About NIA

Health Disparities Strategic Plan: Fiscal Years 2009-2013

1.0: Areas of Emphasis in Research

1.1 Area of Emphasis One: Improve our understanding of Alzheimer’s disease (AD), other dementias of aging, and the aging brain. Develop drug and behavioral interventions for treating these diseases, preventing their onset and progression, and maintaining cognitive, emotional, sensory, and motor health.

The gradual slipping away of mind and memory is frightening and frustrating, both for the person with the disease and for family and friends. AD is an irreversible, progressive brain disease that slowly destroys memory and thinking skills, eventually even the ability to execute the most simplistic tasks. Recent estimates of how many people in the United States currently have AD differ, with numbers ranging from 2.4 million to 5.1 million, depending on how AD is measured. But scientists agree that unless the disease can be effectively treated or prevented, the numbers will increase significantly if current population trends continue.

A better understanding of how the brain ages will provide important information on which to base strategies for maintaining and enhancing cognitive, emotional, sensory, and motor function through biological and behavioral interventions. For example, studies have shown that new neurons form in certain regions of the brain even in adulthood. This phenomenon, known as neurogenesis, suggests that medical and behavioral approaches could be found to stimulate the formation of new neurons to compensate for the loss and functional decline of neurons with aging, disease, or traumatic injury.

Further, the NIA-supported Indianapolis-Ibadan Dementia Project, established in 1991, continues to search for risk factors and protective factors for AD and other cognitive impairment by comparing two groups of community-dwelling elderly who live in vastly different environments: a group of African Americans in Indianapolis, Indiana, and a group of Yoruba in Ibadan, Nigeria. The study periodically conducts assessments of the two groups, employing the same research design, methods, and investigators. One study from this project compared prevalence rates for African Americans in the 1992 community-based sample to a newly enrolled sample in 2001 (Hall, et al., 2009). The overall age-adjusted prevalence rate for AD at age 70 years and older in 2001 was 6.8 percent, and in the 1992 cohort, the prevalence rate was 5.5 percent. These rates, however, were not significantly different despite differences in risk factors between the two cohorts. The 2001 cohort had higher mean years of education, and fewer lived in rural areas during childhood. However, this later cohort also had higher rates of hypertension and history of depression, and more cohort members were taking antihypertensive medications, anti-diabetic medications, and statins.

Our objectives in this area are to:

1.1.1 Understand the mechanisms involved in normal brain aging; the role of cognition in everyday functioning; protective factors for sensory, motor, emotional, and cognitive function; and the pathogenesis of AD and other neurodegenerative disorders of aging within health disparity populations.

1.1.2 Develop better ways of distinguishing within health disparity populations those with normal brain aging from those who will develop mild cognitive impairment (MCI), AD, and related conditions.

1.1.1 Objective One: Understand the mechanisms involved in normal brain aging; the role of cognition in everyday functioning; protective factors for sensory, motor, emotional, and cognitive function; and the pathogenesis of AD and other neurodegenerative disorders of aging within health disparity populations.

1.1.1.1 Action Plan

NIA will support research to harness functional imaging and other advanced technologies that view activity in specific regions of the brain to identify age-related neural changes and mechanisms the older brain uses to maintain optimal learning, memory, and other cognitive functions. We will also work to clarify the interactions between the brain and the peripheral nervous, endocrine, cardiovascular, and immune systems. We will also support the development of preventive and therapeutic approaches to maintaining health in cognition, emotion, sleep function, sensory processes, and motor function. Research on the function of the normal brain and peripheral nervous system will help us understand the ways in which non-dementia related health outcomes arise.

