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S. Debbi Linhart asked me to prepare a statement about how science might guide medical care in the next several years. These are my opinions; I would appreciate yours RSIJMR mwri.magee ; . which are derived from a woman's fat and transformed to smooth muscle cells around a defective urethra to correct incontinence. The aging population is another major challenge to healthcare and research. Enormous implications from population research emphasize the aging of our local and national population. Currently, 12 percent of the United States population is over 65, and this is the most rapidly growing portion of our population. By 2025, it will increase by 80 percent, while the segment of the population consisting of younger adults and children will grow by only 15 percent. Unfortunately, living longer does not currently imply living longer in good health. Four out of five individuals over age 65 have at least one chronic disease. Research also indicates the not-unexpected fact that old people are much different than young people. This includes differences in drug sensitivity and metabolism, but equally important for the delivery of optimal care are different expectations, body image, goals, needs, and coping strategies. All of these differences mandate increased awareness and education of the care providing team. Furthermore, the increased susceptibility to diseases directs increased attention to nutrition and other aspects of health maintenance. Special problems in aging women's health that will challenge us are bone health and pelvic support diseases leading to incontinence as well as cardiovascular and mental health. Many of the aspects of these problems, long attributed to reduced reproductive hormone concentrations after menopause, need to be reassessed, and in recognition of the findings from clinical trials indicating that replacing these hormones is not a panacea, new approaches need to be identified. Finally, the seminal study from the IOM indicated "to err is human" and that medical mistakes, which should be preventable, account for 40, 000 to 90, 000 deaths per year, making this the fifth to eighth leading cause of death in the country. In a time of managing an increasingly complex group of older patients who are on more drugs and suffer more medical problems, it will be necessary to use innovative technical and training solutions to prevent these mistakes. In addition to research findings, emerging research strategies may also carry over into providing health care. One of the major emphases in the recently described new strategies from the National Institute of Health the NIH roadmap ; is to stimulate interdisciplinary research. This recognizes that virtually no biological process is unrelated to others and that a true understanding of health and the human condition mandates this interdisciplinary research. In order to accomplish this, beginning investigators must be trained in multiple disciplines, and the efforts from investigators of diverse backgrounds must be combined to begin acquiring knowledge in a holistic manner. I suspect that the same approach will be increasingly necessary in health care delivery, especially as we begin to manage the complex issues of older women. We must work as a team to recognize the needs of the entire woman Womancare? ; and not just the current problematic health issue. In summary, the directions indicated by "science" converge on a common theme - people are individuals with needs influenced by age, sex, genetic make up, and environment. Our success in improving health mandates research to help us recognize these individual differences, and health care that takes this into account.
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