Budget Request for FY 2010 Witness appearing before the Senate Subcommittee on Labor-HHS-Education Appropriations
Mr. Chairman and Members of the Committee:
I am pleased to present the President’s Fiscal Year 2010 Budget request for the National Institute on Aging (NIA) of the National Institutes of Health (NIH). The FY 2010 budget includes $1,093,143,000, which is $12,347,000 more than the FY 2009 appropriation of $1,080,796,000.
Our nation is currently in the midst of an unprecedented demographic shift. The number of Americans ages 65 and older is expected to double within 25 years. In less than 50 years, the number of “oldest old” – people ages 85 and older – will more than quadruple. As record numbers of Americans reach retirement age and beyond, profound changes will occur in our economic, health care, and social systems.
The National Institute on Aging leads a national effort to understand the nature of aging and the diseases and conditions that are more common among older adults and to develop interventions that will help older adults enjoy robust health and independence, remain physically active, and continue to make positive contributions to their families and communities. We support and conduct a comprehensive and integrated portfolio of genetic, biological, clinical, behavioral, and social research related to the aging process, healthy aging, and diseases and conditions that often increase with age.
UNDERSTANDING HEALTHY AGING AND DISEASE AND DISABILITY
Modern medicine and new insights into lifestyle and other environmental influences are allowing a growing number of people to remain healthy and socially and emotionally vital into advanced ages, and NIA remains at the forefront of the Nation’s efforts to identify the genetic, physical, emotional, and environmental factors that contribute to healthy old age. For example, researchers on the NIA-supported Long Life Family Study are analyzing data from families with two or more siblings over age 79 to identify factors that may contribute to long and healthy life, and the Longevity Consortium brings together leading researchers to facilitate the discovery, confirmation, and understanding of genetic determinants of longevity. NIA intramural investigators are continuing the SardiNIA Project to search for genes associated with nearly 100 traits in a small, genetically homogeneous population and the Age, Gene/Environment Susceptibility (AGES) Study to explore genetic susceptibility and gene/environment interactions that contribute to various health outcomes in old age.
NIA’s biology programs are wide ranging and address organs, systems, and processes throughout the body. For example, the Institute supports research on long-term weight maintenance, diet composition, and energy balance as well as the role of nutrition in the prevention of common age-related conditions such as heart disease and cancer. NIA is also collaborating with the National Institute of Allergy and Infectious Diseases to support research to better understand the mechanisms underlying age-related decline of the thymus, an organ that produces white blood cells known as T cells, a critical component of the body’s ability to launch a robust immune response against infections. Studies on basic bone biology have led to the surprising finding that the protein Lrp5, an important factor in the process through which new bone is created, regulates bone mass formation through serotonin synthesis in the intestine, and not by acting directly on the bone, as was previously believed. This finding broadens our understanding of bone remodeling and suggests new therapeutic approaches to increase bone mass. Research initiatives to help us better understand mechanisms of anemia, chronic kidney disease, and thyroid dysfunction in the elderly have also been established at NIA, and an advisory “summit” meeting was held in September 2008 to identify areas of scientific opportunity and facilitate the formulation of future plans for research on the underlying biology of aging-related changes.
Cognitive aging is a high priority research area for NIA. A new focus on brain health, as opposed to the study of specific causes of brain disease and dysfunction, has emerged in recent years and has become an increasingly important paradigm in neuroscience research. NIA is continuing its involvement with the trans-NIH Cognitive and Emotional Health Project to coordinate and accelerate research leading to interventions for neurological health, as well as with the NIH Neuroscience Blueprint Toolbox initiative on the development of assessment tools for cognitive and behavioral health. NIA also continues to support studies of age-related changes in cognition, including grants funded under two new and related research initiatives – one to develop neural and behavioral profiles of normal cognitive aging and one to develop interventions to remediate age-related cognitive decline as distinct from Alzheimer’s disease (AD) or related conditions.
PROMOTING HEALTHY AGING AND PREVENTING AGE-RELATED DISEASE AND DISABILITY
NIA is continuing to support the development of interventions to maintain health and prevent age-related disease and disability. For example, NIA-supported researchers are conducting a number of studies aimed at reducing the incidence and severity of falls, the leading cause of both fatal and nonfatal injury among older adults in the United States. Ongoing studies are exploring the association between vitamin D insufficiency and fall risk; examining the effects of neighborhood environmental characteristics on risk of outdoor falls; and focusing on development of strategies to improve strength, balance, and gait in the elderly.
The NIA-supported Advanced Cognitive Training for Independent and Vital Elderly Study was the first randomized, controlled trial to demonstrate long-lasting, positive effects of brief cognitive training to forestall cognitive decline in older adults. However, the training did not improve the participants’ ability to tackle everyday tasks. More research is needed to translate the findings from the laboratory into interventions that are effective at home. In 2008, NIA solicited research to convert insights from previous work in cognitive aging into feasible intervention strategies, including cognitive training, lifestyle interventions, dietary interventions, or behavioral change that can be tested in randomized clinical trials. Investigators are encouraged to develop interventions addressing the role of individual differences in cognition, personality, and sociocultural factors in mediating or moderating adherence and outcomes. This research will be active in 2010.
