The National Institute on Aging Works to Enhance Geriatric Care

This fall, a panel of experts will convene for a groundbreaking research conference examining possible links among cognitive, movement and mood disorders in older adults. The conference is the first in a new series of three American Geriatrics Society-initiated "Bedside to Bench" research conferences, which focus on important but poorly understood problems of aging that have been identified by clinicians at "bedside." The series, like an earlier series of three "Bedside to Bench" sessions, is made possible by a grant from the National Institute on Aging (NIA).

"Providing support for conferences such as these is one of the myriad ways that the NIA enhances care for older adults," says Stephanie Studenski, MD, a member of AGS' Research Committee, professor of geriatric medicine at the University of Pittsburgh, and the program head for the new "Bedside to Bench" series. (See related story) In addition to investigating connections among thinking, movement and mood disorders in older people, the series of three annual conferences will also examine idiopathic fatigue of aging and inflammation and nutrient metabolism. The previous, inaugural "Bedside to Bench" series, which began in 2004 and ended last year, explored frailty, comorbidity and cognitive vitality.

The NIA is a major presence in the geriatrics community. It is the lead federal agency conducting and supporting aging research, including initiatives like the AGS conference series. It also supports the training of researchers in the field of aging and disseminates information to scientists, health care providers, and the general public. One of the 27 institutes and centers of the National Institutes of Health (NIH) at the U.S. Department of Health and Human Services, the Institute was established in 1974 in recognition of the aging of the U.S. population.

"Our scope is one of the broadest of any institute at NIH, ranging from research into basic cellular changes straight through to population-based issues," says Judith A. Salerno, MD, MPH, Deputy Director of the NIA and a member of AGS' Research Committee. "Unlike most other institutes that are organ- or disease-specific, we look at all aspects of a person, the organism, organs and how we age. NIA's mission is complex and cross-cutting. Our ultimate purpose for existing is to find ways to improve the health of older people, so we try to understand all of the facets of the aging process."

Most of the Institute's budget -- $1.05 billion in 2005 -- supports research conducted either by independent researchers and academic institutions that receive NIA grants, or at the Institute's Intramural Research Program in Baltimore, MD.

"Research funds from NIA are critically important to advance our knowledge of how to improve health in aging," notes Linda P. Fried, MD, MPH, professor and director of the division of geriatric medicine and gerontology at The Johns Hopkins Medical Institutions and a member of AGS' Board of Directors.

NIA research and NIA-supported research covers four general areas - the biology of aging; age-associated diseases and the spectrum from independent functioning to disability; Alzheimer's disease, neurodegenerative processes and cognitive changes with age; and the behavioral and social aspects of aging. Research issues in aging often cut across more than one of these areas and involve collaborations of scientists with diverse interests.

"Our way of understanding health and illness has been fundamentally altered by the NIA's unique focus on the underlying processes -- biological and psychological and social -- that contribute to aging," Dr. Studenski notes. "Rather than just focusing on who has diabetes or who has arthritis, the focus is now on how aging processes affect individuals. That's very important."

Basic biological research into age-related changes at the genetic, molecular and cellular level has illuminated underlying processes that contribute to the increased risk of age-associated health problems such as dementia, delirium, and geriatric syndromes. NIA-funded research, for example, demonstrated that mice with induced myocardial infarction that were then injected with hematopoietic stem cells were able to regenerate healthy heart muscle. Another study showed that adult mouse bone marrow cells could develop into brain cells. Recent studies testing the compound resveratrol in obese mice on a high-fat diet found that the compound reversed effects of obesity on a number of important measures. These discoveries, Dr. Salerno notes, offer wholly new ways to pursue potential interventions and may lead to a new generation of treatment and prevention strategies for diseases and conditions associated with growing older.

The Institute sponsors a vigorous program to move such findings out of the laboratory and into clinical studies. In 2005, approximately half of NIA's budget was invested in clinical studies and trials.

"NIA is moving much more quickly into clinical studies than in the past because we now have a greater understanding of the fundamentals-- the basics of some of the aging processes -- that allow us to make informed investments for clinical interventions," says Dr. Salerno. The recent discovery of presymptomatic brain changes in Alzheimer's disease, for example, have led to new opportunities for early intervention studies.

Dr. Studenski cites NIA's leadership in promoting research on geriatric syndromes such as falls, incontinence, and delirium. She points to the real clinical difference that findings from such research have made in informing guidelines for falls prevention, the assessment and treatment of incontinence, and the evaluation, treatment and management of dementia and behavioral problems in cognitively impaired persons. "This work helps geriatrics professionals in practice every day," she says.

