National Institute on Aging

National Institutes of Health

U.S. Department of Health and Human Services

Research on Aging Living Long & Well in the 21st Century

Strategic Directions for

We are pleased to share through this document our best insights into the future of research on aging 

and the role of the National Institute on Aging (NIA) in realizing that future. These broad strategic 

goals and objectives have been identified through discussions among NIA staff members with input from 

the National Advisory Council on Aging, NIA’s Board of Scientific Counselors, and other representatives 

of the research and advocacy communities.

As we look to the future, we foresee unprecedented opportunities brought about by advances in science 

and technology coupled with the challenge of using our best scientific judgment to make difficult choices, 

in some cases, about which areas of research to pursue. Our NIA intramural and extramural scientists work 

alongside our grantees and partners in other Institutes and Centers at the National Institutes of Health 

(NIH), other government agencies, and the private sector to build synergy and leverage resources to help 

make it possible for older adults to experience healthier, more productive lives. We strive to gain a clearer 

understanding of what we term “normal” aging along with deeper insights into a multitude of diseases and 

conditions with increased risk and severity among older adults. And we use that knowledge to develop and 

test more effective interventions that will indeed allow people to live long and well in the 21st century. 

We hope that readers will find the information in this document a useful resource for facilitating and 

advancing dialogue about research on aging. 

Richard J. Hodes, M.D. 

Director, National Institute on Aging

November 2007

NIA Director’s Message
This Document Online

This document is available online at www.nia.nih.gov/AboutNIA/StrategicDirections. The online 

version includes hyperlinks to information about NIA programs and initiatives associated with the various 

priority areas described in this document.

Other Helpful Web Sites:

National Institute on Aging Home Page – www.nia.nih.gov

Current Funding Opportunities for Research and Training – www.nia.nih.gov/GrantsAndTraining

NIA Extramural Research Programs – www.nia.nih.gov/ResearchInformation/ExtramuralPrograms

Biology of Aging Program – www.nia.nih.gov/bap

Behavioral and Social Research Program – www.nia.nih.gov/bsr

Neuroscience and Neuropsychology of Aging Program – www.nia.nih.gov/nna

Geriatrics and Clinical Gerontology Program – www.nia.nih.gov/gcg

NIA Intramural Research Programs – www.grc.nia.nih.gov

National Institutes of Health Home Page – www.nih.gov

NIH Roadmap for Medical Research – nihroadmap.nih.gov

NIH Blueprint for Neuroscience Research – neuroscienceblueprint.nih.gov
Contents

Introduction 1

Research Goals 

A Improve our understanding of healthy aging and disease and disability 

among older adults. 4

B Continue to develop and disseminate information about interventions 

to reduce disease and disability and improve the health and quality of life 

of older adults. 14

C Improve our understanding of and develop interventions to prevent and 

treat Alzheimer’s disease, other dementias of aging, and the aging brain. 22

D Improve our understanding of the consequences of an aging society 

and provide that information to inform intervention development 

and policy decisions. 30

E Improve our ability to reduce health disparities and eliminate health 

inequities among older adults. 36

Infrastructure and Resource Goal 

F Support the infrastructure and resources needed to promote high-quality 

research and communicate its results. 44

Living Long & Well in the 21st Century: Strategic Directions for Research on Aging 1

The face of aging in the United States is changing dramatically. People are living longer, achieving 

higher levels of education, living in poverty less 

often, and experiencing increasingly lower rates 

of disability. Life expectancy nearly doubled 

during the 20th century with a ten-fold increase 

in the number of Americans age 65 or older. Today, 

there are approximately 35 million Americans 

age 65 or older, and this number is expected to 

double in the next 25 years. The oldest old—

people age 85 or older—constitute the fastest 

growing segment of the U.S. population. Currently 

about four million people, this population could 

top 19 million by 2050. And living to 100 is 

becoming increasingly commonplace. In 1950, 

there were approximately 3,000 American centenarians. By 2050, there could be nearly one million. 

The challenge for the 21st century will be to 

make these added years as healthy and productive 

as possible and to continue the current trend 

of decline in disability across all segments of 

the population.

Modern medicine and new insights into lifestyle 

and other environmental influences are allowing a 

growing number of people to remain healthy and 

socially and emotionally vital into advanced ages. 

As life expectancy increases, however, diseases and 

conditions that threaten the health of older people 

remain a concern. For example, more than half 

of all Americans 65 or older show evidence of 

osteoarthritis in at least one joint. One in every 

two women and one in four men over age 50 will 

break a bone due to osteoporosis. Alzheimer’s 

disease (AD), cardiovascular disease, cancer, 

and diabetes remain widespread among older 

Americans. In addition, many older Americans 

suffer from multiple health problems, and the 

existence of such comorbidities often complicates 

treatment and can dramatically affect quality 

of life.

Our ability to reduce the burden of illness among 

older adults will depend on an increased understanding of the dynamics of aging and how they 

interact with various environmental and lifestyle 

factors in individuals. We need to explore “aging” 

not as a single process but rather as an intricate 

web of interdependent genetic, biochemical, 

physiological, economic, social, and psychological 

factors, some of which are better understood than 

others. In addition to research on the biological 

basis of aging, some scientists are working to 

gain new insights into disease processes and 

comorbidities, the prevalence of which increases 

with advanced age, and to use this knowledge to 

develop more effective ways to prevent, diagnose, 

and treat diseases and conditions of aging. 

Others are exploring behavioral and social factors 

involved in aging and how they interact with 

genetics and biology. Still others are concerned 

with the economic and societal consequences 

of a rapidly aging population. Building on past 

discoveries, we will continue to focus on finding 

effective interventions to ensure that as people live 

longer, they can do so in better health and with 

greater independence.

The National Institute on Aging 

The National Institute on Aging leads a national 

scientific effort to understand the nature of aging 

in order to promote the health and well-being of 

older adults. NIA is one of the 27 Institutes and 

Centers that make up the National Institutes of 

Health, a component of the U.S. Department of 

Health and Human Services. 

Introduction
2 Living Long & Well in the 21st Century: Strategic Directions for Research on Aging

NIA Research Focuses on the Increased Risk and Severity

of Health Problems As People Age

Older adults are healthier than ever today,

but the risk and severity of a number of

diseases and conditions increase with

age. Much of NIA-supported research

focuses on uncovering the molecular

and cellular determinants of disease

risk as well as the changes that occur

with age at the organ, tissue, cellular,

and molecular levels that may lead to

dysfunction. Some investigators examine

age-related processes from multiple

perspectives, including those of the

genetic, biological, clinical, behavioral,

social, and economic sciences. Other

studies focus on specific diseases or

conditions with increased prevalence as

people age. Many of the disease-specific

research projects we support are collaborative efforts with other Institutes at

the NIH.

 With increasingly sophisticated technological tools, we hope someday to

unravel the mysteries that still surround Alzheimer’s disease, changes

in memory and cognition, and other

degenerative diseases of the nervous

system, and to develop interventions

to prevent, diagnose early, and treat

these conditions.

 Exciting developments in our understanding of cardiovascular disease, 

cancer, and diabetes interface with

new findings about the basic processes

of aging and may soon open doors for

personalized approaches to preempt,

prevent, or treat these diseases across

the lifespan.

 Better options for helping older adults

with vision, hearing, and other 

sensory disorders will dramatically

improve the quality of life for these

individuals.

 For people who suffer from bone, 

muscle, skin, joint, and movement 

disorders, new insights about nutrition

and exercise, better surgical options,

better understanding of the basic

biology leading to new therapies, and

more user-friendly assistive technology

hold promise for helping them lead

more comfortable and active lives.

 Ongoing developments hold promise

for finding better ways to help health

care providers and caregivers more

effectively address a variety of ageassociated disorders such as frailty, 

falls, delirium, incontinence, sleep 

disturbances, and depression.