For example, research shows that the hippocampus, a region of the brain important for acquiring and processing information, is capable of generating new nerve cells. Furthermore, research in mice demonstrates that increased physical and mental activity started in “middle age” can increase hippocampal neurogenesis and decrease signs of neuronal aging. This suggests that neurogenesis may be one factor underlying the beneficial effects of an active lifestyle on brain integrity and behavioral function in humans. We will continue to explore the role of physical and mental exercise in promoting healthy cognitive, emotional, and motor functioning and in activating the cellular machineries that protect the brain from damage and promote its repair. This research will help form the basis for future investigation of more subtle neural changes that occur with age, including selective neuronal loss or dysfunction that impacts memory and other functions, impaired neuronal connections, early brain atrophy, and changes in the responses of glial cells involved in neuron survival and brain plasticity and possibly inflammation.

In addition, we will continue to investigate the changes in brain function that take place in the “oldest old,” people 85 or older. In the absence of disease, many of these individuals, who represent the fastest growing segment of the U.S. population, continue to lead healthy and productive lives even into unusually old age. Others, however, suffer from health conditions that can contribute to cognitive decline and dementia, emotional dysfunction, motor instability, and/or sensory deficits. We will work to identify and address the conditions that most affect brain health in this group in order to find ways to maintain function as long as possible.

NIA will support research to examine the influence of contexts – behavioral, social, cultural, and technological – on the cognitive functioning of older adults; investigate the effects of age-related changes in cognition on activities of daily living, social relationships, and health status; and develop strategies for improving everyday functioning through various interventions such as cognitive training.

Community-based studies of aging and AD are becoming progressively more sophisticated. Traditional interviews, clinical evaluations, and routine laboratory tests are increasingly complemented by advanced imaging and other technologies to identify risk factors and protective factors and to relate them to specific biological mechanisms. NIA will place a special emphasis on community-based studies, including studies in racial and ethnic minority populations, capable of linking early life or midlife factors with late life cognitive decline or impairment. We will include studies of the ways that multiple factors such as lifestyle, genetics, comorbid diseases, or sensory or motor dysfunction interact to cause disease or contribute to cognitive decline.

We will also continue to support research that examines the reciprocity of brain-body interactions in healthy aging and in the course of AD, especially interactions mediated by stress and other hormones. For example, chronic sleep restriction has been associated with hormonal and metabolic changes that may lead to obesity, diabetes, hypertension, increased cardiovascular disease, or cognitive decline. Each condition is experienced more prevalently among health disparity population groups.

We will continue research focused on whether there is a different risk for dementia and AD in particular ethnic groups and whether the course of disease is different in different groups. From the public health perspective, these questions assume great importance as the demographics of the U.S. population change. Not only will there be over four-fold more people over the age of 85 in the year 2050 but the percentage of the population over the age of 65 that is non-Caucasian will increase from 16 percent to 34 percent. Methodological effects on assessment of cognition in aging and dementia prevalence such as cultural and educational bias in assessment are being addressed. A number of grants are directed toward comparing the prevalence and incidence of AD in African-American, Hispanic, Japanese-American and Caucasian populations, including genetic epidemiology studies to assess the importance of different genetic risk factors such as APOE4 in these populations. Non-genetic and protective factors such as socioeconomic status, early life environment, nutrition, education and health are being studied, as are effects of concurrent illnesses such as cardiovascular disease and stroke.

We will explore with the Advisory Council Task Force on Minority Aging Research and Health Disparities a plan and process to measure the impact of the activities described above. Aspects of impact evaluation are often reflected in peer-reviewed publications and research results.

1.1.1.2 Performance Measures

  • Number of studies in cognitive function and decline focused on the specific needs of health disparity aging populations and communities.
  • Number of study participants from health disparity aging populations.
  • Number of special initiatives designed to address health disparities in this area.

1.1.1.3 Outcome Measures

  • Number of research results (anecdotal descriptions) with potential to inform the academy in addressing the needs of health disparity populations and emphasize quality, relevance, and leadership in the field.
  • Number of interventions developed in follow-on to this research specifically targeting health disparity populations.
  • Assessment of potential risk factors and protective factors.

