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Fiscal Year 2003 Budget

Behavioral and Social Research

Behavioral and lifestyle factors have a profound impact on health throughout the lifespan.

Older adults can help to prevent disease and disability and improve their quality of life through healthy behaviors such as proper nutrition, exercise, use of preventive health care, and avoiding smoking and alcohol abuse. Several particularly encouraging studies have shown that disability rates are declining, and NIA research is focusing on ways to sustain and even accelerate the decline in disability, including the use of behavioral interventions and the health care system by older people. In addition, important research efforts, such as the national Health and Retirement Study, continue to collect and analyze demographic data that inform public policy and planning for the health, economic, and social needs of a growing older population.

Potential Impact of Attitudes on Health and Behavior

Emotional state has been associated with health and functional status in old age. Both positive and negative attitudes or emotions can influence health and physical and cognitive function.

Positive Emotions in Early Life Linked to Longevity. Findings from the Nun Study, a longitudinal study of Alzheimer's disease and aging that follows the lives of older members of a religious order in the United States, indicate that positive emotional content in early life autobiographies was strongly associated with longevity six decades later. Nuns who expressed more positive emotions in their autobiographies lived significantly longer than nuns expressing fewer positive emotions. Finding such a strong association between written positive emotional expression and longevity indicates a need for research that sheds light on the underlying mechanisms responsible for and associated with this relationship.

Personality Determinants of HIV Risk Perceptions and Behavior Changes. Eleven percent of people with AIDS in the United States are over age 50.11 A recent study conducted in an economically disadvantaged and high-risk group suggested that personality traits are associated with perceptions of risk for HIV. The investigators also found that individuals who believed they were at high risk for being infected with HIV were no more likely to increase condom use after a four-session risk reduction intervention than those who thought they were at low risk. However, individuals who showed greater conscientiousness and those who had a stronger sense of their own competence and ability to control their own behavior were more likely to adopt condom use. These findings provide insight into high-risk sexual behavior among older Americans and may help us develop interventions that modulate them.

Physical and Cognitive Disability Continue To Decline Among American Elders.

When scientists assess disability in the population, they may look at a number of factors. One is the extent to which individuals can conduct basic activities of daily living such as eating, dressing, or bathing or participate in routine care activities such as everyday household chores or managing money. Scientists also track the extent to which cognitive disabilities such as memory loss are present in the population. Recent studies have indicated that both physical and cognitive decline are decreasing among the elderly in the United States.

The 1999 National Long Term Care Survey (NLTCS), the latest of a series of surveys of the elderly population (particularly those who are functionally impaired), continues to document a dramatic decline in the overall prevalence of physical disability among older Americans over the past two decades. While 26.2 percent of the elderly were assessed as disabled in 1982, this figure dropped to 19.7 percent in 1999. In addition, successive iterations of the NLTCS suggest that the rate of disability decline may be accelerating. Of particularly note is the sharp—and accelerating—reduction in disability rates among African Americans during the 1990s, reversing trends from the 80s.

Results from the 1999 NLTCS also show large declines in severe cognitive impairments, with 900,000 fewer cases in 1999 than expected based on the 1982 rates—a decline in prevalence from 5.2 to 2.7 percent. The finding that cognitive disability is declining is supported by evidence from the Health and Retirement Study, a major national study of the lives of older Americans. In this study, declines were especially large among those with less than a high school education and those ages 80 and older.

Cognitive decline is most prevalent in the oldest old, the segment of the population projected to grow most rapidly in coming years. Thus, if current rates of cognitive impairment persist, the actual number afflicted will increase dramatically. A decline in the percentage of cognitively impaired would have an important effect in countering this trend. These findings are potentially of great significance in identifying and addressing causes of disability, as well as informing national health care policy. Declining rates of chronic disability may also moderate the burden of caregiving, including the informal care provided within families, the care provided through home health services, and the care provided in long-term care institutions. Most importantly, they indicate that elderly Americans are more likely than ever to enjoy the robust health and independence that characterize a life free of chronic physical or cognitive disability.

  1. AIDS Among Persons Aged $ 50 Years --United States, 1991-1996. MMWR 47: 21-27, 1998.