Council Minutes - May 1997

NATIONAL ADVISORY COUNCIL ON AGING

The Seventy-First Meeting

Summary Minutes:
May 22-23, 1997

National Institutes of Health
Building 31, Conference Room 6
Bethesda, Maryland 20892

CONTENTS

1. Call to Order
2. Public Interest Session
3. Office of Research on Women's Health (ORWH)
4. Review of Applications
5. NNA Program Review
6. National Center for Health Statistics and Aging Research
7. Council Task Force on Minority Aging
8. Working Group on Program
9. Adjournment
10. Certification

Department of Health and Human Services
Public Health Service
National Institutes of Health
National Institute on Aging

NATIONAL ADVISORY COUNCIL ON AGING
SUMMARY MINUTES
May 22-23, 1997

The 71st meeting of the National Advisory Council on Aging (NACA) was convened on Thursday, May 22, at 10:30 a.m. in Building 31, Conference Room 6, National Institutes of Health (NIH), Bethesda, Maryland. Dr. Richard J. Hodes, Director, National Institute of Aging (NIA), presided.

In accordance with the provisions of Public Law 92-463, the meeting was open to the public on Thursday, May 22, from 10:30a.m. to 3:00 p.m. and on Friday, May 23, from 8:30 a.m to 12:00 noon. The meeting was closed on Thursday, May 22, from 3:00 p.m. to recess for the review, discussion, and evaluation of grant applications in accordance with the provisions set forth in Sections 552(b)(c)(4) and 552(b)(c)(6), Title 5, U.S. Code, and Section 10(d) of Public Law 92-463.

Council Participants:

Dr. Walter R. Allen
Dr. Carol Barnes
Dr. Elizabeth L. Barrett-Conner
Dr. Helen M. Blau
Dr. Jeffrey A. Bluestone
Dr. Patricia S. Goldman-Rakic
Dr. William R. Hazzard
Dr. James S. Jackson
Mr. Jorge J. Lambrinos
Dr. Gerald E. McClearn
Dr. John W. Rowe
Dr. John Q. Trojanowski
Dr. Robert B. Wallace
Dr. Anne B. Young

Ex Officio Participant:

Dr. George F. Fuller, USUHS
Dr. Dr. Judith A. Salerno, VA

The Council Roster, which gives titles, affiliations, and terms of appointment, is appended to these minutes as Supplement A.

Members of the Public Present:

Nancy Aldrich, Aging Research and Training News
Jerry Barrett, American Sleep Disorders Association
Lynn Beauregard, American Association for Research
Shirley Brown, Gerontology News
Ruth Christie, ADEAR Center
Dale Dirks, American Sleep Disorders Association
Lisa Helfman, ADEAR Center
Nielsen Hobbs, The Blue Sheet
Michele Hogan, American Association of Immunologists
Gail Hunt, National Alliance for Caregiving
Maureen S. Lynch, American Physical Therapy Association
Angela Sharpe, Consortium of Social Science Associations
Carole Sherman, Infoteg
Howard Silver, Consortium of Social Science Associations
Paula Skedsvold, Society for the Psychological Study of Social Issues and American
Psychological Society
William D. Spector, Agency for Health Care Policy and Research and American
Public Health Association
Betsy Sprouse, American Association for Retired Persons - Andrus Foundation
Derek Stepp, Association for Gerontology in Higher Education
Joan Van Nostrand, National Center for Health Statistics and Aging Research
David P. White, American Sleep Disorders Association
Lisa White, The Blue Sheet
Pat White, American Association of Immunologists

In addition to NIA Staff, other Federal employees attending were:

Dr. Lawrence Deyton, NIAID
John James, OER
Dr. James Kiley, NHLBI
Mike Micklin, DRG
Dr. Ramesk K. Nayak, DRG

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1. Call To Order

Dr. Hodes welcomed Council members and introduced new Council members: Dr. Patricia Goldman-Rakic, Professor of Neuroscience, School of Medicine, Yale University; Dr. Elizabeth Barrett-Connor, Professor, Department of Family and Preventive Medicine, School of Medicine, University of California - San Diego; and, Dr. John Rowe, President, Mount Sinai Medical School and Hospital. He announced that Dr. Richard Goldsby, Professor, Department of Biology, Amherst College, is also appointed but was unable to attend the May 1997 meeting. Visitors were invited to introduce themselves.