1.1.1.4 Projected Budget*

2010

$11,187,691

2011

$11,187,691

*No inflationary increases are provided for 2010 and 2011. The sum of all projected budgets will exceed the total sum expended on minority health and health disparities research and activities due to overlap among objectives.

1.1.2 Objective Two: Develop better ways of distinguishing within health disparity populations those with normal brain aging from those who will develop mild cognitive impairment (MCI), AD, and related conditions.

Successfully distinguishing people who are aging normally from those who will develop MCI – often a precursor to AD – and AD itself is critical to promoting healthy aging behaviors and the prevention, early detection and diagnosis, and treatment of disease. Identification of biomarkers of the transition from normal function to different levels of cognitive impairment is facilitating our efforts.

1.1.2.1 Action Plan

Biomarkers may be helpful in earlier and more accurate diagnosis of disease and in tracking disease progression and treatment response in clinical trials, which can decrease the time and cost of trials. Further, we will continue to support development of better tools for assessing cognitive function in the clinic, in the primary care setting, and in the home environment. In one project, NIA helped establish the Uniform Data Set (UDS), comprising both clinical and neuropsychological tests, across all Alzheimer’s Disease Research Centers (ADRCs) in the United States. The UDS will promote uniformity in collection of cognitive function data and will allow researchers to pool large sets of data across ADRCs. We will also participate in plans outlined by the recently funded NIH Neuroscience Blueprint Toolbox project to develop a measurement tool that includes a module for assessing cognitive, sensory, motor, and emotional function in adults. A standardized assessment tool of this type will help researchers track and compare behavioral change over time in longitudinal and epidemiological studies, in clinical trials, and eventually in primary care and other non-research settings.

NIA will continue to examine how the use of sensory testing to predict early neurodegeneration could assist in clinical diagnoses. We will also continue research to explore possible correlations between changes in sensory perception and AD. For example, we will investigate how changes in a person’s ability to visually navigate through the environment or changes in a person’s sense of smell may predict the development of AD.

1.1.2.2 Performance Measures

  • Number of studies focused on the specific needs of health disparity aging populations and communities.
  • Number of study participants from health disparity aging populations.
  • Number of special initiatives designed to address health disparities in this area.

1.1.2.3 Outcome Measures

  • Number of research results (anecdotal descriptions) with potential to inform interventions addressing the needs of health disparity populations.
  • Increased knowledge developed in follow-on to this research specifically targeting health disparity populations.

1.1.2.4 Projected Budget*

2010

$11,187,691

2011

$11,187,691

*No inflationary increases are provided for 2010 and 2011. The sum of all projected budgets will exceed the total sum expended on minority health and health disparities research and activities due to overlap among objectives.

1.2 Area of Emphasis Two: Improve our ability to reduce health disparities and eliminate health inequities among older adults.

During the 21st Century, the United States will experience a dramatic increase in the proportion and diversity of racial and ethnic minorities in its older population. Life expectancy at older ages has increased significantly over the past 25 years, but unacceptable disparities continue to exist in terms of disease burden and lifespan among racial and ethnic groups in the United States. Socioeconomic factors such as work, education, income, and wealth can have a serious impact on health and well being. Economic circumstances can determine whether an individual can afford health care and proper nutrition from early life into old age. Individual and family financial resources and health insurance can determine whether an older adult enters a nursing home or stays at home to be cared for by family and friends.

Health disparities are associated with a broad, complex, and interrelated array of factors. Diagnosis, progression, response to treatment, caregiving, and overall quality of life may each be affected by race, ethnicity, gender, socioeconomic status (SES), age, education, occupation, and other as-yet-unknown lifetime and lifestyle differences. For example, a multi-ethnic epidemiological study supported by NIA indicated that prevalence rates for Alzheimer’s disease (AD) may be higher for African Americans and Hispanics than for other ethnic groups. Another study found striking relationships between SES and both health and longevity. Also gender differences in health and longevity are observed across racial and ethnic groups.

