THE NATIONAL INSTITUTE ON AGING/NATIONAL INSTITUTES OF HEALTH

The present challenge of research on aging is to maintain or even accelerate the trend of declining disability and disease rates in the context of the anticipated rise in the number of older people. Demographic projections show that the U.S. population will begin to age rapidly after 2011, the year the first baby boomers turn sixty-five. Between 2000 and the year 2030, the number of people over sixty-five likely will double, reaching 70.3 million and comprising a larger proportion of the entire population, up from 13 percent in 2000 to 20 percent in 2030.

Of great interest is the explosive growth anticipated among those most at risk for disease and disability, people age eighty-five 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, possibly bringing with it even greater racial and ethnic disparities in health among a more diverse population of Americans. These demographic factors threaten to increase the burden of age-related disease and conditions on individuals, families, and society.

In this new millennium, the National Institute of Aging's (NIA's) research portfolio is aimed primarily at increasing "health span," the years of healthy, active life expectancy. NIA is one of twenty-seven Institutes and Centers of the National Institutes of Health (NIH), established by authority of the U.S. Congress in 1974. The specific missions of the NIA are the following:

• To support and conduct high-quality research on the biochemical, genetic, and physiological mechanisms of aging in humans and animal models; on the structure and function of the aging nervous system; on social and behavioral aspects of aging processes and the place of older people in society; and on the pathophysiology, diagnosis, treatment, and prevention of age-related disease, degenerative conditions, and disabilities. It is the primary federal agency responsible for Alzheimer's Disease (AD) research.
• To train and develop highly skilled research scientists.
• To develop and maintain state-of-the-art resources to accelerate research progress.
• To communicate with the public and disseminate information on health and research advances, and to give new directions for research. (See www.nia.nih.gov.)

Since its inception, NIA has grown significantly, in part because of the recognition by the federal government and Congress of the importance of research on aging. NIA's funding since 1996 increased from $324 million to over $785 million in 2001. About 10 percent of its budget goes to an intramural program that conducts basic and clinical research on aging in several scientific laboratories that are maintained by NIA (www.nia.nih.gov/research/intramural).

More than 85 percent of NIA's budget goes to support extramural research and training activities at educational and research institutions throughout the United States and in other countries. The extramural program helps to set the national scientific agenda for research on aging, and funds research and training at universities, hospitals, medical centers, and other public and private organizations in the United States (www.nia.nih.gov/research/extramural).

The extramural group focuses on four program areas. The Biology of Aging Program emphasizes research on the biochemical, genetic, cellular, and physiological mechanisms of aging, and has revolutionized scientific understanding of cellular and molecular changes occurring throughout the aging process. The Behavioral and Social Research Program focuses on the behavioral (e.g., cognition) and social (e.g., retirement) changes related to aging, and on older people's impact on society as well as society's impact on older persons. The Geriatrics Program focuses on age-related diseases, degenerative conditions, and disabilities. The Neuroscience and Neuropsychology of Aging Program facilitates research on the structure and function of the aging nervous system, including the brain– behavior relationship. Much of NIA's research on AD is located in this program.

Although each intramural and extramural program has a unique focus, the NIA has increasingly fostered research that is integrated across all programs. Research initiatives on genetics, on cognition, and on long-term care are examples of these crosscutting emphases. The NIA also collaborates with other NIH Institutes and Centers on research related to cardiovascular disease, cancer, neurological diseases, osteoporosis, osteoarthritis, diabetes, HIV/AIDS, behavior and health, and alternative and complementary medicine as they relate to an aging population. The NIA supports efforts by the National Academy of Sciences/National Research Council to investigate broad societal issues, such as race and ethnicity, the aging mind, and elder abuse and neglect. NIA also invests in research and infrastructure-building centers throughout the United States that are devoted to AD, minority health and minority scholars, the translation of research into practice, and applied geriatric research, among others.

To guide its future direction, the NIA has created a strategic plan for the years 2001–2005 to guide research across the life span. This research agenda is based upon scientific knowledge in gerontology and geriatrics and on opportunities to eliminate gaps in this knowledge base. Research goals include the following:

To improve health and quality of life of older persons, NIA sponsors and conducts research focusing upon developing strategies for maintaining health and function, understanding the dramatic and continuing decline in disability rates among older people, and preventing or reducing the incidence of age-related diseases, including AD. In addition to investigator-initiated research, NIA continues to support several major studies investigating cognitive, physical, sensory, and behavioral functioning. These include (1) the Roybal Centers, which translate basic behavioral and social research into practical interventions to promote independence and productivity in later life; (2) the Advanced Cognitive Training for Independent and Vital Elders (ACTIVE) clinical trials, which investigate whether targeted behavioral interventions can improve and sustain memory, reasoning skills, or speed of cognitive processing in older adults; (3) the Women's Health and Aging Study, which provides a detailed understanding of the causes and course of physical disability for older women; and (4) the Resources for Enhancing Alzheimer's Caregiver Health (REACH) study, which investigates the impact of caregiving upon the health and functioning of family caregivers of AD patients in order to lessen the profound burdens of caregiving.