 Researchers are also gaining new

insights into the psychological, 

psychiatric, and social changes that

occur with age—from studies of the

psychological adaptation to aging

and disease to the development of

strategies to address the behavioral

symptoms of dementia or stress.

NIA-supported research also focuses

on the effects of chronic illness and

the comorbidities that are so common

among older adults. For example, NIA

researchers are studying the demonstrated association between certain

cardiovascular disorders such as atherosclerosis (hardening of the arteries) and

hyperlipidemia (elevated blood levels

of certain types of fat) and the risk for

neurological disease and other agerelated disorders. Others are investigating the relationship between metabolic

disorders such as diabetes and cognitive

decline in older adults.
Living Long & Well in the 21st Century: Strategic Directions for Research on Aging 3

The Institute’s mission is to:

Support and conduct genetic, biological, clinical, 

behavioral, social, and economic research related 

to the aging process, diseases and conditions 

associated with aging, and other special problems 

and needs of older Americans.

Foster the development of research and clinician 

scientists in aging. 

Communicate information about aging and 

advances in research on aging to the scientific 

community, health care providers, and the public.

We carry out our mission by supporting extramural

research at universities and medical centers across 

the United States and around the world and a 

vibrant intramural research program at NIA 

laboratories in Baltimore and Bethesda, Maryland. 

This document outlines the broad strategic directions of the Institute and provides a point of reference for setting priorities and a framework for 

systematically analyzing the Institute’s scientific 

portfolio and assessing progress in achieving our 

mission. NIA strives to ensure that funding decisions and research initiatives address current and 

projected public health needs and take full advantage of scientific and technological opportunities 

for advancing the field of research on aging. With 

constant monitoring of the health needs of our 

older population and regular consultation with 

our stakeholders, we will optimize our efforts to 

improve the quality of life of older adults.

Our goals are to:

A Improve our understanding of healthy aging 

and disease and disability among older adults.

B Continue to develop and disseminate information about interventions to reduce disease and 

disability and improve the health and quality of 

life of older adults.

C Improve our understanding of Alzheimer’s disease, 

other dementias of aging, and the aging brain. 

Develop drug and behavioral interventions for 

treating these diseases, preventing their onset and 

progression, and maintaining cognitive, emotional, sensory, and motor health.

D Improve our understanding of the consequences 

of an aging society and provide that information 

to inform intervention development and policy 

decisions.

E Improve our ability to reduce health disparities 

and eliminate health inequities among older 

adults.

F Support the infrastructure and resources needed 

to promote high-quality research and communicate its results.

Our vision is to:

Achieve a time when people in their “golden years” 

enjoy robust health and independence, remain 

physically active, and continue to make positive 

contributions to their families and communities.
4 Living Long & Well in the 21st Century: Strategic Directions for Research on Aging
Living Long & Well in the 21st Century: Strategic Directions for Research on Aging 5

Aging comprises a set of dynamic biological,  physiological, and psychosocial processes and 

systems—interactive and independent—that result 

in wide variations among individuals. Adult aging 

often involves common changes that may not be 

harmful such as graying hair. For many, however, 

aging also means a progressive and inexorable loss 

of function leading to increased vulnerability to 

disease, frailty, and disability. Many hypotheses and 

theories to explain this decline have been offered 

through the years, but none by itself can explain 

the array of physical, biological, and psychological 

changes that take place as people age.

NIA-supported researchers are beginning to define 

the link between genes and lifespan. For example, 

numerous genes have been implicated in normal 

aging processes, in age-related pathologies and diseases, and in the longevity of several species including humans. Researchers are also identifying the 

interactions among genes; the environment; and 

lifestyle, behavioral, and social factors and their 

influence on the initiation and progression of some 

diseases. Further research is needed to determine 

the roles and interaction of these diverse factors in 

aging.

One of our challenges in this research is to develop 

a clearer understanding of the normal changes that 

accompany aging and distinguish them from the 

diseases and disabilities that are prevalent among 

older adults. A common thread, for example, is the 

process of inflammation, which leads over time to 

changes in cell, tissue, and organ structure and function. Inflammation may increase the susceptibility 

Research Goal A

Improve our understanding of healthy aging and disease 

and disability among older adults.

to and rate of progression of age-related pathologies 

and may contribute to frailty, independent of overt 

disease. This and other risk or protective processes 

that may occur at various stages, from early life on, 

may influence health and survival outcomes in old 

age. Many older people also suffer from anemia, 

thrombosis, involuntary weight loss, dizziness, sensory deficits such as hearing or vision loss, dementia, 

frailty, or incontinence. Research into the underlying 

causes of these and other geriatric syndromes is 

needed in order to develop new prevention strategies 

and treatment approaches.

NIA-supported research is also helping to identify 

lifestyle factors and health behaviors that directly 

influence physical, cognitive, and emotional fitness 

and risk of disease. Scientists are developing and 

refining recommendations for people of all ages 

regarding optimal diet, use of dietary supplements, 

mental stimulation, physical exercise, quality 

sleep, and other healthy practices to increase their 

likelihood of enjoying healthy old age. Still other 

researchers are looking for better ways to enhance 

the physical, mental, and interpersonal abilities of 

older people and to expand opportunities for them 

to achieve personal goals and contribute to society 

in meaningful ways. As we identify more precisely 

these behaviors and lifestyles that influence health 

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

conserve function, and improve caregiving.
6 Living Long & Well in the 21st Century: Strategic Directions for Research on Aging

To more fully understand aging processes and 

their relationship to disease and disability 

among older people, NIA will:

A-1 Support studies on healthy aging, well-being, 

and longevity. 

A-2 Accelerate the discovery of the causes and risk 

factors associated with disease and disability 

among older adults.

A-3 Encourage translational research to bridge 

basic discovery and intervention development.

A-1 Support studies on healthy aging, 

well-being, and longevity.

Research on the biology of aging has revolutionized 

our understanding of healthy aging. New findings 

about genetic, molecular, and cellular factors and 

processes that affect the course of aging are providing valuable insights about aging, longevity, and 

the genesis of disease. Similarly, population studies 

are uncovering potential risk factors such as environmental exposures, health-related behaviors, and 

social factors, as well as the influence of co-existing 

conditions across the lifespan and their relationship 

to the progression of disease. NIA will continue 

research to:

Identify cellular and molecular factors that 

determine the pace of aging processes.

Researchers have identified key factors affecting 

the pace of aging, including the body’s response 

to a variety of stresses, the function of the 

immune system, and the role of cellular senescence (deterioration of the cell) as a tumor suppression mechanism. NIA will work to identify 

additional factors and to elucidate the role of each 

of these processes in the aging human. 

Determine how the cellular and molecular bases 

of changes associated with aging contribute to 

decreased function and increased incidence of 

disease. Although increasing age is most often 

accompanied by a significant and progressive 

Our Genes Are Key to How We Age

The way we age depends on a mixture of intrinsic and

extrinsic forces. Extrinsic factors such as healthy habits can

be controlled. However, a significant portion of aging is

determined by genes, which may encode causative factors

involved in aging or factors that delay aging and/or promote extended health span (longevity assurance factors). In

humans, it has been estimated that genetics control 25 to 40

percent of life and health span variability, but the identity of

the responsible genes is difficult to pinpoint. Basic researchers have identified about 100 genes that control lifespan in

model organisms, including roundworms called nematodes,

yeast, fruit flies, and mice. Further research is needed to

understand the relationships among these genes and to

determine whether or not the equivalent genes in humans

function in a similar fashion. Research has also identified

subtle and reversible changes in human genes, which, in

some cases, can be passed from generation to generation

and can control the level of activity of some genes. These

“epigenetic” changes represent another area of research

that might yield further insights into aging and age-related

disease.