Future Meeting Dates

September 25-26, 1997 (Thursday-Friday)
February 5-6, 1998 (Thursday-Friday)
May 21-22, 1998 (Thursday-Friday)
September 24-25, 1998 (Thursday-Friday)
February 2-3, 1999 (Tuesday-Wednesday)
May 27-28, 1999 (Thursday-Friday)
September 23-24, 1999 (Thursday-Friday)

Consideration of Minutes of Last Meeting

The minutes of the January 30-31, 1997 meeting were approved as submitted.

 

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2. Public Interest Session

Budget

Dr. Hodes briefed the Council on the President's budget for fiscal year 1998. The NIA budget is projected to be $497 million, with 62% for Research Project Grants, 12% for Research Centers, 5% for Research Contracts, 3% for Research Training, 3% for Other Research, 2.5% for Small Business Innovation Research and Small Business Technology Transfer, 9% for Intramural Research programs, and 4% for Research Management and Support. A more complete report on the projected budget is appended to these minutes.

In discussion, Council members indicated they are being bombarded by e-mail from organizations proposing to double the NIH budget. It was noted that the Senate had passed a "sense of the Senate" resolution to double the NIH budget. Dr. Hodes reminded members that it is difficult to anticipate final outcomes of budget negotiations and that, with the balanced budget policy, the competition for funds between NIH, health and welfare programs, and other programs is considerable. A member asked whether NIA had sufficient numbers of reviewed, high quality applications to support if the budget were to be doubled. It was noted such a prospect might present a problem if implemented immediately but, if the budget doubled over 5 years, we would certainly generate good science in relation to available resources. It was pointed out that with a substantial budget increase, NIA and NIH could anticipate accelerated progress in research on Alzheimer's disease, particularly in basic understanding of and diagnostic criteria for the disease, and in translation to therapy and clinical trials. Moreover, budget increases in the 1980s did lead to an acceleration of investigator-initiated Institute-driven research. Budget growth now would result in funding a larger proportion of the meritorious applications received and development of opportunities that are ripe and not taken advantage of. Also, more people would be trained in research.

In response to a query of whether additional funds would be used to increase NIA's staffing level, Dr. Hodes responded that there is a freeze on that budget category. He informed the Council that NIH is undergoing a review of its administrative structure at the request of Congress.

A member remarked that the training budget has been flat for some years. Dr. Hodes responded that NIH can make decisions about how much of its budget to allocate to training, but that the dilemma has been whether to increase stipends or number of trainees. NIH recently has been trying to effect inflationary increases in stipends for trainees. Another issue raised is that training programs are expensive for institutions and, in response to that fact and market forces, trends and patterns are cyclical: we perceive surpluses and a short time later experience shortages. It was noted that the field of aging differs from others in that, for the intermediate term, there is a continuing need to train gerontologists. This need may well attract highly qualified investigators to aging research who were initially trained in other specialties. An evaluation of NIH training activities is under way.

Legislation

Appropriations hearings have taken place in the House of Representatives. Members were supportive of NIH programs and plans. Senate appropriations hearings are being scheduled. In March, Dr. Hodes and other Institute directors spoke with members of the Health Environment Subcommittee of the House Committee on Commerce who visited NIH laboratories and listened to presentations about ongoing research. Visitors found the meeting informative and responded to it positively. Other meetings with members of Congress and staff included sessions with representatives from the office of Mr. Gingrich, and with staff from the Senate Committee on Aging. At the latter meeting, a presentation on scientific progress and opportunities led to the scheduling of a June hearing on Alzheimer's Disease: Current information and needs.

Organization of Division of Research Grants (DRG) Review Groups: Dr. Hodes noted that three Institutes, Mental Health, Drug Abuse, and Alcohol Abuse and Alcoholism, have previously carried out their own review; however, following their recent integration into NIH, peer review of most of their applications will be carried out by the DRG. As a consequence, reorganization of study sections is being considered more generally, with the goal of assuring quality peer review to identify the most meritorious science. For applications in the neuroscience area, principles to guide the reorganization were developed by directors of Institutes supporting neuroscience. Representatives from DRG and Institute program, review, and policy staff, along with representatives from the extramural community, have participated in the conceptualization and design of new review groups. The plan for neuroscience clusters and initial review groups has been discussed at national meetings and is being made available on the World Wide Web (WWW). Comments are being solicited. The plan has also been discussed at meetings of the DRG Advisory Committee and of the Peer Review Oversight Group. It is expected that the plan for the neuroscience review groups will be approved in November 1997 and will be implemented for the February-March 1998 application receipt dates. Review of applications in the social and behavioral sciences is the next area to be reorganized. Complete information about the newly proposed neuroscience review groups is available on the WWW at HTTP://WWW.DRG.NIH.GOV/REVIEW/NEUROREV.HTM.

