Fiscal Year 2022 Budget

The full Congressional Budget Justification (PDF, 1M) is available in both PDF, and in accessible HTML format below.

Table of Contents

• Director's Overview
• IC Fact Sheet
• Major Changes in Budget Request
• Budget Mechanism Table
• Appropriations Language
• Summary of Changes
• Budget Graphs
• Organization Chart
• Budget Authority by Activity
• Justification of Budget Request
• Program Descriptions
• Appropriations History
• Authorizing Legislation
• Amounts Available for Obligation
• Budget Authority by Object Class
• Salaries and expenses
• Detail of Full-Time Equivalent Employment (FTE)
• Detail of Positions

Director’s Overview

In 2020, approximately 56.4 million Americans were aged 65 and older. This number may rise above 82 million in 2040. This remarkable demographic shift is having and will continue to have profound social and economic impacts on our nation. The National Institute on Aging (NIA) leads the federal government in conducting and supporting research on aging and the health and well-being of older people. We seek to understand the nature of aging and the aging process, and diseases and conditions associated with growing older. Now more than ever, it is critical that we support research on factors throughout the life course that promote healthy aging and research that will enable Americans to maintain healthy, independent, and productive lives throughout life.

Aging itself remains the most important risk factor for many devastating diseases and conditions, including Alzheimer’s disease and related dementias (AD/ADRD), most types of cancer, many types of heart disease, osteoporosis and hip fracture, kidney failure, and diabetes. We are meeting the challenges presented by this demographic shift through our ongoing mission to:

• Support and conduct genetic, biological, clinical, behavioral, social, and economic research on aging.
• Foster the development of research and clinician scientists in aging.
• Provide research resources.
• Disseminate information about aging and advances in research to the public, health care professionals, and the scientific community, among a variety of audiences.

Since 1974, we have pursued this mission by funding extramural research at universities and medical centers across the United States and around the world; maintaining an active communications and outreach program; and conducting a vibrant intramural research program at NIA laboratories in Baltimore and Bethesda, Maryland. We also support robust training programs to train the next generation of researchers investigating aging. Fundamentally, we support science in service to society. We aim to address public health needs with great urgency, close the gap in health disparities, and capitalize on foundational investments to drive future research and innovation.

Answering the Call: Addressing COVID-19 and Aging Research

The coronavirus disease 2019 (COVID-19) pandemic represents a significant and evolving threat to public health, which has particularly devastating consequences for older adults. Older age represents a primary risk factor for both susceptibility to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and adverse outcomes from COVID-19, with adults over the age of 65 exhibiting a 23-fold increase in risk of death relative to those under 65. At NIA, we have responded to the urgent need for research on aging and the novel coronavirus to understand and ameliorate the disproportionate impact of the pandemic on older adult populations.

As a first step in addressing the critical need for high-priority research on aging and COVID-19, we issued a special funding opportunity called a Notice of Special Interest (NOSI). Our NOSI is intended to support supplements to existing grant applications on COVID-19-related topics in the realm of neuroscience and AD/ADRD research, aging biology, behavioral and social research, and geriatrics and gerontology. In addition, we issued a funding opportunity for a multi-site COVID-19 clinical trial implementation grant on aging-related topics in at-risk older adult populations. We have also co-sponsored a variety of other National Institutes of Health (NIH) COVID-19-targeted funding opportunities such as those specific to the Rapid Acceleration of Diagnostics Underserved Populations (RADx-UP) initiative, which is designed to enable and enhance COVID-19 testing in underserved and vulnerable populations, e.g., racial and ethnic minority older adults, residents of nursing homes and assisted living facilities, and individuals with cognitive impairment or dementia.

Our COVID-19 response efforts have yielded an impressive acceleration in research on the novel coronavirus and aging. As of October 2020, we have funded 145 projects on COVID-19, using either our FY 2020 regular appropriations or COVID-19 supplemental appropriations made available through the Office of the Director. Several of these projects have already generated published findings.

