Aging and Women's Health: An Update from the National Institute on Aging.

Older women outnumber older men in the United States and may experience a range of physical, cognitive, social, and emotional challenges. The "Geriatric 5 Ms"-Multicomplexity, Mind, Mobility, Medications, and What Matters Most-provide a useful framework for understanding and addressing the health and wellness needs of older women in the clinic. The National Institute on Aging, a component of the US National Institutes of Health, supports a vibrant program of aging research with many immediately implementable findings and useful resources for the busy clinician.

Affirming NIH's commitment to addressing structural racism in the biomedical research enterprise.

NIH has acknowledged and committed to ending structural racism. The framework for NIH's approach, summarized here, includes understanding barriers; developing robust health disparities/equity research; improving its internal culture; being transparent and accountable; and changing the extramural ecosystem so that diversity, equity, and inclusion are reflected in funded research and the biomedical workforce.

Attracting New Investigators to Alzheimer's Disease Research: Outcomes of Increased Funding and Outreach.

Since 2015, the National Institute on Aging (NIA), National Institutes of Health (NIH), has experienced significant increases in funding for Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD). This analysis assesses the impact of these funds on expanding the AD/ADRD workforce. NIA administered 860 awards to 695 AD/ADRD R01 awardees during fiscal year 2015-2018. Twenty-nine percent of awardees were new or early-stage investigators, while 38% were new to the AD/ADRD research field (NTF). Among these NTFs, 59% were established investigators, that is, experts with NIH funding in another discipline but new to AD/ADRD research. Awards were further analyzed to determine the focus of their research based on International Alzheimer's Disease Research Portfolio (IADRP) categories. Forty-six percent were focused on Molecular Pathogenesis and Physiology. Other IADRP categories, including Diagnosis, Assessment, and Disease Monitoring and Translational Research and Clinical Interventions, represented 5%-15% of awards. Significantly, NTF investigators received 50%, 42%, and 70% of the total grants awarded in Population Studies, Dementia Care, and Brain Aging, respectively, suggesting that NTF investigators are filling research gaps. While these results suggest that enhanced funding is associated with recruitment of new talent, opportunities for further growth remain, particularly related to care, caregiving, and health disparities.

Adequacy of Inclusion of Older Adults in NIH-Funded Phase III Clinical Trials.

In the United States, the population aged 65 and older is rapidly growing, and this group uses more healthcare resources and has unique healthcare needs that do not exist in younger populations. However, it was reported that older adults are excluded or underrepresented in clinical trials for several diseases. We examined phase III clinical trials funded by the National Institutes of Health found in www.clinicaltrials.gov from 1965 to 2015 that addressed top causes for hospitalization and/or disability-adjusted life years in older adults: congestive heart failure (n = 45), cardiac dysrhythmias (n = 24), coronary atherosclerosis (n = 106), heart attack (n = 76), stroke (n = 113), chronic obstructive pulmonary disease (n = 14), pneumonia (n = 48), lung cancer (n = 117), prostate cancer (n = 65), and osteoarthritis (n = 15). We then analyzed the representation of older adults in these studies. We found that 33% of studies had arbitrary upper age limits, and 67% of studies reported mean and/or median ages that skewed younger than expected for the disease or condition of interest. Beyond explicit exclusion by age, older adults were often implicitly excluded based on various comorbid conditions such as polypharmacy/concomitant medication (37%) or cardiac issues (30%). We conclude that outcomes of these trials may not be fully generalizable to the general population of older adults. J Am Geriatr Soc 67:218-222, 2019.

Aging Research: Collaborations Forge a Promising Future.

The National Institute on Aging (NIA), one of 27 institutes and centers at the National Institutes of Health (NIH), was founded in 1974 to conduct and support research on aging and the health and well-being of older people. The Institute's interests span the fundamental processes that contribute to aging and their impact on systems; diseases and conditions for which aging is a risk factor; and interventions that may prevent, delay, or treat these conditions or otherwise contribute to an extension of healthy, active years of life. Multiple fruitful research collaborations within and outside the federal government, spanning the breadth of the Institute's research activities, have marked NIA's growth over the past 40 years, as well as its current areas of ongoing research. This article discusses several highlights of these collaborations, including the Health and Retirement Study, geroscience research, falls injury prevention in elderly adults, and implementation of the National Plan to Address Alzheimer's Disease, from the perspective of past accomplishments and trends for the future.