During discussion, Council members raised the issues of encouraging scientists to serve on study sections and of special roles for senior scientists. Dr. Hodes responded that both issues have been discussed. A very small percentage of scientists being supported by NIH do not serve on review groups, and options for encouraging participation of senior scientists for review are being explored. Another matter brought up was the breadth of the concept of developmental neurobiology. It was pointed out that very often "developmental" is defined as early development and does not include aging.

Dr. Hodes introduced two new senior staff members of the NIA: Dr. J. Taylor Harden, Assistant to the Director for Special Populations, and Dr. Mary Nekola, Chief, Scientific Review Office. Their backgrounds are summarized in the Director's Status Report appended to these minutes.

Presentation by NIA Public Information Office (PIO)

The Public Information Office (PIO) screened 2 short public service video announcements that address anti-aging fads. The announcements have been distributed to 700 markets for telecast. The effects of the announcements were monitored: more than 8,000 telephone calls were received in the 3 days following the initial airing. PIO staff were thanked for producing the videos and for assessing the outcome of their activity.

Comments from Public Interest Groups

For the second successive meeting, the NIA and NACA provided a venue for interested organizations to communicate with the Council. Representatives of four organizations addressed Council: the American Association of Immunologists (AAI), the American Sleep Disorders Association (ASDA), the Consortium of Social Science Associations (COSSA), and the American Heart Association (AHA).

Dr. M. Michele Hogan represented the American Association of Immunologists (AAI), an association of 5,500 M.D., Ph.D., and corporate members. AAI is a member of the Federation of American Societies for Experimental Biology (FASEB). She reported that FASEB recently held a conference on training, a summary of which will be on the FASEB Home Page. After reviewing the functions of her organization, she said that AAI accomplishes its mission through: meetings; publications such as the Journal of Immunology; Cutting Edge, an on-line publication outlet; and, 14 committees that focus on political and policy issues, as well as scientific issues. AAI's initiatives are not targeted to aging research specifically, but aging research is inherent in AAI's mission. The AAI would welcome increased activity in immunology of aging. The AAI has an active Public Affairs program that has been involved in policy breakfasts to present information to members of Congress and their staffs. The Association has also addressed topics such as bridge funding and the Small Business Innovation Research (SBIR) program.

Dr. Howard Silver, Executive Director, Consortium of Social Science Associations (COSSA), described his organization. He stated that COSSA has successfully advocated for appointment of an Assistant Director for Behavioral Sciences at the Office of Science and Technology Policy and an Assistant Director for Behavioral Science at the National Science Foundation, and for establishment of the Office of Behavioral and Social Science Research at NIH. COSSA has also been instrumental in effecting the appointment of behavioral and social scientists to National Advisory Councils at NIH and other agencies, and has encouraged more behavioral science staffers at NIH and other agencies. In its advocacy activities that relate to NIA, COSSA has focused on the demography of aging, the Health and Retirement Survey, quality of life issues, burdens of care, and prevention issues. COSSA has been active in efforts to retain specific census data. Other COSSA activities include a Washington Update newsletter, workshops, and occasional publications.

Dr. David White presented for the American Sleep Disorders Association (ASDA), an organization of 3,000 members which includes practitioners and researchers in specialty areas such as pulmonology, neurology, psychology, and psychiatry. The organization's mission is to advance sleep research, sponsor professional education and publications, assure standards of care, publish sleep guidelines, and accredit and monitor sleep centers that deliver services. The Association publishes a journal, conducts meetings, offers courses on sleep disorders, and sponsors a high school education program. The Association collaborates with the Sleep Center at NIH and advocates for research. Dr. White spoke briefly about sleep and aging. He noted that sleep processes change with aging, as do our circadian systems. He emphasized the importance of research to understand the neurobiology of sleep in aging and the molecular mechanisms that underlie biological clock functions. On the applied side, important issues include whether or not leep apnea is treatable, and the development of pharmacologic and nonpharmacologic interventions to improve sleep.