Scientists supported by NIA are particularly interested in

identifying genetic factors that contribute to healthy aging

as well as unraveling the genetic and biological processes

involved in age-related traits and diseases. Our hope is

that the discovery and increased understanding of genes

involved in aging and longevity will lead to the development

of medical and behavioral interventions that can slow the

aging process and, most importantly, delay or prevent the

onset of age-associated diseases.

decline in almost all physiological functions, 

resulting in increased susceptibility to age-related 

chronic diseases, some functions are remarkably 

well maintained in a large number of people. 

NIA will encourage research in both the loss and 

maintenance of functions during the aging process. Many researchers suspect that this increase 

in susceptibility to diseases may be due to the 

changes occurring as a result of the aging process 

itself. Therefore, manipulation of the basic 
Living Long & Well in the 21st Century: Strategic Directions for Research on Aging 7

processes of aging might provide an effective way 

to prevent or treat age-related diseases. We will 

foster comprehensive studies both in humans and 

in animal models to investigate the health- and 

disease-related effects of manipulating the process 

of aging at the molecular level.

Identify developmental, prenatal, early life, and 

environmental processes that affect aging, age 

changes, and disease. Harmful substances can 

exert profound physical effects on a developing 

fetus, while childhood exposure to environmental 

agents such as infections or drugs can greatly limit 

adult physical and cognitive health and longevity. 

NIA will continue to support epidemiological 

studies to identify such factors and participate 

in translational studies to find ways to minimize 

their effects in adults.

Understand the role of stem cells in tissue maintenance and how stem cells and their environments change with age. Stem cells contribute to 

tissue development and replenishment throughout life. Stem cells are the ultimate precursors to 

all the cells of the body, and they are important 

tools for both cell-based therapies and regenerative medicine. It is clear that tissues and organs 

lose function with advanced age, and such losses 

may result from declines in stem cell function. 

This loss of function occurs at different levels, 

including the stem cells themselves, the microenvironment where they self renew and differentiate (the niche), the receptiveness of the target 

tissues, or even in the communication among the 

target tissues, the niches, and the stem cells. NIA 

will pursue the major challenges in cell-based 

therapies and regenerative medicine, including improvement of the mobilization of native 
8 Living Long & Well in the 21st Century: Strategic Directions for Research on Aging

stem cell pools and definition of the limitations 

of stem cell expansion ex vivo, so that stem cells 

can be grown in adequate numbers for tissue 

repair while preserving their potency. NIA will 

also foster research to create a detailed molecular 

and functional understanding of stem cells, their 

niches, and their target microenvironments as 

well as strategies to direct stem cell differentiation into specific cell types. This research will 

inform efforts to understand and alter the aged 

environments that decrease stem cell function and 

improve the efficiency with which stem cells reach 

their target sites, where they can be effective while 

minimizing potentially harmful side effects.

Understand the influence of obesity and metabolic status in healthy aging. We will continue 

collaborative studies on the relationships among 

obesity, insulin signaling, hypertension, and diabetes. We will continue studies on the efficacy of 

various nutritional and other cognitive and behavioral approaches to maintaining a healthy weight 

and preventing cardiovascular disease, cancer, diabetes, neurodegenerative disease, musculoskeletal 

conditions, and other conditions in older people. 

This research will also help determine whether 

or not general recommendations for healthy 

eating, physical exercise, and sleep in the young 

or middle aged are optimal for older people.

Understand the sensory and motor changes 

associated with aging and how they lead to 

decreased function and increased incidence of 

disease. Mobility changes in the aging adult can 

be age related or the precursor to more severe 

motor disorders. Loss of sensory functions such 

as vision, hearing, or the ability to taste foods 

may result from aging-related processes or may be 

an indication of more severe underlying diseases 

or conditions. We will promote a better understanding of the underlying mechanisms of these 

and other age-associated changes. This research 

will provide the knowledge base necessary to 

develop interventions that optimize mobility and 

sensory function and prevent disease in the later 

years of life.

Continue to support basic research in the psychological science of aging. Understanding agerelated psychological change remains essential for 

advancing our understanding of how age impacts 

behaviors and decisions that, in turn, shape the 

subjective well-being, social relationships, physical 

and mental health, physical function, and economic 

well-being of older adults. Advances in psychological science are needed to improve behavioral 

interventions, and to understand the pathways 

and mechanisms through which psychological 

and social factors impact health. NIA continues 

to support research on basic psychological and 

social processes associated with normal aging; 

their relationship to individual, contextual, and 

environmental factors that impact these outcomes; 

and their neurobiological and genetic basis.
Living Long & Well in the 21st Century: Strategic Directions for Research on Aging 9

Continue research on the impact of social 

interaction on health and well-being.

Although research suggests that positive social 

interaction is health protective, we must 

improve our understanding of the mechanisms 

and pathways through which these factors 

improve both physical and mental health. We 

must also better identify the characteristics of 

social relationships and social environments that 

promote healthy aging. NIA-supported research 

to deepen our understanding in this area will aid 

in tailoring interventions to improve the health 

and quality of life of older adults.

Explore the interplay between genetic, biological, 

clinical, social, economic, psychological, and 

environmental factors affecting aging and 

longevity. Evidence suggests that these factors 

and their interplay are critical to minimizing 

disease and achieving full potential and vitality 

in later years. More research is needed to verify 

the linkages and to better understand their 

underlying mechanisms. 

• Identify factors across the lifespan that contribute 

to exceptional health or its decline. The study of 

older people is shedding light on the biological, 

behavioral, and social factors associated with 

healthy aging. We will continue research that 

links laboratory and longitudinal populationbased studies, providing insights into the factors 

that define resilient individuals and contribute 

to well-being in old age. 

• Expand our knowledge of age- and longevityassociated genes as well as epigenetic alterations 

that affect longevity and well-being, including 

modes of action. NIA-supported research has 

shown that patterns of extreme longevity run in 

families. Furthermore, scientists have identified 

approximately 100 different genes that affect 

longevity in model organisms. We will continue 

work to identify the biological functions of 

longevity genes and to better understand the 

mechanisms of action of known and yet-to-beidentified longevity genes (longevity assurance 

genes). This research will facilitate the development of biologically-based interventions to promote longevity, delay age-related dysfunction, 

extend health span, and improve the quality of 

life of older people.

• Epigenetic alterations (modifications other than 

changes in the DNA sequence that alter gene 

expression) are also likely to play important 

roles in rates of aging, age-related dysfunctions, 

and development of age-related diseases. Like 

changes to the DNA sequence itself, epigenetic 

modifications can be inherited. These modifications affect the cellular machinery responsible 

for turning genes “on” or “off,” allowing or 

preventing them from functioning optimally. 

Environmental agents such as chemicals or 

dietary components can also modify DNA 

and can be transmitted to offspring.
10 Living Long & Well in the 21st Century: Strategic Directions for Research on Aging

• Refine our understanding of the interplay among 

the biological, social, emotional, cognitive, and 

functional changes associated with normal aging.

The impact of changes in emotional, cognitive, 

and physical capacities at different life stages—

in combination with life course changes in 

motivation and goals—on social and economic 

behaviors at different life stages remains 

unknown. We know even less about changes 

in the neurobiological underpinnings of these 

interactions. NIA will use the approaches of 

social neuroscience and neuroeconomics to study 

how the neurobiological changes associated 

with aging influence or are influenced by social, 

emotional, cognitive, and motivational factors.

• Elucidate the biological mechanisms and pathways through which social, psychological, and 

environmental stresses contribute to declines 

in health and well-being among older adults.

Individual differences in the subjective experience 

and physiological and psychological impact of 

stressors may exacerbate or buffer the impact 

of stressors on health. We will encourage 

multi-level and interdisciplinary research in 

collaboration with relevant NIH Institutes on 

the interactive effects of genes, behavior, and 

social environments on health and well-being 

as people age. 

A-2 Accelerate the discovery of the 

causes and risk factors associated 

with disease and disability among 

older adults.

To develop new interventions for the prevention, 

early detection and 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 will continue research to:

Identify the genetic and epigenetic bases of agerelated diseases and conditions as well as factors 

that affect disease initiation and progression.

