The National Institute

on Aging:

Strategic Directions for Research, 2020-2025

ONLINE ONLY
NIA Strategic Directions 2020 1 

From the Director

I am pleased to present the strategic directions of the National Institute on Aging (NIA) for 

2020-2025. 

Today, there are more Americans ages 65 and older — just over 49 million, according to the 

U.S. Census — than at any other time in history, and we expect these numbers to grow as more 

Baby Boomers (individuals born between 1946 and 1964) reach retirement age. We can 

attribute this unprecedented demographic shift to a variety of factors, many of which benefit 

people of all ages. For example, even within the lifetimes of today’s older Americans, infectious 

diseases that once cut millions of lives short have been largely controlled in the U.S., and public 

health campaigns and policy changes — for example, smoking cessation efforts and laws 

mandating seat belt use — have saved many more lives. 

Despite these advances, aging itself remains the most significant risk factor for many chronic

diseases and conditions, including Alzheimer’s disease and related forms of dementia 

(AD/ADRD), most types of cancer, many types of heart disease, osteoporosis and hip fracture, 

kidney failure, and diabetes. While these diseases are rarely inevitable, it is probable that as the 

number of older Americans increases, so too will the number of people with age-related 

diseases. A significant increase in the number of individuals with serious chronic conditions will 

have profound social and economic effects on the nation. 

NIA is meeting these challenges through its ongoing mission to: 

• Support and conduct genetic, biological, clinical, behavioral, social, and economic 

research on aging.

• Foster the development of research and clinician scientists in aging.

• Provide research resources.

• Disseminate information about aging and advances in research to the public, health care 

professionals, and the scientific community, among a variety of audiences.

Our primary activities include funding extramural research at universities and research centers 

across the U.S. and around the world; maintaining an active communications and outreach 

program; and conducting a vibrant intramural research program at NIA laboratories in 

Baltimore and Bethesda, Maryland. In addition, as the lead federal agency for research on 

AD/ADRD, NIA has received an unprecedented influx of funding targeted toward understanding 

and addressing these conditions over the past seven years, and our plans and priorities reflect 

this extraordinary opportunity for discovery.

This document presents our scientific priorities for the next five years. Consistent with guidance 

in the 21st Century Cures Act, we also lay out our goals and objectives with respect to some of 

the “behind the scenes” activities we conduct in order to support the science. It is our hope 

that this description of our priorities is useful to you, whether you’re an independent 

researcher, an advocate, or an interested layperson. 

For up-to-date information about NIA’s activities, priorities, and advances, I invite you to visit 

our web site at www.nia.nih.gov. 

Sincerely,

Richard J. Hodes, M.D.
NIA Strategic Directions 2020 2 

Contents

The National Institute on Aging: Strategic Directions for Research, 2020-2025 ....................... 3

The National Institute on Aging.................................................................................................. 3

About This Document................................................................................................................. 3

Understanding the Dynamics of the Aging Process................................................................ 3

Improving the Health, Well-Being, and Independence of Adults as They Age....................... 3

Supporting the Research Enterprise....................................................................................... 4

How Will We Measure Progress? ............................................................................................... 4

Understanding the Dynamics of the Aging Process................................................................ 5 

Goal A Better understand the biology of aging and its impact on the prevention, 

progression,and prognosis of disease and disability. ...................................................... 5

Goal B Better understand the effects of personal, interpersonal, and societal 

factors on aging, including the mechanisms through which these factors 

exert their effects. ........................................................................................................... 8

The Importance of Longitudinal Data on Aging........................................................................ 11

Improving the Health, Well-Being, and Independence of Adults as They Age........................ 13

Goal C Develop effective interventions to maintain health, well-being, and 

function and prevent or reduce the burden of age-related diseases, 

disorders, and disabilities. ............................................................................................. 13

Goal D Improve our understanding of the aging brain, Alzheimer’s disease, 

related dementias, and other neurodegenerative diseases. Develop 

interventions to address Alzheimer’s and other age-related 

neurological conditions.................................................................................................. 19

Research on Alzheimer’s Disease and Related Dementias....................................................... 20

Goal E Improve our understanding of the consequences of an aging society 

to inform intervention development and policy decisions. .......................................... 26

Goal F Understand health disparities related to aging and develop strategies 

to improve the health status of older adults in diverse populations............................ 29

Supporting the Research Enterprise..................................................................................... 38

Goal G Support the infrastructure and resources needed to promote 

high-quality research. .................................................................................................... 38

Goal H Disseminate information to the public; scientific and medical communities; 

stakeholder advocacy, community and older adult-support organizations; 

the media; and policymakers about research and interventions.................................. 41

Goal I Effectively steward public resources.............................................................................. 43

How NIA Sets Scientific Priorities ............................................................................................. 44

Appendices ......................................................................................................................... 47

Appendix 1: NIA Organizational Chart...................................................................................... 47

Appendix 2: Setting Strategic Directions.................................................................................. 48
NIA Strategic Directions 2020 3 

The National Institute on Aging: Strategic 

Directions for Research, 2020-2025

The National Institute on Aging

The National Institute on Aging (NIA) is one of 27 Institutes and Centers of the National 

Institutes of Health (NIH), a component of the U.S. Department of Health and Human Services.

Our mission encompasses basic, translational, and clinical research; training and career support 

for investigators at all levels; resource allocation; and health communication to a range of 

audiences. Congress established the NIA in 1974 to lead a national scientific effort to 

understand the nature of aging in order to promote the health and well-being of older adults. 

The Institute was subsequently designated as the lead within NIH for research on Alzheimer’s 

disease and related forms of dementia (AD/ADRD). NIA pursues its mission by funding 

extramural research at universities and medical centers across the U.S. and around the world; 

maintaining an active communications and outreach program; and conducting a vibrant

intramural research program at NIA laboratories in Baltimore and Bethesda, Maryland. 

Public Law 93-296 authorizes the establishment of a National Institute on Aging and requires 

that the institute develop a national comprehensive plan to coordinate the Health, Education, 

Welfare (HEW) agencies involved in aging research. The Institute’s purpose, functions, and 

certain activities are described in 42 U.S. Code §285e. 

About This Document

This document outlines NIA’s broad strategic directions. It provides a point of reference for 

setting priorities and a framework for systematically analyzing the Institute’s scientific portfolio 

and assessing progress. NIA developed and refined these goals over a one-year period, 

receiving valuable input and feedback from stakeholders in the research community, 

nongovernmental organizations, partners within NIH and elsewhere within the federal 

government, and members of the general public via a November 2018 Request for Information. 

We will update the document as needed as the field of aging research evolves. 

Our goals are as follows: 

Understanding the Dynamics of the Aging Process

Goal A: Better understand the biology of aging and its impact on the prevention, progression, 

and prognosis of disease and disability. 

Goal B: Better understand the effects of personal, interpersonal, and societal factors on aging, 

including the mechanisms through which these factors exert their effects.

Improving the Health, Well-Being, and Independence of Adults as They Age 

Goal C: Develop effective interventions to maintain health, well-being, and function and 

prevent or reduce the burden of age-related diseases, disorders, and disabilities. 
NIA Strategic Directions 2020 4 

Goal D: Improve our understanding of the aging brain, Alzheimer’s disease, related dementias,

and other neurodegenerative diseases. Develop interventions to address Alzheimer’s and other 

age-related neurological conditions. 

Goal E: Improve our understanding of the consequences of an aging society to inform 

intervention development and policy decisions. 

Goal F: Understand health disparities related to aging and develop strategies to improve the 

health status of older adults in diverse populations. 

Supporting the Research Enterprise

Goal G: Support the infrastructure and resources needed to promote high-quality research. 

Goal H: Disseminate information to the public; scientific and medical communities; stakeholder 

advocacy, community and older adult-support organizations; the media; and policymakers 

about research and interventions.

Goal I: Effectively steward public resources.

Our vision is to enable all Americans to enjoy robust health and independence with advancing age.

How Will We Measure Progress?

As a component of the NIH, NIA supports research with the goal of curing disease and 

improving overall health. However, the path from bench to bedside — that is, from basic 

scientific discovery to clinical application — is often long and is rarely straightforward. It’s the 

nature of biomedical science that years or even decades worth of incremental advances may be 

necessary before a basic discovery, however ground-breaking, pays off in the form of new 

interventions to benefit health. While a direct link can sometimes be drawn between specific 

funding and an improvement in health, more often the story is complex. Furthermore, with 

each new breakthrough, science can advance and evolve in unanticipated ways. These new 

directions also serve as indicators of progress, and we consider them to be a successful 

outcome of our support, even when direct clinical application is not immediately evident. 

With all of this in mind, NIA will use both quantitative and qualitative techniques to measure 

progress toward the priorities described in this document; analyze the scientific, clinical, and 

public health impact of its research; and periodically report results to stakeholders. We will do 

this through regular analysis and evaluation of programs and initiatives that have been 

developed in support of our priorities. Because no two programs or initiatives are exactly the 

same, the tools, measures, and approaches we use for each evaluation or analysis will differ. 

However, we anticipate working with partners across NIH, such as the Office of Portfolio 

Analysis and the Office of Program Evaluation, Performance, and Reporting to track progress 

and initiate course corrections where necessary. 
NIA Strategic Directions 2020 5 

Understanding the Dynamics of the 

Aging Process

Aging is associated with changes in dynamic biological, physiological, environmental, 

psychological, behavioral, and social processes. Some age-related changes are benign, such as 

graying hair. Others result in declines in function of the senses and activities of daily life and 

increased susceptibility to and frequency of disease, frailty, or disability. In fact, advancing age 

is the major risk factor for a number of chronic diseases in humans. 

Studies from the basic biology of aging using laboratory animals — and now extended to human 

populations — have led to the emergence of theories to explain aging. While there is no single 

“key” to explain aging, these studies have demonstrated that the rate of aging can be slowed, 

suggesting that targeting aging will coincidentally slow the appearance and/or reduce the 

burden of numerous diseases and increase healthspan (the portion of life spent in good health). 

To develop new interventions for the prevention, early detection, diagnosis, and treatment of 

aging-related diseases, disorders, and disabilities, we must first understand their causes and the 

factors that place people at increased risk for their initiation and progression. NIA-supported 

researchers are engaged in basic science at all levels of analysis, from molecular to social, to 

understand the processes of aging and the factors that determine who ages “well” and who is 

susceptible to age-related disease and disability. Research is also ongoing to identify the 

interactions among genetic, environmental, lifestyle, behavioral, and social factors and their 

influence on the initiation and progression of age-related diseases and degenerative conditions. 

NIA has established two goals related to the basic science of aging: 

Goal A: Better understand the biology of aging and its impact on the prevention, 

progression, and prognosis of disease and disability. 

Goal B: Better understand the effects of personal, interpersonal, and societal factors on 

aging, including the mechanisms through which these factors exert their effects.

Goal A

Better understand the biology of aging and its impact on the prevention, 

progression, and prognosis of disease and disability.

Aging is not, in and of itself, a disease. However, aging is the major risk factor for developing 

many major chronic diseases. Furthermore, many diseases appear to accelerate the aging 

process — which is manifested as declines in functionality and reduced quality of life.

One of our challenges is to develop a clearer understanding of the basic biology underlying 

changes that accompany aging, as distinct from the basic biology underlying disease. For 

example, in response to bacterial infections or wounds, inflammation is an essential part of the 

recovery and healing process. However, low-level chronic inflammation that appears in the 

absence of clinically diagnosed infection may increase the susceptibility to and rate of 

progression of age-related pathologies. Chronic inflammation may also contribute to frailty in 

ways that are independent of obvious disease.
NIA Strategic Directions 2020 6 

Another challenge is to take advantage of the most promising opportunities presented by 

research in laboratory animals and to translate those findings to humans. A few recent

discoveries offer possibilities for improved human health in an aging population. For example:

• Interventions that extend lifespan also extend healthspan — the portion of lifespan 

spent in good health — suggesting that interventions that extend life can reduce the 

burden of multiple diseases. 

• A particularly promising avenue of research involves cellular senescence, a process in 

which cells lose function, including the ability to divide and replicate, but continue to 

secrete molecules that damage neighboring cells. Investigators found that when treated 

with senolytics, or compounds that selectively remove senescent cells, mice that had 

previously been injected with damaging senescent cells regained physical function. 

Senolytics also extended lifespan and healthspan in naturally aging mice. In addition, 

investigators have found that clearing senescent cells from the brain preserves cognition 

in a mouse model of Alzheimer’s disease. Several senolytics have recently moved into 

early-stage human trials.

• Reduction of caloric intake causes normal cells to mount stress-response defenses that 

cancer cells cannot, a finding that has entered clinical testing as a possible intervention 

to enhance chemotherapy while also reducing some of its side effects.

• Longevity can be inherited across generations through epigenetic changes — that is, 

changes that affect gene behavior but do not alter the underlying sequence of DNA. This 

suggests that parental lifespan and even parental behavior can influence the lifespans 

and healthspans of the next generation through mechanisms other than genetics.

These and newly emerging findings on the basic biology of aging hold great promise for 

improving health, and NIA is committed to continuing support of this research and translating 

these discoveries into interventions that support better health. 

Goal A objectives: 

A-1: Identify genetic, molecular and cellular factors that determine the rate of aging processes. 

