Authorizing Legislation: Section 301 and title IV of the Public Health Service Act, as amended.
Budget Authority:
This document provides justification for the Fiscal Year (FY) 2009 activities of the National Institute on Aging (NIA), including NIH/AIDS activities. Details of the FY 2009 HIV/AIDS activities are in the “Office of AIDS Research (OAR)” Section of the Overview. Details on the Common Fund are located in the Overview, Volume One. Program funds are allocated as follows: Competitive Grants/Cooperative Agreements; Contracts; Direct Federal/Intramural and Other.
Author and humorist Garrison Keillor. Influential film critic Roger Ebert. Legendary filmmaker Martin Scorcese. Nobel Prize-winning neurologist and biochemist Stanley Prusiner. Aretha Franklin, the “Queen of Soul.” In 2007, each of these remarkable Americans continued to lead active and productive lives, making noteworthy contributions to American life and culture. Beyond their undeniable achievements, however, they have one other thing in common: In 2007, each one celebrated his or her 65th birthday.
In reaching this milestone, they join the millions of Americans who are remaining healthy and vital well into older age. They are also representative of a rapidly growing trend. Within 25 years, experts believe, some 70 million Americans will reach age 65 or older – fully double today’s number in that age group. The number of “oldest old” – people age 85 or older – will more than quadruple by 2050, and this group is projected to include nearly one million centenarians, up from three thousand in 1950. As unprecedented numbers of Americans reach retirement age and beyond, profound changes will occur in our economic, health care, and social systems.
The good news is that even as the population ages, the rate of disability among older Americans continues to decline. The percentage of American elders reporting some level of disability fell from 26.5 percent in 1982 to 19 percent in 2004-2005, the most recent years for which estimates are available.1 However, as the number of older Americans continues to rise, we are challenged to discover new and effective ways to make these added years as healthy and productive as possible and to continue the current trend of decline in disability across all segments of the population. The National Institute on Aging (NIA) leads a national scientific effort to understand the nature of aging in order to promote the health and well being of older adults. NIA’s mission is to:
We carry out our mission by supporting extramural research at universities and medical centers across the United States and around the world and a vibrant intramural research program at NIA laboratories in Baltimore and Bethesda, Maryland. NIA’s research programs are broad in scope. Some NIA-supported researchers focus on the biological basis of aging that may provide fundamental knowledge to predict or preempt disease. Others are working to gain new insights into disease processes and comorbidities and using this knowledge to develop more effective ways to prevent, diagnose, and treat diseases and conditions of aging. Still others are exploring behavioral and social factors involved in aging and how they interact with genetics and biology. All of this research holds potential for the development of personalized interventions. Behavioral and social scientists are also concerned with the economic and societal consequences of a rapidly aging population.
Understanding aging processes and developing interventions that will support healthy aging requires an approach that integrates the work of diverse scientific disciplines and promotes the translation of basic research findings into application in medical practice, public health, and policy development. For example, a major NIA initiative seeks to encourage more investigators to move from purely basic research on Alzheimer’s disease and related disorders into translational research, drug testing in clinical trials, and development of effective behavioral interventions. Components of this initiative include solicitations for research grant proposals on drug discovery and preclinical development, as well as a program of toxicology services for academic and small business investigators who believe they have promising compounds for the treatment or prevention of Alzheimer’s disease but lack the resources to perform the necessary toxicology studies. Additional initiatives are targeting the translation of our rapidly expanding understanding of the basic biology of aging to applications for prevention and treatment of a spectrum of age-related diseases and conditions.
An important aspect of research translation is communication of research results to the public. The Institute’s comprehensive communications initiatives support patient participation by reaching out to researchers, health professionals, older adults and their families and caregivers, and the media to provide the latest research findings and evidence-based information on healthy aging and diseases associated with growing older. Key communications-related activities include two websites, the NIA’s main site at www.nia.nih.gov and the Alzheimer’s-dedicated Alzheimer’s Disease Education and Referral (ADEAR) Center at www.alzheimers.org.