Studies of genes associated with aging processes, 

longevity, and age-related diseases will continue to 

provide insights into disease pathologies and vulnerability. However, emerging research suggests 

that epigenetic mechanisms may also underlie, 

in part, the susceptibility to common and complex diseases of aging, particularly those subject 

to environmental influences. We will support 

research to understand the basic mechanisms 

influencing the aging process as a whole. In addition, we will work to understand the interplay 

among genes and environmental influences, as 

this knowledge will be essential to our understanding of the development of both disease and 

healthy aging. 

Improve our understanding of the molecular, 

genetic, cellular, and tissue bases of aging that 

contribute to increased risk for, alter the course 

of, and vary the response to the treatment of 

major age-associated diseases. We will increase 

efforts to understand the genetic and epigenetic 

factors that can alter susceptibility of individuals 

to disease and affect the response to treatment. 

In addition, we will work in collaboration with 

other NIH Institutes and Centers to study how 

phenomena such as anxiety and other negative 
Living Long & Well in the 21st Century: Strategic Directions for Research on Aging 11

emotions can alter nervous system function. 

Although these processes aid the body in responding to dangerous or stressful situations, they can 

damage cells, tissues, and organ systems when 

produced in excess.

Identify the molecular and cellular bases of agerelated decline in immune responses. The agerelated decrease in the adaptive immune response 

(that is, the cellular response for manufacturing 

antibodies and killing pathogens) makes older 

people more prone to a variety of infectious agents 

and reduces the efficacy of vaccinations in older 

adults. These factors have a significant effect on 

the health span and quality of life of older people. 

We will support research to develop more protective vaccine regimens and strategies to improve 

immune responses in the aging population.

Improve our understanding of how the inflammatory process is affected by aging and how 

these changes impact tissue function. The degree 

to which primary age-related changes in inflammation contribute to changes in structure and 

function of various tissues and organs as well as 

the risk or progression of age-related pathologies 

and conditions is not clear. Likewise, researchers 

are continuing to identify the sources of proinflammatory cytokines (proteins used by the 

body for cell-to-cell communication). We will 

examine the role of different cell types, including immune cells and adipose tissue (fat), in the 

age-related increase in levels of pro-inflammatory 

cytokines. We will also investigate how changes in 

the circulating levels of these cytokines contribute 

to pathological changes in tissues and organs. We 

will facilitate exploration of how the response of 

different tissues to pro-inflammatory cytokines is 

affected by age and how these changes contribute 

to the overall balance of the immune system.

Inflammation is a natural and highly regulated response that

provides protection and promotes healing when infection

or injury occurs. However, if left unregulated, these same

processes can cause further tissue injury and damage. It

is unclear to what extent acute or chronic inflammation

influences the pace of aging. Also unknown is whether

age-related changes in inflammatory responses reflect a

“normal” deterioration of cells or are the result of disease

processes, or if psychological factors such as stress could

promote the development of chronic inflammation or

exacerbate its effects.

Inflammatory processes, particularly those resulting in

chronic inflammation, have been implicated in a number of

chronic diseases and conditions of aging, including cardiovascular disease, osteoarthritis, osteoporosis, Alzheimer’s

disease, insulin resistance and diabetes, muscle wasting,

and frailty. However, the precise role of inflammation

in each of these conditions is not well understood. NIAsupported researchers are working to describe more

fully the underlying biology connecting the mediators of

inflammation with these disease processes, including:

 How inflammatory mediators—molecules that coordinate

the inflammatory response at the cellular level—change

with age, and how these changes contribute to disease

 How “normal” age-related cellular changes may trigger an

inflammatory response

 How chronic or acute inflammation resulting from disease

or dysfunction contributes to—or protects against—further

cellular dysfunction

Ultimately, NIA-supported investigators hope to apply an

improved understanding of inflammatory processes

and their cellular mechanisms to develop more precisely

targeted anti-inflammatory interventions.

Inflammation Plays an Important

Role in the Aging Process
12 Living Long & Well in the 21st Century: Strategic Directions for Research on Aging

Identify, analyze, and track changing patterns of 

disability for older adults and better understand 

factors contributing to these patterns. 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 

for younger cohorts. NIA-supported research 

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. 

A-3 Encourage translational research to 

bridge basic discovery and intervention 

development.

Translational research provides the two-way bridge 

necessary to link scientific discoveries with applications in medical practice and public health. For 

research on aging, basic discoveries typically begin 

with studies at a molecular or cellular level to 

understand the mechanisms of normal aging and 

disease or with studies to better understand the 

basic behavioral and social science related to aging 

processes. New knowledge gained at “the bench” 

takes a variety of paths to human intervention studies—the “bedside.” Equally important is providing 

a clear path back to the bench for insights gained at 

the bedside. Several NIH initiatives are focusing on 

the broad issues of culture change required for the 

biomedical community to more successfully support translational activities. In support of our other 

objectives in Research Goal A, NIA will continue to:
Living Long & Well in the 21st Century: Strategic Directions for Research on Aging 13

The Quest for Biomarkers Takes Many Pathways

A biomarker is a physical, biochemical,

or functional measure used as an

indicator of a physiological change

or disease process. Biomarkers—

sometimes referred to as surrogate

markers or clinical endpoints—can be

used to define, diagnose, or predict

disease and enable rational treatment

and monitoring of disease. Basic mechanistic studies of specific disorders

can identify molecules in biological

fluids, tissues, or even breath with

which disease-related changes could

be identified as disease biomarkers.

Biomarker imaging tools such as

positron emission tomography (PET),

magnetic resonance imaging (MRI),

and nuclear magnetic resonance

(NMR) spectroscopy scans can reveal

detailed alterations in tissue due to

disease processes and permit noninvasive longitudinal tracking of

disease progression. Other biomarkers

help determine cognitive declines

through standardized neuropsychological test batteries or the effect of

environmental triggers or social stress

factors on aging and health outcomes.

Some biomarkers can also predict

susceptibility to disease or serve as

measures of drug toxicity.

There is a critical lack of specific,

reliable, quantifiable, and easily

measured biomarkers that correlate

well with early disease progression.

Public and private organizations have

invested heavily in identifying candidate disease biomarkers using technologies such as imaging, genomics,

proteomics, and high-throughput

approaches. NIA-supported initiatives

help to refine technologies for biomarker discovery and apply them to

specific diseases. The Alzheimer’s

Disease Neuroimaging Initiative, for

example, seeks to identify whether

longitudinal and concurrent brain

imaging and biochemical measurements can be used to monitor disease

progression. Improved brain imaging

promises to provide researchers with

the ability to monitor how drugs affect

the accumulation of harmful proteins

as disease progresses. Biological

samples from well-characterized

patients enrolled in this and similar

studies are made available for other

investigations.

NIA is working to improve the precision and validity of biomarkers for

monitoring the progression of other

diseases such as osteoarthritis or

assessing an individual’s risk of cardiovascular disease or diabetes. Advanced

biomarker technology also promises

to streamline clinical trials by identifying clinical subtypes to establish

more homogeneous study populations

and applying biomarker testing to

monitor and assess the effects of

trial interventions.

Identify and optimize opportunities for moving 

new knowledge from basic discovery to intervention development and back. We will accelerate 

our efforts to promote promising preclinical 

studies and 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 NIA-supported scientists 

and clinicians.

Facilitate communication among NIA-supported 

researchers and encourage interdisciplinary collaboration. The complexity of contemporary science 

demands a synergistic approach to ensure collaboration among researchers from multiple scientific 

disciplines along the continuum of research. We 

will invest in multidisciplinary research programs 

and provide supplemental funding to support 

promising interdisciplinary endeavors.