A statement was delivered for the American Heart Association. At a recent retreat, leaders in cardiology noted that the majority of people now being treated for heart conditions are over 65 and that many are over 75 - a major increase in age from prior years. It was proposed that it is timely for NIA to consider a conference to examine the utility of data sets to determine the efficacy of interventions with older people.

Recent Research Findings

Scientific Advances: Each of the NIA programs informed the Council of a recent research advance. Dr. Anna McCormick, Chief, Biology Branch, Biology of Aging Program, highlighted advances in understanding the role of telomeres. Telomeres protect ends of chromosomes from inappropriate interactions. As many cells go through their replicative life span, the telomere shortens. It is plausible that absence of this protection promotes some of the damage that is characteristic of cellular aging; however, no direct evidence exists to support this hypothesis. For germ cells, the enzyme telomerase acts to maintain telomere length after cell division, thus the telomere does not shorten with increasing division in such cells. Tumor cells also maintain the length of telomeres after repeated cell division and telomerase often appears to be the enzyme responsible for maintaining telomere length in these cells, too. Therefore, there is interest in exploring telomere shortening and telomerase as contributors both to aging and to cancer. Dr. McCormick described a recent advance in telomere research that illustrates how independent research with different model systems can yield highly productive interactions that benefit the field. Dr. Victoria Lundblad, an NIA grantee at Baylor College of Medicine, working on a mutant gene of brewer's yeast that, unlike other yeast cells, does show shortening of the telomere with increasing numbers of cell divisions, met Dr. Tom Cech who is working on a protozoa that generates large amounts of telomerase. Dr. Lundblad had isolated a gene involved in telomere maintenance, but was unclear whether the gene was a part of the enzyme or acted to regulate the enzyme's activity. With Dr. Cech, she was able to isolate and identify the structure of the telomerase ribonuclear protein. They discovered that the gene in yeast previously identified by Lundblad had a very similar sequence. Using this information, Drs. Lundblad and Cech returned to the yeast model and knocked out the relevant domains of the gene in cells that normally do maintain telomere length. When they did this, telomerase activity stopped and the telomere shortened with increasing cell division. The finding reveals important information about the mechanism of telomerase action that can now be extended to the telomerase enzyme in humans. In response to questions, Dr. McCormick and Dr. Hodes indicated that it is not yet clear whether telomere shortening has any direct physiological implications, but that the research described will assist researchers to address this question.

Dr. Ronald Abeles, Associate Director, Behavioral and Social Research Program, NIA, spoke about the demographic transition to older populations in developed countries and noted that two changes have been documented: the population is living longer, and the age structure of the population is changing. Compared to prior eras, a large proportion of the population is comprised of older persons. These changes have caused policy planners to speculate about the burdens of supporting a large older population. However, Dr. Kenneth Manton, an NIA grantee, has recently reported that since 1992 there has been a decline in age-related disability of 1% among 65-74 year olds, and a decline of 2% among those over 75 years. These data from the National Long Term Care Survey show that the actual number of people with disabilities is 1.3 million persons less than had been projected. This reduction should result in savings in nursing home costs, as compared to previous population projections. However, in view of increases in longevity, the number of disabled elders will continue to grow. To keep constant the number of people with disabilities would require an annual decline of 1.5% in the disability rate. The challenge for research is to understand the causes for improvements noted by Dr. Manton and to design appropriate interventions that will accelerate the improvement. Among possible causes are changes in lifestyle, education, and income. Differences across subgroups of elders by race and socioeconomic measures have been observed. In discussion, Dr. Rowe questioned the wisdom of the study authors in suggesting that the change may generate savings for Medicare and other Government programs. The media and policy attention given to that statement ignored the possibility that it is because of programs like Medicare that we are seeing the improvements noted by the researchers.

