DEPARTMENT OF HEALTH AND HUMAN SERVICES
NATIONAL INSTITUTES OF HEALTH
Fiscal Year 2009 Budget Request
Witness appearing before the
House Subcommittee on Labor-HHS-Education Appropriations
Richard J. Hodes, M.D., Director
National Institutes on Aging
Richard J. Turman, Deputy Assistant Secretary, Budget
Mr. Chairman and Members of the Committee:
I am pleased to present the President’s budget request for the National Institute on Aging (NIA) of the National Institutes of Health (NIH). The Fiscal Year (FY) 2009 budget of $1,048,278,000 includes an increase of $1,018,000 over the FY 2008 appropriated level of $1,047,260,000.
NIA leads a broad scientific effort to understand the nature of aging and to extend the healthy, active years of life. I appreciate the opportunity to share NIA’s progress and plans.
Today, the nation is in the midst of a truly 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.
Advanced age is a risk factor for many diseases and conditions including cardiovascular disease, cancer, osteoporosis, osteoarthritis, and Alzheimer’s disease (AD). Nevertheless, the rate of disability among older Americans continues to decline. The percentage of American elders reporting some level of disability fell from 26.5 percent in 1982 to 19 percent in 2004-2005. At the same time, however, data from the National Health Interview Survey show that the disability rate among people ages 18-59 has risen significantly in recent years, with the growing prevalence of obesity an important factor in this trend. In fact, some demographers forecast a complete leveling off of the disability decline in the coming decade.
NIA leads the Nation’s research effort to transform the landscape in aging research through a robust portfolio that covers all aspects of aging, from the basic cellular and molecular changes that occur as we age to the prevention and treatment of common age-related conditions to the behavioral and social aspects of growing older, including the demographic and economic implications of an aging society. In addition, our education and outreach programs provide vital information to older people on a wide variety of topics to assist them in more effectively participating in their own care and decision making.
Increasing Our Understanding of Aging Processes and Aging-Related Changes
The study of age-related changes at the molecular, cellular, organ, and tissue levels provides the foundation for understanding diseases and conditions of old age and suggests potential strategies for the development of interventions to prevent disease and maintain optimal health. For example, we know that compared to young adults, the elderly show substantial losses in the ability of tissues and organs to recover from illness or injury. Researchers hypothesize that age-related loss of stem or precursor cells, loss of function in these cells, or loss of the environments needed to initiate repair of weakened or damaged tissues may be responsible. This year, NIA will solicit research applications to identify the cell lineages necessary for tissue maintenance in health and disease. Also, in FY 2007, NIA solicited grant applications for research collaborations to increase our understanding of the interplay among various mechanisms responsible for the repair or removal of damaged, mutated, or misfolded cellular proteins. Findings from this research will provide important information about fundamental processes of aging and may have implications for a number of age-related diseases.
The promise of translational research is exemplified in the Alzheimer’s Disease Translational Research Initiative, which speeds research across the continuum of intervention development, from drug discovery to full-scale clinical trials. Twenty-four promising drug candidates are currently under development through this ground-breaking program, with more expected to follow as basic research provides further insights into the pathology of AD. A trans-NIA working group has been established to identify approaches for cultivating translational research and to coordinate new initiatives on translational research in aging. Last year, this group spearheaded an initiative to award supplements to 14 existing research grants in order to promote translation from basic research findings to clinical application; this initiative will be renewed in FY 2009.
Clinical research provides another bridge along the continuum of research from bed to bedside. NIA currently supports 28 AD-related clinical trials, including studies of hormones, dietary supplements, exercise, antipsychotic medications, and anti-inflammatory drugs. Several of these studies examine lifestyle interventions and treatments for cardiovascular disease or diabetes while other interventions target brain b-amyloid, tau, or other aspects of AD pathophysiology. A cornerstone of NIA-supported AD clinical trials is the Alzheimer’s Disease Cooperative Study, a consortium of about 70 research sites around the U.S. that focuses on trials of compounds that are either off-patent, developed for another use but perhaps useful in treating AD, or developed by individual investigators or small companies without adequate resources for clinical trials.