Foster communication and partnerships with 

other NIH Institutes and Centers and with 

other Federal agencies as well as 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 Roadmap 

for Medical Research 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.
14 Living Long & Well in the 21st Century: Strategic Directions for Research on Aging
Living Long & Well in the 21st Century: Strategic Directions for Research on Aging 15

Continue to develop and disseminate information 

about interventions to reduce disease and disability and 

improve the health and quality of life of older adults.

Modern medicine and new insights into lifestyle and other environmental influences promise 

to have a profound impact on the health and 

well-being of older people and make it possible for 

them to remain physically healthy and cognitively 

and emotionally vital into very advanced ages—

ideally, for as long as they live. Capitalizing on 

new insights from basic research, NIA-supported 

scientists, often in collaboration with other NIH 

Institutes and Centers, will continue to work from 

multiple perspectives to develop and test strategies 

for preempting or reducing the severity of the full 

range of health problems experienced by older 

people. We will work to strengthen the translation 

of basic findings in the laboratory into practical 

applications to improve the health and quality of 

life of older adults.

Our success will depend on progress 

in achieving three objectives in this area:

B-1 Develop effective interventions to maintain 

health and function and prevent or reduce 

the burden of age-related diseases, disorders, 

and disabilities.

B-2 Understand and develop strategies to enhance 

societal roles and interpersonal support for 

older adults, reduce social isolation, and 

prevent elder abuse.

B-3 Increase awareness and promote adoption of 

interventions to improve the health and quality 

of life of older people.

B-1 Develop effective interventions 

to maintain health and function and 

prevent or reduce the burden of 

age-related diseases, disorders, and 

disabilities.

Achieving and maintaining health and function 

in advanced years can be aided by physical fitness, 

proper nutrition, and avoidance of smoking 

and other behaviors that adversely affect health. 

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. Improved health 

habits can help people survive longer, enable them 

to postpone the onset of disability, and increase 

quality of life and function at older ages. Research 

has also shown that optimizing both the physical 

and social environment is important to the health 

and functioning of older people.

NIA will continue to:

Develop efficacious and cost-effective strategies 

for promoting and ensuring adherence to healthy 

and safe behaviors among older adults.

Research Goal B
16 Living Long & Well in the 21st Century: Strategic Directions for Research on Aging

have been established. We 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.

• Develop strategies to reduce falls and their 

consequences. NIA-supported human factors 

research will continue to identify safety risks for 

older people in home and work environments, 

improve screening strategies, and develop 

and disseminate information important to 

reducing the risk of falls.

• Explore new ways to improve safety in the home 

and community through studies of ergonomics 

and the built environment. We will continue 

to support research to identify cost-effective 

alterations in design that can reduce injuries 

and provide a safer, more secure environment 

for older adults.

• Pursue a better understanding of needs and 

develop interventions to improve the safety of 

older drivers. We will continue 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 to support 

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 people, and alternative 

transportation options that help older adults 

maintain as much independence as possible. 

• 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 manipulations such 

as dietary restriction and 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 

develop and test in clinical trials cost-effective 

dietary and other behavioral measures and 

adherence strategies for the prevention or 

delay of disease and disability.

• Use our increased understanding of exercise physiology and other branches of basic science to maximize the positive effect of exercise on older people.

Several studies strongly suggest that modest 

exercise 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, consequently preventing 

osteoporosis and subsequent fragility fractures. 

We will support further research to validate 

exercise and exercise programs and their effects 

on older people within specific age groups and 

develop strategies for promoting adherence.

• Continue research to understand hormone changes 

in older people 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 
Living Long & Well in the 21st Century: Strategic Directions for Research on Aging 17

This research will provide the insights needed 

to develop guidelines for older adults, their 

health care providers, and family members.

• Improve the safe use of medications by older 

adults. Managing medications can be complex 

for older people, many of whom take drugs, 

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. 

NIA-supported research 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 interventions for treating, preventing, 

or delaying the onset of age-related diseases 

and conditions.

• Support research into 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 risks for 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. 

• Test compounds that hold the promise of increasing 

healthy lifespan. Promising compounds must 

undergo preclinical safety and efficacy testing 

using animal and cellular models before being 

tested in full-scale clinical trials. We will continue to support the testing of promising 

compounds in mice and other model systems 

with the long-term goal of selecting for further 

development those most likely to have a 

beneficial effect in humans. 

• Conduct clinical studies and encourage the 

translation of new interventions to the clinical 

setting. As pathways and processes of disease are 

better defined, basic research findings can be 

translated expeditiously to the development 

of clinical applications. We will continue to 

support clinical studies to improve health and 

well-being through better treatments for agerelated diseases and conditions and to test the 

effects of hormone therapy, dietary supplementation, and exercise and fitness. 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.
18 Living Long & Well in the 21st Century: Strategic Directions for Research on Aging

Develop improved approaches for the early 

detection and diagnosis of disabling illnesses and 

age-related debilitating conditions. We will help 

develop and evaluate improved techniques and 

tools to measure the well-being of older people 

as well as symptoms of disease and disability. As 

new interventions are ready, we will facilitate the 

movement of biochemical, imaging, and other 

technologies into mainstream medical practice, 

where they can be used routinely to assist in early 

detection and diagnosis as well as to monitor the 

efficacy of interventions tested in clinical trials.

Find significantly improved and cost-effective 

ways to reduce caregiver, family, and patient 

stress and improve older people’s 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. Investigators will continue 

to evaluate strategies to improve social support, 

skills training, and assistive services both for 

those who cope with chronic disease and for 

their caregivers. NIA-supported research 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 improve the interaction of 

older people 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 percent 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. NIA will help develop 

strategies to assist patients in dealing with multiple 

services and to manage health care financing for 

multiple chronic conditions. We will seek better 

interventions to help older people 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. 

B-2 Understand and develop strategies 

to enhance societal roles and interpersonal support for older adults, reduce 

social isolation, and prevent elder abuse.

Despite negative stereotypes, millions of older 

people work productively and otherwise 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 both 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. Improvements in acute 

and long-term health care for older people are also 

essential, including strategies to ease the burdens of 

caregivers and enhance quality of care at home and 

in different long-term care settings. These initiatives 

should result in more effective approaches for prevention, treatment, and rehabilitation.

NIA will continue to:

Identify ways for older people to retain valued 

roles and maintain independence. Older men 

and women are now working in paid jobs, doing 

essential volunteer work, maintaining a household, 

and/or supporting children and grandchildren. 

NIA-supported research will seek and apply 

technological, social, and behavioral findings to 

extend the ability of older adults to remain 

independent, active, and productive.
Living Long & Well in the 21st Century: Strategic Directions for Research on Aging 19

Conduct research on the social and economic 

aspects of family caregiving and develop 

and disseminate effective interventions for 

patient care in family and community settings.

Intergenerational family support is the most 

common way in which a family assembles and 

allocates its resources of money, skills, and time 

to care for all its members. 

• Assess and evaluate family relationships over 

time. This research will help us understand the 

effects of changing relationships on the health 

and well-being of older people, and gain insight 

into the caregiving, emotional support, and 

family-level economic aspects of aging. 

• 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. 

Develop strategies to help older people and their 

families prepare for and manage age-associated

changes in health, income, function, and roles.

Older adults and family members are faced 

with many complex decisions about retirement, 

finances, health and life insurance, and medical 

treatment. Issues of concern include the ability 

of health care delivery systems to support patient 

and family needs and adherence to a patient’s 

advanced directives. NIA-supported research will 

inform decisions about complex issues of health, 

finances, and family roles in late life, both for 

individuals and policymakers. We will compile 

up-to-date information about patterns of work 

and retirement, sources of retirement income, 

intergenerational income transfers, and status of 

health and disability at the regional, national, 

and global levels. This compilation will be used 

to develop and make available information and 

other resources for people as they plan for later 

life transitions and possible loss of independence 

as well as to inform policy decisions.
20 Living Long & Well in the 21st Century: Strategic Directions for Research on Aging

Research and develop strategies to improve decision making for long-term and end-of-life care.

