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Goal E: Improve our understanding of the consequences of an aging society to inform intervention development and policy decisions

While the increased longevity and improved health at older ages seen in many parts of the world represent one of the crowning achievements of the 20th century, these trends also present significant challenges. Societal aging can affect economic growth, patterns of work and retirement, the way that families function, the ability of governments and communities to provide adequate resources for older adults, and the prevalence of chronic disease and disability.

At the same time, the U.S. lags behind other developed nations with respect to health, longevity, and other key indicators. For example, gains in life expectancy over the past 30 years have not kept pace with those in other developed nations. Since 1980, Americans have, on the average, gained five years in life expectancy from birth, while individuals living in comparable nations have gained eight.1

NIA will continue to support research on the social, economic, and demographic consequences of the aging population in the U.S. and other countries. We will support research to better understand the impact of the changing age composition of the population and economic factors across the lifespan that affect health and well-being.

Goal E objectives:

Approach

E-1: Understand how population aging and changes in the social, economic, and demographic characteristics of cohorts reaching old age affect the health and well-being of older adults in the U.S. and other countries.

  • Identify, analyze, and track changing patterns of disability and mortality for older adults and better understand factors contributing to these patterns. Research supported and conducted by NIA will address disability dynamics at several levels, including longitudinal research to understand the determinants of onset, severity, and recovery from disabling conditions. At the population level, we will foster research to understand the pathways to disability and the causes of change in mobility and function over time as well as subgroup disparities. We will also invest in research on more sensitive measures of functional disability that are needed to better track these changes.

  • Analyze the effects of social and demographic factors on health and well-being at older ages. For example, educational attainment is one of the strongest correlates of physical health and cognitive functioning at older ages. We will support research to unravel the reasons for such connections, help project health and long-term care needs, and devise ways to intervene and to reduce disparities.

  • Assess the impact of changing family structures on health and caregiving. NIA will support research on the ways the evolution of the American family structure will affect the well-being of older adults. Changing kinship systems in modern American society and unprecedented demographic changes have profound implications for living arrangement options for older adults, cost of living, cost of health care, caregiving, retirement, and Social Security. Researchers will need to examine how the availability of home- and community-based services (e.g., adult day services, home visits, and assisted living) influences the experience of family caregiving.

  • Encourage comparative analyses to evaluate the impact of institutions and networks on population and individual well-being and foster longitudinal studies on aging. Other countries have larger proportions of their populations at older ages than the U.S., and some of those with currently younger populations are aging at a much more rapid rate. We will support comparative research on the effects of these changes on behavior, and we will evaluate institutional reform efforts to gain insights useful both in the U.S. and elsewhere for enhancing population health.

  • Examine the bases for individual and societal attitudes toward older adults and develop effective strategies to improve them. Older adults may hold negative attitudes about their own aging or be the target of inaccurate and negative stereotypes and discrimination. We will support research to explore the causes of these negative attitudes and develop strategies to counter them with behavioral, community, and other interventions. For example, engaging older adults in meaningful volunteer work may prove to be a “win-win” situation, replacing the image of dependence with one of active and productive citizenship. Understanding the individual, interpersonal and institutional drivers of both positive and negative attitudes toward aging can help identify malleable targets for intervention.

  • Continue research on the measurement of subjective well-being in a policy-relevant framework. Measurement of subjective and psychological well-being in population-based surveys and in intervention studies holds potential for understanding how older adults’ lives are affected by major challenges of aging, including retirement, caregiving, living with disability, onset of illness and impending death, and for ensuring that interventions promote not only better health, but better quality of life at older ages.

E-2: Understand how social and economic factors throughout the lifespan affect health and well-being at older ages.

Individual differences in potential for a healthy and secure old age emerge in midlife. For example, chronic conditions and disability influence work and employment decisions for many older and even middle-aged individuals. NIA will continue to:

  • Support and conduct research on how middle-aged and older adults manage the multiple health-related decisions imposed by increasing longevity. NIA will support research to better understand the social determinants of health and well-being of older adults, including incentives and supports provided by public and private programs that have an impact on health outcomes. Such research will include the measurement of the economic value of good health.

  • Support research on the consequences of changes in older Americans’ experience of work and retirement. Age at retirement in the U.S. has been rising over the last few decades, primarily as a consequence of changes in women’s labor force participation, changes in pension plans, and increasing education. Still, most workers today can expect to spend two decades in retirement; some may be retired for three or more decades. The intersection of implications of changes in working life for the health and well-being of older adults during retirement remains an important area of investigation that can inform intervention and policy decisions.

  • Support and conduct research that models and measures the economic risks of old age with the potential for developing interventions to protect against these risks and adverse health consequences. Demographic and retirement income trends lead to expanding economic risks among older Americans and associated impact on health. Many Americans will require long-term care, but few purchase private insurance to support formal care expenses. We will support research to understand the behavioral aspects of demand for insurance against these older-age risks as well as alternative models to support efficacious long-term care.

  • Promote the development of data resources to support the development of effective interventions. Measures of time use, experience sampling, and in-home sensor-based technologies also offer potential for new insights for understanding and designing interventions to promote healthy aging.

E-3: Conduct research aimed at modifying organizational or individual behaviors in order to improve important health outcomes among members of population groups at older ages.

Research examining the cognitive effects of work and retirement as well as changing environmental defaults to influence health-related aging outcomes have generated findings with enormous practical implications. Country comparisons available through harmonized surveys have revealed the role of a longer work/career life in maintaining cognitive function. Recent evidence also suggests that changes in the economic incentives within the Medicare program increase the use of preventive services. We will support research to better understand the factors in the health care system that support prevention and the successful management of disease. Through support of research that identifies institutional mechanisms that affect health, NIA will encourage institution-level interventions involving economic, organizational, and systemic interventions to promote better health and reduce health disparities.

E-4: Understand and address the reasons the U.S. is falling behind other countries in health and mortality.

The current pattern of increased “active life expectancy,” the average number of years an individual will live without a limiting disease or disability in parallel with increased length of life, is threatened by increases in obesity and disability rates among younger Americans. Likewise, longevity rates in the U.S. are lagging relative to other developed nations. We will support research to understand and address the reasons for these trends.