Constructing a representative sample of out-of-care HIV patients from a representative sample of in-care patients.

Individuals infected with HIV who are out of care are at a higher risk of HIV-related morbidity and mortality. It has been difficult to recruit a representative sample of out-of-care patients for epidemiological studies. Using a novel weighting method, we constructed a representative sample of out-of-care HIV patients from a representative sample of in-care patients. In-care patients were weighted based on the probability of receiving care during the study period and the probability of selection to participate in the study, and out-of-care patients were represented by those who were previously out of care and recently returned. The method can be used in other patient populations, if every patient in the population has a known, non-zero probability of receiving care and a known, non-zero probability of participating in the study.

The National Institute on Aging Health Disparities Research Framework.

OBJECTIVE: Development of a new framework for the National Institute on Aging (NIA) to assess progress and opportunities toward stimulating and supporting rigorous research to address health disparities. DESIGN: Portfolio review of NIA's health disparities research portfolio to evaluate NIA's progress in addressing priority health disparities areas. RESULTS: The NIA Health Disparities Research Framework highlights important factors for health disparities research related to aging, provides an organizing structure for tracking progress, stimulates opportunities to better delineate causal pathways and broadens the scope for malleable targets for intervention, aiding in our efforts to address health disparities in the aging population. CONCLUSIONS: The promise of health disparities research depends largely on scientific rigor that builds on past findings and aggressively pursues new approaches. The NIA Health Disparities Framework provides a landscape for stimulating interdisciplinary approaches, evaluating research productivity and identifying opportunities for innovative health disparities research related to aging.

Obstacles and opportunities in Alzheimer's clinical trial recruitment.

The 2012 National Plan to Address Alzheimer's Disease set an ambitious goal: to both prevent and effectively treat Alzheimer's disease by 2025. To reach this goal, tens of thousands of volunteers will be needed to participate in clinical trials to test promising new interventions and therapies. To mobilize these volunteers and their health care providers to participate in future clinical trials, it will be necessary to achieve a better understanding of the barriers keeping people from participating in Alzheimer's research; form innovative partnerships among researchers, health care and social service providers, and the public; and develop more-effective outreach strategies. In this article we explore recruitment issues, including those unique to Alzheimer's studies, and we suggest concrete steps such as establishing a structured consortium linking all of the registries of Alzheimer's trials and establishing new partnerships with community and local organizations that can build trust and understanding among patients, caregivers, and providers.

National Institute on Aging at middle age--its past, present, and future.

The National Institute on Aging (NIA) at the National Institutes of Health (NIH) leads the federal effort conducting and supporting research on aging. It is also designated as the lead within NIH for research on Alzheimer's disease. Since NIA's establishment in 1974, it has grown to a billion dollar enterprise featuring a balanced program of basic, clinical, and behavioral and social science. Investigator-initiated research and strategic investments have been critical to the NIA's success in bringing new insights and understandings to aging processes and diseases and conditions associated with advancing age. In recent years, constraints in the growth of resources have posed new challenges as the NIA and NIH leadership seek to maintain a robust and productive program. This article will review the history of the NIA, discuss current programs and priorities, and point to new directions in research, looking ahead.

Challenges and opportunities in advancing models of care for older adults: an assessment of the National Institute on Aging research portfolio.