A-2: Determine how cellular and molecular changes associated with aging contribute to decreased 

resilience and increased morbidity and influence response to treatment of age-associated 

physical conditions.

A-3: Determine how cellular and molecular bases of changes associated with aging contribute to 

the development and course of age-related dementia and treatment response.

A-4: Identify factors associated with successful aging and resilience against disease and 

dysfunction.

A-5: Understand the sensory and motor changes associated with aging and how they lead to 

decreased function and increased risk of morbidity.

A-6: Identify and characterize interventions that hold the promise of increasing healthy lifespan. 

A-7: Develop and/or identify biomarkers (including genetic, epigenetic, molecular, cellular, 

immunological, metabolic, and microbiome-related) that are applicable to aging and 

geroscience research.
NIA Strategic Directions 2020 7 

A-8: Use comparative biology to understand how adaptations in diverse species ultimately 

affect aging.

Approach

A-1 Identify genetic, molecular and cellular factors that determine the rate of aging processes. 

Researchers continue to identify and explain key factors affecting the rate of aging, including 

the body’s response to a variety of stresses; the function of the immune system; the role of 

cellular senescence; the body’s response to macromolecular damage (damage to large 

molecules such as proteins or lipids), such as that caused by oxidative stress; and protein 

quality control (proteostasis). Studies of genes and epigenetic mechanisms associated with 

aging processes, longevity, and age-related diseases, as well as the interplay among genes and 

environmental influences, also continue to provide insights into disease pathologies and 

vulnerability. NIA will support research to identify additional factors and to clarify their roles 

both in animal models of aging and in humans. 

A-2 Determine how cellular and molecular changes associated with aging contribute to 

decreased resilience and increased morbidity and influence response to treatment of ageassociated physical conditions. Increasing age is often accompanied by a progressive decline 

in most physiological functions, resulting in increased susceptibility to disease. At the same 

time, many people maintain physical function and enjoy robust health well into older age. 

Together, these findings inform the emerging field of geroscience, which hypothesizes that 

manipulating basic processes of aging could help to maintain physiological function and might 

provide an effective way to prevent or treat age-related diseases. NIA will encourage research 

in both the loss and maintenance of functions during the aging process and will foster studies 

both in humans and in animal models to investigate the health- and disease-related effects of 

manipulating aging-related processes at the molecular or cellular level. 

A-3 Determine how cellular and molecular bases of changes associated with aging contribute to 

the development and course of age-related dementia and treatment response. Aging itself is 

the primary risk factor for the development of Alzheimer’s disease and most other forms of 

dementia, in addition to diseases and conditions (e.g., type 2 diabetes, hypertension, and 

vascular disease) that are associated with increased dementia risk. However, we do not fully 

understand the mechanisms through which aging-related changes influence the brain and 

increase vulnerability to pathological change. NIA will conduct and support research on how 

aging processes influence the development of neurological disease. In addition, we will test 

interventions in animal models and ultimately in humans that have been shown to increase 

lifespan and healthspan in animals to determine their effect on cognitive function. 

A-4 Identify factors associated with successful aging and resilience against disease and 

dysfunction. Some people seem to be resistant to age-related disease and dysfunction. These 

“super-agers” may even perform cognitively or physically at levels more often seen in people 

who are decades younger. NIA will work to illuminate the factors that are associated with this 

resilience, and to determine whether those factors can be harnessed to increase resilience 

more broadly across the population.
NIA Strategic Directions 2020 8 

A-5 Understand the sensory and motor changes associated with aging and how they lead to 

decreased function and increased risk of morbidity. Mobility changes in the aging adult can 

result from changes in gait, balance, and physical strength, and can negatively influence the 

number and severity of falls, social participation, and independence. Loss of sensory functions 

such as vision, hearing, or the ability to taste is also common among older adults. NIAsupported research to better understand the underlying mechanisms of age-associated 

sensory and motor changes will provide the knowledge base necessary to develop 

interventions that optimize mobility and sensory function in the later years of life. 

A-6 Identify and characterize interventions that hold the promise of increasing healthy lifespan.

The NIA established and continues to support the Intervention Testing Program to test the 

reproducibility of candidate interventions that will prolong lifespan and increase healthspan. In 

this and other research the NIA promotes studies in both female and male organisms. Similar 

studies are supported in the Caenorhabditis Interventions Testing Program, a multiinstitutional study that investigates interventions that might extend lifespan or healthspan 

using diverse species and strains of the worm Caenorhabditis, to explore the impact of genetic 

diversity on the efficacy of interventions. We support studies on the mechanisms of action of 

these interventions which will facilitate their translation to benefit healthy aging in humans. 

A-7 Develop and/or identify biomarkers (including genetic, epigenetic, molecular, cellular, 

immunological, metabolic, imaging, and microbiome-related) that are applicable to aging 

and geroscience research. Aging is associated with changes at multiple physiological levels. 

Research is needed to enable us to predict, identify, and where necessary address these 

changes. 

A-8 Use comparative biology to understand how adaptations in diverse species ultimately affect 

aging. Lifespan is a complex biological trait resulting from multiple genetic interactions. In fact, 

we have identified roughly 400 genes involved in human lifespan. Comparing processes at the 

molecular, cellular, structural, and organismal levels across animal species and diverse human 

populations can provide important information about how these genes interact and illuminate 

critical molecular pathways that determine both lifespan and healthy function at older ages.

Goal B

Better understand the effects of personal, interpersonal, and societal factors on 

aging, including the mechanisms through which these factors exert their effects. 

Behavioral and psychological factors — for example, physical activity, smoking and other health 

behaviors, cognitive and social engagement, personality, and psychosocial stress — play a 

critical role in health across the lifespan. Studies have shown that up to 50% of preventable 

deaths in the U.S. can be attributed to adverse health behaviors such as smoking as well as

unhealthy diet that result in obesity. Social factors, such as social relationships and 

socioeconomic circumstances, have a similarly important impact on health and well-being. For 

example, subjective feelings of loneliness are known to be a risk factor for serious functional 

declines and even death, and converging lines of evidence from multiple cross-national 

epidemiological studies indicate that social isolation is a major risk factor for morbidity and 

premature mortality. And the relationship between personality — relatively stable individual 

differences in dispositions to think, feel, and act in particular ways — and aging-related 
NIA Strategic Directions 2020 9 

outcomes has been well documented: Conscientiousness is related both to longevity and to the 

development of AD, and neuroticism is linked to health in both positive and negative ways. A 

more comprehensive understanding of the causal pathways through which behavior, 

personality, social relationships, and socioeconomic circumstances are associated with health 

and well-being outcomes may suggest novel targets for intervention.

Furthermore, we now know that behavioral and social factors interact with genetic, molecular, 

and cellular mechanisms to influence health at older ages. Basic behavioral science is 

uncovering individual-level psychological, social, and behavioral factors that predict adaptive 

and healthy aging or confer risk for age-related decline. Evidence suggests that addressing 

these factors and their interplay are critical to minimizing disease and achieving full potential 

and vitality as people age. NIA will support and conduct research to verify these linkages and to 

better understand their underlying mechanisms. 

Research supported and conducted by NIA is helping to identify lifestyle factors and health 

behaviors that directly influence physical, cognitive, sensory, and emotional health and risk of 

disease as people age, such as research linking work and social engagement to cognition. 

Scientists are developing and refining recommendations for people of all ages regarding 

optimal diet, use of dietary supplements, mental stimulation, physical exercise, quality sleep, 

social engagement, stress reduction, and other practices to increase their likelihood of enjoying 

healthy old age. Still other researchers are looking for better ways to enhance the physical, 

mental, and social capacities of older adults and to expand opportunities for them to achieve 

personal goals and contribute to society in meaningful ways. As investigators more precisely 

identify the psychological, behavioral, and social processes that influence health and quality of 

life, we will be able to reinforce prevention efforts, enhance symptom management, and 

conserve function among older adults. 

Goal B objectives: 

B-1: Understand the basic behavioral, social, and psychological aspects of aging. 

B-2: Illuminate the pathways by which social, psychological, economic, and behavioral factors affect 

health in middle-aged and older adults. 

B-3: Identify developmental, prenatal, early life, and environmental exposures that affect individual 

differences in trajectories of biological, cognitive, and functional aging; the risk of disease and 

death; and the capacity for resilience and adaptation. 

B-4: Explore the mechanisms that account for the effects of social adversity and disadvantage, 

including research that focuses on critical periods for reversing such effects and/or the optimal 

timing of intervention. 

B-5: Better understand motivation, decision-making, and mechanisms of behavior change among 

older adults. 

B-6: Consider the role of place in the aging processes, taking into account geography in studies of 

late-life disability and mortality trends. 
NIA Strategic Directions 2020 10

Approach

B-1 Understand the basic behavioral, social, and psychological aspects of aging. Along with new 

physical, social, and emotional challenges, increasing age brings changes in cognition and 

emotion that have impacts on subjective well-being, social relationships, decision making, and 

self-control. How individuals respond to these challenges has implications for their 

independence, cognitive function, social relationships, mental health, physical function, and 

economic well-being. 

NIA will continue to conduct and support basic research in cognition, emotion, and 

motivation in normal aging, including their neurobiological and genetic bases. We will also 

explore these factors’ relationships to individual differences, social processes, and 

contextual factors. Finally, NIA will continue research on the interrelationships among 

emotion, cognition, and brain function; this information will guide the development of new 

biobehavioral interventions.

B-2 Illuminate the pathways by which social, psychological, economic, and behavioral factors 

affect health in middle-aged and older adults. Research is needed to help fully establish the 

pathways through which genes, environments, and behavior interact. We will encourage 

multilevel and interdisciplinary research on the interactive effects of genes, behavior, biology, 

and social and physical environments on health and well-being as people age. Finally, we will 

work to identify important biomarkers that are linked to aging-relevant social and behavioral 

phenomena, including the integration of neuroimaging data in large-scale surveys and 

laboratory-based studies with representative samples. 

B-3 Identify developmental, prenatal, early life, and environmental exposures that affect 

individual differences in trajectories of biological, cognitive, and functional aging; risk of 

disease and death; and the capacity for resilience and adaptation. Exposure to adverse social, 

interpersonal, and physical environments can exert profound and long-lasting psychological 

and physical effects on a developing organism, with long-term impacts on adult physical and 

cognitive health and longevity. Contextual factors such as residential segregation and 

socioeconomic status may be associated with or compound the effects of these adverse 

exposures. Conversely, environmental factors such as educational attainment have been 

associated with a reduced risk of cognitive decline and dementia. NIA will continue to support 

mechanistic and epidemiological studies to identify such factors and participate in 

translational studies to find ways to minimize their effects in adults. NIA will also continue to 

encourage research using a life-course approach to behavioral, psychological, economic, and 

social explanations for health outcomes that also incorporates the geroscience agenda.

B-4 Explore the mechanisms that account for the effects of social adversity and disadvantage, 

including research that focuses on critical periods for reversing such effects and/or the 

optimal timing of intervention. Many outcomes and behaviors in older adults are influenced 

by events, social relationships, noncognitive character skills, environmental factors, and habits 

that begin relatively early in life. Subgroups of the population experience disadvantage 

throughout their lives or for extended periods in life that generate persistent stress, and their 

patterns of stress reactivity appear to hasten the progression of disease. It is therefore 

important to elucidate the processes by which these adverse social exposures become 

biologically and psychologically embedded and contribute risk for disease and distress. In 
NIA Strategic Directions 2020 11

addition, it is important to examine the malleability of these biobehavioral risk mechanisms in 

order to identify opportunities for their amelioration. Life-course data connecting childhood 

circumstances to midlife/old-age outcomes will facilitate research that identifies such 

mechanisms. Because many health disparities and chronic conditions emerge in midlife, NIA 

will continue to support research on processes of aging during this life stage to identify optimal 

timepoints for interventions to reverse or redirect the impact of early-life adversity and 

cumulative stress exposures on aging processes.

B-5 Better understand motivation, decision-making, and mechanisms of behavior change among 

older adults. As the population ages, it will be important to understand how people make 

decisions about retirement, lifestyle, social relationships, health, and health care. Age-related 

changes in the interplay between motivation, cognition, and emotion, along with changes in 

life circumstances, health status, and social roles, combine to shape how individuals make 

both everyday choices around health behaviors and major decisions related to life transitions 

and long-term goals. The ability to make sound decisions is an important component of 

cognitive health, and deficits in decision-making abilities may be an early warning sign of 

dementia. NIA seeks to better understand the basic psychological processes involved in 

decision-making and how they change with aging, how social factors and social networks 

influence those decisions, and the incentives that motivate middle-aged and older adults to 

make health-supportive decisions in a wide range of life domains. We will support research in 

this area along the full spectrum, from neuroeconomic, cognitive and affective research on 

how aging individuals perceive stimuli and make decisions to social network research.

B-6 Consider the role of place in aging processes, taking into account geography in studies of 

late-life disability and mortality trends. Health and mortality can vary dramatically across 

geographic regions, localities, census tracts, and even ZIP codes. We will continue to support 

and conduct research to identify the drivers behind these differences as well as policies and 

interventions that may close gaps between health and mortality in diverse locales. 