NIA optimizes its efforts through collaborations with other federal, nonprofit, private, and international partners. Major collaborative efforts such as the Osteoarthritis Initiative with the National Institute of Musculoskeletal and Skin Disorders; the Alzheimer’s Disease Neuroimaging Initiative with an array of federal, private, and nonprofit organizations; and the Cognitive and Emotional Health Project (see page NIA-17) provide the opportunity for the Institute to build synergy and leverage resources in pursuit of our overall goal to make it possible for people to have not only longer but healthier and more productive lives in the 21st century.
In the following pages, we describe some of our plans for progress in FY 2009. Our recently updated strategic directions document, Living Long and Well in the 21st Century: Strategic Directions for Research on Aging, is available online at www.nia.nih.gov/AboutNIA/StrategicDirections.
NIA will continue to support new investigators and to maintain an adequate number of competing RPGs. In order to maximize the number of competing research project grants that can be made, NIA has a cap on the amount that can be awarded to individual program project awards and is following the NIH policy in providing no inflationary increases for non-competing or competing grants. In addition, the NIA has targeted a portion of the funds available for competing research project grants to support high priority projects outside of the payline, including awards to new investigators and first-time renewals. The Institute also seeks to maintain a balance between solicitations issued to the extramural community in areas that need stimulation and funding made available to support investigator-initiated projects. Intramural Research and Research Management and Support receive modest increases to help offset the cost of pay and other increases.
Investigators supported by NIA’s Biology of Aging Program (BAP) seek to better understand the basic biological mechanisms underlying the process of aging and age-related diseases. Basic biochemical, genetic, and physiological studies are carried out primarily in animal models, including both mammals and non-mammalian organisms (e.g. flies, worms, and yeast). BAP’s goal is to provide the biological basis for interventions in the process of aging, which is the major risk factor for many chronic diseases affecting the American population. In FY 2007, NIA began planning for a “Biology of Aging Summit” to review BAP’s current research portfolio, identify areas of opportunity, and facilitate the formulation of cohesive and comprehensive plans for the future. This conference will be held in FY 2008.
Budget Policy: The FY 2009 budget estimate for the Biology of Aging Program is $178,396,000, a decrease of $237,000 or .1 percent from the FY 2008 level of $178,633,000. Program objectives for FY 2009 include plans to:
NIA’s Behavioral and Social Research Program (BSR) supports social and behavioral research to better understand the processes of aging at both the individual and societal level. Research areas include the behavioral, emotional, and social changes individuals undergo throughout the adult lifespan; interrelationships between older people and social institutions; and the societal impact of the changing age composition of the population. BSR also supports research training; development of research resources such as publicly available, cross-nationally comparable databases that support critical multidisciplinary behavioral and social research; and a knowledge base for the development of interventions to maximize active life and health expectancy. In 2007, NIA commissioned an evaluation of its highly successful Demography of Aging Centers and Roybal Centers for Applied Gerontology. The evaluators were enthusiastic about the Centers’ activities and accomplishments; NIA plans to renew both programs in FY 2009. In addition, in February 2007, NIA partnered with the Department of State to host a Summit on Global Aging, which provided a unique and important opportunity to catalyze greater international dialogue and encourage coordinated international studies about the health, economic, social, and security implications of this important issue.
Budget Policy: The FY 2009 budget estimate for the Behavioral and Social Sciences Research Program is $171,706,000, a decrease of $227,000 or .1 percent from the FY 2008 level of $171,933,000. Program objectives for FY 2009 include plans to:
NIA’s Neuroscience and Neuropsychology of Aging (NNA) Program supports a broad spectrum of research and training aimed at better understanding age-related normal and pathological changes in the structure and function of the nervous system and how such changes affect behavior. The basic mission is to expand knowledge on the aging nervous system to allow improvement in the quality of life of older people. This includes basic and clinical studies of the nervous system, clinical trials of treatments and preventive interventions for neurological disease, and epidemiological research to identify risk factors and to establish prevalence and incidence estimates of pathologic conditions. Additionally, it supports research relevant to those geriatric problems arising from psychiatric and neurological disorders associated with aging.
In October 2007, in partnership with the McKnight Brain Research Foundation and the Foundation for the National Institutes of Health, NIA held a Cognitive Aging Summit. The purpose of this major meeting was to bring together experts from a variety of research fields to discuss the latest advances in our understanding of age-related brain and behavioral changes. Recommendations from this conference will inform NIA’s research directions in the field of cognitive aging in the coming years.