For example, NIA-funded investigators have reported that age-related changes can increase COVID-19 susceptibility and severity, including problems with regulation of immune function, widespread inflammation, advanced biological aging, and genetics-related changes.¹ NIA-funded researchers are also attending to the social, behavioral, and economic implications of the COVID-19 pandemic and mitigation strategies for the health and well-being of older Americans. This includes a better understanding of increases in COVID-19-associated discrimination and mental distress, particularly among racial and ethnic minorities, and challenges in providing care for vulnerable older adults, particularly those with cognitive impairment, disability, or multiple chronic conditions. These topics represent only a small sample of NIA-supported work currently underway to combat the COVID-19 pandemic, and additional research initiatives are in progress to address this unprecedented crisis.

Understanding the Dynamics of the Aging Process

Aging is associated with changes in dynamic biological, physiological, environmental, psychological, behavioral, and social processes. Some age-related changes are benign, such as graying hair. Others result in declines in function of the senses and activities of daily life, and increased susceptibility to and frequency of disease, frailty, or disability. To develop new interventions for the prevention, early detection, diagnosis, and treatment of aging-related diseases, disorders, and disabilities, we must first understand their causes and the factors that place people at increased risk. NIA-supported researchers are engaged in basic science studies to understand the processes of aging and the factors that determine who ages “well” and who is susceptible to age-related disease and disability. Research is also ongoing to identify the interactions among genetic, environmental, lifestyle, behavioral, and social factors, and their influence on the start and progression of age-related diseases and degenerative conditions.

Aging is the major risk factor for chronic diseases and frailty in people over the age of 55. Geroscience is an evolving field of study specifically aimed at understanding how genetic, molecular, and cellular mechanisms can lead to common chronic conditions and diseases in older adults. Researchers in the field hypothesize that slowing the rate of aging will have a beneficial impact on the health of older adults by delaying the onset or reducing the severity of most chronic diseases and frailty, i.e., improving health at older ages. NIA’s Translational Geroscience Network is transforming our approach to age-related disease and disability by targeting fundamental aging processes in the context of several age-related diseases. In addition, we support clinical trials of interventions for a range of disorders and conditions related to aging, including cardiovascular diseases, osteoporosis, arthritis, cancer, and pain.

A particularly promising avenue of research related to geroscience involves cellular senescence, a process in which cells lose function, including the ability to divide and replicate, but continue to release molecules that damage neighboring cells. NIA-supported investigators found that when treated with senolytics, or compounds that selectively remove senescent cells, mice that had previously been injected with damaging senescent cells regained physical function. Senolytics have also extended the lifespan and healthspan in naturally aging mice.² In addition, investigators have found that clearing senescent cells from the brain preserves cognition in a mouse model of Alzheimer’s disease.³ Senolytic compounds have recently moved into early-stage human trials supported by NIA. With our involvement, the Cellular Senescence Network was approved in concept in FY 2020 as a Common Fund project by the NIH Council of Councils. The objective of this project is to identify and characterize how different types of senescent cells affect multiple tissues to impact human health, disease, and lifespan.

Additionally, we now know that behavioral and social factors interact with genetic, molecular, and cellular mechanisms to influence health at older ages. We support behavioral science that is uncovering individual-level psychological, social, and behavioral factors throughout the life course that predict adaptive and healthy aging or confer risk for age-related decline. With many chronic conditions emerging in midlife, attention to the interplay of behavioral and social factors with biological processes during this life stage holds potential for identifying optimal time-points for interventions to reverse or redirect aging processes. Evidence suggests that addressing these factors and their interplay will be critical to minimizing disease and achieving full potential and vitality as people age.

Improving the Health, Well-Being, Brain Function, and Independence of Adults as they Age

The brain plays a role in all aspects of thinking — remembering, planning, organizing, making decisions, and much more. These cognitive abilities affect how well we do everyday tasks and whether we can live independently. A better understanding of how the brain ages can provide important information on which to base strategies for maintaining and enhancing cognitive, emotional, sensory, and motor function. Human and animal studies supported by NIA suggest that adaptive or resilient processes (i.e., brain plasticity) may be needed for maintenance of brain structure and function during normal aging. Surprisingly, little is understood about how different areas of the brain connect and work together as a system, yet connectivity is critical to understanding, diagnosing, and treating certain neurological and psychiatric disorders. Problems in connectivity are now suspected in several disorders, including Alzheimer’s disease. We will continue to work to elucidate the processes that occur during “normal” brain aging and to identify and find ways to activate the cellular processes that protect the brain from damage and promote its repair.