The Importance of Longitudinal Data on Aging

NIA supports a number of longitudinal studies in which we have already collected a large 

amount of data on the participants. Because so much is already known about participants in 

theses studies, they provide us with a unique “living laboratory” in which to study both risk 

persistence mechanisms and factors that enhance responsiveness to intervention. New 

techniques for inferring causality from observational studies and complex data are also 

enabling us to draw important conclusions about the links between behavior and biology, and 

about possible behavioral interventions, as a complement to experimental studies and 

randomized controlled trials. 

A cornerstone of our longitudinal data collection efforts continues to be the Health and 

Retirement Study (HRS), NIA’s long-running study of health, retirement, disability, resources, 

and family support among Americans ages 50 and older. The HRS has been harmonized with 

similar studies in over a dozen countries in Europe, Africa, South America, and Asia, facilitating 

partnership and comparative research on aging around the world. HRS has also fielded a costeffective algorithmic approach to assessing cognitive impairment and dementia, the 

Harmonized Cognitive Assessment Protocol, that will provide a basis for comparing trends over 
NIA Strategic Directions 2020 12

time across the U.S. as well as other countries with HRS-like longitudinal studies of aging. We 

will continue to invest in a robust data collection infrastructure that enables study of the 

influence of population aging on the health and well-being of older adults.

Finally, we will continue our investments in select studies originally conceived of for other 

purposes but valuable for the study of early-life and midlife conditions and intergenerational 

influences on later-life outcomes. Cohorts from studies such as the Wisconsin Longitudinal 

Study and the Midlife in the U.S. Study, among many others, can be followed as they move 

through middle age to older adulthood in order to identify early-life risk and protective factors 

for age-related disease and dysfunction.
NIA Strategic Directions 2020 13

Improving the Health, Well-Being, and 

Independence of Adults as They Age

New insights into lifestyle, psychological, and other environmental influences on health 

promise to have a profound impact on the ability of older adults to remain physically healthy 

and cognitively, emotionally, and socially vital into very advanced ages – ideally, for as long as 

they live. Capitalizing on new insights from basic research, scientists will continue to work from 

multiple perspectives to develop and test strategies for preempting or reducing the severity of 

health problems that midlife and older adults experience. We will also work to strengthen the 

translation of basic findings and cutting-edge technological breakthroughs into practical 

applications to improve health and well-being at older ages. 

NIA has established four goals for improving the health, well-being, and independence of adults 

as they age. 

Goal C: Develop effective interventions to maintain health, well-being, and function and 

prevent or reduce the burden of age-related diseases, disorders, and disabilities.

Goal D: Improve our understanding of the aging brain, Alzheimer’s disease, related 

dementias, and other neurodegenerative diseases. Develop interventions to address 

Alzheimer’s and other age-related neurological conditions.

Goal E: Improve our understanding of the consequences of an aging society to inform 

intervention development and policy decisions.

Goal F: Understand health disparities related to aging and develop strategies to improve the 

health status of older adults in diverse populations.

Goal C

Develop effective interventions to maintain health, well-being, and function and 

prevent or reduce the burden of age-related diseases, disorders, and disabilities.

As previously noted, aging is the primary risk factor for an array of diseases and conditions. 

However, research has shown that health habits and behaviors such as physical activity, proper 

nutrition, and avoidance of smoking and other health-harming behaviors can help people live 

longer, postpone the onset of disability, and increase quality of life and function at older ages. 

Conversely, unhealthy lifestyle choices may be associated with significant health problems.

However, research has shown that it is almost never too late to decrease risk of disease and 

disability by establishing healthier patterns. Research has also shown that optimizing both the 

physical and social environment is important to the health and functioning of older adults. 

While much of our research in this area will promote the most basic and fundamental aspects 

of health and well-being — a nutritious diet, adequate exercise, and healthy behaviors — we 

will also aggressively leverage powerful emerging technologies that will result in new and 

effective ways to maintain health and independence. For example, wearable technologies can 

help older adults and their health care providers track both activities and health indicators such 
NIA Strategic Directions 2020 14

as blood pressure and exercise level in real time. Apps linked to a phone or device can assist 

with medication management. And remote sensors and artificial intelligence can be integrated 

to facilitate care of older adults, including those with dementia, and may also help older adults 

remain comfortably within their own homes as they age.

Goal C objectives: 

C-1: Develop efficacious and cost-effective strategies for promoting and ensuring adherence to 

healthy and safe behaviors among older adults. 

C-2: Develop improved approaches for the early detection and diagnosis of disabling illnesses and 

age-related debilitating conditions. 

C-3: Develop interventions for treating, preventing, or mitigating the impact of age-related diseases 

and conditions. 

C-4: Find significantly improved and cost-effective ways to reduce caregiver, family, and patient 

stress and improve older adults’ ability to cope with chronic disease. 

C-5: Develop strategies to improve the interaction of older adults with the health system.

C-6: Understand and develop strategies to enhance societal roles and interpersonal support for 

older adults, reduce social isolation, and promote positive caregiving outcomes and supports.

Approach

C-1 Develop efficacious and cost-effective strategies for promoting and ensuring adherence to 

healthy and safe behaviors among older adults.

• Build on our understanding of the roles of nutrition, obesity, sleep, and metabolic 

status to develop more effective health maintenance strategies. Epidemiological 

studies — and, in some cases, studies in animals — have shown clear positive effects of 

lifestyle choices such as healthy diet and physical activity, as well as the negative effects 

of obesity, malnutrition, and less-than-optimal sleep patterns on health and age-related 

morbidity. We will use these and other findings to launch clinical trials of dietary and 

other behavioral measures and adherence strategies for the prevention or delay of 

disease and disability.

• Support research on mechanisms of behavior change in midlife and older age.

Behavior change is difficult, yet adherence to healthy lifestyles can reduce the risk of 

disease and increase healthspan. Having a better understanding of how and why 

successful behavior change occurs is the key to providing blueprints for effective and 

efficient behavior interventions that could reliably improve health outcomes. We will 

support research on the behavioral, psychological, interpersonal, and neurobiological 

mechanisms that drive healthy behavior change to inform the design of interventions to 

prevent disease and promote adaptive aging. 

• Use our increased understanding of the underlying science to maximize the positive 

effect of physical activity on older adults. Several studies strongly suggest that modest 

physical activity may have beneficial effects in maintaining health — including mental 

health — and that these benefits are possible even at advanced ages. For example, 

weight-bearing exercise can build bone strength, protecting against osteoporosis and 
NIA Strategic Directions 2020 15

subsequent fragility fractures, and balance exercises such as Tai Ji Quan may help 

prevent future falls. We will:

o Continue to foster research into the molecular, cellular, and physiological 

mechanisms by which physical activity improves health.

o Support further research on the effects of physical activity programs on older adults 

within specific age groups and develop strategies for promoting adherence.

o Continue to disseminate information about the importance of physical activity for 

older adults. 

o Study the effects of physical activity and exercise on mental health and cognition.

o Support basic and translational research on the behavioral, psychological, and 

interpersonal mechanisms that support initiation and long-term engagement in 

physical activity over the adult lifespan.

• Continue to support and conduct research to understand hormone changes in older 

adults and pursue the development of interventions to address these changes without 

unwanted side effects. Counteracting some effects of aging by supplementing 

hormones such as estrogen, testosterone, human growth hormone, melatonin, and 

DHEA (dehydroepiandrosterone) is an area of active study, but there are concerns that 

individuals may be taking such agents before their safety and efficacy have been 

established. NIA will support studies to understand the biological action of hormonal 

changes in older men and women, assess whether or not hormone therapy will improve 

health, investigate the use of compounds to produce the beneficial responses of 

hormones in the body without detrimental side effects, and determine the potential to 

regulate hormone production in specific body tissues where increased or decreased 

amounts of these hormones are favorable to health. 

• Support and conduct research to understand and address the needs of people with 

multiple chronic health conditions. Data from the Centers for Disease Control and 

Prevention show that more than half of Americans ages 65 and older are living with two 

or more chronic conditions. NIA will support research to identify, test, and disseminate

interventions to facilitate optimal management of multiple conditions. 

• Improve the safe use of medications by older adults. Managing medications can be 

complex for older adults; their medications are often prescribed by more than one 

physician, for multiple health problems. Complications include adverse drug interactions 

and interactions with dietary supplements coupled with the physiological and functional 

changes associated with aging or age-related diseases. Research supported and 

conducted by NIA will improve our understanding and maximize the effectiveness of 

medications, develop new technical aids for physicians to monitor drug use, and provide 

new technologies and information to enable patients to manage medications better and 

avoid adverse reactions.

• Develop strategies to reduce falls and their consequences. Research supported and 

conducted by NIA will continue to identify safety risks for older adults in home and work 

environments, improve screening strategies, and develop and disseminate information 

important to reducing the risk of falls. 
NIA Strategic Directions 2020 16

• Explore new ways to improve safety in the home and community through studies of 

ergonomics and the built environment. This will include continuing research to identify 

cost-effective alterations in design that can reduce injuries and provide a safer 

environment for older adults, and an environment that encourages physical activity and 

social engagement. 

• Pursue a better understanding of needs and develop interventions to improve the 

safety of older drivers. NIA will continue to support research to identify factors such as 

visual impairment, hearing, attention, speed of processing, and other cognitive changes 

that put older drivers at risk of automobile accidents. In addition, we will continue to 

support the development of tools for assessing visual, cognitive, and other abilities 

associated with safe driving, interventions to improve the physical and cognitive skills 

necessary for safe driving, and technology and design changes to accommodate or 

compensate for the special needs of older drivers. We will also support research to 

understand the dynamics of making the decision to stop driving, the implications of that 

decision for the health and well-being of older adults, and alternative transportation 

options that help older adults maintain as much independence as possible. This research 

will provide the insights needed to develop guidelines for older adults, their health care 

providers, and family members.

C-2 Develop improved approaches for the early detection and diagnosis of disabling illnesses and 

age-related debilitating conditions. NIA will help develop and evaluate improved biochemical, 

imaging, and other techniques and tools to measure the well-being of older adults as well as 

symptoms of disease and disability. As new interventions are ready, the institute will 

disseminate information about the interventions to the public and health care communities, 

working to help move interventions into mainstream medical practice.

C-3 Develop interventions for treating, preventing, or mitigating the impact of age-related 

diseases and conditions. 

• Investigate the mechanisms by which lifestyle interventions affect aging-related 

changes and determine how individuals can maintain function with age or regain that 

function after loss due to immobility, illness, or trauma. After peaking in early 

adulthood, most tissue functions decline with advancing age. This leads to increased risk 

of developing diseases such as cardiovascular disease and cancer and may lead to 

declines in overall health and quality of life. Further research is needed on the 

mechanisms through which common interventions, both medical and behavioral, may 

slow physical and cognitive decline. NIA will continue to support research into the 

mechanisms of functional decline and its delay, with the goals of identifying molecular 

targets for drug interventions and treatments that minimize losses and promote the 

recovery of function after illness or trauma. 

• Support the development of behavioral interventions based on principles of basic 

behavioral and social science and designed with an eye to real-world implementation, 

in line with the NIH Stage Model. Because behavioral interventions frequently do not 

move beyond efficacy testing to effectiveness or implementation, NIH has developed a 

model to define and clarify the activities in behavioral intervention development and to 

facilitate scientific development of interventions that are both potent and 
NIA Strategic Directions 2020 17

implementable. NIA will use this model as a guide for developing interventions that will 

be effective in real-world settings. (For more on the NIH Stage Model, see 

https://www.nia.nih.gov/research/dbsr/nih-stage-model-behavioral-interventiondevelopment).

• Identify, characterize, and where appropriate, develop interventions for physiological

changes that influence the risk of age-related diseases across the human lifespan.

Studies will include changes that are associated with increased risk of disease and 

disabling conditions such as sarcopenia (reduced muscle mass), as well as those that are 

associated with exceptional health and longevity. 

• Conduct clinical studies and encourage the translation of new interventions to the 

clinical setting. As mechanisms, pathways, and processes of disease are better defined, 

and as potential healthspan-extending interventions are validated in model systems, 

development and testing of clinical applications in humans can begin. We will pursue 

the use of novel, flexible research designs where appropriate, and we will work with 

others to facilitate the navigation of barriers to the translation of promising compounds 

into clinical trials and ultimately approval by the U.S. Food and Drug Administration. 

• Support comparative effectiveness research. NIA will continue to support research to 

identify the relative merits of differing interventions for older adults. For example, 

investigators are testing the effectiveness of different interventions in improving quality 

and efficiency, eliminating disparities in treatment, and reducing unwarranted variations 

in expenditures at hospitals. Still others are comparing physical activity interventions 

and cognitive interventions to determine their relative effectiveness and examining the 

interactive effects of a combined physical activity/cognitive intervention program. 

C-4 Find significantly improved and cost-effective ways to reduce caregiver, family, and patient 

stress and improve older adults’ ability to cope with chronic disease. Families and others who 

care for people with chronic disease frequently face emotional stress as well as physical and 

financial burdens. At present, the direct economic costs of caregiving to caregivers and society 

are unknown, and it is not well understood how caregiving impacts the health and well-being of 

some caregivers and why some caregivers thrive in the experience of caregiving, whereas 

others experience distress, burden, and unhealthy outcomes of their own. Using approaches 

grounded in basic behavioral and social science, investigators will continue to develop and 

evaluate strategies to improve social support, skills training, and assistive services both for 

those who cope with chronic disease and for their caregivers. These initiatives should result in 

more effective and implementable approaches for prevention, treatment, and rehabilitation, as 

well as the ultimate adoption of these approaches in real-world contexts. Research supported 

and conducted by NIA will clarify needs and patterns of family caregiving and how people make 

decisions on providing care and inform guidance on support and skills, including a focus on 

families with diverse ethnic and socioeconomic backgrounds. 

