
BUT THIS KIND OF PIGEON-HOLING TENDS TO GIVE THE IMPRESSION THAT
HEALTH PROBLEMS OCCUR FOR THE INDIVIDUAL -- ALMOST SPONTANEOUSLY -- AS
SOON AS HE OR SHE LEAVES ONE CATEGORY AND ENTERS THE NEXT ONE,

AND THAT'S JUST NOT SO,


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  THE FACT OF THE MATTER IS THAT MANY DISEASE CONDITIONS OF THE
ELDERLY CAN BE TRACED TO THE KIND OF CARE THEY RECEIVED AS INFANTS,, a-
IN THEIR DIET AND THEIR IMMUNIZATION RECORDS AS CHILDREN, MANY YOUNG
PEOPLE SUFFER TRAUMA ON THE HIGHWAY OR IN SPORTS AND WE KNOW THAT THE
EFFECTS LINGER AND BECOME AGGRAVATED AS OLD AGE SETS IN, THE STRESS
OF A BAD MARRIAGEwTHE EFFECTS OF BEING AN ABUSED CHILD AND AN
ABUSING PARENT,,,ALCOHOLISM,, ,DRUG ABUSE, ,,ALL THESE AND MANY, MANY
OTHER CONDITIONS OF THE BODY, THE MIND, AND THE SPIRIT, EXPERIENCED
EARLY IN LIFE, HAVE PROFOUND AFFECTS UPON THE INDIVIDUAL AS SHE OR HE
ENTERS THE FIFTH AND SIXTH DECADES,

  HOW MUCH BETTER OFF MANY OF OUR OLDER PERSONS WOULD BE, IF, AS
ADOLSCENTS, THEY HAD BEEN EXPOSED TO -- AND HAD TAKEN SERIOUSLY -- THE
KIND OF HEALTH PROMOTION AND DISEASE PREVENTION MESSAGE THAT TODAY IS
CARRIED FAR AND WIDE BY VIRTUALLY EVERY RESPONSIBLE HEALTH AGENCY,
PUBLIC OR PRIVATE?


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  JUST THE TOLL TAKEN BY TOBACCO ALONE -- THE LUNG AND HEART AND
GASTROINTESTINAL DISEASES GENERATED BY CIGARETTE SMOKING -- THAT TOLL
WOULD NOT BE SUFFERED BY MILLIONS OF AMERICANS AND THEIR FAMILIES,

  AND THE TERRIBLE DAMAGE FROM ALCOHOL,, ,NOT JUST THE COLLAPSE OF
DISEASED INTERNAL ORGANS, BUT THE INTER-PERSONAL DAMAGE, THE HOMICIDES
AND THE FAMILY VIOLENCE THAT SO FREQUENTLY ACCOMPANIES ALCOHOLwTHAT
DAMAGE WOULD NOT BE BORNE BY SO MANY OF OUR ELDERLY, IF THEY HAD BEEN
IMPRESSED IN THEIR YOUTH WITH THE DANGERS OF HEAVY DRINKING,

  AND THE WEAK BONES AND MUSCLE GROUPS, ,,THE LOSS OF TEETH, ,,THE
GASTROINTESTINAL DISEASES,, ,THE BLUNTING OF MANY MENTAL PROCESSES,, ,
ALL THESE AND OTHER PHENOMENA MIGHT OCCUR WITH MUCH LESS FREQUENCY OR
INTENSITY -- OR NOT ALL -- HAD THE INDIVIDUAL PAID CLOSER ATTENTION TO
LIFESTYLES, OVER WHICH HE OR SHE HAD SOME CONTROL,


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  THE SAME CAN BE SAID OF SUCH BEHAVIORS AS THAT OF COMPLIANCE, OR
FOLLOWING DIRECTIONS FOR TAKING MEDICINES,   SO MANY PHYSICIANS HAVE

TOLD ME -- AND EVERYONE HERE HAS HEARD THE SAME THING, I'M SURE --
THAT ONE OF THE MOST DISCOURAGING ASPECTS OF TREATING THE ELDERLY IS
THEIR CAVALIER ATTITUDE TOWARD THE REGIMENS FOR DRUG-TAKING:

  MANY ELDERLY PATIENTS DON'T FILL THE PRESCRIPTIONS THEY ARE

GIVEN,

  OTHERS FILL THEM, BUT THEN IGNORE THEM,,,OR THEY GET REFILLS OF
MEDICINES THAT HAVE BECOME FAVORITES -- BUT ARE NO LONGER SAFE AND
EFFECTIVE FOR THEIR CONDITION,

