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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, they 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.

NIA will continue to support research on the social, economic, and demographic consequences of the aging population in the United States 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.

Our objectives in this area are to:

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 United States and other countries.

  • Analyze the effects of social and demographic factors on health and well-being at older ages. Educational attainment, for example, is one of the strongest correlates of physical health and cognitive functioning at older ages, and changes in family structure can affect both the need for and the supply of informal caregivers. 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.
  • Seek to better understand decision making among older adults. As the population ages, it will be important to understand how people make decisions about retirement, lifestyle, health, and health care. NIA seeks to better understand the incentives that keep people in the workforce and what motivates people to make healthy choices. 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.
  • Assess the impact of changing family structures on health and caregiving. NIA will support research on the ways in which 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 care, 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 United States, 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 United States and elsewhere for enhancing population health.
  • Examine the bases for individual and societal attitudes toward older people and develop effective strategies to improve them. Older people may 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 community and other interventions. For example, engaging older people in meaningful volunteer work may prove to be a "win-win" situation, replacing the image of dependence with one of active and productive citizenship.
  • 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 impacted by major challenges of aging, including retirement, caregiving, living with disability, onset of illness and impending death, and for assuring 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, work and other decisions by people in their 50s and 60s are already affected by chronic conditions and disability. 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 people, 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 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 concomitant 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 old age risks.
  • 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, the basic science of behavior change, and 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-life in maintaining cognitive function. Recent evidence suggests that personality and self-control are relatively stable individual traits that predict long-term health and mortality. NIA will continue to support interventions involving behavioral treatments, economic incentives, dynamic recursive treatment regimes, and conditioned incentives interventions to promote adaptive behaviors in midlife and older age. We will support research to better understand the factors in the health care system that support prevention and the successful management of disease.