• Develop strategies to help older adults and their families prepare for and manage ageassociated changes in health, income, function, and roles. Older adults and family 

members are faced with many complex decisions about medical treatment and various 

aspects of their retirement, finances, and long-term care that can affect their 

independence and well-being. Issues of concern include the ability of health care 

delivery systems to support patient and family needs, adherence to a patient’s advance 
NIA Strategic Directions 2020 18

directives, and financial resources to cover out-of-pocket costs for acute and long-term 

care and assistance needed for maintenance of optimal health. We will support research 

to develop data resources incorporating work, financial status, health care utilization, 

and outcomes to allow analyses of pathways to independent healthy aging. We will 

support the development of principle-based supportive interventions that can be 

implemented in real-world contexts. Research findings will be useful for people as they 

plan for later-life transitions as well as to inform policy decisions. 

• Investigate the social aspects of family caregiving and develop and disseminate 

effective interventions for patient care in family and community settings. 

o Assess and evaluate family relationships over time. This research will help us 

understand the role of interpersonal processes and the effects of changing 

relationships and social roles on the health and well-being of older adults.

o Address issues centered on the increased demands faced by family caregivers in light 

of changing patterns of work and family demographics. We will pay particular 

attention to the ways in which characteristics such as gender, marital status, income, 

socioeconomic status, race, and ethnicity influence these demands.

• Research and develop strategies to improve decision making for long-term and end-oflife care. There is a pressing need to identify approaches that will ensure quality, 

affordable long-term care that maintains optimal health and function for older adults.

There is also a critical lack of peer-reviewed research on how to improve quality at the 

end of life. To better address these issues, we will:

o Support research to examine component parts of health care delivery systems and 

their impact on medical, social, functional, and cost outcomes and use this 

information to test interventions to improve care. This research will help inform the 

development of interventions to coordinate care that promotes attention to patient 

and family preferences, facilitates smooth transitions among care settings, and 

maximizes independence. We will explore ways to support long-term care including 

care provided in the home. We will focus on interventions that reduce the burdens 

of caregivers, with an emphasis on the unique challenges faced by caregivers of 

patients with dementia.

o Understand caregiving patterns and improve the effectiveness of strategies for 

helping families manage the care needs of the physically frail. For example, we will 

support research to identify effective caregiving strategies, environmental 

modifications, and technological supports for both informal and formal long-term 

care settings.

o Develop strategies to improve the experience of older adults at the end of life. We 

will support research to better understand the decision-making process and 

changing preferences associated with advance care planning; better understand the 

transitions among end-of-life care settings such as the home, hospital, nursing 

home, and hospice; assess the benefit of end-of-life therapies and the cost 

effectiveness of interventions to improve end-of-life care; develop better measures 

of end-of-life quality for the patient and the family to improve our understanding of 
NIA Strategic Directions 2020 19

psychosocial issues that impact the end-of-life experience; and understand the social 

and economic context of caring for an older person who is dying. 

C-5 Develop strategies to improve the interaction of older adults with the health system. For 

older adults and their families, effective health care requires quality communication with and 

among health care professionals. According to one study, fewer than 40% of people 

experiencing symptoms associated with heart and circulatory or musculoskeletal systems seek 

a physician’s care. Similarly, women often avoid seeking care for urinary incontinence. We will 

seek better interventions to help older adults recognize the implications of disease-related 

signs and symptoms and consult a physician or other health care provider when they first occur. 

And we will work to find ways to help health care providers coordinate their services to older 

adults to optimize health status. 

C-6 Understand and develop strategies to enhance societal roles and interpersonal support for 

older adults, reduce social isolation, and promote positive caregiving outcomes and supports.

Despite negative stereotypes, millions of older adults work productively, contribute to society, 

and place a high value on retaining their independence. Research suggests that social support 

and continued involvement in useful activities foster positive effects on physical and mental 

health and on longevity. This effort is especially important for older adults who are at increased 

risk for multiple diseases, disability, and functional limitations that may keep them from fully 

engaging in the world around them. NIA will continue to support and conduct research to: 

• Identify ways for older adults to retain valued roles and maintain independence. Older 

men and women often continue to work in paid jobs, perform meaningful work as 

volunteers, maintain their own households, and/or support children and grandchildren.

Research supported and conducted by NIA will seek and apply technological, social, and 

behavioral findings to interventions that help extend the ability of older adults to 

remain independent, active, and productive. 

• Understand and develop strategies to address self-neglect, adverse social 

relationships, and susceptibility to physical, emotional and financial abuse among 

older adults. NIA will support basic research on the individual, interpersonal, and social 

environmental risk and protective factors for elder mistreatment and abuse. These 

efforts will help to inform the design of preventive interventions in individuals at risk for 

these outcomes. We will continue to partner with other agencies to identify the best 

ways to detect and address financial fraud and abuse facing older adults, promote 

adaptive self-care and care of others, and develop strategies to identify and support 

vulnerable elders in our communities. 

Goal D

Improve our understanding of the aging brain, Alzheimer’s disease, related 

dementias, and other neurodegenerative diseases. Develop interventions to 

address Alzheimer’s and other age-related neurological conditions. 

A better understanding of how the brain ages can provide important information on which to 

base strategies for maintaining and enhancing cognitive, emotional, sensory, and motor 

function. For example, studies have shown that, contrary to what scientists believed for 

decades, new neurons form in certain regions of the brain even in adulthood. This 
NIA Strategic Directions 2020 20

phenomenon, known as neurogenesis, suggests that we may be able to develop medical and 

behavioral approaches to stimulate formation of new neurons to compensate for the loss and 

functional decline of neurons with aging, disease, or traumatic injury. 

NIA will continue to support research to identify age-related neural changes and mechanisms 

the older brain uses to maintain optimal learning, memory, and other cognitive functions.

We will continue to support research to clarify the interactions between the brain and the 

peripheral nervous, endocrine, blood and circulatory, cardiovascular, and immune systems.

In addition, we will support the development of preventive and therapeutic approaches to 

maintaining health in cognition, emotion, sleep function, sensory processes, and motor 

function. 

Research on Alzheimer’s Disease and Related Dementias

NIA is the lead federal agency for research on Alzheimer’s disease and related forms of 

dementia (AD/ADRD), and our portfolio reflects this important responsibility. In fact, since 

2012, funding for AD/ADRD research has increased such that today, over one-half of our grants

research budget is dedicated to research on various forms of dementia. These funds support a 

broad range of projects, from basic molecular and cellular studies of the aging brain, to largescale clinical trials of interventions to prevent symptoms of dementia from taking hold, to 

development of a robust infrastructure for discovery, to demographic studies of AD/ADRD in 

different geographic, racial and ethnic, and socioeconomic populations. 

Strategic planning for AD/ADRD research is handled through its own dedicated process, and 

therefore many of the goals and objectives outlined here are necessarily broad. For more 

information on specific goals, milestones, and plans for AD/ADRD research, please see:

AD/ADRD Milestones Database: This database contains detailed information about research 

implementation plans and progress toward the goal of effectively treating or preventing 

AD/ADRD by 2025. www.nia.nih.gov/research/milestones 

Bypass Budget for AD/ADRD Research: NIH annually submits to the President and then to 

Congress a professional judgment budget that estimates the additional funding, above the base 

for AD/ADRD, needed to effectively treat and prevent these disorders by 2025. The estimate — 

often referred to as a "bypass budget" because it is presented without modification through the 

traditional federal budget process — also summarizes NIH-funded research and promising 

research opportunities. 

www.nia.nih.gov/about/bypass-budget-proposal-archive 

Goal D objectives: 

D-1: Understand the mechanisms involved in normal brain aging; the role of plasticity and 

resilience in maintaining brain function; the role of cognition and sleep in everyday functioning; 

and protective factors for sensory, motor, emotional, cognitive, and sleep function.

D-2: Identify and understand the genetic, molecular, and cellular mechanisms underlying the 

pathogenesis of AD/ADRD and other neurodegenerative disorders of aging. 
NIA Strategic Directions 2020 21

D-3: Improve assessment and diagnostic tools for distinguishing people with normal brain aging 

from those who will develop mild cognitive impairment (MCI), Alzheimer’s disease, and related 

conditions. 

D-4: Translate basic discovery into effective treatment and/or prevention strategies for AD/ADRD 

and other age-related neurological conditions. 

D-5: Better understand and develop interventions to address the special caregiving needs of 

patients with AD/ADRD, as well as the needs of their caregivers. 

D-6: Track epidemiologic trends in AD/ADRD, including incorporating new measures into national 

surveys. 

Approach

D-1 Understand the mechanisms involved in normal brain aging; the role of plasticity and 

resilience in maintaining brain function; the role of cognition and sleep in everyday 

functioning; and protective factors for sensory, motor, emotional, cognitive, and sleep 

function.

• Improve our understanding of normal brain aging. Changes in brain structure and 

function may continue throughout life, and studies in model organisms and humans are 

helping to define the normal trajectory of changes in the brain over the adult lifespan. 

Structural neuroimaging and anatomical studies of brain have shown declines in total 

gray and white matter, along with shrinkage or atrophy and synaptic changes in certain 

regions of the brain in aging. Functional imaging studies are defining the workings of 

large-scale neural and cognitive networks in the aging human brain. Human and animal 

studies suggest that adaptive or resilient processes (i.e., brain plasticity) may be needed 

for maintenance of brain structure and function during normal aging. At the molecular 

and cellular level of analysis in animal models, brain aging is associated with changes in 

gene and epigenetic expression, mitochondrial and energy metabolism, calcium 

regulation, protein homeostasis, glia, and neural plasticity and synaptic function. We will 

continue to work to elucidate the processes that occur during “normal” brain aging and 

to identify and find ways to activate the cellular processes that protect the brain from 

damage and promote its repair. 

• Identify the behavioral, psychological, and neural mechanisms and processes that 

confer successful aging and resilience to cognitive impairment. A subset of older adults 

remain asymptomatic, despite the presence of amyloid plaques and tau tangles — 

pathological hallmarks of AD/ADRD — in the brain. We don’t fully understand the

protective factors that prevent these individuals from cognitive decline or symptoms of 

dementia. We will support research to identify the cellular, molecular, behavioral, 

psychological, and social/environmental factors associated with cognitive resilience and, 

where possible, to use this knowledge as the basis for development of preventive 

interventions. 

• Determine how genetic, molecular, cellular, and social/environmental factors interact 

for optimal brain health and functioning, including in the oldest old (people ages 85 

and older). The overall integrity of brain structure and many neural systems is largely 

preserved in normal aging, whereas in age-related diseases, specific brain cell types and 
NIA Strategic Directions 2020 22

their connections are damaged or lost. NIA will work to gain a greater understanding of 

the many factors that interact to maintain brain structure and function, including 

compensatory mechanisms and adaptive or dynamic changes. For example, we will: 

o Continue to pursue a greater understanding of the interaction among genetic factors 

that underlie normal cognitive, emotional, sensory, motor, and sleep function as 

well as abnormal decline and the interactions between genetics and the 

environment. 

o Investigate epigenetic changes, which can significantly influence the structure, 

function, and expression of genes and molecular pathways within the cell. 

o Support research to better understand the neurological and behavioral effects of 

environmental factors, both early and later in life. 

In addition, we will continue to investigate the changes in brain structure and function 

that take place in people 85 or older. In the absence of disease, many of these 

individuals 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. NIA 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. 

• Understand the role of cognition, emotion, and motivation in everyday functioning. 

NIA will support research to examine the influence of contexts — behavioral, social, 

cultural, and technological — on older adults’ cognitive and emotional functioning; 

investigate the effects of age-related changes in motivation, cognition, and emotional 

well-being on activities of daily living, social relationships, and health status; and 

develop strategies for improving everyday functioning through various interventions 

such as cognitive training, stress reduction, and social and cognitive engagements. 

• Understand the role of sleep and other restorative processes in supporting everyday 

functioning. There is increasing recognition that positive psychological functioning 

influences health above and beyond negative psychological functioning (including 

depression, anxiety, and loneliness). Most research on the relationship between 

psychological factors and health to date has focused on deteriorative biological 

processes and related health outcomes. Significantly less is known about restorative 

biological processes such as sleep, physical activity, and other restorative processes that 

may support optimal well-being and everyday physical and psychological functioning. 

D-2 Identify and understand the genetic, molecular, and cellular mechanisms underlying the 

pathogenesis of AD/ADRD and other neurodegenerative disorders of aging. 

• Refine our knowledge of genetic, molecular, and cellular changes involved with the

development of AD and other dementias of aging. Studies of the neurobiology of aging 

have given us increasing insight into the ways brain aging itself is associated with the 

development of AD/ADRD. However, key questions remain. We will encourage a 

systems-based approach to investigate the pathological changes associated with the 

preclinical development of AD/ADRD, including accumulation of abnormal proteins, loss 

of synapses, and death of neurons. We will also explore the impact of genetic and 
NIA Strategic Directions 2020 23

inflammatory processes on the development of AD. We will promote further 

characterization of these pathological changes in tissue culture, animal models, 

and humans.

