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Goal C: Develop effective interventions to maintain health, well-being, and function and prevent or reduce the burden of age-related diseases, disorders, and disabilities

As previously noted, aging is the primary risk factor for an array of diseases and conditions. However, research has shown that health habits and behaviors such as physical activity, proper nutrition, and avoidance of smoking and other health-harming behaviors can help people live longer, postpone the onset of disability, and increase quality of life and function at older ages.

Conversely, unhealthy lifestyle choices may be associated with significant health problems. However, research has shown that it is almost never too late to decrease risk of disease and disability by establishing healthier patterns. Research has also shown that optimizing both the physical and social environment is important to the health and functioning of older adults.

While much of our research in this area will promote the most basic and fundamental aspects of health and well-being — a nutritious diet, adequate exercise, and healthy behaviors — we will also aggressively leverage powerful emerging technologies that will result in new and effective ways to maintain health and independence. For example, wearable technologies can help older adults and their health care providers track both activities and health indicators such as blood pressure and exercise level in real time. Apps linked to a phone or device can assist with medication management. And remote sensors and artificial intelligence can be integrated to facilitate care of older adults, including those with dementia, and may also help older adults remain comfortably within their own homes as they age.

Goal C objectives:

Approach

C-1: Develop efficacious and cost-effective strategies for promoting and ensuring adherence to healthy and safe behaviors among older adults.

  • Build on our understanding of the roles of nutrition, obesity, sleep, and metabolic status to develop more effective health maintenance strategies. Epidemiological studies — and, in some cases, studies in animals — have shown clear positive effects of lifestyle choices such as healthy diet and physical activity, as well as the negative effects of obesity, malnutrition, and less-than-optimal sleep patterns on health and age-related morbidity. We will use these and other findings to launch clinical trials of dietary and other behavioral measures and adherence strategies for the prevention or delay of disease and disability.

  • Support research on mechanisms of behavior change in midlife and older age. Behavior change is difficult, yet adherence to healthy lifestyles can reduce the risk of disease and increase healthspan. Having a better understanding of how and why successful behavior change occurs is the key to providing blueprints for effective and efficient behavior interventions that could reliably improve health outcomes. We will support research on the behavioral, psychological, interpersonal, and neurobiological mechanisms that drive healthy behavior change to inform the design of interventions to prevent disease and promote adaptive aging.

  • Use our increased understanding of the underlying science to maximize the positive effect of physical activity on older adults. Several studies strongly suggest that modest physical activity may have beneficial effects in maintaining health — including mental health — and that these benefits are possible even at advanced ages. For example, weight-bearing exercise can build bone strength, protecting against osteoporosis and subsequent fragility fractures, and balance exercises such as Tai Ji Quan may help prevent future falls. We will:

    • Continue to foster research into the molecular, cellular, and physiological mechanisms by which physical activity improves health.

    • Support further research on the effects of physical activity programs on older adults within specific age groups and develop strategies for promoting adherence.

    • Continue to disseminate information about the importance of hysical activity or older adults.

    • Study the effects of physical activity and exercise on mental health and cognition.

    • Support basic and translational research on the behavioral, psychological, and interpersonal mechanisms that support initiation and long-term engagement in physical activity over the adult lifespan.

  • Continue to support and conduct research to understand hormone changes in older adults and pursue the development of interventions to address these changes without unwanted side effects. Counteracting some effects of aging by supplementing hormones such as estrogen, testosterone, human growth hormone, melatonin, and DHEA (dehydroepiandrosterone) is an area of active study, but there are concerns that individuals may be taking such agents before their safety and efficacy have been established. NIA will support studies to understand the biological action of hormonal changes in older men and women, assess whether or not hormone therapy will improve health, investigate the use of compounds to produce the beneficial responses of hormones in the body without detrimental side effects, and determine the potential to regulate hormone production in specific body tissues where increased or decreased amounts of these hormones are favorable to health.

  • Support and conduct research to understand and address the needs of people with multiple chronic health conditions. Data from the Centers for Disease Control and Prevention show that more than half of Americans ages 65 and older are living with two or more chronic conditions. NIA will support research to identify, test, and disseminate interventions to facilitate optimal management of multiple conditions.

  • Improve the safe use of medications by older adults. Managing medications can be complex for older adults; their medications are often prescribed by more than one physician, for multiple health problems. Complications include adverse drug interactions and interactions with dietary supplements coupled with the physiological and functional changes associated with aging or age-related diseases. Research supported and conducted by NIA will improve our understanding and maximize the effectiveness of medications, develop new technical aids for physicians to monitor drug use, and provide new technologies and information to enable patients to manage medications better and avoid adverse reactions.

