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Fiscal Year 2003 Budget

Introduction

This document provides justification for the FY 2003 activities of the National Institute on Aging (NIA), including HIV/AIDS-related activities. A detailed description of the NIH-wide FY 2003 HIV/AIDS activities can be found in the NIH section entitled "Office of AIDS Research (OAR)."

The President's appropriations request of $971,709,000 for this account includes current law adjusted by assuming Congressional action on the proposed Managerial Flexibility Act of 2001.

At 77, former U. S. President Jimmy Carter writes, lectures, travels extensively, and spearheads numerous humanitarian activities. Award-winning author Madeleine L'Engle published two new books this year; she's 83. 89-year-old Julia Child continues to practice and promote the gourmet cookery that made her a household name. And legendary runner Johnny Kelley, now 94, gave up running marathons about 10 years ago, but continues to participate in shorter races and serves each year as the grand marshal of the Boston Marathon.

These are only a few of the millions of Americans over age 65 who remain healthy, active, and productive well into old age. More people than ever before are enjoying robust health and productivity well into their seventies, eighties, and even beyond.1 Life expectancy, around 49 years in 1900, has increased over the past century to about 76, thanks to improvements in health care, nutrition, and the overall standard of living for most people, and nearly three quarters of people 65 and older rate their health as "good," "very good," or "excellent."

But good health is far from a universal reality for older Americans. The latest national surveys indicate that about one-fifth of people age 65 and older—more than 7 million people—report some disability.2 Chronic disease, memory impairment, and depressive symptoms affect large numbers of older people and the risk of such problems significantly rises with age. Nearly half of those age 85 and older suffer from Alzheimer's disease.3 These millions of less fortunate older people struggle with daily activities as simple as bathing and dressing, with families and friends taking on the difficult and often costly role of caregiver.

Understanding the differences between advanced years that are active and independent and those that are characterized by frailty and dependence is at the heart of the NIA's research program. Since the Institute's founding in 1974, research has shed considerable light on aging and health. It is now known that aging itself is not the cause of disease, disability, and frailty. Indeed, the converse is true: It is disease and disabling processes, influenced by age-related changes in the body and by unhealthy choices and sedentary lifestyles, that are the most important factors in compromising the quality of life for older people. This fundamental shift in thinking was reinforced most recently with insights from the National Long Term Care Survey (NLTCS). According to this study, the rate of disability among older Americans dramatically declined from the 1980s through the mid 1990s, even among people age 85 and older. These findings, along with evidence from a number of clinical trials and studies testing specific interventions, suggest more strongly than ever that disease and disability are not inevitable consequences of aging.

The challenge now is to maintain and even accelerate the trend in declining disability and to reduce rates of disease amid a steep rise in the number and proportion of older people. The task is urgent. Demographic projections show that the U.S. population is beginning to age at a rapid pace, with the first baby boomers turning 65 in 2011. Between now and the year 2030, the number of individuals age 65 and older likely will double, reaching 70.3 million and comprising a larger proportion of the entire population, up from 13 percent today to 20 percent in 2030.4 Of great interest is the explosive growth anticipated among those most at risk of disease and disability, people age 85 and older. Their ranks are expected to grow from 4.3 million in 2000 to at least 19.4 million in 2050. The racial and ethnic makeup of the older population will change dramatically as well, creating a more diverse population of older Americans. These demographic factors combined threaten to increase the burden of age-related diseases and conditions on individuals, families, and society. Unless new understandings and interventions are developed and implemented to reduce disease and disability, the costs, in both human and financial terms, could be extraordinary.

In the 20th century, health research and public health practices did much to extend life and improve health. At the start of this new millennium, the NIA's research portfolio is aimed primarily at increasing "healthspan," or years of healthy active life expectancy. Aging research is well poised to build upon the work of recent years to improve the lives of older Americans and their families. Toward that end, NIA's overall program is wide-ranging and includes research on: the biochemical, genetic, and physiological mechanisms of aging in humans and animal models; the structure and function of the aging nervous system; social and behavioral aspects of aging processes and the place of older people in society; and the pathophysiology, diagnosis, treatment, and prevention of age-related diseases, degenerative conditions, and disabilities. The NIA is also the lead federal agency for Alzheimer's disease research. In close collaboration with the National Advisory Council on Aging and other public and private organizations, the NIA has developed a strategic plan for aging research, to identify goals for the years 2001–2005. These goals address scientific areas with the greatest promise for advancing knowledge, many outlined in this narrative. The NIA also recently completed a strategic plan on disparities in health status of older Americans of different racial and ethnic backgrounds. In this narrative, the Institute focuses on recent progress and future directions for research in four key areas: Section I) Alzheimer's disease and the neuroscience of aging; Section II) reducing disease and disability; Section III) the biology of aging; and Section IV) the behavioral and social aspects of growing older. In all of its efforts, the Institute is paying special attention to reducing health disparities among different groups of Americans (Section V).


  1. Federal Interagency Forum on Aging Related Statistics. Older Americans 2000: Key Indicators of Well-Being. 2000.
  2. Manton KG et al. Chronic disability trends in elderly United States populations: 1982-1994. Proc Nat Acad Sci USA 94: 2593-2598, 1997.
  3. Evans DA et al. Prevalence of Alzheimer's disease in a community population of older persons; higher than previously reported. JAMA 262: 2551-2556, 1989.
  4. Federal Interagency Forum on Aging Related Statistics. Older Americans 2000: Key Indicators of Well-Being. 2000.