Goal B: Better understand the effects of personal, interpersonal, and societal factors on aging, including the mechanisms through which these factors exert their effects

Behavioral and psychological factors — for example, physical activity, smoking and other health behaviors, cognitive and social engagement, personality, and psychosocial stress — play a critical role in health across the lifespan. Studies have shown that up to 50% of preventable deaths in the U.S. can be attributed to adverse health behaviors such as smoking as well as unhealthy diet that result in obesity. Social factors, such as social relationships and socioeconomic circumstances, have a similarly important impact on health and well-being. For example, subjective feelings of loneliness are known to be a risk factor for serious functional declines and even death, and converging lines of evidence from multiple cross-national epidemiological studies indicate that social isolation is a major risk factor for morbidity and premature mortality. And the relationship between personality — relatively stable individual differences in dispositions to think, feel, and act in particular ways — and aging-related outcomes has been well documented: Conscientiousness is related both to longevity and to the development of AD, and neuroticism is linked to health in both positive and negative ways. A more comprehensive understanding of the causal pathways through which behavior, personality, social relationships, and socioeconomic circumstances are associated with health and well-being outcomes may suggest novel targets for intervention.

Furthermore, we now know that behavioral and social factors interact with genetic, molecular, and cellular mechanisms to influence health at older ages. Basic behavioral science is uncovering individual-level psychological, social, and behavioral factors that predict adaptive and healthy aging or confer risk for age-related decline. Evidence suggests that addressing these factors and their interplay are critical to minimizing disease and achieving full potential and vitality as people age. NIA will support and conduct research to verify these linkages and to better understand their underlying mechanisms.

Research supported and conducted by NIA is helping to identify lifestyle factors and health behaviors that directly influence physical, cognitive, sensory, and emotional health and risk of disease as people age, such as research linking work and social engagement to cognition. Scientists are developing and refining recommendations for people of all ages regarding optimal diet, use of dietary supplements, mental stimulation, physical exercise, quality sleep, social engagement, stress reduction, and other practices to increase their likelihood of enjoying healthy old age. Still other researchers are looking for better ways to enhance the physical, mental, and social capacities of older adults and to expand opportunities for them to achieve personal goals and contribute to society in meaningful ways. As investigators more precisely identify the psychological, behavioral, and social processes that influence health and quality of life, we will be able to reinforce prevention efforts, enhance symptom management, and conserve function among older adults.

Goal B objectives:

B-1: Understand the basic behavioral, social, and psychological aspects of aging.
B-2: Illuminate the pathways by which social, psychological, economic, and behavioral factors affect health in middle-aged and older adults.
B-3: Identify developmental, prenatal, early life, and environmental exposures that affect individual differences in trajectories of biological, cognitive, and functional aging; the risk of disease and death; and the capacity for resilience and adaptation.
B-4: Explore the mechanisms that account for the effects of social adversity and disadvantage, including research that focuses on critical periods for reversing such effects and/or the optimal timing of intervention.
B-5: Better understand motivation, decision-making, and mechanisms of behavior change among older adults.
B-6: Consider the role of place in the aging processes, taking into account geography in studies of late-life disability and mortality trends.

Approach

B-1: Understand the basic behavioral, social, and psychological aspects of aging.

Along with new physical, social, and emotional challenges, increasing age brings changes in cognition and emotion that have impacts on subjective well-being, social relationships, decision making, and self-control. How individuals respond to these challenges has implications for their independence, cognitive function, social relationships, mental health, physical function, and economic well-being.

NIA will continue to conduct and support basic research in cognition, emotion, and motivation in normal aging, including their neurobiological and genetic bases. We will also explore these factors’ relationships to individual differences, social processes, and contextual factors. Finally, NIA will continue research on the interrelationships among emotion, cognition, and brain function; this information will guide the development of new biobehavioral interventions.

B-2: Illuminate the pathways by which social, psychological, economic, and behavioral factors affect health in middle-aged and older adults.

Research is needed to help fully establish the pathways through which genes, environments, and behavior interact. We will encourage multilevel and interdisciplinary research on the interactive effects of genes, behavior, biology, and social and physical environments on health and well-being as people age. Finally, we will work to identify important biomarkers that are linked to aging-relevant social and behavioral phenomena, including the integration of neuroimaging data in large-scale surveys and laboratory-based studies with representative samples.

B-3: Identify developmental, prenatal, early life, and environmental exposures that affect individual differences in trajectories of biological, cognitive, and functional aging; risk of disease and death; and the capacity for resilience and adaptation.