Part of the Institute's effectiveness stems from its partnerships with a variety of organizations, from other NIH institutes to academic research centers and practice-based groups like the AGS. Last year, NIA collaborated with 19 of the 27 institutes and centers at NIH on a variety of projects. Currently, NIA is working with the National Cancer Institute on research concerning cancer in late life. It's also partnering with the National Institute of Child Health and Human Development to examine how early life experiences affect health and well-being in later life - a new focus for the Institute. NIA also contributed to the National Institute on Diabetes and Digestive and Kidney Diseases' watershed Diabetes Prevention Program clinical trial. The trial, which found that adults at high risk of the disease could cut that risk 58% by changing their eating and exercise habits, found an even greater benefit for older adults who made such changes. Trial participants 60 and older cut their risk of diabetes by a staggering 71% with lifestyle changes. Beyond such efforts, the Institute actively participates in the NIH Roadmap for Medical Research initiatives. The roadmap is comprised of 28 new initiatives that help move research findings from bench to bedside as swiftly as possible, with an emphasis on interdisciplinary research.

To help build future generations of researchers and clinicians with an interest in aging and the care of older adults, the NIA supports numerous training and educational initiatives.

"NIA funds training grants that academic divisions in geriatric medicine rely on to support the training of post doctoral fellows who are developing their skills as researchers," says Dr. Fried. "That's essential if we're to have a cadre of academic leaders in geriatrics who have the expertise to ask important questions, to provide new knowledge, and to develop ways to improve care and outcomes for older people. Without NIA supporting this training, we wouldn't have the mechanism to create this workforce. It's that critical."

One key mechanism by which NIA supports research and funds training of researchers and practitioners in aging is the nation's network of 10 Claude D. Pepper Older Americans Independence Centers. The centers conduct and train investigators in both basic and applied research aimed at helping older people remain as independent as possible.

"The Pepper Centers have been innovative, rich incubators of novel ideas about promoting independence in older people and have been central to creating the next generation of investigators," says Dr. Studenski. "One of the things that's very important about these centers is that they focus not only on prolonging years of life but improving quality of life and function throughout life." She lauds, among others, Evan Hadley, MD, director of NIA's geriatrics and clinical gerontology program, for the development and continuing support of the centers. For their efforts to spearhead and foster research and other collaborations, Studenski also credits Dr. Salerno and Susan Nayfield, MD, chief of the NIA's geriatrics branch, and Rosemary Yancik, PhD, health science administrator, both in the geriatrics and clinical gerontology program.

NIA furthers the careers of physician researchers through training grant awards programs. The prestigious Paul B. Beeson Career Development Awards in Aging Research program fosters the independent scientific careers of clinically trained investigators whose research and leadership enhance the health and quality of life of older Americans. In 2004, the NIA became a major supporter of the Beeson program, joining The John A. Hartford Foundation, The Atlantic Philanthropies, The Commonwealth Fund, and the Starr Foundation in this effort.

By increasing the number of researchers who focus on the health of minority elders and by mentoring academic researchers for careers in minority health research, the NIA hopes to diversify the pool of scientists as one way to help reduce health disparities among older people. The Institute supports seven Roybal Centers for Applied Research and Research Centers for Minority Aging Research (RCMARs) towards that end. The RCMARs strive to improve recruitment and retention methods used to enlist minority elders in studies and create culturally sensitive health measures that accurately assess the health status of minority elders and increase the effectiveness of interventions. The NIA also invites emerging researchers working with diverse populations to participate in the annual Summer Institute on Aging Research, which one alumna dubbed "researchers' bootcamp."

This interest in new investigators, Dr. Salerno stresses, does not stop at training. "We give careful consideration to grant applications from new investigators and we are promoting the funding of investigators who are not yet independent and whose grants have been meritoriously reviewed," she adds. "We're committed to continuing to support the pipeline of new investigators in aging and geriatrics."

NIA also plays a key role in disseminating research findings and related information to clinicians and older adults and their families. The Institute's communications office works with organizations like the AGS to support such efforts. Recently, the AGS joined NIA in efforts to develop content for its comprehensive, authoritative Web site for consumers, www.nihseniorhealth.gov. A frequently visited Internet site on aging and health, NIHSeniorHealth has a number of features that enhance its use by older adults. One allows visitors to the "talking" Web site -- created in collaboration with the National Library of Medicine and other NIH institutes -- to listen to a recorded narration of the text while they browse. "The text is reviewed by many experts and we ask AGS to help us review the material from the perspective of clinicians," Dr. Salerno notes.

The Institute also recently began work on another new initiative -- drafting easy-to-understand booklets to help readers with limited literacy. Topics covered so far include memory problems, how to use medicines safely and how to stay safe in cold weather. The Institute's Age Page series of fact sheets on health issues of interest to older people is particularly popular, and Dr. Salerno invites AGS members to provide these and other publications to their patients, through the Institute's Web site, www.nia.nih.gov.

In light of current fiscal constraints, says Dr. Fried, it's critical that researchers, trainees and others who benefit from NIA funding and initiatives raise awareness -- among legislators and the general public -- of the importance of this funding and support.

"We need to take every opportunity to publicly explain why NIH funding -- and NIA funding and initiatives in particular -- are so vital," she adds, noting that the AGS has launched an advocacy campaign to urge Congress to increase funding for the institute. "We need to make this clear to the public and Congress -- and encourage legislators to increase their investment in the NIA and aging research."

The National Institute on Aging plans to release a draft of its new strategic plan for the future as early as this spring, and will invite comments from organization such as AGS and interested individuals.