We will continue to support essential research to increase our understanding of and reduce health disparities and inequities among older adults. We will support research to establish the scientific basis for redressing differences and inequities affecting older adult populations. We will work to understand the extent to which genetic, behavioral, social, and other factors that show variation across racial and ethnic groups influence health and longevity. And we will use new knowledge to develop behavioral and public health interventions for reducing disparities and increasing quality of life for all older adults.

There are three objectives in this area of emphasis:

1.2.1 Understand health differences and health inequities among older adults.

1.2.2 Develop strategies to promote active life expectancy and improve the health status of older adults in minority and other health disparity populations.

1.2.3 Use research insights and advances to inform policy on the health, economic status, and quality of life of all older adults.

1.2.1 Objective One: Understand health differences and health inequities among older adults.

There are many complex and interacting factors related to race, ethnicity, gender, environment, SES, geography, place of birth, recency of immigration, and culture that can affect the health and quality of life of older adults. Socioeconomic factors related to work, retirement, education, income, and wealth can have a serious impact on the health and well being of the elderly. Biological and genetic factors can also affect the course and severity of disease and disability. Furthermore, a person’s culture can have a tremendous influence on health-related factors such as diet and food preferences and attitudes toward exercise. All of these factors and their interactions must be understood in order to design effective interventions to improve health equity among various ethnic/racial and low SES population groups.

1.2.1.1 Action Plan

We will characterize normal processes of aging in minority and low SES populations to increase our understanding of the course of disease and disability, and to identify the similarities and differences among racial and ethnic groups and among groups living in different geographic locations.

Further, early life events can play an important role in the aging process. Differences in nutrition, education, disease incidence, environmental exposure and health care in fetal development and early life can affect disease and disability in later life. Research into the influence of early and midlife experience on the health of the aging will advance our ability to predict the health status of future cohorts of older adults.

We will compile data from multiple sources to assemble the necessary volume and types of information needed. Research to understand health disparities requires data that are accessible to researchers on a national level as well as appropriate ways to utilize multiple small data sets collected by many different researchers. NIA will support the use of these data to discover new scientific knowledge and to help in the evaluation and design of policies to deal with an aging society. This approach will allow data from several sources to be linked by a common identifier and analyzed in ways not previously possible.

Further, we will use ongoing data collection programs to oversample minority populations. These data will provide important information on living arrangements, income, health care needs, and other topics, while continuing to support surveys focused on specific groups and concentrated on issues of illness and well being.NIA will continue to support and expand surveys of racial, ethnic, and language minority groups in order to provide the data needed by researchers and public policy makers.

Health and quality of life, particularly in later years, are affected by many interrelated factors. NIA will learn more about risk factors for disease and preventive factors contributing to good health by researching these influences individually and in concert. We will place a special emphasis on longitudinal data, which provide information about individuals across their lifespan, to untangle the multitude of factors that affect health and well being. Continued support for the following studies are key components to our health disparities plan and for advancing knowledge to assist with the development of research initiatives, identifying physiologic and other types of factors across the lifespan, affecting onset and progression of disease with advancing age, as well as elucidation of protective factors contributing to healthy aging: Bogalusa Heart Study(BHS), Health and Retirement Study (HRS), Health, Aging, and Body Composition Study (Health ABC), Healthy Aging in Neighborhoods of Diversity Across the Life Span (HANDLS), Honolulu-Asia Aging Study (HAAS), and the Study of Women’s Health Across the Nation (SWAN). This is a partial list.

We will explore with the Advisory Council Task Force on Minority Aging Research and Health Disparities a plan and process to measure the impact of the activities described above. Aspects of impact evaluation are often reflected in peer reviewed publications and research results.

1.2.1.2 Performance Measures

  • Establishment of a linked set of data from multiple sources to assemble the necessary volume and types of information needed for research on health disparities among aging populations.
  • Number of projects exploring cross-group racial and ethnic differences.
  • Number of grants funded using meta-analysis to explore differences in functional limitations in racial and ethnic groups using different data sources.