• Refine our knowledge of the cognitive and behavioral changes associated with the 

development of AD and other forms of dementia. Our research will also address the 

behavioral and psychological changes associated with the development of AD as well as 

psychiatric conditions such as clinical depression. 

• Investigate the relationship between systemic factors and brain function during 

preclinical AD. Systemic risk factors such as obesity, diabetes, hypertension, infection 

with the human immunodeficiency virus (HIV), and heart disease during midlife are 

associated with accelerated age-related cognitive decline and with increased risk for AD, 

particularly among individuals with three or more of these risk factors. We will continue 

to support research to examine the mechanisms by which these risk factors may 

influence the transition between normal brain aging and AD, and whether the negative 

impact of metabolic and vascular risk factors on brain aging can be counteracted 

through behavioral and lifestyle changes. We will also continue to support research that 

examines brain-body interactions in AD and overall health, especially interactions 

mediated by stress and other hormones. For example, short sleep — less than an 

average of six hours per night — has been associated with hormonal and metabolic 

changes associated with obesity, diabetes, hypertension, cardiovascular disease, and 

cognitive decline. 

• Understand the role of sleep in brain function and neurodegenerative disorders of 

aging. Sleep and circadian clock disruption affect age-related brain function and alter 

the expression and course of neurodegenerative diseases. We will support research on 

the molecular and cellular underpinnings of age-related changes in quality and quantity 

of sleep and deterioration of circadian function. We will continue efforts to determine

the effects of sleep deficiency on the brain and behavior, as well as the association 

between sleep and circadian disruption and neurodegenerative disease. 

D-3 Improve assessment and diagnostic tools for distinguishing people with normal brain aging 

from those who will develop mild cognitive impairment (MCI), Alzheimer’s disease, 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, diagnosis, and treatment of disease. A 

critical step in accomplishing this goal is to clearly delineate changes that occur with aging in 

people who do not develop MCI or AD until very late in life. This knowledge can help in the 

identification of biomarkers of the transition from normal function to cognitive impairment and 

disease. NIA will continue to support research to: 

• Identify and establish links among neuroimaging, biological, and clinical markers for 

early detection of cognitive decline, MCI, and AD and for understanding the 

progression from normal cognitive aging to MCI to early AD. 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. The Alzheimer’s Disease Neuroimaging Initiative has achieved considerable 

success in developing sensitive and precise tools for detecting AD at its earliest stages 
NIA Strategic Directions 2020 24

and following the disease’s progression through the use of a combination of biomarkers.

These results are also supporting the development of measures to assess the 

effectiveness of potential interventions. Future efforts will include continued collection 

of biomarkers to fill critical gaps in our understanding of the biomarker trajectories of 

AD and aging. 

• Improve neuropsychological, functional, and passive assessment of cognitive function.

Despite remarkable advances in neuroimaging, neuropsychological assessment of 

cognitive function continues to be the gold standard by which AD is diagnosed. We will 

continue to support the development and translation of tools for assessing cognitive 

function in the clinic, in the primary care setting, and in the home environment. 

• Improve methods for assessing changes in sensory and motor systems as markers of 

age-related change and AD and decrease the frequency of late and misdiagnoses. Agerelated changes in sensory systems occur in both normal individuals and those with AD.

We 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 navigate visually 

through the environment or changes in a person’s sense of smell may predict the 

development of AD. Finally, we will develop new methods to detect subtle changes in 

cognition or behavior that could herald the onset of AD/ADRD, including mobile 

technology and devices.

• Improve methods for assessing changes in affective processes as markers of normal 

age-related change, risk for AD, or signs of early psychological changes associated with 

AD/ADRD. Aging is also associated with changes in emotion, motivation, and stress 

resilience. We will continue to support research to advance understanding of normal 

age-related changes in these processes, the interconnections between these processes 

and cognitive changes with aging, and how dysfunction in these processes might 

manifest in MCI and the early stages of AD/ADRD, and/or account for any of the 

neuropsychiatric symptoms observed in these disorders. Such studies may identify novel 

targets for interventions or prevention efforts or provide clues to intervention strategies 

that might normalize emotion dysregulation or strengthen resilience in people with and 

without AD/ADRD. 

D-4 Translate basic discovery into effective treatment and/or prevention strategies for AD/ADRD 

and other age-related neurological conditions. Studies supported and conducted by NIA have 

tested both cognitive training and drug treatments, alone and in combination, to improve 

memory in patients with dementia. Other NIA supported and conducted trials focus on slowing 

the progression of cognitive symptoms in dementia and on strategies to manage behavioral 

symptoms. Still others focus on preventing the early stages of cognitive decline. NIA supported 

and conducted translational studies apply the findings of basic science on brain mechanisms in 

healthy aging and in disease to the identification and preclinical testing of new prevention and 

treatment strategies as a precursor to testing in human clinical trials. NIA will continue to: 

• Stimulate translational research aimed at discovery and preclinical development of 

new candidate drugs and biologics. By supporting early steps of the drug discovery and 

development process, we can play a critical role in facilitating the often long, difficult,
NIA Strategic Directions 2020 25

and enormously expensive process of translating the wealth of basic science discoveries 

into successful therapeutics. 

• Support clinical trials for drug interventions to prevent, treat, and delay the onset and 

progression of cognitive decline, MCI, AD, and other dementias. We will continue to 

test promising new and repurposed drugs in clinical trials with the intention of moving 

them rapidly into clinical practice. We will examine ways to streamline the drug 

discovery, drug development, and clinical trial processes that advance the development 

for promising prevention and treatment targets. 

• Support clinical trials for nonpharmacologic interventions to prevent, treat, and delay 

the onset and progression of cognitive decline, MCI, AD, and other dementias. Some 

evidence suggests that diet, physical activity, and other lifestyle factors may promote 

cognitive health and forestall decline. We will support studies to determine the effects 

of these and other factors and develop evidence-based communications to share with 

the public regarding the efficacy of such interventions.

D-5 Better understand and develop interventions to address the special caregiving needs of 

persons with AD/ADRD, as well as the needs of their caregivers. A number of recent studies 

have demonstrated that caring for a family member with dementia can have lasting 

psychological and even physical effects on the caregiver. For example, sleep-wake patterns are 

altered in AD patients, often leading to chronic sleep deprivation for patient and caregiver.

Research has shown that caregivers of AD patients have an increased risk of depression, 

elevated stress levels, increased vulnerability to influenza, and poor wound healing. NIA will 

continue to: 

• Conduct research on the family and economic impacts of AD and other dementias. We 

will support research at several levels, including studies on the mechanisms through 

which the stress of caregiving affects physical and mental health. Because formal and 

informal care for older adults with dementia is a major cost for families, private insurers, 

and the public sector, we will support other studies to help us to quantify and 

understand the economic impacts associated with care provision and quality of care. 

• Develop better strategies for the care of patients with MCI and AD and for their 

caregivers. NIA-supported investigators have developed multifaceted, personalized 

interventions that can significantly improve the quality of life for people with dementia 

and their caregivers. New technologies such as location tracking devices, socially

assistive robots, communications devices, and medication management tools, are also

facilitating care of older adults with dementia. We will continue to develop and test 

other interventions of this type to support implementation in the real-world contexts in 

which they are needed. In addition, we will research the needs of spousal caregivers 

following the death of their spouses and support development of post-bereavement 

interventions. 
NIA Strategic Directions 2020 26

D-6 Track epidemiologic trends in AD/ADRD, including incorporating new measures into national 

surveys. Longitudinal, demographic, and 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. 

• Explore possible additional risk and protective factors for brain health and function, 

cognitive decline, MCI, and AD through epidemiological and other population studies.

NIA will place a special emphasis on research that elucidates the pathways by which 

behavioral and social factors confer risk for cognitive decline, MCI and AD/ARDR. We 

will leverage community-based studies, including studies in racial and ethnic minority 

populations in sufficient numbers to study sources of variation within groups, 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 stress, discrimination, mental 

health, education, social engagement, complex work, lifestyle, genetics, comorbid 

diseases, sleep, or sensory or motor dysfunction interact to cause disease or contribute 

to cognitive decline. We will also support international comparative research on risk 

factors, incidence, and prevalence of cognitive impairment and dementia. 

Goal E 

Improve our understanding of the consequences of an aging society to inform 

intervention development and policy decisions.

While the increased longevity and improved health at older ages seen in many parts of the 

world represent one of the crowning achievements of the 20th century, these trends also 

present significant challenges. Societal aging can affect economic growth, patterns of work and 

retirement, the way that families function, the ability of governments and communities to 

provide adequate resources for older adults, and the prevalence of chronic disease and 

disability. 

At the same time, the U.S. lags behind other developed nations with respect to health, 

longevity, and other key indicators. For example, gains in life expectancy over the past 30 years 

have not kept pace with those in other developed nations. Since 1980, Americans have, on the 

average, gained five years in life expectancy from birth, while individuals living in comparable 

nations have gained eight.1

1 http://kff.org/slideshow/life-expectancy-in-the-u-s-and-how-it-compares-to-other-countries-slideshow/

 

NIA will continue to support research on the social, economic, and demographic consequences 

of the aging population in the U.S. and other countries. We will support research to better 

understand the impact of the changing age composition of the population and economic 

factors across the lifespan that affect health and well-being. 
NIA Strategic Directions 2020 27

Goal E objectives: 

E-1: Understand how population aging and changes in the social, economic, and demographic 

characteristics of cohorts reaching old age affect the health and well-being of older adults in 

the U.S. and other countries. 

E-2: Understand how social and economic factors throughout the lifespan affect health and wellbeing at older ages. 

E-3: Conduct research aimed at modifying organizational or individual behaviors in order to 

improve important health outcomes among members of population groups at older ages.

E-4: Understand and address the reasons the U.S. is falling behind other countries in health and 

mortality.

Approach

E-1 Understand how population aging and changes in the social, economic, and demographic 

characteristics of cohorts reaching old age affect the health and well-being of older adults in 

the U.S. and other countries. 

• Identify, analyze, and track changing patterns of disability and mortality for older 

adults and better understand factors contributing to these patterns. Research 

supported and conducted by NIA will address disability dynamics at several levels, 

including longitudinal research to understand the determinants of onset, severity, and 

recovery from disabling conditions. At the population level, we will foster research to 

understand the pathways to disability and the causes of change in mobility and function 

over time as well as subgroup disparities. We will also invest in research on more 

sensitive measures of functional disability that are needed to better track these 

changes. 

• Analyze the effects of social and demographic factors on health and well-being at 

older ages. For example, 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 such connections, help project health and long-term care needs, 

and devise ways to intervene and to reduce disparities. 

• Assess the impact of changing family structures on health and caregiving. NIA will 

support research on the ways the evolution of the American family structure will affect 

the well-being of older adults. Changing kinship systems in modern American society 

and unprecedented demographic changes have profound implications for living 

arrangement options for older adults, cost of living, cost of health care, caregiving, 

retirement, and Social Security. Researchers will need to examine how the availability of 

home- and community-based services (e.g., adult day services, home visits, and assisted 

living) influences the experience of family caregiving. 

• Encourage comparative analyses to evaluate the impact of institutions and networks 

on population and individual well-being and foster longitudinal studies on aging.

Other countries have larger proportions of their populations at older ages than the U.S., 

and some of those with currently younger populations are aging at a much more rapid 

rate. We will support comparative research on the effects of these changes on behavior, 
NIA Strategic Directions 2020 28

and we will evaluate institutional reform efforts to gain insights useful both in the U.S.

and elsewhere for enhancing population health. 

• Examine the bases for individual and societal attitudes toward older adults and 

develop effective strategies to improve them. Older adults may hold negative attitudes 

about their own aging or be the target of inaccurate and negative stereotypes and 

discrimination. We will support research to explore the causes of these negative 

attitudes and develop strategies to counter them with behavioral, community, and 

other interventions. For example, engaging older adults in meaningful volunteer work 

may prove to be a “win-win” situation, replacing the image of dependence with one of 

active and productive citizenship. Understanding the individual, interpersonal and 

institutional drivers of both positive and negative attitudes toward aging can help 

identify malleable targets for intervention.

• Continue research on the measurement of subjective well-being in a policy-relevant 

framework. Measurement of subjective and psychological well-being in populationbased surveys and in intervention studies holds potential for understanding how older 

adults’ lives are affected by major challenges of aging, including retirement, caregiving, 

living with disability, onset of illness and impending death, and for ensuring that 

interventions promote not only better health, but better quality of life at older ages. 

E-2 Understand how social and economic factors throughout the lifespan affect health and wellbeing at older ages. Individual differences in potential for a healthy and secure old age emerge 

in midlife. For example, chronic conditions and disability influence work and employment 

decisions for many older and even middle-aged individuals. NIA will continue to: 

• Support and conduct research on how middle-aged and older adults manage the 

multiple health-related decisions imposed by increasing longevity. NIA will support 

research to better understand the social determinants of health and well-being of older 

adults, including incentives and supports provided by public and private programs that 

have an impact on health outcomes. Such research will include the measurement of the 

economic value of good health. 

