The proposed research program will further the development and testing of hypotheses concerning the management of age-related diseases. These hypotheses depend on careful contextual description of the natural histories of age-related diseases and the analysis of folk etiologies or explanatory models held by both laymen and professionals. This research has begun with an investigation of the behavioral contexts of urinary incontinence among the relatively healthy community-living elderly. The proposed next step of the research program is the description and analysis of the natural history of urinary incontinence among the frail, homebound elderly. The research program will then be extended in two directions: expansion of the hypotheses developed through the analysis of urinary incontinence to other age-related disorders, and testing of these hypotheses through intervention research that focuses on both behavior change and change of folk etiologies held by elderly patients and their health providers. The initial expansion of the basic research component of the research program will be an examination of doctor-patient communications surrounding age-related disorders. The intervention component of the research program will include clinical trials of behavioral interventions for stress incontinence and mixed-etiology stress incontinence among elderly women. This research will examine both patient and provider behavior change and the effect of each on the effectiveness of treatment of stress incontinence. In order to achieve the goals of this research program, the researcher will combine the ongoing research tasks with certain training components. First, she will obtain further training in the basics of human anatomy, physiology, and pathology. The second area of knowledge acquisition will be in methodological and theoretical aspects of sociolinguistics, in preparation for the analysis of doctor-patient communication. The third activity that is vital preparation for this research program will focus on the research groundwork necessary for the design of observational research in the clinical setting. This will include attention to logistical, ethical and methodological constraints of this particularly difficult research site as well as the further development of collaborative research ties with geriatricians.