Dr. Evan Hadley, Associate Director, NIA, Geriatrics Program, reported on recent research on growth hormone therapy to ameliorate an age-associated decrease in IGF-1. Studies in healthy elders show that growth hormone replacement results in more lean body mass, less fat, and increased bone density, but no increase in strength. At issue is whether the increases in lean body mass reflect a true increase in protein versus an increase in water in the tissue. Protein-turnover studies examined the effects of 4 weeks of administration of growth hormone or IGF-1 on protein metabolism and net protein synthesis and found not only increased protein synthesis but also an increased rate of protein turnover. As pointed out by Dr. Hodes, more research needs to be done on whether the increased synthesis and turnover rate can be used effectively, and whether these effects could have beneficial consequences for a number of aging related processes. Discussion centered around gender differences (subjects in the reported study were all women). It was noted that estrogen is associated with higher growth hormone level and that endogenous IGF-1 level is associated with bone density in females but not in males.

Dr. Marcelle Morrison-Bogorad, Associate Director, Neuroscience and Neuropsychology of Aging Program, NIA, spoke about advances in research on Alzheimer's disease (AD). She noted that in epidemiological studies several substances have been associated with reduced risk of, or slower cognitive decline in, AD. Among them are anti-inflammatory drugs, antioxidants, and estrogen. However, clinical trials are needed to establish direct evidence linking these substances to AD. The AD Cooperative Study has now completed a study of the effects of selegiline and vitamin E (both antioxidants) on the progression of AD. Primary outcomes of interest were death, institutionalization, loss of Activities of Daily Living (ADL), and severe dementia. The placebo control group reached the clinical endpoints much faster than the groups taking either of the antioxidants or the group taking the antioxidants in combination. Dr. Morrison-Bogorad cautioned that, although no significant negative side-effects of drug administration were observed, the doses taken were many times higher than the recommended daily allowance. Discussion covered how the dosage was determined, the likely safety of such a dose, the complexities introduced into clinical trials when multiple endpoints are studied, the absence of direct effects on cognition in the treated patients, and the appropriate ethical standard for future control groups in clinical trials of AD.

 

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3. Office Of Research On Women's Health(ORWH)

Dr. Vivian Pinn, Director, Office of Research on Women's Health, traced the history of ORWH and informed Council of its mandates: to implement a women's health agenda at NIH; to include women in health research; and, to recruit and advance women in biomedical science. The ORWH implements these mandates with the advice of a coordinating committee with representatives from the different Institutes and with an Advisory Committee, equivalent to the National Advisory Council on Aging. The ORWH works through the several Institutes in order to carry out the resulting priorities. The ORWH was also instructed to implement a legislative mandate from the 1993 Revitalization Act to ensure that women and minorities shall be included in research, as appropriate, to study design and objectives. This last mandate has led to the development of a system to track performance of NIH with respect to inclusion.

Dr. Pinn described the research agenda for her office, emphasizing an interest in women's health across the life span. Health of aging women is one priority. Dr. Pinn enumerated other priority areas. The research agenda set 5 years ago is being updated, and progress and needs are being assessed. Attention is being paid to implementation of research outcomes in the development of public health policy.

Dr. Pinn briefly described major studies in which NIA is involved: Postmenopausal Estrogen Prevention Intervention; Study of Women Across the Nation; and, the Women's Health Initiative. She went on to note that her office cofunds these studies as well as special initiatives NIH-wide, such as the career awards for people re-entering science after a gap in their research careers.

Discussion touched upon why Alzheimer's disease is not a listed priority in the agenda of the ORWH. Dr. Barrett-Connor commented that, although more women are diagnosed with Alzheimer's disease than men, there are many more older women than men. Most studies concur that the incidence of Alzheimer's is no greater in women than in men. Discussion also focused on problems experienced with recruiting women into research studies and on the involvement of drug companies in ancillary studies associated with the Women's Health Initiative.

 

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1. Review Of Applications

This portion of the meeting was closed to the public in accordance with the determination that it was concerned with matters exempt from mandatory disclosure under Sections 552b(c)(4) and 552b(c)(6), Title 5, U.S. Code and Section 10(d) of the Federal Advisory Committee Act, as amended (5 U.S.C. Appendix).

A total of 690 applications requesting $484,600,845 for all years were reviewed. Council recommended 513 for a total of $327,174,028 for all years. The actual funding of the awards recommended is determined by the availability of funds, percentile ranks, priority scores, and program relevance.