1.2.1.3 Outcome Measures

  • Accessibility of the data to researchers on a national level as well as appropriate ways to utilize multiple small data sets collected by many different researchers.
  • Number of existing NIA-supported surveys with oversampling of minorities.
  • Successful dissemination of findings to extramural research community for validation of findings.
  • Number of research results (anecdotal descriptions) with potential to inform the academy in addressing the needs of health disparity populations, emphasizing quality, relevance and leadership in the field.

1.2.1.4 Projected Budget*

2010

$15,583,983

2011

$15,583,983

*No inflationary increases are provided for 2010 and 2011. The sum of all projected budgets will exceed the total sum expended on minority health and health disparities research and activities due to overlap among objectives.

1.2.2 Objective Two: Develop strategies to promote active life expectancy and improve the health status of older adults in minority and other health disparity populations.

As life expectancy increases among all population groups, there are more adults living with one or more chronic conditions that may not affect their length of life but may dramatically affect quality of life. Research shows that these differences in active life expectancy are more marked among the medically underserved. Genetic, lifestyle, and socioeconomic factors also play an important role in the time of onset or severity of disease and disability. NIA’s efforts to understand the special needs of racial/ethnic minority and other health disparity older adults will facilitate the design of effective interventions to improve health status and quality of life for our entire aging population.

1.2.2.1 Action Plan

NIA will take a variety of action steps to track and analyze disease prevalence and course in diverse older adult populations to understand disparities in the prevalence of diseases and conditions such as heart disease, obesity, hypertension, frailty, diabetes, comorbidities, and certain types of cancer among health disparity and underserved populations. For example, African Americans suffer from hypertension and prostate cancer at higher rates than their white counterparts. Hispanics suffer more from diabetes but less from heart disease. NIA-supported researchers will explore socioeconomic factors such as education, language, and access to health care as well as how genetic, molecular, and cellular factors contribute to differences across populations. We will support research to better understand the differences in the prevalence of AD among African Americans, Asians, and Hispanics compared to non-Hispanic whites. For example, Japanese Americans living in Hawaii have lower prevalence of stroke-related dementia but higher rates of AD than Japanese nationals. We will continue to examine a range of possible causes of these disparities, including the impact of diseases such as hypertension, cardiovascular disease, and diabetes; health behaviors; and disease processes in health disparity populations. The research will draw on culturally appropriate, equivalent, and standardized measures to better understand these differences and to suggest culturally appropriate interventions.

The NIA will develop appropriate health strategies for disease, illness, and disability prevention and healthy aging among the underserved. For example, adults with low levels of education and limited fluency in English may need specially adapted assessments of cognitive function for the diagnosis of AD. Diet and exercise recommendations may need to be adjusted to take into account religious, ethnic, and cultural sensitivities. Adults are more likely to use their medication appropriately if the labels and instructions are printed in their native language. To address these and other concerns, NIA will:

  • Develop and promote culturally appropriate interventions to improve healthy behaviors along with strategies to increase the likelihood that these interventions will be initiated and maintained.
  • Design and promote interventions appropriate for older adults in diverse populations to more effectively prevent, diagnose, or reduce the effects of disease.
  • Design and promote culturally appropriate strategies for self management of chronic diseases.
  • Investigate the factors affecting medication misuse and culturally appropriate strategies for enhancing proper use and compliance with medication regimens.

We will continue efforts to develop evidence-based practices that will facilitate communication of symptoms and care instructions between the patient and the health care provider. Recent studies have revealed that how older adults are diagnosed and treated is as much a function of who they are, who is treating them, and where care is provided as it is a function of the symptoms they present. NIA will investigate ways to ensure that each individual is treated with appropriate evidence-based interventions regardless of race, ethnicity, or cultural background.