  SOME OBTAIN PRESCRIPTIONS -- QUITE LEGALLY -- BUT FROM TWO OR
THREE DIFFERENT PHYSICIANS WHO ARE OFTEN UNKNOWN TO EACH OTHER,,,AND
THE OLDER PATIENT MAY THEREFORE BE GETTING DRUGS WHICH OUGHT NOT TO BE
TAKEN TOGETHER,

  STILL OTHERS FILL PRESCRIPTIONS AND THEN DECIDE FOR THEMSELVES
WHAT THE REGIMEN SHOULD BE, ,,HOW MUCH TO TAKE AND WHEN TO TAKE IT,


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  OF COURSE, SOME OLDER PEOPLE RESPOND THIS WAY BECAUSE THEY FEEL
FINANCIAL PRESSURE AND TRY TO CUT A CORNER HERE OR THERE -- INCLUDING
THE MEDICINE CORNER, NO, I'M TALKING ABOUT THE OLDER PERSON WHO, IN
EARLIER YEARS, HAD LITTLE EXPERIENCE WITH -- OR RESPECT FOR --
PHARMACEUTICALS AND HAS NOT CHANGED, EVEN THOUGH LIFE ITSELF MAY BE
RIDING ON THE PROPER USE OF THESE DRUGS,

  WE ARE FAIRLY POSITIVE THAT ONE OF THE BEST BEHAVIORS AN OLDER
PERSON CAN CULTIVATE IS THAT OF BEING AWARE OF ONE'S OWN BODY -- WHAT
IT'S DOING AND HOW IT'S DOING,
      WE ARE ASKING OUR RESEARCH POPULATIONS
TO ADOPT THIS BEHAVIOR, BUT FOR MANY OF THEM IT IS NEW, UNCOMFORTABLE,

AND STRANGE,

  THEY'VE HAD A LIFETIME OF BEING UNCONCERNED ABOUT THEIR PERSONAL
HEALTH,, ,DISRESPECTFUL OF THEIR OWN BODIES, ,,AND SOME OF THEM --
WHETHER CORRECTLY OR NOT -- FEEL IT IS SIMPLY TOO LATE TO REVERSE
THEMSELVES AND LEARN A NEW AND MORE SENSIBLE KIND OF PERSONAL HEALTH
BEHAVIOR,


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  I WOULD NOT WANT THE PROGRAM FOR THESE TWO DAYS TO CHANGE,, ,TO BE
STRETCHED OR WARPED SO AS TO PERMIT PRESENTATIONS BY SPECIALISTS IN
ADOLESCENT HEALTH OR PERINATAL NUTRITION, THAT'S NOT NECESSARY,
INSTEAD, I WILL CLOSE MY REMARKS THIS MORNING WITH THIS SINGLE BUT
SINCERE PLEA:

DO NOT LOOK UPON THE PROBLEMS OF GERIATRIC HEALTH -- INCLUDING
DRUG USAGE -- AS ISOLATED IN ANY WAY FROM HEALTH PROBLEMS
AFFECTING THE ENTIRE LIFE-SPAN, THEY ARE NOT, ONE'S LIFE EVOLVES
WITHIN A SEAMLESS WEB OF CIRCUMSTANCE, COMPARTMENTALIZATION MAY
BE INTELLECTUALLY DESIRABLE, BUT IT IS BIOLOGICALLY UNTENABLE, I
BELIEVE YOUR MOST EFFECTIVE MEDICAL CARE SHOULD BENEFIT NOT ONLY
TODAY'S ELDERLY -- WHO ARE VERY MUCH ON OUR MINDS AT THIS MEETING
-- BUT ALSO TODAY'S CHILDREN, YOUTH, AND YOUNG ADULTS, 1,
TOMMORROW'S ELDERLY,


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  THAT SMACKS A LITTLE OF THOSE LINES FROM ONE OF THE EARLIEST
TREATISES WRITTEN ON THE SUBJECT OF OLD AGE, CICERO WAS THE AUTHOR,
MORE THAN 2,000 YEARS AGO, ALTHOUGH HE HIMSELF WAS MURDERED IN ROME,
POOR MAN, AT THE AGE OF 63 AND NEVER GOT TO ENJOY WHAT HE BELIEVED
WOULD BE A WONDERFUL TIME OF LIFE, AT ANY RATE, HE SAID,,,

"GIVE ME A YOUNG MAN IN WHOM THERE IS SOMETHING OF THE OLD, AND AN
OLD MAN WITH SOMETHING OF THE YOUNG: GUIDED SO, A MAN MAY GROW OLD
IN BODY BUT NEVER IN THE MIND,"

I THINK HE WAS ABSOLUTELY RIGHT,

  ONCE AGAIN, LET ME CONGRATULATE THE HOSTS AND SPONSORS OF THIS
WORKSHOP FOR ASSEMBLING A REALLY FIRST-RATE PROGRAM,

THANK YOU,

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