OBJECTIVES: To identify existing projects supported by the National Institute on Aging (NIA) that may relate to the recommendations for models of care (MOCs) presented in the 2008 Institute of Medicine Report, Retooling for an Aging America: Building the Healthcare Workforce. DESIGN: Cross-sectional analysis of NIA's grant portfolio. SETTING: NIA. PARTICIPANTS: NIA grantees. MEASUREMENTS: NIA's grant portfolio was queried for the period 1999 to 2008 using a variety of search terms related to MOCs. Inclusion criteria were adherence to guiding principles for MOCs (comprehensive care, efficient care, older person as an active partner) or focus on innovative feature(s) of MOCs (interdisciplinary care, care management, chronic disease self-management, pharmaceutical management, preventive home visits, proactive rehabilitation, transitional care). Exclusion criteria were lack of focus on an intervention and focus on informal caregivers. Expert NIA staff reviewed and validated projects. RESULTS: One hundred thirty-five grants were identified. These grants represent fewer than 1% of the approximate number of grants NIA has funded over this same period of time (∼24,000 grants). Forty-four percent focused on components of comprehensive care and 34% on active involvement of older adults. Approximately half specifically focused on innovative features of MOCs, ranging from chronic disease self-management (32%) and proactive rehabilitation (26%) to preventive home visits (1%) and transitional care (1%). The majority of projects were investigator-initiated grants (46%). CONCLUSION: NIA has supported the development of many interventions that include components of MOCs related to recommendations from the IOM report. The challenge for the future will be determining which of the many components of comprehensive care systems are most effective for which subsets of the elderly population and assessing opportunities for enhanced collaboration between public and private aging research stakeholders.

Comparative effectiveness research priorities at federal agencies: the view from the Department of Veterans Affairs, National Institute on Aging, and Agency for Healthcare Research and Quality.

In the last year, attention has been focused on translating federally sponsored health research into better health for Americans. Since the passage of the American Recovery and Reinvestment Act (ARRA) on February 17, 2009, ARRA funds to support Comparative Effectiveness Research (CER) have increased this focus. A large proportion of topical areas of interest in CER affects the older segment of the population. The Department of Veterans Affairs (VA), the National Institute on Aging (NIA), and the Agency for Healthcare Research and Quality (AHRQ) have supported robust research portfolios focused on aging populations that meet the varying definitions of CER. This short article briefly describes the research missions of the AHRQ, NIA, and VA. The various definitions of CER as the Congressional Budget Office, the Institute of Medicine, and the ARRA-established Federal Coordinating Council have put forward, as well as important topics for which CER is particularly needed, are then reviewed. Finally, approaches in which the three agencies support CER involving the aging population are set forth and opportunities for future CER research outlined.

Strength and influence of geriatrics departments in academic health centers.

The United States is establishing new medical schools and increasing class size by 30% in response to the predicted increased needs of the baby boom generation, which will retire soon and live longer than prior generations. Society in general and the medical profession in particular are ill equipped to care for the special needs of the elderly. Since the early 1980s, departments of geriatric medicine have been developed in the United States. However, the prevailing U.S. system for the training of physicians in geriatrics is through sections, divisions, or institutes. This article reviews the advantages and disadvantages of departments of geriatrics, using case examples from three (University of Oklahoma College of Medicine, Florida State University College of Medicine, and University of Hawaii at Mãnoa John A. Burns School of Medicine) of the extant 11 medical schools in the United States with departments of geriatrics. Commonalities among the three departments include a seat at the planning table in academic life, equal treatment and collaboration with other departments in academic and research program development, and direct access to key decision makers and opportunities for negotiation for funds. Each department has outreach to all undergraduate medical students through its training program. All three departments were launched through the investment of significant resources obtained both internally and externally. The challenge for the future will be to definitively demonstrate the efficacy of the department model versus the more prevalent section, division, and institute approach to training physicians to care for the elderly.

Nutritional considerations in institutionalized elders.

PURPOSE OF REVIEW: The aim of this article is to emphasize the importance of malnutrition in frail institutionalized elderly and discuss recent interventions that have been shown to decrease its prevalence. RECENT FINDINGS: A Medline search was conducted from 1968 to 2007 under the search terms aging, nutrition, and nursing homes. The most current reviews relevant to the care of institutionalized elders were selected for inclusion in this report. Recent reports have shown that application of screening protocols in long-tem care institutions improved nutritional status. A complete physical assessment, with special attention to the oral cavity, should be conducted. Monitoring of weight and intake should be part of the institutional routine, recognizing that there may be differences between prescribed diet and actual intake. Nutritional interventions should be tried as early as possible, including enhancement of environment and increasing staff to assist with feeding, as malnutrition in this population is associated with falls (particularly with deficient vitamin D) and increased morbidity and mortality. To optimally facilitate nutritional care of nursing home patients reforms are needed to facilitate optimal staffing in the institutional setting. SUMMARY: It is important to educate healthcare workers in the nursing home about simple interventions that could improve nutritional status.