• Support research on the consequences of changes in older Americans’ experience of 

work and retirement. Age at retirement in the U.S. has been rising over the last few 

decades, primarily as a consequence of changes in women’s labor force participation, 

changes in pension plans, and increasing education. Still, most workers today can expect 

to spend two decades in retirement; some may be retired for three or more decades. 

The intersection of implications of changes in working life for the health and well-being 

of older adults during retirement remains an important area of investigation that can 

inform intervention and policy decisions.

• Support and conduct research that models and measures the economic risks of old age 

with the potential for developing interventions to protect against these risks and 

adverse health consequences. Demographic and retirement income trends lead to 

expanding economic risks among older Americans and associated impact on health.

Many Americans will require long-term care, but few purchase private insurance to 

support formal care expenses. We will support research to understand the behavioral 
NIA Strategic Directions 2020 29

aspects of demand for insurance against these older-age risks as well as alternative 

models to support efficacious long-term care. 

• Promote the development of data resources to support the development of effective 

interventions. Measures of time use, experience sampling, and in-home sensor-based 

technologies also offer potential for new insights for understanding and designing 

interventions to promote healthy aging. 

E-3 Conduct research aimed at modifying organizational or individual behaviors in order to 

improve important health outcomes among members of population groups at older ages.

Research examining the cognitive effects of work and retirement as well as changing 

environmental defaults to influence health-related aging outcomes have generated findings 

with enormous practical implications. Country comparisons available through harmonized 

surveys have revealed the role of a longer work/career life in maintaining cognitive function. 

Recent evidence also suggests that changes in the economic incentives within the Medicare 

program increase the use of preventive services. We will support research to better understand 

the factors in the health care system that support prevention and the successful management 

of disease. Through support of research that identifies institutional mechanisms that affect 

health, NIA will encourage institution-level interventions involving economic, organizational, 

and systemic interventions to promote better health and reduce health disparities.

E-4 Understand and address the reasons the U.S. is falling behind other countries in health and 

mortality. The current pattern of increased “active life expectancy,” the average number of 

years an individual will live without a limiting disease or disability in parallel with increased 

length of life, is threatened by increases in obesity and disability rates among younger 

Americans. Likewise, longevity rates in the U.S. are lagging relative to other developed nations.

We will support research to understand and address the reasons for these trends.

Goal F

Understand health disparities related to aging and develop strategies to 

improve the health status of older adults in diverse populations.

Health Disparities are differences in any health-related factor — disease burden, diagnosis, 

response to treatment, quality of life, health behaviors and access to care, to name only a few

— that exist among population groups. Health disparities are associated with a broad, complex, 

and interrelated array of factors, and may reflect: 

• Age

• Race

• Ethnicity

• Socioeconomic status

• Disability status

• Identity and expression* (e.g., gender, racial, ethnic)

• Geographic location (e.g., rural or urban environment) 

• Education 
NIA Strategic Directions 2020 30

• Health care (e.g., access, quality) 

• Culture (e.g., norms, traditions, collective responses) 

• Health behaviors (e.g., smoking, violence, substance abuse) 

• Biological (e.g., sex, chronic inflammation, telomere attrition, cellular senescence) 

• Or a combination of these

In 2015, NIA developed and adopted its new “NIA Health Disparities Research Framework” 

(https://ethndis.org/edonline/index.php/ethndis/article/view/39/63) to stimulate the study of 

environmental, sociocultural, behavioral, and biological factors that influence health disparities 

related to aging. Many of these factors are broad, complex, and interrelated. 

To address the contribution of these factors to health disparities related to aging, NIA has 

supported research, for example, that found Alzheimer’s disease to be more prevalent among 

African Americans and Hispanics than among other ethnic groups in the U.S. Other studies have 

found that lower socioeconomic status is associated with poorer health and reduced lifespan in 

the U.S. Scientists have also observed sex differences in health and longevity. For example, 

overall women live longer than men, but are more likely to develop osteoporosis or depressive 

symptoms or to report functional limitations as they age; men, on the other hand, are more 

likely to develop heart disease, cancer, or diabetes. 

Social environmental factors such as residential segregation, discrimination, immigration, social 

mobility, work, retirement, education, income, and wealth can also have a serious impact on 

health and well-being. Economic circumstances can determine whether an individual can afford 

quality health care and proper nutrition from early life into old age. Individual and family 

financial resources and health insurance often determine whether an older adult enters an 

assisted living facility or nursing home or stays at home to be cared for by family members. 

The causes of health disparities are dynamic and multidimensional, and to address them 

adequately, NIA will consider environmental, social cultural, behavioral, and biological factors. 

For this reason, NIA will use an integrative approach to motivating health disparities research 

related to aging. 

Goal F objectives: 

F-1: Identify and understand environmental, social, cultural, behavioral, and biological factors that 

create and sustain health disparities among older adults. 

F-2: Develop strategies to promote active life expectancy and improve the health status of older 

adults in diverse populations. 

F-3: Develop and implement strategies to increase inclusion of underrepresented populations in 

aging research. 

F-4: Support research on women’s health, including studies of how sex and gender influence aging 

processes and outcomes.
NIA Strategic Directions 2020 31

Approach

F-1 Identify and understand environmental, social, cultural, behavioral, and biological factors 

that create and sustain health disparities among older adults. Many complex and interacting 

factors can affect the health and quality of life of older adults. For example: 

• Environmental factors related to income, education, occupation, retirement, and wealth 

may have a serious impact on key determinants of health over the life course and 

ultimately the health and well-being of older adults. 

• Social factors such as individual and structural forms of discrimination and bias can 

shape the everyday experience of individuals from minority or vulnerable populations. 

• Cultural factors can have a tremendous influence on approaches for managing stress, 

diet and food preferences, attitudes toward physical activity, and other critical 

health/coping behaviors. 

• Behavioral factors and psychological processes represent major pathways by which 

environmental and social factors affect health. Optimism, pessimism, and sense of 

control serve as risk or resilience factors for impacting health, while chronic stress 

exposure can enhance vulnerability. 

• Biological factors that are influenced by environmental and sociocultural factors — and 

transduced through behavioral processes — may alter the course, severity and 

acceleration of disease and disability. 

All these factors and their interconnections must be understood to develop and implement 

effective interventions to address health disparities among various population groups. NIA 

will support and conduct research across diverse population groups to: 

• Gather data to further distinguish patterns of health disparities and causes. 

o Gather and analyze data on burdens and costs of illness, healthy life expectancy, 

longevity, and mortality trajectories. Determining the health burden and other 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 health and 

monetary costs. These difficulties are compounded across populations by 

differences in use of formal medical care and informal family caregiving. Projections 

of future healthy 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 be archived in the best 

interest of all populations and will provide valuable information for projecting the 

specific needs for health care services within various population groups. 

o Support the development and wide sharing of data resources that are needed to 

conduct health disparities research related to aging. Research to understand health 

disparities requires that data from multiple sources be accessible in standard 

formats to researchers on a national level. NIA will continue to support and expand 

surveys of health disparity populations in order to provide the data needed by 

researchers and public policy makers, including cross-national, comparative, and 
NIA Strategic Directions 2020 32

historic research. We will provide access to these and related data for use in health 

disparities research and to inform policy development. 

o Develop comparable databases — including cross-national databases — on health 

outcomes, risk factors, and determinants of health disparities. Although many of the 

disparities in adult health and life expectancy across national, racial/ethnic, and 

social class boundaries are well documented, causal mechanisms are less well 

understood. Research to understand these differences will be critical to the 

development of behavioral and public health interventions. 

o Use ongoing data collection programs to oversample health disparities populations.

These data will provide important information on socioeconomic factors, health care 

needs, collective cultural responses, social network characteristics, perceptions of 

stress and resilience, risk/coping behaviors, genetic stability, and other important 

factors. 

• Track and analyze reduced life expectancy and disease prevalence in diverse older 

adult populations. 

o Identify the determinants of disparities in the prevalence of diseases and conditions 

such as heart disease, obesity, hypertension, frailty, diabetes, comorbidities, and 

certain types of cancer. Researchers will explore the influence of contextual factors 

such as residential segregation, stress, education, language, and access to health 

care and how these may link with genetic, molecular, and cellular mechanisms to 

sustain differences across populations. 

o Determine the reasons for variation in the prevalence of cognitive decline and 

AD/ADRD across population groups. NIA will support research to better understand 

the differences in the prevalence of AD and related dementias among African 

Americans, Asians, and Hispanics compared to non-Hispanic whites. We will 

continue to examine a range of possible causes of these disparities, including the 

impact of comorbidities such as hypertension, cardiovascular disease, and diabetes; 

health behaviors; and disease processes. This research will draw on culturally 

appropriate and standardized measures to better understand these differences and 

to suggest culturally appropriate interventions. 

• Understand differences in aging processes across diverse populations. We will 

characterize normal and accelerated processes of aging in diverse populations to 

increase our understanding of the course of disease and disability and to identify 

similarities and differences. 

• Understand how environmental, sociocultural, behavioral, and biological factors lead 

to disparities in health at older ages and develop interventions to reduce those 

disparities. Health disparities persist within and across diverse racial, ethnic, and 

socioeconomic groups. Research is needed to understand the causes of these disparities 

and how they relate to relevant factors. Examination of cross-national research 

opportunities has the potential to provide increased knowledge of natural experiments 

in divergent aging experiences and aging policy developments that would inform a more 

general understanding in aging societies. 
NIA Strategic Directions 2020 33

• Explore mechanisms through which the effects of environmental and sociocultural 

factors manifest themselves, as well as critical periods for reversing such effects 

and/or the optimal timing of intervention. Specific groups of the U.S. population 

experience chronic socioeconomic disadvantage throughout their lives or for extended 

periods in life that generate persistent, chronic stress. The patterns of stress reactivity 

appear to hasten the progression of disease. It is therefore important to invest in 

research on the effects of discrimination, bias, stigma, and stereotypes, particularly the 

mechanisms through which these environmental and sociocultural factors become 

biologically embedded to influence health disparities. 

• Determine how environmental, sociocultural, behavioral, and biological determinants 

interact to increase risk of disease and disability. Environment, socioeconomic factors, 

and risk behaviors can all interact to influence biological influences and accelerate aging

as well as the development, progression, and outcome of disease in populations groups.

NIA will support research to 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 to untangle the multitude 

of factors that affect health and well-being. 

• Determine the effects of early-life factors on health disparities among older adults.

Differences in childhood socioeconomic status, stress exposure, risk/coping behaviors, 

disease incidence, environmental exposure, and health care in fetal development and 

early life can affect disease and disability in later life. NIA will support research to 

identify these early-life factors, as well as the mechanisms through which they influence 

health in later life. These findings can then be used to inform clinical and even policy 

interventions to reverse the effects of childhood disadvantage among older adults.

F-2 Develop strategies to promote active life expectancy and improve the health status of older 

adults in diverse populations. Life expectancy has increased among all population groups; 

however, notable disparities remain. For example, African American men have the lowest life 

expectancy of all racial/gender population groups in the U.S. In addition, more adults are living 

with one or multiple chronic conditions that may not affect length of life but may dramatically 

affect quality of life, and significant disparities have been observed in this area, as well. For 

example, African Americans suffer disproportionately from hypertension and prostate cancer, 

and Hispanics suffer more from diabetes. NIA will continue to: 

• Support research to better understand effective strategies for communicating health 

messages that are appropriate in diverse populations. Because of language, 

educational, and cultural differences, disproportionately affected populations do not 

always receive important information about healthy behaviors. Research on 

communication with specific audiences will assist the development of appropriate 

health messages and dissemination channels; we will continue to communicate with 

diverse audiences in various ways. 

• Develop appropriate strategies for disease, illness, and disability prevention and 

healthy aging among the underserved. Aging Americans need understandable, 

culturally appropriate tools they can use to maintain and improve their well-being. For 

example, diet and physical activity recommendations may need to be adjusted to take 
NIA Strategic Directions 2020 34

into account religious, ethnic, and cultural sensitivities. To address these concerns, 

researchers will: 

o 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. 

o Design and promote interventions appropriate for older adults in diverse 

populations to more effectively prevent, diagnose, or reduce the effects of disease. 

o Design and promote evidence-based and culturally appropriate strategies for selfmanagement of chronic diseases. 

o Investigate the factors affecting medication misuse and culturally appropriate 

strategies for enhancing proper use and compliance with medication regimens. 

• Develop and disseminate interventions to improve culturally appropriate health care 

delivery. NIA will promote better access to appropriate preventive care and clinical 

treatment, earlier diagnosis, improved outcomes, and reduced health care costs in 

diverse populations by supporting the development, usage, and clinical translation of 

research findings. 

o Develop interventions that build long-term and meaningful relationships among 

community leaders and members to create trust and to understand the cultural 

limitations of interventions. 

o Develop interventions to reduce health disparities and inequities associated with 

poor provider-patient interactions. 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, sexual 

orientation/gender identity, place of birth, or cultural background. 

• Develop training programs to prepare culturally proficient researchers. We will 

facilitate training of researchers in the biomedical, behavioral, and social sciences 

working with older adults to help them better understand the medical implications of 

the growing diversity of our population. Training programs will help prepare the next 

generation of health professionals by incorporating new materials sensitive to these 

issues and preparing a cadre of culturally competent health care providers prepared to 

assist with patient decision making.