There is a pressing need to define organizational 

mechanisms that will ensure quality, affordable 

health care for older people. There is also a 

critical lack of empirically generated knowledge 

on how to maximize quality at the end of life. 

Medical culture is oriented primarily to patient 

care and not to addressing the multifaceted needs 

of dying patients and their families. To better 

address these issues, we will:

• Examine component parts of health care delivery 

systems and their impact on medical, social, functional, and cost outcomes and use this information to develop 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, most 

often provided in a home setting. We will focus 

on interventions that reduce the burdens of 

caregivers, with an emphasis on the unique 

challenges faced by patients with dementia and 

their caregivers.

• Understand caregiving patterns and improve the 

effectiveness of different strategies for helping families manage the care needs of the physically frail.

For example, we will use knowledge gained 

from this research to develop and disseminate 

evidence-based guidance on caregiving skills, 

environmental modifications, and technological 

supports for both informal and formal longterm care settings. 

• Develop strategies to improve the experience of 

older people at the end of life. We will support 

research to better understand the decisionmaking 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 endof-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 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.

An essential component of the NIA mission is the dissemination of information about research and aging-related

topics to the general public, health professionals, the media,

policymakers, and advocacy organizations. The Institute

reaches out to the public through the NIA Web site, two

Information Clearinghouses with toll-free numbers, and the

NIHSeniorHealth Web site.

 The NIA Web site, www.nia.nih.gov, offers information

about NIA programs, research findings, grants and training opportunities, and public and professional education

materials. The NIA Spanish-language Web site, www.nia.

nih.gov/Espanol has information on a wide range of

health topics, free publications in Spanish, and links to

other health-related, Spanish-language Web sites.

 The NIA Information Center, 1-800-222-2225, distributes

a variety of public and professional education materials,

including Age Pages on more than 40 health topics—

from arthritis and diabetes to sleep and skin care. NIA’s

evidence-based Exercise Guide provides simple, easy-tofollow exercises to improve endurance, strength, flexibility,

and balance.

 The Alzheimer’s Disease Education and Referral (ADEAR)

Center, 1-800-438-4380, offers information on diagnosis,

treatment, patient care, caregiver needs, clinical trials, and

research related to Alzheimer’s disease. 

 www.NIHSeniorHealth.gov is a collaborative effort with

the National Library of Medicine. Based on research on

cognition and aging, the site provides information on more

than 30 health topics. Information is available in a variety

of senior-friendly formats, including large print, opencaption videos, and audio versions.

Dissemination of Research Results Is a

Critical Component of the NIA Mission
Living Long & Well in the 21st Century: Strategic Directions for Research on Aging 21

• Assess the impact of health care organizations and 

provider interactions on the quality of life for 

dying individuals. Special attention will be given 

to developing strategies that enhance support of 

the older person, the family, and medical care 

providers who are attempting to provide humane 

and life-affirming services at the end of life.

Understand and develop strategies to address 

elder neglect and abuse. Although isolated studies 

have documented the devastating long-term 

consequences of elder mistreatment, research 

on elder neglect and abuse has been inadequate. 

We will support methodological research to help 

determine the prevalence of elder physical, psychological, and financial neglect and abuse. We will 

also work to develop and disseminate reliable 

measurement tools for assessing neglect and abuse 

and interventions to reduce its incidence.

B-3 Increase awareness and promote 

adoption of interventions to improve the 

health and quality of life of older people.

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 certain knowledge, attitudes, 

or health behaviors; dispel misconceptions about 

aging; and encourage individual or collective action. 

Health education programs, activities, and materials 

also can inform, influence, and motivate the public.

Communicating effectively about health is challenging. Health 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 also may conflict with long held personal beliefs. To succeed, health communication 

programs and materials must be based on an appreciation of the needs and interests of the target audience. Large scale, multi-year, multi-media efforts 

utilizing community organizations already in place 

may be needed to inform, persuade, convince, and 

sustain behavior change. To address these concerns 

and ensure that research results are disseminated to 

all who need them, NIA will:

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 target audience perceives and reacts to health 

messages, how the public is persuaded to change 

behavior, and how people in general, and older 

people in particular, respond to various media.

Develop appropriate materials and programs for 

a variety of target audiences. We will continue to 

work to overcome gender, cultural, and language 

barriers to the effective communication of 

health information.

Explore successful networks for the transfer of 

research knowledge and evaluate the usefulness 

of transferred interventions for older adults in 

broadly designed and applied outcomes research.

NIA will continue to work with other Federal 

agencies, State and local governments, and the 

private and nonprofit sectors to ensure that results 

of research on behavioral and community interventions are widely shared and have an impact on 

policies and programs. 

Provide information to support the training 

of 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.
22 Living Long & Well in the 21st Century: Strategic Directions for Research on Aging
Living Long & Well in the 21st Century: Strategic Directions for Research on Aging 23

Abetter understanding of how the brain ages will provide important information on which 

to base strategies for maintaining and enhancing 

cognitive, emotional, sensory, and motor function 

through biological and behavioral interventions. 

For example, studies have shown that new neurons 

form in certain regions of the brain even in adulthood. This phenomenon, known as neurogenesis, 

suggests that medical and behavioral approaches 

could be found to stimulate the formation of new 

neurons to compensate for the loss and functional 

decline of neurons with aging, disease, or traumatic 

injury. NIA will support research to harness functional imaging and other advanced technologies 

that view activity in specific regions of the brain to 

identify age-related neural changes and mechanisms 

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

will also work to clarify the interactions between 

the brain and the peripheral nervous, endocrine, 

hematopoietic, cardiovascular, and immune systems. We will also support the development of 

preventive and therapeutic approaches to maintaining health in cognition, emotion, sleep function, 

sensory processes, and motor function. Research 

on the function of the normal brain and peripheral 

nervous system will help us understand the ways in 

which non-dementia-related health outcomes arise. 

Our objectives in this area are to: 

C-1 Understand the mechanisms involved in 

normal brain aging; the role of cognition in 

everyday functioning; protective factors for 

sensory, motor, emotional, and cognitive function; and the pathogenesis of AD and other 

neurodegenerative disorders of aging.

C-2 Develop better ways of distinguishing people 

with normal brain aging from those who will 

develop mild cognitive impairment (MCI), 

AD, and related conditions.

C-3 Translate discoveries about the cellular and 

molecular mechanisms of cognitive, emotional, sensory, and motor function with age 

and the mechanisms of AD pathogenesis 

into diagnostic, treatment, and/or prevention 

strategies.

C-4 Conduct research to better understand and 

develop interventions to address the special 

caregiving needs of patients with AD and 

other dementias.

Improve our understanding of Alzheimer’s disease, 

other dementias of aging, and the aging brain. Develop 

drug and behavioral interventions for treating these diseases, 

preventing their onset and progression, and maintaining 

cognitive, emotional, sensory, and motor health.

Research Goal C
24 Living Long & Well in the 21st Century: Strategic Directions for Research on Aging

Determine how genetic, molecular, cellular, and 

environmental factors interact for optimal brain 

health and functioning, including in the oldest 

old. The overall integrity of brain structure and 

many neural systems are largely preserved in 

normal aging, while in age-related diseases, 

specific brain cell types and their connections 

are damaged or lost. Evidence suggests that 

achieving the full potential of the central and 

peripheral nervous systems depends on developing the brain optimally in early life, continuing 

activity to maintain function in midlife, and 

stimulating the brain to compensate for cell death 

C-1 Understand the mechanisms 

involved in normal brain aging; the role 

of cognition in everyday functioning; 

protective factors for sensory, motor, 

emotional, and cognitive function; 

and the pathogenesis of AD and other 

neurodegenerative disorders of aging.