Further, we will explore with the Advisory Council Task Force on Minority Aging Research and Health Disparities a plan and process to measure the impact of the activities described above. Aspects of impact evaluation are often reflected in peer reviewed publications and research results.

1.2.2.2 Performance Measures

  • Number of participants recruited for epidemiologic studies of health disparity populations.
  • Successful design and implementation of culturally appropriate, equivalent, and standardized measures of prevalence for diseases and conditions among minority and health disparity populations.

1.2.2.3 Outcome Measures

  • Estimates of mortality, morbidity (prevalence and incidence) for diseases of aging in minority and health disparity populations.
  • Survival rates for diseases of aging in minority and health disparity populations and assessments of potential risk factors and protective factors (expressed statistically in terms of odds ratios or hazard ratios). These outcome measures would be the basis for comparisons among different ethnic/racial groups within studies or between studies.
  • Number of research results (anecdotal descriptions) with potential to inform the academy in addressing the needs of health disparity populations and emphasizing quality, relevance, and leadership of the field.

1.2.2.4 Projected Budget*

2010

$15,583,983

2011

$15,583,983

*No inflationary increases are provided for 2010 and 2011. The sum of all projected budgets will exceed the total sum expended on minority health and health disparities research and activities due to overlap among objectives.

1.2.3 Objective Three: Use research insights and advances to inform policy on the health, economic status, and quality of life of all older adults.

A key resource for understanding health disparities and inequities that exist among older adults is data on trends and patterns that can explain the interaction between financial assets and health outcomes in different racial and ethnic groups and within economically disadvantaged groups. Data that increase our understanding of the role of educational status in improving health behaviors and health status will also inform the development of more effective policies.

Minority and health disparity elders depend more heavily on Social Security, receive little support from private pensions, derive less income from accumulated assets, and rely to a larger extent on earnings from employment in old age. Challenges for policy makers include finding ways to encourage individual savings and home ownership and facilitate continued employment.

1.2.3.1 Action Plan

To support this objective, NIA will continue to study population changes and underlying causes of health and function of older adults across the lifespan. Many studies have identified significant risk factors for the development of chronic diseases that pre-date onset of symptoms by at least a decade. Population-based studies in which individuals are tracked from birth and across the lifespan help researchers understand the changes in health over time and the large variations in health across racial and ethnic populations. NIA-supported research will continue to develop, maintain, and analyze longitudinal data sets.

Determining the costs of specific illnesses has always been difficult due to the lack of adequate data on incidence and prevalence as well as inconsistencies in calculating direct and indirect medical costs. These difficulties are compounded in health disparity populations by differences in use of formal medical care and informal family caregiving. Projections of future active life expectancy, longevity, and mortality depend on assumptions about how groups of individuals will change over time, particularly as recent immigrants become culturally assimilated. This research will provide valuable information for projecting the specific needs for health care services within various population groups.

Additionally, although many of the disparities in adult health and life expectancy across national, racial, occupational, and social class boundaries are well documented, causal mechanisms are less well understood. NIA-supported research to understand these differences will be critical to the development of behavioral and public health interventions. NIA will continue to collect nationally representative longitudinal data on retirement, health insurance, savings, and family variables and share this data and trends with researchers, policy analysts, and program planners. Research findings of reduced disability among the elderly have become prominent in the public policy debate regarding Medicare and Social Security. NIA will investigate whether disability is being prevented or postponed, identify contributors to disability decline, determine the impact of changes in health care, and examine the economic implications of reduced rates of disability.

We will explore with the Advisory Council Task Force on Minority Aging Research and Health Disparities a plan and process to measure the impact of the activities described above. Aspects of impact evaluation are often reflected in peer reviewed publications and research results.

1.2.3.2 Performance Measures

  • Development and maintenance of sound longitudinal data sets that track individuals from birth and across the lifespan that help researchers understand the changes in health over time and the large variations in health across racial and ethnic populations.