 

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5. NNA Program Review

Dr. Marcelle Morrison-Bogorad, Director, Neuroscience and Neuropsychology of Aging (NNA) Program, NIA, gave an overview of the program. She noted that the program is the largest in the Institute and comprises just under half the grants' budget. The program includes basic and clinical studies and is vertically organized to facilitate translational research. The NNA program has three branches: Neurobiology, Dementias of Aging, and Neuropsychology of Aging. The largest number of grants supported by the Program are research project grants, such as RO1s, RO3s, and PO1s. In addition there are 27 center grants and a variety of training, career development awards, and fellowships.

Dr. Morrison-Bogorad stressed that much important training takes place in the program projects and centers. As an example, she mentioned that 40% of the pilot projects funded by the centers had gone on to attract independent funding. The neurobiology area has 25% of the program's budget, neuropsychology has 7%, and dementias of aging 67%. She then detailed program areas more specifically to convey a sense of the scope an nature of the NNA portfolio. For example, studies are supported in fundamental neuroscience, integrative neurobiology, sleep and biological rhythms, sensory and motor processes, cognitive neuroscience, epidemiology, and neurological disorders associated with aging, including the genetics and molecular biology of Alzheimer's disease. The studies involve research on humans and on animals, using a variety of technologies. Dr. Morrison-Bogorad highlighted several areas of recent progress within the program's portfolio. These included: advances in understanding Alzheimer's disease pathology; the creation of transgenic and second-generation transgenic mouse models; and, the recent success of clinical intervention trials.

Dr. Carol Barnes presented the report of the ad hoc group that reviewed the NNA program. She began by describing the review process. To start, a telephone conference call between Dr. Morrison-Bogorad and the three Council-member reviewers identified possible external reviewers. Dr. Morrison-Bogorad presented a possible organizational scheme for the review that was later modified by reviewers. They requested that Dr. Morrison-Bogorad present an overview of the program and its portfolio. The process was shaped further through conference calls and a meeting just prior to the review. Reviewers looked at recommendations made 2 years ago at a prior review and assessed progress as follows: 1) It was recommended that there be an increase in program staff. A new Associate Director has been hired. Other recruitments are under way. 2) Alzheimer's Disease Research Centers: Questions were raised in the prior review about quality of research, clinical interventions, and sharing information. Since that time, some Centers failed to succeed in recompetition. Others have demonstrated as supported by peer review that they effectively carry out clinical trials and conduct cutting edge research in Alzheimer's disease. 3) Integrative and Multidisciplinary functions: An increase in level of multidisciplinary research has been recommended. More integrative research is now present. 4) The study of normal aging was noted. Progress is being made in this area. 5) Training: New mechanisms to recruit and retain scientists are needed. Reviewers went on to make recommendations about the program. The NNA staff was judged to be outstanding, particularly with respect to their proactive activities. Reviewers were pleased to learn that three additional staff are being recruited. Reviewers recommended that one new staff person be expert in emerging technologies. Because technology changes rapidly, a succession of technical experts was recommended. Each would serve for 1 year and have expertise in a different aspect of emerging technology. A recruitment in epidemiology is planned. Reviewers suggested that expertise in molecular biology and genetics, as well as in traditional epidemiology, be sought to exercise leadership in studies of normal aging in groups that differ in genetic and environmental backgrounds. Such studies should focus on risk assessment, prevention of disease, and development of therapies in the Alzheimer's area. The Centers should be encouraged to undertake more studies on normal aging, particularly as add-ons to ongoing studies supported by other Institutes or organizations. The individual being recruited in cognitive neuroscience should have expertise in biology as well as behavior.

Recommendations for reorganization of the NNA program: Reviewers observed that recruitment of a new program chief affords an opportunity to reconsider the organization of the program. It was recommended that a systems neuroscience branch be organized to integrate reductionist and molar approaches to neuroscience. For example, age-related memory loss would benefit from anatomic, physiological, and pharmacologic study of relevant systems. In vivo animal models might inform studies of normal brain and behavior relationships. In response to questions from other Council members, reviewers indicated that they anticipated an increase in applications on integrative neuroscience and suggest program development work to help shape the resulting science. Reviewers felt that the disciplinary distinctions between NNA and the Behavioral and Social Research program are blurred, although they reflect different thrusts within cognitive science. Council discussion emphasized the need for both sufficient program staff to accomplish the integrative work and program staff to interact to facilitate that development.