Budget Policy: The FY 2009 budget estimate for the Neuroscience and Neuropsychology of Aging Program is $412,655,000, a decrease of $546,000 or .1 percent from the FY 2008 level of $413,201,000. Program objectives for FY 2009 include plans to:
Although most people remain relatively alert and mentally able as they grow older, some loss of cognitive function is normal with advancing age. However, the mechanisms behind these cognitive losses are not fully understood, and interventions are needed to help older people maintain optimal brain health for as long as possible. With the aging of the U.S. population, the development of strategies to maintain cognitive health into late old age is becoming increasingly important.
A new focus on brain health, as opposed to the study of causes of specific brain diseases and dysfunction, has emerged in recent years and has become an increasingly important paradigm in neurosciences research. One NIH initiative to support the study of brain health is the Cognitive and Emotional Health Project (CEHP). Established in 2001 by NIA, the National Institute of Mental Health, and the National Institute of Neurological Disorders and Stroke, the goal of the CEHP is to coordinate and accelerate research leading to interventions for neurological health. One major effort has been the systematic review and critique of published literature on factors for cognitive and emotional health in the adult. Based on suggestions from the CEHP panel that conducted the evaluation of the published literature, the NIH Blueprint for Neuroscience Research awarded a contract in 2006 to develop an assessment tool to measure cognitive, emotional, motor and sensory function in large cohort studies. Other ongoing CEHP efforts include the development of a comprehensive online bibliography and a database of large longitudinal and epidemiological studies that have captured data on cognitive and emotional health risk and prevention factors. A perspective on CEHP and related research supported by NIA and NIH was published in the April 2007 supplementary issue of the journal Alzheimer’s and Dementia.
Studies of normal cognitive aging may also inform our understanding of cognitive dysfunction -- and vice versa. For example, low levels of AD pathology observed in the brains of those enjoying apparently normal aging, without cognitive abnormalities, could be early signs of the disease. Conversely, studies conducted under the Alzheimer’s Disease Neuroimaging Initiative might be particularly informative as we seek to better understand normal aging. This study aims to identify imaging and biochemical markers for “healthy” or normally functioning persons, for those with mild cognitive impairment (MCI), and for persons with AD or other dementias. Eventually, such markers will help to identify people at high risk for cognitive decline or dementia.
In October 2007, NIA, in partnership with the McKnight Brain Research Foundation and the Foundation for the National Institutes of Health, held a Cognitive Aging Summit. Participants in this advisory meeting generated innovative recommendations for advancing the field of cognitive aging research, with particular emphasis on ways to promote and maintain cognitive health and brain health in older adults. We anticipate that research initiatives stimulated by this meeting will be launched in FY 2009.
As we age, our risk for many other types of disease and/or disability increases dramatically. NIA’s Geriatrics and Clinical Gerontology (GCG) Program supports research on health, disease, and disability in the aged (other than neurodegeneration, which is the focus of the NNA Program). Areas of focus include age-related physical changes and their relationship to health outcomes, the maintenance of health and the development of disease, and specific age-related risk factors for disease. The program also plans and administers clinical trials.
In FY 2007, NIA issued a research solicitation for the renewal of the Claude D. Pepper Older American Independence Centers Program, the goal of which is to increase scientific knowledge leading to better ways to maintain or restore independence in older persons. Awards will be made in FY 2008.
Budget Policy: The FY 2009 budget estimate for the Geriatrics and Clinical Gerontology Program is $136,076,000, a decrease of $180,000 or .1 percent from the FY 2008 level of $136,256,000. Program objectives for FY 2009 include plans to:
NIA’s Intramural Research Program (IRP) includes the scientific disciplines of biochemistry, cell and molecular biology, structural biology, genetics, immunology, neurogenetics, behavioral sciences (psychology, cognition, and psychophysiology), epidemiology, statistics, and clinical research and the medical disciplines of neurobiology, immunology, endocrinology, cardiology, rheumatology, hematology, oncology, and gerontology. The program seeks to understand the changes associated with healthy aging and to define the criteria for evaluating when a change becomes pathologic. Studies focus on both common age-related diseases (e.g., Alzheimer’s disease, Parkinson’s disease, stroke, atherosclerosis, osteoarthritis, diabetes, cancer) and the determinants of healthy aging.