F-3 Develop and implement strategies to increase inclusion of underrepresented populations in

aging research. The ability to recruit and retain research participants that are representative of 

the total U.S. population is essential to the conduct of rigorous health disparities research 

related to aging. However, specific racial, ethnic and socioeconomic population groups have 

been underrepresented in health-related research, including clinical trials and population-based 

research. NIA will: 

• Continue to support training for clinical and research staff in message development, 

recruitment strategies, and community and media outreach. NIA will explore effective 

ways to mitigate the difficulties associated with enrollment of health disparities 
NIA Strategic Directions 2020 35

populations in research studies and clinical trials. For example, Community Based 

Participatory Research methods may be used to address cultural and language barriers 

and encourage effective communication about the potential benefits of studies and 

trials that seek to address health disparities and improve public health in priority 

communities. 

• Investigate novel approaches for increasing recruitment and retention of 

underrepresented researchers pursuing careers in science, particularly health 

disparities research. NIA will work to identify the best strategies for training and 

attracting a diverse workforce of new, midcareer, and senior researchers. This may be

important for evaluating important strategies — including those that account for 

cultural and geographic factors — to enhance the recruitment of underrepresented 

groups into aging research. We will continue programs to train high-quality researchers 

through flexible mechanisms that reflect the rapidly changing needs of science and 

provide cross-disciplinary training. NIA will also work to tap the talents of all groups of 

society by encouraging degree-granting institutions to establish and improve programs 

for identifying, recruiting, and training diverse groups of individuals for careers in 

biomedical science. 

• Engage broad segments of the U.S. population in research on Alzheimer’s disease and 

related dementias. As funding for AD/ADRD has increased, the need for more people to 

participate in relevant research has grown. In particular, an urgent need exists to engage 

underrepresented communities. Today’s participants in AD/ADRD research are mostly 

white, non-Hispanic, well-educated, heterosexual, and married, with a spouse study 

partner. However, studies point to significant differences between rates of AD in specific 

populations, for whom factors like diet, culture, genetic influences, geography, and 

medical conditions may play a role. Broadly diverse participation in both observational 

and clinical studies will help us to better define and address racial, ethnic, gender, and 

other differences so that interventions can be better tailored to communities and 

individuals. We will continue to provide resources and support to facilitate widespread 

engagement in our research studies.

F-4 Support research on women’s health, including studies of how sex and gender influence aging 

processes and outcomes. Older women outnumber older men in the U.S., and the proportion 

of the population that is female increases with age. In 2014, women accounted for 56% of the 

population ages 65 and older and for 66% of the population ages 85 and older. Despite living 

longer, however, older women are more likely to report depressive symptoms or limitations in 

physical function, are more likely to live alone (a potential indicator or risk factor for isolation, 

lack of caregivers, or lack of support), and live in poverty at a disproportionately high rate.

American women also lag significantly behind their counterparts in other higher-income nations 

in terms of longevity, and since 1980, the pace of gains in life expectancy of older U.S. women 

has slowed markedly compared to that in other industrialized countries. 

NIA supports a diverse portfolio of research on older women’s health, including studies on 

sex differences in the basic biology of aging; hormonal influences on cognitive health; 

women’s health across the life course, with a particular emphasis on the menopausal 

transition; sex and gender-related demographic disparities in older age; economic 

implications of sex and gender at older ages; and age-related diseases and conditions that 
NIA Strategic Directions 2020 36

are unique to or more common in women, such as osteoporosis, breast and ovarian cancer, 

and urinary tract dysfunction. In addition, we support initiatives to ensure that women are 

fully represented in NIH-supported research, including the Sex as a Biological Variable 

(SABV) and Inclusion Across the Lifespan policies. As part of our commitment to supporting 

research on women’s health, NIA will:

• Encourage research to understand sex and gender differences in health and disease at 

older ages. Sex differences in health, longevity, and response to various preventive and 

treatment interventions are well documented. For example, many of the compounds 

tested through the Interventions Testing Program demonstrate differential effects on 

male and female mice. We will accelerate research on the basic biology driving health 

differences between sexes. In addition, recent demographic and economic trends have 

gender-specific implications for health and well-being at older ages. Unmarried women, 

for example, are less likely than unmarried men to have accumulated assets and 

pension wealth for use in older age, and older men are less likely to form and maintain 

supportive social networks. We will support research to explain how these and other 

factors may contribute to the differences in life expectancy and disability rates among 

men and women at older ages. 

• Support research on sex and gender differences in cognitive decline and AD/ADRD 

etiology, presentation, prevention, and treatment. Recent estimates suggest that 

nearly two-thirds of individuals diagnosed with AD are female. At the same time, most 

studies conducted in the U.S. have not observed sex differences in the incidence of 

Alzheimer’s disease — that is, in the rate of developing the disease. This may be in part 

because women, on average, live longer than men. Other potential reasons for this are 

complex and may include differences in brain structure; possible differential effects of 

the APOE ε4 genotype, which is the most common genetic risk factor for late-onset 

disease; differences in education between men and women in the age cohorts currently 

at greatest risk; and effects of sex steroid hormones on the brain. NIA will continue to 

study possible AD/ADRD risk and protective factors in both men and women, the 

mechanisms through which estrogen and other sex hormones work on the brain, and 

the effects of different forms of menopausal hormone therapy on cognition.

• Solicit and support research on topics that are uniquely relevant to the health of older 

women. Some age-related health issues — for example, menopause and certain types 

of cancer — are unique to women. Others, such as osteoporosis, are significantly more 

common in women than in men. We will support research designed to understand and 

address these conditions, with an additional focus, where appropriate, on how common 

diseases manifest and respond differently to treatment in women and men.

• Support initiatives designed to ensure that women are fully represented in basic, 

translational, and clinical research. Data from the NIH Office of Research on Women’s 

Health suggests that women now account for roughly half of all participants in NIHsupported clinical research. However, basic and preclinical biomedical research 

frequently focuses on male animals and cells, which may obscure understanding of key 

sex influences on health processes and outcomes. NIH has adopted a stringent “Sex as a 

Biological Variable” policy stating that the organism’s sex will be factored into research 

designs, analyses, and reporting in vertebrate animal and human studies. NIA will 
NIA Strategic Directions 2020 37

continue to support this and other policies designed to ensure full representation of 

women in all levels of research.

• Track, monitor, and report on participation of women in NIA-supported research, 

including adherence to the NIH SABV policy. We will continue to report on progress in 

this domain through programs currently active across the NIH. 
NIA Strategic Directions 2020 38

Supporting the Research Enterprise

Goal G 

Support the infrastructure and resources needed to promote high-quality 

research.

The availability of the infrastructure, resources, and training needed to support present and 

future research, program management, and information dissemination is critical to the NIA 

mission. NIA will provide resources to develop a skilled interdisciplinary research workforce, 

ensure that scientists have access to the technology and equipment they need to perform the 

research, promote clinical research participation, and facilitate the dissemination of research 

results to scientists, health professionals, and the public. 

Goal G objectives: 

G-1: Foster interdisciplinary exchange and encourage collaborative research across disciplines. 

G-2: Engage in partnerships within and among institutions and organizations, including patient and 

advocacy groups. 

G-3: Train and attract the workforce necessary for rigorous research on aging, including new, 

midcareer, and senior investigators. 

G-4: Attract and train more researchers from diverse scientific and cultural backgrounds. 

G-5: Develop, maintain, and share research resources. 

G-6: Develop the necessary infrastructure to encourage translation of research between basic 

discovery and intervention development. 

Approach

G-1 Foster interdisciplinary exchange and encourage collaborative research across disciplines. 

• Support workshops and conferences that bring scientists from various disciplines 

together for discussion and planning. 

• Provide funding opportunities that encourage interdisciplinary efforts and/or 

partnerships across two or more institutions or organizations. 

• Facilitate dialogue with researchers and professional organizations. 

G-2 Engage in partnerships within and among institutions and organizations as well as patient 

and advocacy groups. 

• Work closely with other NIH Institutes and Centers, other government agencies, and the 

private sector to collaborate across the continuum of research from basic science 

through translational research to clinical studies. 

• Partner with other government agencies, professional organizations, private funders of 

research, and international research groups to collect data and other resources to 

facilitate understanding of science on a global level. 
NIA Strategic Directions 2020 39

• Continue to participate in trans-NIH efforts such as the NIH Common Fund and the NIH 

Blueprint for Neuroscience Research. 

• Partner with other government agencies, professional organizations, and advocacy 

groups to ensure that research results are translated into public health programs and 

medical practice and used to inform public policy. 

• Collaborate with public and private partners to make results of research and other 

findings on successful patient recruitment strategies, including strategies targeted to 

minority and special populations, widely available to the research community. 

G-3 Train and attract the workforce necessary for rigorous research on aging, including new, 

midcareer, and senior investigators. 

• Develop and promote flexible mechanisms to meet the rapidly changing needs of 

science and prepare scientists, clinicians, and communicators to work effectively in 

interdisciplinary team environments across the continuum of research. 

• Develop partnerships with academia, professional organizations, and other entities to 

establish and improve programs for identifying, recruiting, and training scholars for 

careers in research on aging. 

• Participate in NIH efforts to improve recruitment, training, and retention of scientists 

across the full spectrum of research on aging. 

• Expand bioethics training for investigators to address issues specific to older adults in 

research. 

G-4 Attract and train more researchers from diverse scientific and cultural backgrounds.

Participate in NIH efforts to narrow the racial gap in grant approval. Work to recruit, train, and 

retain scientists from underrepresented groups, including people of diverse racial and ethnic 

backgrounds; gender identities; ages; and socioeconomic, geographic, and disability status. 

G-5 Develop, maintain, and share research resources. 

• Support colonies of aged animal models that are necessary for research on aging 

processes and specific age-related diseases. 

• Make available cell cultures and tissue, cell, and blood banks for basic and 

epidemiological research. 

• Create and make available DNA resources for genetic studies on aging and disease. 

• Support access to imaging and other advanced technologies in shared facilities for 

examining aging biological systems. 

• Support the development of population-based datasets, especially from longitudinal 

studies, suitable for analysis of biological, behavioral, and social factors affecting health, 

well-being, and functional status through the life course. 

• Support data archiving and data sharing. Consider innovative means for cost-effectively 

sharing data that expand research use while reducing disclosure risk. 

• Support the development of internationally harmonized biological, social, and 

behavioral longitudinal data on aging to foster cross-national research. 
NIA Strategic Directions 2020 40

• Support computer technologies to record and analyze interdisciplinary research findings 

on basic biological studies and long-term, population-based data. 

• Implement efforts to encourage older adults, including individuals from traditionally 

underrepresented groups, to participate in research and increase the numbers of 

participants in clinical trials. 

• Support candidate drug evaluation programs, facilities, and related resources for animal 

and clinical studies. 

• Develop innovative changes in the design, planning, and implementation of clinical trials 

and social and behavioral studies on the health and well-being of older adults. 

G-6 Develop the necessary infrastructure to encourage translation of research between basic 

discovery and intervention development. Translational research links scientific discoveries 

with their application in medical practice and public health. For research on aging, basic 

discoveries typically begin with studies at the molecular or cellular level that help us 

understand the mechanisms of normal aging and disease or with basic behavioral or social 

science that uncovers potential mechanisms driving differences in aging processes across 

individuals, groups, and geographical regions. New knowledge gained in the laboratory or field

may then take a variety of paths to human intervention. Equally important, however, are the 

basic and mechanistic insights gained in the context of intervention development and testing. 

Several NIH initiatives are focusing on ways the biomedical and behavioral science community 

can more successfully support translational activities that embody this process of back-andforth translation. NIA will continue to: 

• Identify and optimize opportunities for moving new knowledge from basic discovery 

to intervention development and back. We will continue to support promising 

preclinical studies, and community as well as health systems research. We will also work 

to ensure that new technologies such as advanced imaging and bioinformatics and other 

resources needed for effective translational research are accessible to scientists and 

clinicians. 

• Support a robust clinical trials infrastructure to facilitate the translation of basic 

research to human application in age-related diseases and vice versa. This support will 

include technical assistance for patient recruitment and retention of older adults in 

clinical trials. 

• Foster communication and partnerships with other NIH Institutes and Centers and 

with other federal agencies as well as with other national and international research 

organizations. NIA will continue to collaborate with other NIH Institutes and Centers on 

projects with a multidisciplinary focus such as the NIH Common Fund, the GeroScience

Interest Group, and the NIH Blueprint for Neuroscience Research. We will continue to 

participate in partnerships with outside organizations to share resources, support 

collaborative research, eliminate barriers to drug development, and communicate 

research findings to the public. 
NIA Strategic Directions 2020 41

Goal H 

Disseminate information to the public; scientific and medical communities; 

stakeholder advocacy, community and older adult-support organizations; the 

media; and policymakers about research and interventions.

Communication efforts play a critical role in educating the public about research advances to 

improve health and well-being in later life. Health communication activities can increase the 

public's awareness of a specific aging issue, problem, or solution; reinforce knowledge, 

attitudes, or health behaviors; dispel misconceptions about aging; and encourage individual or 

collective action. Health education programs, activities, and materials can also inform, 

influence, and motivate the public. 

