The face of aging in the United States is changing dramatically and much of the 21st Century will be defined by population aging (Goldstein, 2010). People are living longer, achieving higher levels of education, living in poverty less often, and experiencing increasingly lower rates of disability. Life expectancy nearly doubled during the 20th Century with a ten-fold increase in the number of Americans age 65 or older. Today, there are approximately 35 million Americans age 65 or older, and this number is expected to double in the next 25 years. The oldest old – people age 85 or older – constitute the fastest growing segment of the U.S. population. Currently about four million people, this population could top 19 million by 2050. And living to 100 is becoming increasingly commonplace. In 1950, there were approximately 3,000 centenarians in the United States. By 2050, there could be nearly one million. The challenge for the 21st Century will be to make these added years as healthy and productive as possible and to continue the current trend of decline in disability across all segments of the population.
The racial and ethnic makeup of the older population is also expected to change with approximately 14 million older Hispanics, 8.6 million older African/African-Americans, and 5.8 million older adults from other racial and ethnic groups. Research on aging continues to document the existence of persistent health differentials among older racial and ethnic groups in the United States, both before and after age 65. While life expectancy may be increasing, gaps continue; life expectancy at birth, in 2000, averaged 77.4 years for Caucasians and 71.7 for Black Americans. While disability rates are declining, older Black Americans have higher rates of disability in activities of daily living and experience a gap of 5 percent reporting no disability, with 75 percent of Blacks age 65 and older saying they have no disability compared with 80 percent of older Caucasians (Manton, PNAS May 22, 2001). To reiterate, current population projections suggest that by 2050, the total number of non-Hispanic whites, aged 65 and over will double, the number of Blacks, aged 65 and over will triple and the number of Hispanic elders will increase eleven-fold (IOM, CPOP, Understanding Racial and Ethnic Differences in Health in Late Life, 2004).
Modern medicine and new insights into lifestyle and other environmental influences are allowing a growing number of people to remain healthy, and socially and emotionally vital into advanced ages. As life expectancy increases, however, diseases and conditions that threaten the health of older people remain a concern. For example, more than half of all Americans 65 or older show evidence of osteoarthritis in at least one joint. One in every two women and one in four men over age 50 will break a bone due to osteoporosis. Cardiovascular disease, cancer, and diabetes remain widespread among older Americans, and close to five million Americans 65 years or older suffer from Alzheimer’s disease. In addition, many older Americans suffer from multiple health problems, and the existence of such comorbidities often complicates treatment and can dramatically affect quality of life.
Our ability to reduce the burden of illness among older and racial/ethnic minority adults will depend on an increased understanding of the dynamics of aging and how they interact with various environmental and lifestyle factors in individuals. We need to explore “aging” not as a single process but rather as an intricate web of interdependent genetic, biochemical, physiological, economic, social, and psychological factors, some of which are better understood than others. In addition to research on the biological basis of aging, some scientists are working to gain new insights into disease processes and comorbidities, the prevalence of which increases with advanced age, and to use this knowledge to develop more effective ways to prevent, diagnose, and treat diseases and conditions of aging. Others are exploring behavioral and social factors involved in aging and how they interact with genetics and biology. Still others are concerned with the economic and societal consequences of a rapidly aging population. Each of the efforts enables us to advance knowledge redressing health disparities. Building on past discoveries, we will continue to focus on finding effective interventions to ensure that as people live longer, all can do so in better health and with greater independence.
The National Institute on Aging (NIA) leads a national scientific effort to understand the nature of aging in order to promote the health and well being of older adults. NIA’s mission is to:
We carry out our mission by supporting extramural research at universities and medical centers across the United States and around the world and a vibrant intramural research program at NIA laboratories in Baltimore and Bethesda, Maryland.
Our vision is to achieve a time when older adults enjoy robust health and independence, remain physically and mentally active, and continue to make positive contributions to their families and communities. The content of the Health Disparities Strategic Plan is complementary to and reflective of the content in the NIA strategic document, Living Long & Well in the 21st Century: Strategic Directions for Research on Aging.