NIA will continue research to:

Improve our understanding of nervous system 

and behavioral changes that occur with normal 

aging and how brain function is maintained 

and enhanced. Changes in brain structure and 

function, some of which may compensate for 

age-related decrements, may continue throughout life. For example, research shows that the 

hippocampus, a region of the brain important for 

acquiring and processing information, is capable 

of generating new nerve cells. Furthermore, 

research in mice demonstrates that increased 

physical and mental activity started in middle 

age can increase hippocampal neurogenesis and 

decrease signs of neuronal aging. This suggests 

that neurogenesis may be one factor underlying 

the beneficial effects of an active lifestyle on brain 

integrity and behavioral function in humans. We 

will continue to explore the role of physical and 

mental exercise in promoting healthy cognitive, 

emotional, and motor functioning and in activating the cellular machineries that protect the 

brain from damage and promote its repair. This 

research will help form the basis for future investigation of more subtle neural changes that occur 

with age, including selective neuronal loss or 

dysfunction that impacts memory and other 

functions, impaired neuronal connections, early 

brain atrophy, and changes in the responses of 

glial cells involved in neuron survival and brain 

plasticity and possibly inflammation.
Living Long & Well in the 21st Century: Strategic Directions for Research on Aging 25

We Need To Better Distinguish

Patterns of Brain Aging

As with other bodily organ systems, brain function declines

with age. Many older people notice changes in memory,

learning, or other cognitive performance. These changes are

associated with loss of neurons, the basic operative cells of

the brain. The extent of “normal” brain aging varies among

individuals and can be somewhat difficult to quantify. With

“abnormal” brain aging, however, cognitive losses are typically more severe, and after the individual dies, significant

pathological changes related to underlying disease processes

are usually found in the brain at autopsy. The early identification of people at risk for abnormal brain aging is the

subject of intense ongoing research on genetic, biochemical,

and neuropsychological aspects of the transition from

normal to pathologic aging.

Standardized neuropsychological tests have been developed

and validated with consensus thresholds of abnormal performance that aid clinicians in evaluating mild cognitive

impairment and dementia. The development of drug therapies or behavioral modifications to slow or possibly halt the

complex processes involved in cognitive decline requires the

earliest possible intervention. Hence researchers are searching for biochemical or imaging markers that might be used

to predict the clinical course of dementia versus normal

aging patterns or to monitor treatment progress. A better

understanding of factors involved in normal and abnormal

brain aging will aid our ability to enhance healthy brain

aging, for example with dietary and behavioral practices

that could prolong normal brain function.

and injury in older age. We will work to gain a 

greater understanding of the many factors that 

interact to maintain brain function, including 

compensatory mechanisms and adaptive or 

dynamic changes. This research will enhance 

our understanding of, and potentially our ability 

to prevent, brain function decline in aging 

and disease.

For example, we will:

• Continue to pursue a greater understanding of the 

interaction among genetic factors that underlie 

normal cognitive, emotional, sensory, and motor 

function as well as abnormal decline and the 

interactions between genetics and the environment.

• Investigate epigenetic changes, which can significantly influence the structure and function of 

genes within the cell.

• 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 function that take place in the 

oldest old, 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. We 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 in everyday 

functioning, including work environments, 

decision making, and interaction with technology. NIA will support research to examine the 

influence of contexts—behavioral, social, cultural, 

and technological—on the cognitive functioning 

of older adults; investigate the effects of agerelated changes in cognition on activities of daily 

living, social relationships, and health status; 

and develop strategies for improving everyday 

functioning through various interventions such 

as cognitive training.
26 Living Long & Well in the 21st Century: Strategic Directions for Research on Aging

Explore possible additional risk and protective 

factors for brain health and function, cognitive 

decline, mild cognitive impairment, and AD 

through epidemiological and other population 

studies. 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. NIA will place a special emphasis 

on community-based studies, including studies in 

racial and ethnic minority populations, 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 

lifestyle, genetics, comorbid diseases, or sensory 

or motor dysfunction interact to cause disease or 

contribute to cognitive decline.

Refine our knowledge of molecular, cellular, 

cognitive, and other behavioral changes that 

cause or accompany development of AD and 

other dementias of aging. We will investigate the 

multiple pathological changes associated with the 

development of AD, including accumulation of 

abnormal proteins, loss of synapses, and death of 

neurons. We will promote further characterization 

of these pathological changes in tissue culture, 

animal models, and humans. 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. This research will enhance our basic 

knowledge of altered neural, cognitive, and 

behavioral function in older adults and will aid 

in the development of appropriate treatments.

Investigate the relationship between systemic 

metabolism and brain function during normal 

aging and in AD. Epidemiological research has 

shown that the presence of metabolic and vascular 

risk factors such as obesity, diabetes, hypertension, and heart disease during midlife as well as 

current smoking are associated with accelerated 

age-related cognitive decline and with increased 

risk for AD. This association is even more pronounced in individuals with three or more vascular risk factors. Given the prevalence of obesity 

and other components of metabolic syndrome in 

the U.S. population, we will stimulate research 

to examine the mechanisms by which disrupted 

systemic metabolism may influence the transition 

between normal brain aging and AD. This effort 

will provide not only a better understanding of 

the etiology of AD, but may also benefit the 

search for biomarkers of cognitive aging and AD. 

Ultimately we are interested in exploring whether 

the negative impact of metabolic and vascular 

risk factors on brain aging can be counteracted 

through behavioral and lifestyle changes and the 

relevant mechanisms.
Living Long & Well in the 21st Century: Strategic Directions for Research on Aging 27

We will also continue to support research that 

examines the reciprocity of brain-body interactions 

in healthy aging and in the course of AD, especially 

interactions mediated by stress and other hormones. 

For example, short sleep—less than an average of 6 

hours per night—has been associated with hormonal 

and metabolic changes that may lead to obesity, 

diabetes, hypertension, increased cardiovascular 

disease, or cognitive decline. 

C-2 Develop better ways of distinguishing 

people with normal brain aging from 

those who will develop mild cognitive 

impairment, AD, 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 and diagnosis, and treatment of disease. Identification of biomarkers of the transition 

from normal function to different levels of cognitive 

impairment is facilitating our efforts.

NIA will work to:

Identify neuroimaging and other biological 

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.

Improve neuropsychological 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 development of better tools 

for assessing cognitive function in the clinic, in 

the primary care setting, and in the home environment. In one project, NIA helped establish 

the Uniform Data Set (UDS), comprising both 

clinical and neuropsychological tests, across all

Alzheimer’s Disease Research Centers (ADRCs) 

in the United States. The UDS will promote 

uniformity in collection of cognitive function 

data and will allow researchers to pool large sets 

of data across ADRCs. We will also participate 

in plans outlined by the recently funded NIH 

Neuroscience Blueprint Toolbox project to develop 

a measurement tool that includes a module for 

assessing cognitive, sensory, motor, and emotional 

function in adults. A standardized assessment 

tool of this type will help researchers track and 

compare behavioral change over time in longitudinal and epidemiological studies, in clinical 

trials, and eventually in primary care and other 

non-research settings.

Improve methods of assessing changes in sensory 

and motor systems as markers of age-related 

change and AD. Age-related 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.
28 Living Long & Well in the 21st Century: Strategic Directions for Research on Aging

C-3 Translate discoveries about the 

cellular and molecular mechanisms of 

cognitive, emotional, sensory, and motor 

function with age and the mechanisms 

of AD pathogenesis into diagnostic, 

treatment, and/or prevention strategies.

NIA-supported studies have combined both cognitive training and standard drug treatments such 

as donepezil to improve memory in patients with 

dementia. Other NIA-supported trials focus on 

slowing the progression of cognitive symptoms in 

dementia and on strategies to manage the behavioral 

symptoms. Still others focus on preventing the early 

stages of cognitive decline. NIA-supported 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. A number of NIAsupported trials focus on slowing the progression of 

cognitive symptoms in dementia and on strategies 

to manage the behavioral symptoms of dementia, 

while others focus on preventing the early stages of 

cognitive decline. Still others combine intervention 

strategies such as cognitive training and standard 

drug treatments (e.g., donepezil) to improve cognition in patients with dementia.