Clinical research is ongoing in other areas, as well, with a particular emphasis on the identification of previously unconsidered avenues for prevention of disease or dysfunction. For example, the recent finding that obesity “spreads” in social networks in measurable ways related to the nature of the social tie suggests that social ties may also be exploited to help prevent obesity in at-risk individuals. Other investigators are exploring the use of various drugs for other indications than those for which they are already used. For example, animal studies suggest that fenoterol, widely used for treatment of pulmonary disease, may be effective in treatment of congestive heart failure. Other studies in animal models have shown that erythropoietin, used to treat certain types of anemia, has a protective effect on the heart if administered shortly after a heart attack. Based on these results, NIA has initiated clinical trials to establish the safety and efficacy of both agents in humans.
Reducing the burden of common yet poorly understood health conditions is another area of emphasis. For example, over half the cases of anemia in older adults occur without a clearly identifiable cause. An ongoing NIA-supported program supports research to better understand the epidemiology, pathophysiology, and clinical aspects of anemia in the elderly. In addition, a consortium to facilitate research on anemia in the elderly and stimulate clinical studies of promising new approaches to its management will be established in early 2008.
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 (RCMARs), and the Institute has compiled a web-based toolkit on outreach, recruitment, and retention of minority populations in clinical research on aging. Other programs, notably the NIA Alzheimer's Disease Centers, have a strong focus on minority health and health disparities in both research and outreach.
Infrastructure for Progress
One of NIA’s most important roles is to build and maintain the infrastructure that will facilitate discovery. Today, I would like to highlight our efforts in two areas.
- Researcher development. We give special consideration for funding to new investigators who narrowly miss the established payline for research project grants using NIA’s discretionary funds and partner with private and nonprofit groups to foster the development of young physician-scientists through the Paul B. Beeson Career Development Awards in Aging Research. We encourage researchers from underserved populations to become involved in aging-related research through the NIA Summer Institute and NIH-wide programs to increase diversity in the research workforce.
- Collaboration. Our partners include other NIH Institutes, other Federal agencies, and collaborators in the private, nonprofit, academic, and for-profit sectors. Ongoing collaborative activities include the Alzheimer’s Disease Neuroimaging Initiative with several Federal, private, and nonprofit partners; interagency agreements with the Centers for Medicare and Medicaid Services for data sharing on large, longitudinal studies such as the Health and Retirement Study; the Study of Women’s Health Across the Nation, a longitudinal study of the menopausal transition with the NIH Office of Research on Women’s Health; and NIHSeniorHeath.gov, a website jointly developed with the National Library of Medicine and regularly updated with information from other NIH Institutes.
Transforming the Future
Research on aging has benefited tremendously from the development of new technologies that are propelling the field forward. For example, new functional imaging technologies are enabling us to visualize brain activity at the molecular level in “real time.” Coupled with new compounds such as Pittsburgh Compound B, IMPY, and FDDNP, which permit visualization of Alzheimer’s disease’s pathological lesions in the living brain, these tools will have far-reaching effects on how we diagnose, treat, and monitor AD. Another emerging technique, genome-wide association studies, involves rapidly scanning markers across the complete sets of DNA, or genomes, of many people to find genetic variations associated with a particular disease. This powerful technique has facilitated the identification of a number of genes, notably SORL1, which NIA-supported investigators recently determined to be associated with an increased risk of late-onset AD as well as genes connected with blood lipid levels, which are important risk factors for coronary artery disease. These and other new technologies are facilitating discoveries that are enabling us to better understand the underlying mechanisms of disease, which will in turn facilitate the development of interventions and preventive strategies tailored to individuals.
Once again, thank you. I welcome your questions.
 Manton K, Gu X, Lamb VL. Change in chronic disability from 1982 to 2004/05 as measured by long-term changes in function and health in the U.S. elderly population. PNAS 2006 Nov; 103(48): 18374-18379.
 Goldman DP et al. Consequences of Health Trends and Medical Innovations for the Future Elderly. Health Affairs online special issue “Health and Spending of the Future Elderly.” R5-R17, 2005.