The development of interventions that will extend life span as well as health span is another emerging area of study. Through the innovative Interventions Testing Program, NIA-supported researchers are investigating promising treatments, including diets, pharmaceuticals, and nutritional supplements, that have the potential to extend the life span and delay disease and dysfunction in mice, with the long term goal of identifying those interventions most likely to have a beneficial effect in humans. Fourteen compounds are currently under study, with three more slated to be added in 2009. Testing on these compounds will continue through 2010.
EARLY DETECTION, DIAGNOSIS, AND TREATMENT OF AGE-RELATED DISEASE
Improved technologies as well as advances in our understanding of the mechanisms of disease are allowing for the development of interventions to predict, detect, diagnose, and treat age-related disease and disability. Scientists in NIA’s groundbreaking Alzheimer’s Disease Neuroimaging Initiative have made a significant step forward in developing a test to diagnose the early stages of Alzheimer’s disease (AD) earlier and more accurately by measuring two biomarkers—tau and beta-amyloid proteins—in cerebrospinal fluid. The investigators found that certain changes in biomarker levels in cerebrospinal fluid may signal the onset of AD. They also established a method and standard for testing of these biomarkers.
NIA currently supports over 30 clinical trials of interventions to prevent, slow, or treat AD. Interventions under study include a highly promising immune approach; hormonal treatments, including testosterone and raloxifene; diabetes drugs such as metformin and insulin; antioxidants; physical and mental exercise; commonly used psychiatric drugs; and many others. The identification of imaging and biological markers as well as the development of improved clinical and neuropsychological evaluation methods will enable us to perform less expensive, shorter, and more efficient intervention trials.
In addition, NIA supports studies of treatments for a variety of other conditions including new therapies for menopausal hot flashes; hormone supplementation in men with symptoms related to low levels of testosterone; and cognitive behavioral therapy for older adults with arthritis pain and insomnia. A follow-up study to the ground-breaking Diabetes Prevention Program established the efficacy of a lifestyle intervention and drug treatment that can sharply decrease the risk of type 2 diabetes in overweight individuals, which was most pronounced for individuals age 60 or over.
ADDRESSING THE SOCIETAL IMPLICATIONS OF AN AGING POPULATION
The social and economic implications of aging are multi-faceted. NIA supports long term studies of older Americans covering a wide range of topics, including retirement and economic status, care giving, behavioral medicine, the dynamics of health and functional change at older ages, cognition, and long-term care. These studies include the ongoing Health and Retirement Study, the leading source of combined data on health and financial circumstances of Americans over age 50 and a valuable resource to follow and predict trends and help inform health policy. NIA also supports studies on the social, emotional, cognitive, and motivational processes and neurobiological mechanisms of economic behavior as these influence social, financial, and health-related decisions of middle-aged and older adults.
One of NIA’s most urgent priorities is to improve our ability to reduce health disparities and eliminate health inequities among older adults. NIA works to identify ways to reduce health disparities through its Resource Centers for Minority Aging Research, and the Institute has compiled a web-based toolkit on outreach, recruitment, and retention of minority populations in clinical research on aging. Through the Healthy Aging in Neighborhoods of Diversity across the Life Span study, NIA intramural researchers are continuing their efforts to disentangle the complex relationships among race, socioeconomic status, and health outcomes.Other programs, notably the NIA Alzheimer's Disease Centers, have a strong focus on minority health and health disparities in both research and outreach.
Once again, thank you. I welcome your questions.
Richard J. Hodes, M.D.
Director, National Institute on Aging
Richard J. Hodes, M.D., directs the research program of the National Institute on Aging (NIA) at the National Institutes of Health. A leading immunologist, Dr. Hodes was named Director of the NIA in 1993, to oversee studies of the basic, clinical, epidemiological and social aspects of aging. Under Dr. Hodes’ stewardship, the NIA budget has surpassed $1 billion, reflecting increased public interest in aging as America and the world grow older. Dr. Hodes has devoted his tenure to the development of a strong, diverse, and balanced research program, focusing on the genetics and biology of aging, basic and clinical studies aimed at reducing disease and disability, including Alzheimer’s disease and age-related cognitive change, and investigation of the behavioral and social aspects of aging. Ultimately, these efforts have one goal -- improving the health and quality of life for older people and their families.
In the past decade, the NIA has worked in new and innovative ways to conduct research and to translate research findings into practical interventions and public information. In Alzheimer’s disease (AD), new initiatives to find genes involved in AD and to identify biomarkers are expected to considerably reduce the length and cost of clinical trials, thereby speeding up the testing of new therapies for AD. In studies of the basic biology of aging, research conducted and supported by the NIA examines the genetic and other factors influencing lifespan and age related diseases and conditions. Research in geriatrics and clinical gerontology is uncovering new ways to combat the development of frailty and disability with age, and social and demographic research is deepening understanding of the individual behaviors and societal decisions that affect well-being.
Dr. Hodes is a Diplomate of the American Board of Internal Medicine. In 1995, he was elected as a member of The Dana Alliance for Brain Initiatives; in 1997, he was elected as a Fellow of the American Association for the Advancement of Science; and in 1999, he was elected to membership in the Institute of Medicine of the National Academy of Sciences.
Dr. Hodes is a graduate of Yale University and received his M.D., from Harvard Medical School. As an author of more than 200 research papers, he is an influential scientist in and contributor to the field of immunology.