Living Long & Well in the 21st Century: Strategic Directions for Research on Aging
Research Goal B: Continue to develop and disseminate information about interventions to reduce disease and disability and improve the health and quality of life of older adults.
Modern medicine and new insights into lifestyle and other environmental influences promise to have a profound impact on the health and well-being of older people and make it possible for them to remain physically healthy and cognitively and emotionally vital into very advanced ages—ideally, for as long as they live. Capitalizing on new insights from basic research, NIA-supported scientists, often in collaboration with other NIH Institutes and Centers, will continue to work from multiple perspectives to develop and test strategies for preempting or reducing the severity of the full range of health problems experienced by older people. We will work to strengthen the translation of basic findings in the laboratory into practical applications to improve the health and quality of life of older adults.
Our success will depend on progress in achieving three objectives in this area:
- B-1 Develop effective interventions to maintain health and function and prevent or reduce the burden of age-related diseases, disorders, and disabilities.
- B-2 Understand and develop strategies to enhance societal roles and interpersonal support for older adults, reduce social isolation, and prevent elder abuse.
- B-3 Increase awareness and promote adoption of interventions to improve the health and quality of life of older people.
B-1 Develop effective interventions to maintain health and function and prevent or reduce the burden of age-related diseases, disorders, and disabilities.
Achieving and maintaining health and function in advanced years can be aided by physical fitness, proper nutrition, and avoidance of smoking and other behaviors that adversely affect health. 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. Improved health habits can help people survive longer, enable them to postpone the onset of disability, and increase quality of life and function at older ages. Research has also shown that optimizing both the physical and social environment is important to the health and functioning of older people.
NIA will continue to:
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 manipulations such as dietary restriction and 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 develop and test in clinical trials cost-effective dietary and other behavioral measures and adherence strategies for the prevention or delay of disease and disability.
- Use our increased understanding of exercise physiology and other branches of basic science to maximize the positive effect of exercise on older people. Several studies strongly suggest that modest exercise 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, consequently preventing osteoporosis and subsequent fragility fractures. We will support further research to validate exercise and exercise programs and their effects on older people within specific age groups and develop strategies for promoting adherence.
- Continue research to understand hormone changes in older people 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. We 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.
- Develop strategies to reduce falls and their consequences. NIA-supported human factors research will continue to identify safety risks for older people 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. We will continue to support research to identify cost-effective alterations in design that can reduce injuries and provide a safer, more secure environment for older adults.
- Pursue a better understanding of needs and develop interventions to improve the safety of older drivers. We will continue 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 to support 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 people, 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.
- Improve the safe use of medications by older adults. Managing medications can be complex for older people, many of whom take drugs, 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. NIA-supported research 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 interventions for treating, preventing, or delaying the onset of age-related diseases and conditions.
- Support research into 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 risks for 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.
- Test compounds that hold the promise of increasing healthy lifespan. Promising compounds must undergo preclinical safety and efficacy testing using animal and cellular models before being tested in full-scale clinical trials. We will continue to support the testing of promising compounds in mice and other model systems with the long-term goal of selecting for further development those most likely to have a beneficial effect in humans.
- Conduct clinical studies and encourage the translation of new interventions to the clinical setting. As pathways and processes of disease are better defined, basic research findings can be translated expeditiously to the development of clinical applications. We will continue to support clinical studies to improve health and well-being through better treatments for age-related diseases and conditions and to test the effects of hormone therapy, dietary supplementation, and exercise and fitness. 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.
- Develop improved approaches for the early detection and diagnosis of disabling illnesses and age-related debilitating conditions. We will help develop and evaluate improved techniques and tools to measure the well-being of older people as well as symptoms of disease and disability. As new interventions are ready, we will facilitate the movement of biochemical, imaging, and other technologies into mainstream medical practice, where they can be used routinely to assist in early detection and diagnosis as well as to monitor the efficacy of interventions tested in clinical trials.
- Find significantly improved and cost-effective ways to reduce caregiver, family, and patient stress and improve older people’s 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. Investigators will continue to evaluate strategies to improve social support, skills training, and assistive services both for those who cope with chronic disease and for their caregivers. NIA-supported research 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 improve the interaction of older people 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 percent 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. NIA will help develop strategies to assist patients in dealing with multiple services and to manage health care financing for multiple chronic conditions. We will seek better interventions to help older people 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.
B-2 Understand and develop strategies to enhance societal roles and inter-personal support for older adults, reduce social isolation, and prevent elder abuse.
Despite negative stereotypes, millions of older people work productively and otherwise 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 both 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. Improvements in acute and long-term health care for older people are also essential, including strategies to ease the burdens of caregivers and enhance quality of care at home and in different long-term care settings. These initiatives should result in more effective approaches for prevention, treatment, and rehabilitation.
