Research Goal D: Improve our understanding of the consequences of an aging society and provide that information to inform intervention development and policy decisions.

The greater longevity and improved health seen at older ages in many parts of the world represent one of the crowning achievements of the last century, but also present a significant challenge. Societal aging may affect economic growth, patterns of work and retirement, the way families function, the ability of governments and communities to provide adequate resources for older people, and the prevalence of chronic disease and disability.

NIA will continue to support research on the social, economic, and demographic consequences of the rapidly aging population in the United States and other countries. In addition, we will continue to support research on how social and economic factors across the lifespan affect health and well-being during old age.

NIA’s objectives in this area are to:

D-1 Understand how population aging and changes in social, economic, and demographic characteristics of cohorts reaching old age affect health and well-being in the United States and other countries.
D-2 Understand how social, economic, and health system factors produce disparities in health at older ages and develop interventions to reduce disparities.
D-3 Understand how social and economic factors throughout the lifespan affect health and well-being at older ages.

D-1 Understand how population aging and changes in social, economic, and demographic characteristics of cohorts reaching old age affect health and well-being in the United States and other countries.

	Young Children and Older People as a Percentage of Global Population
	View chart

The social, economic, and demographic changes the Nation is experiencing at the population level may have profound effects on health and well-being at the individual level. For example, alterations in family structure may lead to changing trends in family caregiving practices, chronic diseases of aging may become more common, and the health care system may experience strain as greater numbers of Americans require services.

NIA will continue to:

• Explore the effects of education and other social and demographic factors on health and well-being at older ages. Educational attainment is one of the strongest correlates of physical health and cognitive functioning at older ages. We will support research to unravel the reasons for this connection to help project health and long-term care needs and devise ways to intervene to reduce disparities.
  
  
• Assess the impact of changing family structures on health and caregiving. Changing family structures mean that people now approaching old age are more likely than their predecessors to be divorced, childless, or in stepfamilies. Researchers will need to examine how the presence of home- and community-based services (e.g., waiver programs, assisted living) influence the experience of family caregiving from an economic, social, and emotional perspective. Additional data are also needed to track the migration trends of older people as they move from community to community as well as from independent living to different levels of assisted living and nursing home care. We will support research on the ways in which the evolution of the American family structure will affect the well-being of the elderly by influencing living arrangements, caregiving, and economic support.
  
  
• Encourage comparative analyses to evaluate the impact of institutions on population and individual well-being and foster longitudinal studies on aging. Other countries have larger proportions of their populations now at older ages than the United States, and many of those with currently younger populations are aging at a much more rapid rate. A wide variety of institutional arrangements for income support, home health care, long-term care, and acute care have been developed in response to the challenges of population aging. We will support comparative research on the effects of these changes on behavior, and we will evaluate institutional reform efforts to gain insights useful both in the United States and elsewhere. We will also encourage analyses on the impact of global population aging on macroeconomic factors and their influence on institutions and well-being.
  
  
• Develop a research plan to understand the dynamic changes that occur across the life course. Researchers will need to understand how experiences/exposures across the life course (infancy to older age) to a variety of environmental, intellectual, and social factors influence aging and age-related well-being. We will examine factors contributing to maintenance or decrement of cognitive and physical functioning over the life course in an effort to forestall negative consequences and enhance health and well-being.
  
  
• Examine the bases for individual and societal attitudes toward older people and develop effective strategies to improve them. Older people may be the target of inaccurate and negative stereotypes. We will support research to explore the causes of these negative attitudes and develop strategies to counter them with community and other interventions. For example, engaging older people in meaningful volunteer work may prove to be a “win-win” situation for society, replacing the image of dependence with one of active and productive citizens.

D-2 Understand how social, economic, and health system factors produce disparities in health at older ages and develop interventions to reduce disparities.

Health disparities continue to exist among racial, ethnic, and socioeconomic groups. Research is needed to understand the causes of these disparities and how they relate to social, economic, and health system factors and develop interventions to reduce the disparities.

NIA will continue to:

• Encourage cross-national, comparative and historic research as an approach to understanding the burden of disease and health disparities. Cross-national, comparative research using microlevel data has proven very useful in understanding how the structure of pension systems affects work and savings decisions. Many countries have already reached the stage of population aging that is not expected in the United States until much later in the century, and many developing countries have populations that are aging faster than in the United States. Research on long-term trends in the burden of disease and risk factors can improve projections. Comparative research on the increasing burden of chronic diseases, and on ways in which families and health care systems cope with disease management and long-term care, could provide insights useful in the United States and globally.
  
  
• Encourage interdisciplinary biodemographic, health systems, social, and economic perspectives to understand gender differences in health and disease at older ages. Recent demographic and economic trends have gender-specific implications for health and well-being at older ages. Non-married women, for example, are less likely than non-married men to have accumulated assets and pension wealth for use in older age, and older men are less likely to form and maintain supportive social networks. We will support research to explain how these and other factors may contribute to the differences in life expectancy and disability rates among men and women at older ages. This research will inform development of targeted policies to achieve dual goals of increasing longevity and delaying the onset and severity of disability.

D-3 Understand how social and economic factors throughout the lifespan affect health and well-being at older ages.

	THE SPEED OF POPULATION AGING Number of years for population age 65+ to increase from 7% to 14%
	See chart 1 (pdf) See chart 2 (pdf)

Individual differences in chances for a healthy and secure old age emerge in midlife. For example, NIA-supported research indicates that Americans in late middle age have much wider variation in wealth (i.e., total accumulated assets) than in current income (i.e., earnings). Furthermore, work and other decisions by people in their 50s and 60s are already affected by chronic conditions and disability. NIA-supported research will focus on both observational studies and interventions to improve function based on a life course perspective.

We will continue to:

• Support research on social insurance and health insurance systems (e.g., Social Security and Medicare) to assist other agencies in promoting the health and well-being of the elderly while ensuring program efficiency. As record numbers of Americans reach retirement age, programs such as Social Security and Medicare will face unprecedented challenges. We will support research to assist these and related programs to work as effectively and efficiently as possible to safeguard the health and well-being of older Americans. Such research will include the measurement of the economic value of good health and the development of techniques to produce National Health Accounts. Our studies on the social, educational, public health, and biomedical variables that affect length of life and rates of disability, also will inform decisions related to social and health insurance systems. We will also support continued work to understand the biological, behavioral, economic, and social basis for decisions of individuals, employers, and families that affect income security in retirement and the financing of long-term care.
  
  
• Support research that models and measures the economic risks of old age with the potential for developing interventions to insure against these risks. Demographic and retirement income trends are expanding economic risks in old age. Higher life expectancy can increase the likelihood of outliving retirement savings, and the shift in pensions from defined benefit to defined contribution plans suggests that more Americans will reach retirement with Social Security as their only annuity. Although homes often represent the most significant part of retiree wealth, relatively few retirees make use of reverse mortgages to insure against retirement income shortfalls. Many Americans will require long-term care, but few purchase private insurance to support formal care expenses. Research that seeks to understand the behavioral aspects of demand for insurance against these old age risks and developing interventions that translate findings from behavioral research to improve well-being will be encouraged.

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