1.2.3.3 Outcome Measures

  • Information made available to researchers and policy makers on risk factors for the development of chronic diseases, costs of specific illnesses, and underlying causal mechanisms significant for diverse populations.
  • Number or anecdotal descriptions of behavioral and public health interventions targeting health disparity populations based on this evidence.

1.2.3.4 Projected Budget*

2010

$15,583,983

2011

$15,583,983

*No inflationary increases are provided for 2010 and 2011. The sum of all projected budgets will exceed the total sum expended on minority health and health disparities research and activities due to overlap among objectives.

1.3 Area of Emphasis Three: Improve our understanding of the consequences of an aging society and provide that information to inform intervention development and policy decisions.

The greater longevity and improved health seen at older ages in many parts of the world represent one of the crowning achievements of the last century, but also present a significant challenge. Societal aging may affect economic growth, patterns of work and retirement, the way families function, the ability of governments and communities to provide adequate resources for older people, and the prevalence of chronic disease and disability.

NIA will continue to support research on the social, economic, and demographic consequences of the rapidly aging and diverse population in the United States and other countries. In addition, we will continue to support research on how social and economic factors across the lifespan affect health and well being during old age for racial and ethnic minority older adults.

NIA objectives in this area are to:

1.3.1 Understand how population aging and changes in social, economic, and demographic characteristics of cohorts reaching old age affect health and well being in the United States and other countries.

1.3.2 Understand how social, economic, and health system factors produce disparities in health at older ages and develop interventions to reduce disparities.

1.3.3 Understand how social and economic factors throughout the lifespan affect health and well being at older ages.

1.3.1 Objective One: Understand how population aging and changes in social, economic, and demographic characteristics of cohorts reaching old age affect health and well being in the United States and other countries.

The social, economic, and demographic changes the Nation is experiencing at the population level may have profound effects on health and well being at the individual level. For example, alterations in family structure may lead to changing trends in family caregiving practices, chronic diseases of aging may become more common, and the health care system may experience strain as greater numbers of Americans require services.

1.3.1.1 Action Plan

The NIA will explore the effects of education and other social and demographic factors on health and well being at older ages. Educational attainment is one of the strongest correlates of physical health and cognitive functioning at older ages. We will support research to unravel the reasons for this connection to help project health and long term care needs and devise ways to intervene to reduce disparities.

Researchers will need to examine how the presence of home- and community-based services (e.g., waiver programs, assisted living) influence the experience of family caregiving from an economic, social, and emotional perspective. Additional data are also needed to track the migration trends of older people as they move from community to community as well as from independent living to different levels of assisted living and nursing home care. We will support research on the ways in which the evolution of the American family structure will affect the well being of the elderly by influencing living arrangements, caregiving, and economic support.

Further, a wide variety of institutional arrangements for income support, home health care, long term care, and acute care have been developed in response to the challenges of population aging. We will support comparative research on the effects of these changes on behavior and will evaluate institutional reform efforts to gain insights useful both in the United States and elsewhere. We will also encourage analyses on the impact of global population aging on macroeconomic factors and their influence on institutions and well being.

We will explore with the Advisory Council Task Force on Minority Aging Research and Health Disparities a plan and process to measure the impact of the activities described above. Aspects of impact evaluation are often reflected in peer reviewed publications and research results.

1.3.1.2 Performance Measures

  • Number of studies focused on how social, economic, and demographic factors affect health and well-being among older segments of health disparity populations.
  • Number of special initiatives designed to address health disparities in this area.

1.3.1.3 Outcome Measures

  • Number of research results (anecdotal descriptions) with potential to inform interventions addressing the needs of health disparity populations.

1.3.1.4 Projected Budget*

2010

$15,583,983

2011

$15,583,983

*No inflationary increases are provided for 2010 and 2011. The sum of all projected budgets will exceed the total sum expended on minority health and health disparities research and activities due to overlap among objectives.

1.3.2 Objective Two: Understand how social, economic, and health system factors produce disparities in health at older ages and develop interventions to reduce disparities.