We also support and conduct research that 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 these individuals to achieve personal goals and continue to 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.

NIA is the lead federal agency for research on AD/ADRD, and our portfolio reflects this important responsibility. In fact, funding for AD/ADRD research has increased so rapidly over the past several years that today, more than half of our awarded grant dollars are dedicated to research on various forms of dementia. These funds support a broad range of projects, including basic molecular and cellular studies of the aging brain; large scale clinical trials of interventions to prevent symptoms of dementia from taking hold; development of a robust infrastructure for drug discovery; and demographic studies of AD/ADRD in different geographic, racial and ethnic, and socioeconomic populations. In order to provide efficacious care for persons living with dementia as well as support for their caregivers, we also fund research on dementia care targeting service access and service quality for persons with dementia, better models of care across care settings with particular interest in care coordination, as well as how regulatory and socio-economic incentives and constraints affect access, quality, and health outcomes for affected individuals.

However, none of this research will ultimately have an impact on public health without sustained efforts to enhance recruitment and retention of participants in our clinical research studies, particularly individuals from diverse backgrounds. To this end, we continue to fund collaborative teams to target gaps in methods and outcomes regarding the challenge of diversity in recruitment. To date, we have funded more than 60 projects submitted in response to a special initiative designed to encourage grant applications for projects that examine health disparities related to AD/ADRD, as well as strategies for recruitment and retention into clinical studies. This funding opportunity will remain active until November 2021, and planning for future initiatives is underway. Topics range from investigating racial and geographic disparities in the risk of AD/ADRD to exploring the effects of participation in long-term community-based trials on lifestyle and risk for Alzheimer’s. We have also awarded a contract that will allow comprehensive management and tracking of clinical research, identify and support sites not able to meet recruitment goals, learn from top-performing sites, and provide transparency regarding recruitment efforts and successes. This contract investment will also enable critical, timely information for ensuring that NIA’s clinical trial sites are making appropriate progress toward reaching recruitment goals related to multiple under-represented groups.

Supporting the AD/ADRD Research Enterprise

A key part of our strategy for developing new treatments for AD/ADRD is to bolster the drug discovery and development pipeline. This strategy helps ensure scientists are addressing these multifaceted diseases through a wide range of approaches. The congressionally targeted increase in funding for AD/ADRD research has enabled us to capitalize on foundational work and enhance investments in key research areas necessary for a precision medicine approach to treatment and prevention. From cutting-edge disease mechanisms and genetics research to population studies and innovative drug and biomarker development programs, we continue to make crucial advancements toward delivering the right treatments to the right people at the right time. Additionally, we have launched several programs over the past six years to provide researchers with an infrastructure for developing their ideas for medicines and other products, including: the Alzheimer’s Disease Sequencing Project, Accelerating Medicines Partnership for Alzheimer’s Disease (AMP-AD), the Model Organism Development and Evaluation for Late-Onset Alzheimer’s Disease (MODEL-AD) consortium, and the TaRget Enablement to Accelerate Therapy Development for Alzheimer’s Disease (TREAT-AD) consortium. A hallmark of these programs is that each one brings together scientists from academia and industry who are working in many different disciplines, from epidemiology and genetics to data science and computational biology, molecular and cell biology, and medicinal chemistry and pharmacology. Working collaboratively, NIA-supported researchers employ an open-science/open-source approach at every step of the translational science process. They are discovering new and better targets for treatment, producing and analyzing comprehensive and shareable sets of molecular data, and developing high quality translational research tools. To date, AMP-AD researchers have identified more than 500 new potential Alzheimer’s drug targets.

