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When is one not enough? Multiple chronic conditions research

Marcel SALIVE,
Health Scientist Administrator,
Division of Geriatrics and Clinical Gerontology (DGCG)

The NIA has long been interested in understanding the role of aging on the development and progression of specific chronic diseases. More recently, we’ve begun to try to understand why two or more conditions might occur together in older people, and perhaps more importantly, what to do about it. Rather than treating each disease or condition as the only framework for health policy, researchers and health officials acknowledged that these conditions cluster in older adults. In fact about 75 percent of older adults have multiple chronic conditions. A vast majority of health spending goes toward treating people with multiple chronic conditions (MCCs). Although most combinations of conditions can be managed using typical approaches, the complexity increases and sometimes important disease-treatment interactions may be problematic.

We’re seeking applications.

Recently, NIA released a set of Program Announcements on self-management of chronic conditions, seeking applications using R01, R15, or R21 mechanisms. These Program Announcements highlight our interest in promoting research to evaluate and optimize strategies that older people could use. The National Institute of Nursing Research also sponsors this set of Program Announcements, which was inspired in part by a 2012 Institute of Medicine report, Living Well with Chronic Illness, that identified patient self-management as a cross-cutting approach that might substantially improve quality of life.

Another Program Announcement, Behavioral Interventions to Address Multiple Chronic Health Conditions in Primary Care, seeks to fund R01s that take a common behavioral strategy to address the underlying causes and management of MCCs. A number of grants have been funded under this long-standing program announcement, although none yet by NIA.

A wide range of grant mechanisms are available.

MCC research can take many different approaches, including basic, clinical, and translational research. Nearly all grant mechanisms are suitable for research on multiple chronic conditions, in all sizes from small to large. One early approach, for example, used exploratory and developmental R21 grants to analyze existing healthcare data sets. We are still accepting proposals for analysis of data and stored biospecimens under PA-13-168. Other important research topics include:

  • evaluation of treatments for people with MCCs
  • understanding the comparative safety and effectiveness of treatments and their interactions
  • development of health outcomes measures

What kinds of applications does the NIA want?

We’re interested in studies that will advance care and prevention in several areas, such as:

  • observational studies that will provide information to help older patients with two or more chronic conditions understand the risks, benefits, and prognosis associated with treating their conditions
  • studies of practical interventions that, if successful, have potential for implementation in primary care
  • finding out whether certain behavior changes can help patients prevent or manage multimorbidity, with improved outcomes
  • health care research on management of MCCs in a variety of different settings—for example, home, hospital, short- and long-term care facilities—as well as transitions across these settings

Can you think of other questions that might accelerate our understanding of how to manage multiple chronic conditions? Many other related research topics might be encouraged. For instance, the NIA does not recommend specific diseases to study, and a variety of chronic conditions that affect older adults might be of interest. We are at the early stages of research into multiple chronic conditions and we are still grappling with how best to approach the problem so that we can make progress in improving both treatment and quality of life.

The field is wide open. But I can tell you that, if you are considering submitting an application, the applications that tend to make reviewers happy are those that go beyond a mere description to identifying some aspect of preventing or treating MCCs that improves health outcomes.

Please feel free to comment below. If you’re considering a specific proposal in response to these Program Announcements, but you’re unsure if it will fit with the NIA’s interest in this area, send me an email. I may be able to tell you which of our divisions would be the best home for your proposal, to get a conversation—and perhaps a proposal—going.


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