Recommendations for Alzheimer's Disease Centers: Overall the Centers program has been successful, although efforts to spread Centers geographically resulted in funding some relatively weak Centers. It was recommended that NIA continue the practice of open competition for Centers so that only strong Centers receive support. Further, focus on excellence of Centers rather than breadth was recommended. Reviewers supported the concept of a coordinated database to be shared among Centers, including a core minimum data set to which all Centers (not only formal Alzheimer's Centers) would contribute. Data from non-Center longitudinal studies and other databases might be included. The reviewers favored continuation of the Centers and efforts to increase integration among them.

Recommendations for Training: Reviewers expressed concern about limited growth in training resources in view of their judgment that more personnel will be needed as the neuroscience of aging field continues to grow. It was recommended that NIA consider a new Research Scientist Award modeled after NIMH's KO5 that provides near full-time salary support for research activities to senior scientists. Further, support of training in the context of Program Project and Centers grants was urged. The environment of these projects provides a rich and integrative learning experience for students. Following discussion, Dr. Hodes and members of Council thanked the reviewers for a thorough and thoughtful review and report and commented that the NIA takes great pride in the NNA program.

 

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6. National Center For Health Statistics And Aging Research

Dr. Ed Sondik, Director, the National Center for Health Statistics (NCHS), was welcomed by Dr. Hodes. Dr. Sondik spoke to Council about the NCHS, emphasizing current and projected collaborations with NIA. Among current collaborations are the Interagency Forum on Aging-Related Statistics and an International Collaborative Effort on Aging. The Interagency Forum on Aging-Related Statistics has been in existence for 10 years and has proven useful. The International Collaborative Effort on Aging emphasizes methodology, data-related issues, and issues in health-reporting systems, and brings a needed international perspective to topics such as nursing-home outcomes, hip fractures, and vitality status.

NCHS, part of the Centers for Disease Control and Prevention (CDC), is a designated statistical agency of the Government, similar to the Bureau of Labor Statistics. NCHS has responsibility for reporting births and deaths in the Nation. Beyond that role, NCHS has four areas of concentration: health status; health systems; treatment and care; and, social and economic influences on health including health habits, knowledge, attitudes, beliefs, social norms and influences, and access to care. Data are collected from a variety of surveys, several of which were briefly described. Among them are the large-scale Health Interview Survey and the on-site assessments done on a continuous basis for the National Health and Nutrition Survey (NHANES). The Agency also produces the Atlas of Mortality that provides information on causes and rates of death. Information about cost of illness is also provided. Dr. Sondik noted that NCHS data are increasingly available on the World Wide Web. The information from the surveys is used to compile national statistics on height, weight, and causes of death. They also provide information vital to health policy, for example, in tracking levels of lead in the population. Recent initiatives include an effort to speed the production of data from the surveys, an effort supported by NIA, to ascertain more reliable cost of illness estimates, and initiatives to make data available through CD-ROM technology and via the internet.

Council members asked about individual vs. group data and sample sizes in estimating cost of illness, on surveying people in nursing homes, and efforts to go beyond death certificate information in determining cause of death. On the latter, Dr. Sondik reported that follow-back surveys have been conducted to trace medical conditions prior to death. He welcomed these comments and suggestions and invited Council members and staff to let him know what kinds of data are most useful to them, and to inform him about ideas for studies and protocol design. Dr. Sondik emphasized that NIA made many suggestions that helped shape the NHANES surveys and contributed to its success in including elders. Dr. Sondik presented some findings from NHANES to show how it has contributed both to knowledge and to policy development, and how collected samples continue to be available for new studies as knowledge and methodology change. He indicated that NIA is participating in NHANES IV which is due to have a pilot in January 1998, and expressed a high degree of interest in collaborative support for a full follow-back survey of NHANES III participants that can be linked to genetic information. Further, he highlighted the longitudinal study of aging which measures changes over time in health status, function, and utilization of services. He illustrated these surveys with reports of findings on changing patterns of hospital discharge frequency and on emergency room visits by cause of injury.

Council discussion focused on: distinguishing between Medicare Part A and Part B; criteria used to assess bone density; the retention rate, including differences by sub-population, in the longitudinal survey on aging; the best methods to continue dialogue among the Federal agencies; and, collecting quality of life information.