Communicating effectively about health can be challenging because such information is often 

complex and technical. Moreover, the information may be inconclusive, controversial, 

contradictory, or subject to change as new research findings are released. Health information 

may also conflict with long-held personal beliefs. In addition, developments in technology are 

quickly and dramatically shifting the landscape for communicating health information. To 

succeed, health communication programs and materials must be based on an appreciation of 

the needs, interests and capabilities of the target audience, often with special considerations 

for physical and cognitive changes that come with age that may affect how information is 

received. 

Large scale, multiyear, multimedia efforts engaging community organizations, such as ongoing 

NIA efforts to promote healthy aging and clinical trials participation, are needed to inform, 

persuade, convince, and guide behavior change. Such efforts may include engaging key 

representatives of health care providers, aging-related networks, and community services, 

advocates in aging and age-related diseases, the media, and others. 

NIA communications are directly focused as well on professional audiences in research, clinical 

care and service delivery, and policy/legislation. These constituencies are interested not only in 

evidence-based health information, but also in NIA's budget, grants and review policies and 

practices, funding opportunities, emerging research programs and priorities, and more. NIA will 

continue to engage these communities in the planning and conduct of research as appropriate 

and in the dissemination of research results, and we will work to ensure that research 

directions and study results are communicated as widely as possible. 

Goal H objectives:

H-1: Increase awareness and promote adoption of evidence-based strategies to improve health and

quality of life of older adults.

H-2: Disseminate information to the public; scientific and medical communities; stakeholder

advocacy, community, and older adult-support organizations; the media; and policymakers 

about research and interventions.
NIA Strategic Directions 2020 42

Approach

H-1 Increase awareness and promote adoption of evidence-based strategies to improve health 

and quality of life of older adults.

• Develop, test, and conduct health communication programs and outreach activities to 

inform the public about the interventions and health-related progress validated by the 

results of research on aging. We will craft and deliver messages and materials based on 

research to understand how the various audiences perceive and react to health 

messages, how the public is persuaded to change behavior, and how people in general

— and older adults in particular — respond to various tactics.

• Explore successful networks for the transfer of research knowledge and to evaluate 

interventions for older adults. NIA will continue to work with other NIH Institutes and 

Centers, federal agencies, state and local governments, and both the private for-profit 

and not-for-profit sectors to ensure information about research and findings on 

diagnostics, treatment, prevention strategies, and behavioral and community 

interventions are widely shared, and that strategies are developed and embraced for 

effective impact on policies and programs. We will develop and maintain relationships 

with key journalists through both traditional and evolving media, providing evidencebased information and access to experts on aging and AD/ADRD research.

• Provide information that supports training for people who work with older adults. We 

will provide professional societies, community organizations, and academic institutions 

with research-based information that can be used in training geriatricians, social 

workers, counselors, and other community professionals and volunteers to work 

effectively with older adults and to implement evidence-based interventions.

• Promote the importance of exercise and physical activity, nutrition, and cognitive 

health among older adults. NIA will continue to use its website, social media, print, and 

other communications tactics to provide information and motivation for a diverse 

audience of older adults about the role of exercise/physical activity, nutrition, and 

cognitive health in healthy aging. 

H-2 Disseminate information to the public; scientific and medical communities; stakeholder 

advocacy, community, and older adult-support organizations; the media; and policymakers 

about research and interventions. 

• Develop appropriate materials and programs for a variety of target audiences. We will

continue to work to overcome age, gender, cultural, and language barriers to the 

effective communication of health information, always considering the best format(s)

for transmitting this information. We will continue to provide print materials for older 

adults who do not have access to digital and online resources. As older adults become 

increasingly adept at using digital and online resources, we will continue to employ 

mobile-friendly/responsive design and web analytics to enhance and expand use of new 

technologies — such as voice search capabilities — for health information.

• Rapidly and effectively disseminate information to the medical community. We will 

make widely available the latest advances in geriatric medicine, research on aging, and 

related health data through publications, professional education materials, public 
NIA Strategic Directions 2020 43

service announcements, videos, as well as new and emerging communications platforms 

and technologies. 

• Make available health information and reports of research activities and findings on 

the NIA website and through other communications channels. The NIA website will 

continue to serve as our institute’s information hub for the public, researchers, health 

professionals, stakeholder organizations, journalists, and policymakers interested in 

health, aging, and research. Mobile applications, social media, and other resources will 

enable our information to reach our audiences directly and invite them to learn more 

via our website. NIA recognizes the different needs of these audiences, and to the 

extent possible, will continue to tailor the information it shares using a variety of 

outreach channels to enhance communications. These include the Inside NIA blog for 

researchers and stakeholders, webinars, videos, social media postings, meetings with 

stakeholder groups and organizations, staff and leadership presentations, and more. NIA 

will continue to proactively explore ways to maintain and upgrade communications with 

both established and new audiences.

• Maintain and promote the NIA Alzheimer's Disease Education and Referral (ADEAR) 

Center. Through this NIA information center — the federal government's premier public 

information on Alzheimer's disease and age-related cognitive change — the institute will 

continue to provide and expand evidence-based materials about these conditions, 

related research, participation in clinical trials, and caregiving. 

• Facilitate and support recruitment for Alzheimer’s and aging clinical trials and 

inclusion of older adults in research. NIA will continue to convene experts and develop 

resources to enhance older adult participation in research, including but not limited to 

maintaining, evolving, and promoting the NIA Alzheimer’s & Dementia Outreach, 

Recruitment & Engagement (ADORE) resources. ADORE contains hundreds of resources 

on topics related to the engagement, recruitment, and retention of participants in 

clinical trials and studies on Alzheimer’s disease and related dementias. NIA will 

continue to develop this website to help researchers better engage with their research 

communities. In addition, we will continue with related recruitment strategy and public 

outreach efforts through tactics such as testimonial videos.

• Develop materials for special audiences and diverse populations. These may include 

non-English language materials and materials for those with limited literacy.

• Support national education efforts to encourage healthy practices among older 

adults. These may include collaborations with other federal agencies, as well as state 

and community efforts.

Goal I

Effectively steward public resources.

As a federal agency, NIA is responsible for ensuring that we efficiently and effectively use 

taxpayer funds to the ultimate benefit of all Americans. This requires, among other things, 

that we establish a solid foundation for discovery that includes informed planning and priority 

setting; consistent, expert review and management of grant applications; and a competent, 

flexible workforce that is capable of meeting the challenges presented by a rapidly changing 
NIA Strategic Directions 2020 44

scientific milieu. This charge also demands transparency within the limits imposed by privacy 

and the ethical conduct of research.

Goal I objectives: 

I-1: Optimally manage research funds through careful planning and priority-setting, scientific 

review, and evaluation of investments.

I-2: Encourage innovation across all areas of our mission. 

I-3: Ensure timely and accurate reporting of funding for AD/ADRD and in other scientific categories.

I-4: Recruit and retain a highly qualified and diverse workforce.

I-5: Identify and effectively manage risks that may affect the research enterprise.

Approach

I-1 Optimally manage research funds through careful planning and priority-setting, scientific 

review, and evaluation of investments. 

• Establish realistic scientific goals and priorities based on thorough understanding of 

the current state of the science. This will involve regular communication via multiple 

channels with our various constituencies, including the scientific, medical, and advocacy 

communities and private industry.

• Optimize scientific review of funding applications. NIA receives thousands of 

applications for funding each year but can only fund a limited number of the 

applications it receives. We will continually identify and recruit expert reviewers and 

where necessary revise processes to ensure efficient, seamless grant review and award.

• Regularly evaluate outcomes of major initiatives. Regular evaluation will ensure that 

our long-running initiatives continue to produce results consistent with our level of 

investment and will allow us to revise our strategies when our goals are not being met.

How NIA Sets Scientific Priorities

NIA routinely engages in activities to assess research needs, gauge progress in meeting those 

needs, set priorities for future research, and plan new initiatives. The primary goals of our 

science planning and priority setting activities are to:

• Identify new and emerging areas of scientific opportunity, identify research gaps, and 

propose new research directions. 

• Integrate and align science planning and priority setting with resource allocation 

decisions.

• Maintain the kind of flexibility that will enable institute programs to keep pace with 

rapid scientific and technological progress.

In establishing scientific priorities, NIA must carefully balance public health need with scientific 

opportunity. This assessment begins at the program level within NIA’s four scientific Divisions 

and the Intramural Research Program, where experts in a broad variety of disciplines, from 
NIA Strategic Directions 2020 45

molecular biology to population research, maintain ties with the greater scientific community 

through regular attendance at conferences and vigilant tracking of the scientific literature. Once 

this knowledge base is established, priorities emerge from: 

• Periodic reviews of NIA programs conducted by members of the National Advisory 

Council on Aging for extramural divisions and the Board of Scientific Counselors for the 

Intramural Research Program. The reports from these reviews are used extensively to 

inform future planning. 

• Twice-monthly meetings of NIA senior staff (the Planning Group) to guide and 

coordinate future directions and activities and support the NIA Director in making 

decisions on a variety of topics. 

• Twice-yearly planning retreats as forums for wider participation by institute staff in 

presenting and discussing needs, opportunities, and priorities for moving the field of 

research on aging forward.

• Working groups on special aging-related topics to coordinate the implementation of 

initiatives that are cross-cutting to NIA programs.

I-2 Encourage innovation across all areas of our mission. Addressing the issues faced by our 

aging society will require focus, passion, and creativity. NIA is committed to supporting 

innovation in research and developing new ways of viewing and managing age-related changes 

at both the individual and societal levels.

A key driver of innovation is NIA’s Small Business Innovation Research (SBIR) and Small Business 

Technology Transfer Programs (STTR). All NIA research divisions participate in these programs, 

which offer funding up to $2.5 million to commercialize products addressing aging and agingrelated diseases and conditions, AD/ADRD, and the special challenges and needs of older 

Americans. The SBIR-STTR programs target early-stage research and development (R&D) and 

encompass a broad range of research topics and types, including translational and secondary 

R&D. All applicants are expected to develop, implement, and test the effectiveness of their 

products and services. NIA will:

• Continue to support a robust SBIR/STTR program that attracts high-quality applications 

and supports innovators in commercializing their technologies.

• Participate in trans-NIH initiatives to leverage new modalities, methodologies, and 

technologies to enhance health and wellness in the American population.

• Develop and maintain initiatives that facilitate innovation in aging research, including 

initiatives that are relevant to AD/ADRD.

I-3 Ensure timely and accurate reporting of funding for AD/ADRD and in other scientific 

categories. Our constituencies, including members of the American public, should be able to 

determine how we’re spending taxpayer funds and to feel confident in those figures’ accuracy 

and completeness. We will:
NIA Strategic Directions 2020 46

• Work with NIH-level experts to optimize tools for categorizing research, including 

defining and refining disease-based categories, Minority Health/Health Disparities, 

Women’s Health, basic versus applied research, and others.

• Ensure that reporting in all categories is complete, timely, and accurate.

I-4 Recruit and retain a highly qualified and diverse workforce. Every member of NIA’s staff, from 

the Director to the newest student volunteer, makes an important contribution as we strive 

daily to turn discovery into health. To carry out our mission, we need staff who are expert, 

creative, dedicated, and energetic, and who represent a diversity of background and 

experience. We recognize the importance both of recruiting new staff with new skills and 

insights and retaining seasoned employees who have extensive experience and strong 

institutional memory. We will:

• Continually assess and evaluate the institute’s evolving workforce needs and develop 

and implement plans to address those needs.

• Provide training and other critical tools to enable NIA staff to conduct the nation’s 

business efficiently and effectively.

• Support workflow efficiency by appropriate management of administrative burden 

on staff.

• Regularly assess employee performance and provide opportunities for growth.

• Maintain a safe and supportive working environment.

• Take steps to ensure equality of opportunity for employment and advancement 

within NIA.

• Facilitate succession planning to ensure continuity of operations.

I-5 Identify and effectively manage risks that may affect the research enterprise. NIA’s risk 

management activities are designed to proactively identify and mitigate risks to help promote 

the achievement of our objectives, strategy, and mission. All staff work to identify risks across 

programs and operations so that appropriate actions can be taken to address them. NIA will 

continue to:

• Develop and implement appropriate, cost effective management controls for resultsoriented management.

• Assess the adequacy of internal controls in programs and operations.

• Identify needed improvements and take corresponding corrective action where 

appropriate.
NIA Strategic Directions 2020 47

Appendices

Appendix 1: NIA Organizational Chart
NIA Strategic Directions 2020 48

Appendix 2: Setting Strategic Directions

This document was developed over approximately eighteen months (beginning in June 2018) by 

staff in the NIA Office of Planning, Analysis, and Evaluation (OPAE). The process began with a 

series of meetings with senior institute staff to review the existing Strategic Directions, discuss 

advances in science, and brainstorm potential new priorities to be outlined in the new 

document. These meetings were followed by presentations at several conferences, including 

the Gerontological Society of America national conference in November 2018, to encourage 

members of the scientific community to contribute their insights to the process. 

A cornerstone of the process was a Request for Information (RFI) that NIA issued in November 

2018. The RFI was spotlighted on the NIA blog and on social media, and between these 

mechanisms we received thoughtful responses from over 20 organizations, researchers, and 

community members. This valuable input informed the development of new content for the 

current document.

OPAE staff used all these sources, along with internal assessments and evaluations, to draft the 

current document. The document then underwent several rounds of internal review as well as 

final review by the National Advisory Committee on Aging.