Exposure to adverse social, interpersonal, and physical environments can exert profound and long-lasting psychological and physical effects on a developing organism, with long-term impacts on adult physical and cognitive health and longevity. Contextual factors such as residential segregation and socioeconomic status may be associated with or compound the effects of these adverse exposures. Conversely, environmental factors such as educational attainment have been associated with a reduced risk of cognitive decline and dementia. NIA will continue to support mechanistic and epidemiological studies to identify such factors and participate in translational studies to find ways to minimize their effects in adults. NIA will also continue to encourage research using a life-course approach to behavioral, psychological, economic, and social explanations for health outcomes that also incorporates the geroscience agenda.

B-4: Explore the mechanisms that account for the effects of social adversity and disadvantage, including research that focuses on critical periods for reversing such effects and/or the optimal timing of intervention.

Many outcomes and behaviors in older adults are influenced by events, social relationships, noncognitive character skills, environmental factors, and habits that begin relatively early in life. Subgroups of the population experience disadvantage throughout their lives or for extended periods in life that generate persistent stress, and their patterns of stress reactivity appear to hasten the progression of disease. It is therefore important to elucidate the processes by which these adverse social exposures become biologically and psychologically embedded and contribute risk for disease and distress. In addition, it is important to examine the malleability of these biobehavioral risk mechanisms in order to identify opportunities for their amelioration. Life-course data connecting childhood circumstances to midlife/old-age outcomes will facilitate research that identifies such mechanisms. Because many health disparities and chronic conditions emerge in midlife, NIA will continue to support research on processes of aging during this life stage to identify optimal timepoints for interventions to reverse or redirect the impact of early-life adversity and cumulative stress exposures on aging processes.

B-5: Better understand motivation, decision-making, and mechanisms of behavior change among older adults.

As the population ages, it will be important to understand how people make decisions about retirement, lifestyle, social relationships, health, and health care. Age-related changes in the interplay between motivation, cognition, and emotion, along with changes in life circumstances, health status, and social roles, combine to shape how individuals make both everyday choices around health behaviors and major decisions related to life transitions and long-term goals. The ability to make sound decisions is an important component of cognitive health, and deficits in decision-making abilities may be an early warning sign of dementia. NIA seeks to better understand the basic psychological processes involved in decision-making and how they change with aging, how social factors and social networks influence those decisions, and the incentives that motivate middle-aged and older adults to make health-supportive decisions in a wide range of life domains. We will support research in this area along the full spectrum, from neuroeconomic, cognitive and affective research on how aging individuals perceive stimuli and make decisions to social network research.

B-6: Consider the role of place in aging processes, taking into account geography in studies of late-life disability and mortality trends.

Health and mortality can vary dramatically across geographic regions, localities, census tracts, and even ZIP codes. We will continue to support and conduct research to identify the drivers behind these differences as well as policies and interventions that may close gaps between health and mortality in diverse locales.

The Importance of Longitudinal Data on Aging

NIA supports a number of longitudinal studies in which we have already collected a large amount of data on the participants. Because so much is already known about participants in theses studies, they provide us with a unique “living laboratory” in which to study both risk persistence mechanisms and factors that enhance responsiveness to intervention. New techniques for inferring causality from observational studies and complex data are also enabling us to draw important conclusions about the links between behavior and biology, and about possible behavioral interventions, as a complement to experimental studies and randomized controlled trials.

A cornerstone of our longitudinal data collection efforts continues to be the Health and Retirement Study (HRS), NIA’s long-running study of health, retirement, disability, resources, and family support among Americans ages 50 and older. The HRS has been harmonized with similar studies in over a dozen countries in Europe, Africa, South America, and Asia, facilitating partnership and comparative research on aging around the world. HRS has also fielded a cost-effective algorithmic approach to assessing cognitive impairment and dementia, the Harmonized Cognitive Assessment Protocol, that will provide a basis for comparing trends over time across the U.S. as well as other countries with HRS-like longitudinal studies of aging. We will continue to invest in a robust data collection infrastructure that enables study of the influence of population aging on the health and well-being of older adults. Finally, we will continue our investments in select studies originally conceived of for other purposes but valuable for the study of early-life and midlife conditions and intergenerational influences on later-life outcomes. Cohorts from studies such as the Wisconsin Longitudinal Study and the Midlife in the U.S. Study, among many others, can be followed as they move through middle age to older adulthood in order to identify early-life risk and protective factors for age-related disease and dysfunction.