In FY 2009, the NIA IRP sustained a program of high-quality research on the basic biochemical and molecular underpinnings of aging and age-related diseases and conditions. In addition, IRP investigators conducted clinical research on a variety of conditions, including studies of the etiology of anemia, treatment trials for lymphoma, and studies to better understand several connective tissue disorders. In addition, work continued under the groundbreaking Baltimore Longitudinal Study of Aging, which will celebrate its fiftieth anniversary in 2008.
Budget Policy: The FY 2009 budget estimate for the NIA’s Intramural Research Program is $109,231,000, an increase of $1,614,000 or 1.5 percent over the FY 2008 level of $107,617,000. Additional funds will be used to partially offset the costs associated with pay raises and other increases. Program objectives for FY 2009 include plans to:
The NIA supports longitudinal studies within both its intramural and extramural programs. These studies, in which data is collected repeatedly in groups of people over a period of months or years, can provide unique insights into the physiologic, health, economic, and other changes seen in populations over time. Data from longitudinal studies can be used to generate and test hypotheses about long-term effects of health exposures, factors affecting onset and progression of disease with advancing age, and protective factors that contribute to exceptionally healthy aging.
NIA supports America’s longest-running scientific study of human aging, the Baltimore Longitudinal Study of Aging (BLSA). Established in 1958, the BLSA has provided a wealth of information on the physical consequences of aging, as well as how to sort out changes due to aging from those due to disease, genetic makeup, environmental or lifestyle factors, or other causes. NIA is now planning to initiate the BLSA Elite Aging Study of men and women who have already achieved substantial longevity (85 years and older) and are still free of major diseases and disability. We anticipate that this study will provide critical information on the biological mechanisms that allow some people to substantially delay or even avoid age-related sickness and functional decline.
Another major NIA-supported longitudinal study, the National Long Term Care Study (NLTCS), fielded from 1982 to 2005, has been one of the leading resources for studying changes in health and functional status and for tracking health expenditures, Medicare service use, and the availability of personal, family and community resources for caregiving. No additional waves of data collection are currently planned for the NLTCS; however, in light of the importance of the kind of data generated by this study as a resource for program planning and policy development, the NIA issued a request for grant applications in November 2007 for proposals to design and conduct a longitudinal, nationally-representative survey of disability trends and dynamics among the U.S. older population. Work will begin under this RFA in September 2008.
In recent years, a new generation of NIA-supported longitudinal studies has emerged. These new studies build on the ideas and hypotheses generated in earlier studies and therefore tend to focus on targeted specific aspects of aging and the aging process. For example, Health ABC is a study of age-associated changes in body composition and their effect on health and functional status in late life; the Women’s Health and Aging Study deals with risk factors for disability and disability progression in older women who are already impaired; investigators on the InCHIANTI study are collecting information on biomarkers of aging and are identifying factors affecting the development of mobility disability in late life; and the Health and Retirement Study focuses on the economic status of a cross section of the aging population in the United States. Other ongoing NIA-supported longitudinal studies include surveys focused on women’s health (for example, the Study of Women’s Health Across the Nation), cognitive health (e.g., the Nun Study), economic behavior and social and psychological measures (the Panel Study on Income Dynamics), and cardiovascular health (such as the Bogalusa Study).
NIA RMS activities provide administrative, budgetary, logistical, and scientific support in the review, award, and monitoring of research grants, training awards and research and development contracts. RMS functions also encompass strategic planning, coordination, and evaluation of the Institute’s programs, regulatory compliance, international coordination, and liaison with other Federal agencies, Congress, and the public. The Institute currently oversees more than 1,940 research project grants and centers, as well as more than 500 full-time training positions and 100 research and support contracts.
Budget Policy: The 2009 budget estimate for NIA’s Research Management and Support is $40,214,000, an increase of $594,000 or 1.5 percent over the FY 2008 level of $39,620,000. Additional funds will be used to partially offset the costs associated with pay raises and other increases.
The NIA participates in the support of the following Roadmap initiatives funded through the NIH Common Fund:
1 Manton K, Gu X, Lamb VL. Change in chronic disability from 1982 to 2004/05 as measured by long-term changes in function and health in the U.S. elderly population. PNAS 2006 Nov; 103(48): 18374-18379.
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