  • Develop strategies to reduce falls and their consequences. Research supported and conducted by NIA will continue to identify safety risks for older adults in home and work environments, improve screening strategies, and develop and disseminate information important to reducing the risk of falls.

  • Explore new ways to improve safety in the home and community through studies of ergonomics and the built environment. This will include continuing research to identify cost-effective alterations in design that can reduce injuries and provide a safer environment for older adults, and an environment that encourages physical activity and social engagement.

  • Pursue a better understanding of needs and develop interventions to improve the safety of older drivers. NIA will continue to support research to identify factors such as visual impairment, hearing, attention, speed of processing, and other cognitive changes that put older drivers at risk of automobile accidents. In addition, we will continue to support the development of tools for assessing visual, cognitive, and other abilities associated with safe driving, interventions to improve the physical and cognitive skills necessary for safe driving, and technology and design changes to accommodate or compensate for the special needs of older drivers. We will also support research to understand the dynamics of making the decision to stop driving, the implications of that decision for the health and well-being of older adults, and alternative transportation options that help older adults maintain as much independence as possible. This research will provide the insights needed to develop guidelines for older adults, their health care providers, and family members.

C-2: Develop improved approaches for the early detection and diagnosis of disabling illnesses and age-related debilitating conditions.

NIA will help develop and evaluate improved biochemical, imaging, and other techniques and tools to measure the well-being of older adults as well as symptoms of disease and disability. As new interventions are ready, the institute will disseminate information about the interventions to the public and health care communities, working to help move interventions into mainstream medical practice.

C-3: Develop interventions for treating, preventing, or mitigating the impact of age-related diseases and conditions.

  • Investigate the mechanisms by which lifestyle interventions affect aging-related changes and determine how individuals can maintain function with age or regain that function after loss due to immobility, illness, or trauma. After peaking in early adulthood, most tissue functions decline with advancing age. This leads to increased risk of developing diseases such as cardiovascular disease and cancer and may lead to declines in overall health and quality of life. Further research is needed on the mechanisms through which common interventions, both medical and behavioral, may slow physical and cognitive decline. NIA will continue to support research into the mechanisms of functional decline and its delay, with the goals of identifying molecular targets for drug interventions and treatments that minimize losses and promote the recovery of function after illness or trauma.

  • Support the development of behavioral interventions based on principles of basic behavioral and social science and designed with an eye to real-world implementation, in line with the NIH Stage Model. Because behavioral interventions frequently do not move beyond efficacy testing to effectiveness or implementation, NIH has developed a model to define and clarify the activities in behavioral intervention development and to facilitate scientific development of interventions that are both potent and implementable. NIA will use this model as a guide for developing interventions that will be effective in real-world settings. (Learn more about the NIH Stage Model).

  • Identify, characterize, and where appropriate, develop interventions for physiological changes that influence the risk of age-related diseases across the human lifespan. Studies will include changes that are associated with increased risk of disease and disabling conditions such as sarcopenia (reduced muscle mass), as well as those that are associated with exceptional health and longevity.

  • Conduct clinical studies and encourage the translation of new interventions to the clinical setting. As mechanisms, pathways, and processes of disease are better defined, and as potential healthspan-extending interventions are validated in model systems,development and testing of clinical applications in humans can begin. We will pursue the use of novel, flexible research designs where appropriate, and we will work with others to facilitate the navigation of barriers to the translation of promising compounds into clinical trials and ultimately approval by the U.S. Food and Drug Administration.

  • Support comparative effectiveness research. NIA will continue to support research to identify the relative merits of differing interventions for older adults. For example, investigators are testing the effectiveness of different interventions in improving quality and efficiency, eliminating disparities in treatment, and reducing unwarranted variations in expenditures at hospitals. Still others are comparing physical activity interventions and cognitive interventions to determine their relative effectiveness and examining the interactive effects of a combined physical activity/cognitive intervention program.

C-4: Find significantly improved and cost-effective ways to reduce caregiver, family, and patient stress and improve older adults’ ability to cope with chronic disease.

Families and others who care for people with chronic disease frequently face emotional stress as well as physical and financial burdens. At present, the direct economic costs of caregiving to caregivers and society are unknown, and it is not well understood how caregiving impacts the health and well-being of some caregivers and why some caregivers thrive in the experience of caregiving, whereas others experience distress, burden, and unhealthy outcomes of their own. Using approaches grounded in basic behavioral and social science, investigators will continue to develop and evaluate strategies to improve social support, skills training, and assistive services both for those who cope with chronic disease and for their caregivers. These initiatives should result in more effective and implementable approaches for prevention, treatment, and rehabilitation, as well as the ultimate adoption of these approaches in real-world contexts. Research supported and conducted by NIA will clarify needs and patterns of family caregiving and how people make decisions on providing care and inform guidance on support and skills, including a focus on families with diverse ethnic and socioeconomic backgrounds.