With this remarkable foundation in place, recent growth in federal funding for dementia research has enabled us to make additional investments to strengthen the current infrastructure with new, state-of-the-art resources. For example, we are enhancing and expanding the Alzheimer’s Disease Research Centers (ADRCs) and the Alzheimer’s Disease Neuroimaging Initiative (ADNI). NIA is particularly active in supporting new and better ways to promote data sharing and reproducibility, provide research resources, and foster public-private partnerships among a broad range of experts and advocates. Already, investigators can more quickly and effectively work with vast amounts of genetic and molecular data to identify new therapeutic drug and nonpharmacological targets and parlay what they learn into the design and testing of potential therapies.

To accelerate the discovery of effective treatments that will become broadly available to the public, we have developed programs to make data, knowledge, and research tools widely available to all researchers. Complementing the new translational infrastructure is support for new cross-disciplinary training programs funded through NIA’s Institutional Training Programs to Advance Translational Research on AD/ADRD. Through this program, we are supporting a new and more diverse generation of translational scientists with expertise in biology, data science, engineering, and drug development, who are able to participate and lead team-science programs from target discovery to clinical trials. In addition, the NIA-funded Alzheimer’s Clinical Trials Consortium (ACTC), a clinical trials infrastructure to accelerate and expand studies for therapies in AD/ADRD, continues to provide centralized resources and shared expertise to researchers nationwide to hasten the development of effective clinical interventions. In 2020, the ACTC launched the Institute on Methods and Protocols for Advancement of Clinical Trials in AD/ADRD course designed to educate and promote diversity among research professionals and future researchers in the AD/ADRD field.

Overall budget policy: The FY 2022 President’s Budget request for NIA is $4,035.6 million, an increase of $135.7 million or 3.5 percent compared with the FY 2021 Enacted level. This increase will allow NIA to increase research across all its program areas, with a portion of the increase targeted toward research into safer, non-addictive pain therapeutics that will reduce or eliminate the need for opioids.

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IC Fact Sheet

Focus of NIA Research

The National Institute on Aging (NIA) leads the federal government in conducting and supporting research on aging and the health and well-being of older people. NIA is also the lead federal agency for research on Alzheimer’s disease and related dementias (AD/ADRD). NIA supports a strong, diverse, and balanced research program, focusing on the genetics and biology of aging; basic and clinical studies aimed at reducing disease and disability, including AD/ADRD; age-related cognitive change; and investigations of the behavioral and social aspects of aging.

Dr. Richard J. Hodes, Director

Richard J. Hodes, M.D., a leading researcher in the field of immunology, has served as NIA director since 1993. Under Dr. Hodes’ stewardship, the NIA budget has grown to approx. $3.9 billion, reflecting increased public interest in aging research as America and the world grow older.

Current Activities

• NIA funds a new effort called the Imbedded Pragmatic Alzheimer’s disease and related dementias Clinical Trials (IMPACT) Collaboratory. Through this effort, researchers are developing and testing care interventions in real-world settings.
• NIA invests in the Alzheimer’s Clinical Trials Consortium (ACTC) to accelerate and expand studies for therapies in AD/ADRD. The goal is to provide an optimized clinical trial infrastructure, utilizing centralized resources and shared expertise, to accelerate the development of interventions.
• NIA funds a multi-institutional Interventions Testing Program that uses animal models to investigate treatments with the potential to extend lifespan and delay disease and dysfunction.
• NIA supports the Grants for Early Medical/Surgical Specialists' Transition to Aging Research (GEMSSTAR) program. This program fosters the development of clinician-scientists whose clinical research leads to improved care and more effective treatment options for older patients.

Recent Research Accomplishments

High blood pressure, or hypertension, is very common in people over age 50. It is a leading risk factor for heart disease, stroke, and kidney failure, and a growing body of research suggests that it may increase risk for dementia later in life. In 2019, results from the Systolic Blood Pressure Intervention Trial– Memory and Cognition in Decreased Hypertension (SPRINT-MIND) were the first to show beneficial effects of intensive lowering of high blood pressure for reducing risk of mild cognitive impairment (MCI), a known precursor for dementia. Intensive control was defined as reducing the systolic blood pressure below 120 millimeters of mercury (mmHg), rather than the standard goal of reducing it below 140 mmHg.