NIA uses a deliberative process for categorizing research projects as minority health and health disparity research. The process is consistent with the NIH process and accounts for the inclusion of minorities and other health disparity populations in research activities in five categories: basic research; clinical research; infrastructure; research training and career development; and outreach. For purposes of this plan, minority health issues are considered to be a subset of health disparities issues. Racial minorities are defined by statute as American Indians/Alaskan Natives (including Eskimos and Aleuts); Asian Americans; Native Hawaiians and other Pacific Islanders; and Black or African Americans. Ethnic group members are Hispanic or Latino (i.e., individuals whose origin is Mexican, Puerto Rican, Cuban, Central or South American, or any other Spanish-speaking country). Health disparity populations, as defined by Public Law 106-525, have a significant disparity in the overall rate of disease incidence, prevalence, morbidity, mortality, or survival rates in the population as compared to the health status of the general population and include racial/ethnic minority populations, low socioeconomic status (low-SES) populations, and rural populations. Additional search terms used to identify relevant aging and health disparities projects and activities are: homeless, low income, Medicaid, medical indigence, medically underserved population, migrant, public assistance, rural area, social class, social mobility, social status, and urban poverty area.
The elimination of the racial gap in life expectancy is a major national priority. The time it will take to reduce the overall gap will depend on the speed of reduction of the leading cause-specific mortality differences, which will require intensified efforts in both prevention and treatment (Wang, Remington, and Kindig, 1999). This document outlines the broad strategic directions of the Institute and provides a point of reference for setting priorities and a framework for systematically analyzing the Institute’s scientific portfolio and assessing progress in achieving our goals for eliminating health disparities. NIA strives to ensure that funding decisions and research initiatives address current and projected public health needs and take full advantage of scientific and technological opportunities for advancing research on aging. With constant monitoring of the health needs of our older population and regular consultation with our stakeholders, we will optimize our efforts to improve the quality of life of older adults in minority and other health disparity populations.
At the NIA, the Office of Planning, Analysis, and Evaluation (OPAE) guides, facilitates, and supports the Institute’s planning, portfolio analysis, evaluation, and reporting activities. OPAE staff work closely with Institute leadership and scientific staff, and team regularly with NIA’s legislative liaison, budget, and communications offices. This office functions to categorize, map, and analyze NIA’s scientific research, resources, and accomplishments in support of priority-setting, planning, evaluation, and reporting efforts. It also provides consultation for NIA staff on evaluation design and implementation, and assistance in applying for evaluation set-aside funds.
Divisions and/or programmatic components of the NIA are typically evaluated every four years. NIA evaluations are used to assess the overall effectiveness of the division or component to determine what changes might be warranted for future progress, including potential adjustments to scope, goals, and objectives. The process for evaluation includes cooperation to (1) establish a project plan and approach, (2) identify qualified external candidates for and recruit expert panel members, and (3) establish the schedule for and organize the expert panel meetings, evaluation, report development, and review/evaluation. The evaluation can consist of three primary tasks: (1) Review of extant information about the evaluation entity, including comparisons across previous published requests for applications (RFAs), summaries of activities and accomplishments, and commentary provided by NIA program staff; (2) Guided interviews with principal investigators (PIs), which can be supplemented by written responses; and (3) Deliberations by an expert panel comprising invited members. Expert panels meet by teleconference and typically once on site at the NIA. Recommendations are generated during a second or third teleconference and included in a subsequent report to the NIA Director. Reports are shared with the National Advisory Council on Aging. The NIA continues to successfully compete for evaluation set-aside funding from the NIH Division of Program Coordination, Planning, and Strategic Initiatives in our efforts to improve NIA program efficiency, effectiveness, and goal attainment.
The NIA leadership utilizes the information made available through evaluations to plan future initiatives, prioritize funding, identify opportunities for collaboration, and report progress. Evaluation results also provide the National Advisory Council on Aging with crucial information that will help them to more effectively advise the NIA Director. We anticipate applying a similar evaluation process to the area of minority health and health disparities within the five year horizon covered by this strategic plan.
We are pleased to share through this plan our best insights into the future of research on health disparities among older adults and the role of the National Institute on Aging (NIA) in realizing that future. The content of this plan is complementary to and reflective of the content in the NIA strategic document, Living Long &Well in the 21st Century: Strategic Directions for Research on Aging. The online version includes hyperlinks to information about NIA programs and initiatives associated with the various priority areas described in this document.
Our priorities as reflected in the areas of emphasis in this document are to:
The total direct FY 2009 Health Disparity funding was $120,902,123.