  • Develop strategies to help older adults and their families prepare for and manage age-associated changes in health, income, function, and roles. Older adults and family members are faced with many complex decisions about medical treatment and various aspects of their retirement, finances, and long-term care that can affect their independence and well-being. Issues of concern include the ability of health care delivery systems to support patient and family needs, adherence to a patient’s advance directives, and financial resources to cover out-of-pocket costs for acute and long-term care and assistance needed for maintenance of optimal health. We will support research to develop data resources incorporating work, financial status, health care utilization, and outcomes to allow analyses of pathways to independent healthy aging. We will support the development of principle-based supportive interventions that can be implemented in real-world contexts. Research findings will be useful for people as they plan for later-life transitions as well as to inform policy decisions.

  • Investigate the social aspects of family caregiving and develop and disseminate effective interventions for patient care in family and community settings.

    • Assess and evaluate family relationships over time. This research will help us understand the role of interpersonal processes and the effects of changing relationships and social roles on the health and well-being of older adults.

    • Address issues centered on the increased demands faced by family caregivers in light of changing patterns of work and family demographics. We will pay particular attention to the ways in which characteristics such as gender, marital status, income, socioeconomic status, race, and ethnicity influence these demands.

  • Research and develop strategies to improve decision making for long-term and end-of-life care. There is a pressing need to identify approaches that will ensure quality, affordable long-term care that maintains optimal health and function for older adults. There is also a critical lack of peer-reviewed research on how to improve quality at the end of life. To better address these issues, we will:

    • Support research to examine component parts of health care delivery systems and their impact on medical, social, functional, and cost outcomes and use this information to test interventions to improve care. This research will help inform the development of interventions to coordinate care that promotes attention to patient and family preferences, facilitates smooth transitions among care settings, and maximizes independence. We will explore ways to support long-term care including care provided in the home. We will focus on interventions that reduce the burdens of caregivers, with an emphasis on the unique challenges faced by caregivers of patients with dementia.

    • Understand caregiving patterns and improve the effectiveness of strategies for helping families manage the care needs of the physically frail. For example, we will support research to identify effective caregiving strategies, environmental modifications, and technological supports for both informal and formal long-term care settings.

    • Develop strategies to improve the experience of older adults at the end of life. We will support research to better understand the decision-making process and changing preferences associated with advance care planning; better understand the transitions among end-of-life care settings such as the home, hospital, nursing home, and hospice; assess the benefit of end-of-life therapies and the cost effectiveness of interventions to improve end-of-life care; develop better measures of end-of-life quality for the patient and the family to improve our understanding of psychosocial issues that impact the end-of-life experience; and understand the social and economic context of caring for an older person who is dying.

C-5: Develop strategies to improve the interaction of older adults with the health system.

For older adults and their families, effective health care requires quality communication with and among health care professionals. According to one study, fewer than 40% of people experiencing symptoms associated with heart and circulatory or musculoskeletal systems seek a physician’s care. Similarly, women often avoid seeking care for urinary incontinence. We will seek better interventions to help older adults recognize the implications of disease-related signs and symptoms and consult a physician or other health care provider when they first occur. And we will work to find ways to help health care providers coordinate their services to older adults to optimize health status.

C-6: Understand and develop strategies to enhance societal roles and interpersonal support for older adults, reduce social isolation, and promote positive caregiving outcomes and supports.

Despite negative stereotypes, millions of older adults work productively, contribute to society, and place a high value on retaining their independence. Research suggests that social support and continued involvement in useful activities foster positive effects on physical and mental health and on longevity. This effort is especially important for older adults who are at increased risk for multiple diseases, disability, and functional limitations that may keep them from fully engaging in the world around them. NIA will continue to support and conduct research to:

  • Identify ways for older adults to retain valued roles and maintain independence. Older men and women often continue to work in paid jobs, perform meaningful work as volunteers, maintain their own households, and/or support children and grandchildren. Research supported and conducted by NIA will seek and apply technological, social, and behavioral findings to interventions that help extend the ability of older adults to remain independent, active, and productive.

  • Understand and develop strategies to address self-neglect, adverse social relationships, and susceptibility to physical, emotional and financial abuse among older adults. NIA will support basic research on the individual, interpersonal, and social environmental risk and protective factors for elder mistreatment and abuse. These efforts will help to inform the design of preventive interventions in individuals at risk for these outcomes. We will continue to partner with other agencies to identify the best ways to detect and address financial fraud and abuse facing older adults, promote adaptive self-care and care of others, and develop strategies to identify and support vulnerable elders in our communities.

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