NIA will continue to:
- Identify ways for older people to retain valued roles and maintain independence. Older men and women are now working in paid jobs, doing essential volunteer work, maintaining a household, and/or supporting children and grandchildren. NIA-supported research will seek and apply technological, social, and behavioral findings to extend the ability of older adults to remain independent, active, and productive.
Conduct research on the social and economic aspects of family caregiving and develop and disseminate effective interventions for patient care in family and community settings. Intergenerational family support is the most common way in which a family assembles and allocates its resources of money, skills, and time to care for all its members.
- Assess and evaluate family relationships over time. This research will help us understand the effects of changing relationships on the health and well-being of older people, and gain insight into the caregiving, emotional support, and family-level economic aspects of aging.
- 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.
- Develop strategies to help older people 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 retirement, finances, health and life insurance, and medical treatment. Issues of concern include the ability of health care delivery systems to support patient and family needs and adherence to a patient’s advanced directives. NIA-supported research will inform decisions about complex issues of health, finances, and family roles in late life, both for individuals and policymakers. We will compile up-to-date information about patterns of work and retirement, sources of retirement income, intergenerational income transfers, and status of health and disability at the regional, national, and global levels. This compilation will be used to develop and make available information and other resources for people as they plan for later life transitions and possible loss of independence as well as to inform policy decisions.
Research and develop strategies to improve decision making for long-term and end-of-life care. There is a pressing need to define organizational mechanisms that will ensure quality, affordable health care for older people. There is also a critical lack of empirically generated knowledge on how to maximize quality at the end of life. Medical culture is oriented primarily to patient care and not to addressing the multifaceted needs of dying patients and their families. To better address these issues, we will:
- Examine component parts of health care delivery systems and their impact on medical, social, functional, and cost outcomes and use this information to develop 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, most often provided in a home setting. We will focus on interventions that reduce the burdens of caregivers, with an emphasis on the unique challenges faced by patients with dementia and their caregivers.
- Understand caregiving patterns and improve the effectiveness of different strategies for helping families manage the care needs of the physically frail. For example, we will use knowledge gained from this research to develop and disseminate evidence-based guidance on caregiving skills, environmental modifications, and technological supports for both informal and formal long-term care settings.
- Develop strategies to improve the experience of older people 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.
- Assess the impact of health care organizations and provider interactions on the quality of life for dying individuals. Special attention will be given to developing strategies that enhance support of the older person, the family, and medical care providers who are attempting to provide humane and life-affirming services at the end of life.
- Understand and develop strategies to address elder neglect and abuse. Although isolated studies have documented the devastating long-term consequences of elder mistreatment, research on elder neglect and abuse has been inadequate. We will support methodological research to help determine the prevalence of elder physical, psychological, and financial neglect and abuse. We will also work to develop and disseminate reliable measurement tools for assessing neglect and abuse and interventions to reduce its incidence.
B-3 Increase awareness and promote adoption of interventions to improve the health and quality of life of older people.
Communication efforts play a critical role in educating the public about research advances to improve health and well-being in later life. Health communication activities can increase the public’s awareness of a specific aging issue, problem, or solution; reinforce certain knowledge, attitudes, or health behaviors; dispel misconceptions about aging; and encourage individual or collective action. Health education programs, activities, and materials also can inform, influence, and motivate the public.
Communicating effectively about health is challenging. Health information is often complex and technical. Moreover, the information may be inconclusive, controversial, contradictory, or subject to change as new research findings are released. Health information also may conflict with long held personal beliefs. To succeed, health communication programs and materials must be based on an appreciation of the needs and interests of the target audience. Large scale, multi-year, multi-media efforts utilizing community organizations already in place may be needed to inform, persuade, convince, and sustain behavior change. To address these concerns and ensure that research results are disseminated to all who need them, NIA will:
- Develop, test, and conduct health communication programs and outreach activities to inform the public about the interventions and health-related progress validated by the results of research on aging. We will craft and deliver messages and materials based on research to understand how the target audience perceives and reacts to health messages, how the public is persuaded to change behavior, and how people in general, and older people in particular, respond to various media.
- Develop appropriate materials and programs for a variety of target audiences. We will continue to work to overcome gender, cultural, and language barriers to the effective communication of health information.
- Explore successful networks for the transfer of research knowledge and evaluate the usefulness of transferred interventions for older adults in broadly designed and applied outcomes research. NIA will continue to work with other Federal agencies, State and local governments, and the private and nonprofit sectors to ensure that results of research on behavioral and community interventions are widely shared and have an impact on policies and programs.
- Provide information to support the training of people who work with older adults. We will provide professional societies, community organizations, and academic institutions with research-based information that can be used in training geriatricians, social workers, counselors, and other community professionals and volunteers to work effectively with older adults and to implement evidence-based interventions.