To understand the healthy aging process, ongoing NIA-sponsored research is working toward unlocking the secrets of aging, health, and longevity by examining the influences of biological, environmental, psychological, and social factors. As part of this goal, NIA supports basic and applied research aimed toward understanding behavioral and biological changes that occur with normal brain aging and with neurodegenerative disorders such as AD. The highly successful and visible Alzheimer's Disease Centers program is a national resource to gain insight into the causes and treatment of this disabling and prevalent condition. NIA also actively supports research on age-related changes in movement, perception, sensory function (e.g., taste, smell, vision, hearing); changes in sleep physiology and circadian rhythms in the elderly and in AD patients; the effects of stress on immune function; behavior in the elderly; and how personality and cognition change with age. NIA funds the Nathan Shock Centers to facilitate research on the basic biology of aging through their research resource cores that support specialized research technologies. NIA also supports Demography Centers, which focus on trends in mortality, biodemography, and longevity. These Centers are at the forefront of developing needed data and training for understanding population aging. As a national resource, NIA sustains research infrastructure activities through large longitudinal data collection efforts, such as the Health and Retirement Study and the National Long-Term Care Survey, both of which are providing insights into the antecedents and consequences of retirement, economic, and health circumstances of people as they age.

To reduce health disparities among older persons and populations, NIA sponsors research to improve active life expectancy and health status for older minority individuals. Efforts to understand health differences associated with race, ethnicity, gender, environment, socioeconomic status, geography, and culture can inform policy debates on health disparities. NIA has made reducing health disparities a major priority and is committed to supporting basic research, clinical studies, and infrastructure-building for special populations. Notable projects include (1) the Honolulu-Asian Aging Study, a longitudinal epidemiological investigation of older Japanese-American men in Hawaii; (2) the Mexican Health and Aging Study, which investigates the paradoxical health advantages of foreign-born Hispanics who seem to be healthier than U.S.-born Hispanics; and (3) the Washington Heights-Inwood Columbia Aging Project study, the Indianapolis-Nigeria project, and the Chicago Health and Aging Project, all examining the differences in dementia rates and severity among and between African, African-American, Hispanic, and white populations. NIA also sponsors the Resource Centers for Minority Aging Research to create infrastructure for research on minority health. In addition, many large-scale studies (e.g., the previously mentioned Health and Retirement Study) oversample minority populations to assure adequate examination of the health of these groups. Finally, research by independent scholars addressing health disparities is highly encouraged by each NIA program.

To enhance resources to support high-quality research, NIA maintains a strong commitment to developing and maintaining an infrastructure to support future research, program management, and information dissemination. This includes resources to train a skilled research workforce, provide necessary equipment and research resources, and disseminate information to the scientific community and to the public. To that end, NIA supports training programs for degree-granting institutions and individuals enrolled in these programs, thus enabling the production of skilled researchers. These institutions are also encouraged to establish and improve programs for identifying, recruiting, and training women and men, including minorities and individuals with disabilities, for careers in aging-related biomedical and social science. In addition, NIA provides research institutions with essential physical resources, including colonies of animal species (such as genetically altered animals) necessary for research on aging processes and specific age-related diseases. Resources for cell and tissue cultures, DNA resources for genetics, and imaging technologies for exploring the body are also supported by NIA. Further, the NIA sponsors information technologies to provide broad access to archived data vital to researchers and policymakers, and to ensure protection of anonymity and confidentiality of participants in research.

Through the research of NIA-sponsored scientists, significant strides have been made since 1990 to address major health concerns of older people. This research has helped to shift the paradigm from the supposition that degeneration of body systems and cognition is a normal consequence of aging. Instead, research on aging has promoted the view that aging is a process in which health, learning, and development can be, and should be, expected to continue throughout the life span. The NIA strives to highlight progress, emphasize scientific opportunities for additional research, and set the research agenda on aging into the twenty-first century. With the help of research on aging, the world's population can anticipate a longer, more productive, and more healthful lifespan.

Sidney M. Stahl Kimberly M. Firth

See also Medicalization of Aging.