Health disparities continue to exist among racial, ethnic, and socioeconomic groups. Research is needed to understand the causes of these disparities and how they relate to social, economic, and health system factors and develop interventions to reduce the disparities.

1.3.2.1 Action Plan

NIA will continue to encourage cross-national comparative and historic research as an approach to understanding the burden of disease and health disparities. Cross-national comparative research using micro-level data have proven very useful in understanding how the structure of pension systems affects work and savings decisions. Many countries have already reached the stage of population aging that is not expected in the United States until much later in the century, and many developing countries have populations that are aging faster than in the United States. Research on long term trends in the burden of disease and risk factors can improve projections. Comparative research on the increasing burden of chronic diseases, and on ways in which families and health care systems cope with disease management and long term care, could provide insights useful in the United States and globally.

NIA will explore with the Advisory Council Task Force on Minority Aging Research and Health Disparities a plan and process to measure the impact of the activities described above. Aspects of impact evaluation are often reflected in peer reviewed publications and research results.

1.3.2.2 Performance Measures

  • Number of studies focused on how social, economic, and demographic factors interact to influence health disparities.
  • Number of special initiatives designed to address health disparities in this area.

1.3.2.3 Outcome Measures

  • Quality, quantity and relevance of interventions developed in follow-on to this research.
  • Number of research results (anecdotal descriptions) with potential to inform the academy in addressing the needs of health disparity populations and emphasizing quality, relevance, and leadership of the field.

1.3.2.4 Projected Budget*

2010

$15,583,983

2011

$15,583,983

*No inflationary increases are provided for 2010 and 2011. The sum of all projected budgets will exceed the total sum expended on minority health and health disparities research and activities due to overlap among objectives.

1.3.3 Objective Three: Understand how social and economic factors throughout the lifespan affect health and well being at older ages.

Individual differences in chances for a healthy and secure old age emerge in midlife. For example, NIA-supported research indicates that Americans in late middle age have much wider variation in wealth (i.e., total accumulated assets) than in current income (i.e., earnings). Furthermore, work and other decisions by people in their 50s and 60s are already affected by chronic conditions and disability. NIA-supported research will focus on both observational studies and interventions to improve function based on a life course perspective.

1.3.3.1 Action Plan

We will continue to support research on social insurance and health insurance systems (e.g., Social Security and Medicare) to assist other agencies in promoting the health and well being of the elderly while assuring program efficiency. As record numbers of Americans reach retirement age, programs such as Social Security and Medicare will face unprecedented challenges. We will support research to assist these and related programs to work as effectively and efficiently as possible to safeguard the health and well being of older Americans. Such research will include the measurement of the economic value of good health and the development of techniques to produce National Health Accounts. Our studies on the social, educational, public health, and biomedical variables that affect length of life and rates of disability, also will inform decisions related to social and health insurance systems. We will also support continued work to understand the biological, behavioral, economic, and social basis for decisions of individuals, employers, and families that affect income security in retirement and the financing of long term care. Research that seeks to understand the behavioral aspects of demand for insurance against these old age risks and developing interventions that translate findings from behavioral research to improve well being will be encouraged.

We will explore with the Advisory Council Task Force on Minority Aging Research and Health Disparities a plan and process to measure the impact of the activities described above. Aspects of impact evaluation are often reflected in peer reviewed publications and research results.

1.3.3.2 Performance Measures

  • Number of studies on lifespan influences.
  • Number of special initiatives designed to address health disparities in this area.

1.3.3.3 Outcome Measures

  • Numbers of research results with potential to inform intervention development.
  • Number of interventions developed in follow-on to this research on social and economic factors.

1.3.3.4 Projected Budget*

2010

$15,583,983

2011

$15,583,983

*No inflationary increases are provided for 2010 and 2011. The sum of all projected budgets will exceed the total sum expended on minority health and health disparities research and activities due to overlap among objectives.