 

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7. Council Task Force On Minority Aging

The next agenda item was the report of the Council Task Force on Minority Aging. Dr. Harden, Assistant to the Director for Special Populations, NIA, introduced the topic by acknowledging Dr. Eugenia Wang's substantial contributions as past chair. She indicated that Mr. Lambrinos, the new chair of the Task Force, would present data on a program that provides small supplements to MERIT awardees who recruit a minority student to their laboratory. As background for this presentation, Dr. Harden described the MERIT award program. In his remarks, Mr. Lambrinos noted that the twin goals of training minority scientists and pursuing more minority research are consonant with population changes occurring in the country. These changes mean that over time more of the medical problems confronting research are ones that are prevalent in minority populations. He noted that the MERIT minority supplement program is only one of several NIA mechanisms that are designed to increase numbers of highly trained minority researchers. He stated that the task force intends to review all the mechanisms ogether at the September meeting with the idea of developing an integrated long-range plan to increase the numbers of minority researchers and the quality of their training.

Mr. Lambrinos explained that the program provides $5,000 designated to recruit a minority student/scientist to a MERIT awardee immediately on identifying the candidate. He then reviewed awards made by year of the program and noted that though 34 appointments were made in 1995, only one was made in 1996. In looking for reasons for the decline, several factors stand out: unlike in prior years, no letter was mailed to MERIT awardees in 1996 indicating that the program was available; 1996 was a chaotic year in which NIH was closed for almost a month due to a furlough; and, perhaps more importantly, NIA staff were not able to attend the Gerontological Society of America meeting where they had previously advertised the program. In reviewing statistics of appointees, Mr. Lambrinos noted a preponderance of male undergraduate and female graduate students, and no postdoctoral trainees. The majority of appointees were African-American.

Council discussion focused on the reasons for the absence of postdoctoral trainees and the apparent underutilization of this and similar programs. Members also questioned whether $5,000 is sufficient for this program. Staff clarified that this award is a bridging mechanism designed to support students for 2 to 3 months while other support is sought. Members agreed that utilization of these programs is an appropriate topic for the Task Force. Dr. Allen, a Task Force member, urged greater Council participation in the meeting to ensure that a broader Council perspective is provided.

 

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8. Working Group On Program

Dr. Trojanowski presented the report of the Working Group on Program. Because of Dr. Wang's absence, the Working Group discussion of NIA training programs was postponed until the September meeting. Dr. Trojanowski mentioned that interim reports are now voluntary and that the NIA Public Information Office can assist in editing the reports. Dr. Wallace, Mr. Lambrinos, and Dr. Allen, together with Dr. Trojanowski, are in various stages of producing reports. The Working Group discussion of the electronic Council books revealed considerable sentiment for their continued use. Dr. Trojanowski observed that he found them slow and difficult to work with when doing intensive work in a particular program area. In planning the next NIA program review, the Working Group recommended that the overall NIA program review on translational research be conducted on the same model as the current NNA program review. Items on the agenda for the September meeting include the postponed discussion of NIA training, and a new suggestion to consider the effects of receiving an "unscored" rating on junior investigators' future research activity. He and Dr. Hodes called for additional agenda items.

Council discussion focused on training activities and their relation to the minority initiatives discussed earlier, and on the best timing of the Working Group and minority task force meetings to ensure broad participation.

Dr. Hodes mentioned that the upcoming Council agenda includes a presentation from the Lead Deputy Commissioner of the Food and Drug Administration. He asked Council members to submit questions or topics they would like to have addressed. He also asked for suggestions for future speakers at Council. Suggestions included a representative from NIMH; the NIH Associate Director for Behavioral and Social Research, focusing on NIH activities in this research area; the Director, National Cancer Institute; and, a speaker to address the topic of the effects of health care reform on medical schools.

 

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9. Adjournment

The 71st meeting of the National Advisory Council on Aging was adjourned at 12:00 noon on May 23, 1997. The next meeting is scheduled for September 25-26, 1997.

Attachments:
A. Roster of Council Members (Not available)
B. Director's Report to the NACA (Not available)

 

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10. Certification

I hereby certify that to the best of my knowledge the foregoing minutes and attachments are accurate and complete.

Richard J. Hodes, M.D.
Chairman, National Advisory Council on Aging
Director, National Institute on Aging

Prepared by Miriam F. Kelty, Ph.D.