Clinical guidelines note the benefits of aspirin for preventing heart attacks and strokes in persons with vascular conditions such as coronary artery disease. There has been, however, past uncertainty about whether aspirin is beneficial for otherwise healthy older people without those conditions. In a large clinical trial to determine the risks and benefits of daily low-dose aspirin in healthy older adults without previous cardiovascular events, aspirin did not prolong healthy, independent living (free of dementia or persistent physical disability). Moreover, adverse events were experienced by the group receiving aspirin. This study shows the importance of assessing benefits and risks among healthy older persons.

On the Horizon

• NIA, in partnership with NINDS, and involving NCATS and the Clinical Center, is establishing a Center for Alzheimer’s and Related Dementias (CARD) in the NIH Intramural Research Program. CARD will combine the power of NIH scientists with the work of researchers around the globe to create new opportunities in basic, translational, and clinical AD/ADRD research and training.
• NIA is finding new ways to use existing technology for early detection or monitoring of chronic health problems and as part of clinical trials. Technological advances may also assist in early detection and monitoring of AD/ADRD.
• CDC data show over half of Americans aged 65+ are living with two or more chronic conditions. NIA continues to prioritize research to identify and test interventions that will facilitate optimal management of multiple chronic conditions.

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Major Changes in the Fiscal Year 2022 President’s Budget Request

Major changes by budget mechanism and/or budget activity detail are briefly described below. Note that there may be overlap between budget mechanisms and activity detail, and these highlights will not sum to the total change for the FY 2022 President’s Budget request for NIA, which is $4,035.6 million, an increase of $135.7 million from the FY 2021 Enacted level. The FY 2022 President’s Budget reflects the administration’s fiscal policy goals for the federal government. Within that framework, NIA will pursue its highest research priorities through strategic investments and careful stewardship of appropriated funds.

Non-Competing Research Project Grants (+$164.1 million; total $1,817.4 million):
NIA will continue to support its established non-competing Research Project Grants (RPGs) awarding a total of 2,186 RPGs, an increase of 210 from FY 2021. This increase is the result of the increased number of competing RPGs that NIA awarded during previous fiscal years.

Ruth L. Kirschstein Training Awards (+$5.5 million; total $49.4 million):
Support for the Ruth L. Kirschstein Training Awards will increase by $5.5 million to accommodate stipend increases, newly implemented childcare allowances, and increases to other training related expenses. NIA intends to solicit additional training applications to promote diversity in translational research for Alzheimer’s disease and related dementias.

Research & Development Contracts (+$8.8 million; total $138.3 million):
NIA will continue to fund research and development contracts for Alzheimer’s disease and related dementias as well as other projects throughout NIA and the NIH. This increase provides for increased costs in NIA’s existing contracts.

¹ doi: 10.18632/aging.103344 (Back to text)

² doi: 10.1038/s41591-018-0092-9 (Back to text)

³ doi: 10.1038/s41593-019-0372-9 (Back to text)

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Program Changes	FY2021 Enacted #: FTEs	FY2021 Enacted Amount	FY2022 PB #: FTEs	FY 2022 PB Amount	Change from FY 2021: FTEs	Change from FY 2021: Enacted Amount
6. Intramural Research	248	$221,761	260	$229,523	12	-$5,488
7. Research Management and Support	230	119,738	260	123,928	30	1,180
8. Construction	n/a	0	n/a	0	n/a	0
9. Buildings and Facilities	n/a	0	n/a	0	n/a	0
Subtotal, Program	478	$3,899,926	520	$4,035,591	42	$119,405
Total built-in and program changes	n/a	n/a	n/a	n/a	n/a	$135,665

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Fiscal Year 2022 Budget Graphs

History of Budget Authority and FTEs:

Distribution by Mechanism:

Change by Selected Mechanism:

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Organizational Chart

 

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