NIA will continue to:

Stimulate translational research. We will continue 

to stimulate translational research aimed at 

discovery and preclinical development of new 

candidate drugs and biologics. By supporting the 

early steps of the drug discovery and development 

process, we can play a critical role in facilitating 

the very long, difficult, and enormously expensive 

process of translating the wealth of basic science 

discoveries into successful AD therapeutics. We 

will also support research to identify behavioral 

interventions aimed at maintaining brain and 

behavioral health and function during aging. We 

will apply what we are learning about the interplay 

among biological, behavioral, and social factors to 

develop more targeted and effective interventions.

Support clinical trials for drug and behavioral 

interventions to prevent, treat, and delay the 

onset and progression of cognitive decline, MCI, 

AD, and other dementias. We will continue to 

support research to test promising new drug, 

behavioral, or combination interventions in clinical trials with the intention of moving them rapidly into clinical practice.

C-4 Conduct research to better understand and develop interventions to 

address the special caregiving needs of 

patients with AD and other dementias.

A number of recent studies have demonstrated that 

the chronic stresses of caring for a family member 

with dementia can cause lasting psychological and 

even physical consequences. These effects are multifold. For example, sleep-wake patterns are altered 
Living Long & Well in the 21st Century: Strategic Directions for Research on Aging 29

in AD patients, often leading to chronic sleep 

deprivation in the patients and their caregivers. 

Research has shown that caregivers of AD patients 

have an increased risk of depression, elevated stress 

hormones, increased vulnerability to influenza, and 

poor wound healing (in the older caregivers). 

NIA will continue to:

Conduct research on the family and economic 

burdens of AD and other dementias. Formal and 

informal care for older persons with dementia is 

a major cost for families, private insurers, and the 

public sector. We will support research at several 

levels, including studies on the mechanisms 

through which the stress of caregiving affects 

health. We will work with others to develop 

new types of interventions for alleviating stress. 

Other studies will help us quantify and understand the economic burdens to inform health 

policy decisions.

Develop better strategies for the care of patients 

with MCI and AD and for alleviating caregiver 

burden. NIA-supported investigators have developed a multifaceted, personalized intervention 

that can significantly improve the quality of life 

for caregivers of people with dementia. We will 

continue to develop and test other interventions of 

this type. In addition, we will research the needs 

of long-term spousal caregivers following the 

death of their spouses and support development 

of post-bereavement interventions aimed at 

providing social support and working through 

the persistent traumatic and stressful thoughts 

of the prior years of caregiving.
30 Living Long & Well in the 21st Century: Strategic Directions for Research on Aging

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Living Long & Well in the 21st Century: Strategic Directions for Research on Aging 31

Improve our understanding of the consequences of 

an aging society and provide that information to inform 

intervention development and policy decisions.

The greater longevity and improved health seen at older ages in many parts of the world represent one of the crowning achievements of the last 

century, but also present a significant challenge. 

Societal aging may affect economic growth, patterns 

of work and retirement, the way families function, 

the ability of governments and communities to 

provide adequate resources for older people, and 

the prevalence of chronic disease and disability. 

NIA will continue to support research on the social, 

economic, and demographic consequences of the 

rapidly aging population in the United States and 

other countries. In addition, we will continue to 

support research on how social and economic factors 

across the lifespan affect health and well-being 

during old age.

NIA’s objectives in this area are to:

D-1 Understand how population aging and 

changes in social, economic, and demographic 

characteristics of cohorts reaching old age 

affect health and well-being in the United 

States and other countries.

D-2 Understand how social, economic, and health 

system factors produce disparities in health 

at older ages and develop interventions to 

reduce disparities.

D-3 Understand how social and economic factors 

throughout the lifespan affect health and 

well-being at older ages.

D-1 Understand how population aging 

and changes in social, economic, and 

demographic characteristics of cohorts 

reaching old age affect health and 

well-being in the United States and 

other countries.

The social, economic, and demographic changes 

the Nation is experiencing at the population level 

may have profound effects on health and well-being 

at the individual level. For example, alterations in 

family structure may lead to changing trends in 

family caregiving practices, chronic diseases of aging 

may become more common, and the health care 

system may experience strain as greater numbers of 

Americans require services.

NIA will continue to:

Explore the effects of education and other 

social and demographic factors on health and 

well-being at older ages. 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 this connection to help project health and 

long-term care needs and devise ways to intervene 

to reduce disparities.

Research Goal D
32 Living Long & Well in the 21st Century: Strategic Directions for Research on Aging

Assess the impact of changing family structures 

on health and caregiving. Changing family 

structures mean that people now approaching old 

age are more likely than their predecessors to be 

divorced, childless, or in stepfamilies. Researchers 

will need to examine how the presence of homeand community-based services (e.g., waiver 

programs, assisted living) influence the experience 

of family caregiving from an economic, social, 

and emotional perspective. Additional data are 

also needed to track the migration trends of 

older people as they move from community to 

community as well as from independent living 

to different levels of assisted living and nursing 

home care. We will support research on the ways 

in which the evolution of the American family 

structure will affect the well-being of the elderly 

by influencing living arrangements, caregiving, 

and economic support.

Encourage comparative analyses to evaluate the 

impact of institutions on population and individual well-being and foster longitudinal studies

on aging. Other countries have larger proportions 

of their populations now at older ages than the 

United States, and many of those with currently 

younger populations are aging at a much more 

rapid rate. A wide variety of institutional arrangements for income support, home health care, 

long-term care, and acute care have been developed in response to the challenges of population 

aging. We will support comparative research on 

the effects of these changes on behavior, and we 

will evaluate institutional reform efforts to gain 

insights useful both in the United States and 

elsewhere. We will also encourage analyses on 

the impact of global population aging on macroeconomic factors and their influence on institutions and well-being.

Develop a research plan to understand the 

dynamic changes that occur across the life 

course. Researchers will need to understand 

how experiences/exposures across the life course 

(infancy to older age) to a variety of environmental, intellectual, and social factors influence aging 

Understanding of

Disability Trends Provides Insights

for Effective Interventions

Disability rates among older Americans—the numbers of

people unable to carry out, to specified levels, essential

activities of daily living—have declined in recent decades,

suggesting an improvement in health and function. Activities 

of daily living assessed in these studies generally include

eating, dressing, bathing, toileting, and transferring from a

lying down to a sitting or standing position. Researchers

sometimes also examine “instrumental activities of daily

living” like shopping or using the telephone.

The disability decline has been demonstrated in a number of

studies, including the most recent U.S. National Long-Term

Care Survey. This analysis revealed that the prevalence of

chronic disability has dropped significantly from 1982 to the

present. The continuing decline in disability among older

people is one of the most encouraging and important trends

in the aging of the American population. However, this trend

may be threatened by rising rates of obesity and sedentary

lifestyles in children and younger adults—both risk factors for

late life disability.

Continued research on the causes of disability will inform the

development and implementation of effective medical and

behavioral interventions as well as public health programs to

promote their use. For example, the Department of Health and

Human Services uses health and disability trend information

to create programs such as HealthierUS, a national effort

to improve people’s lives, prevent and reduce the costs of

disease, and promote community health and wellness through

physical activity, healthy diet, preventive screening, and cessation of high health risk behaviors such as cigarette smoking.
Living Long & Well in the 21st Century: Strategic Directions for Research on Aging 33

and age-related well-being. We will examine 

factors contributing to maintenance or decrement 

of cognitive and physical functioning over the 

life course in an effort to forestall negative 

consequences and enhance health and well-being.

Examine the bases for individual and societal 

attitudes toward older people and develop 

effective strategies to improve them. Older 

people may be the target of inaccurate and 

negative stereotypes. We will support research 

to explore the causes of these negative attitudes 

and develop strategies to counter them with 

community and other interventions. For example, 

engaging older people in meaningful volunteer 

work may prove to be a “win-win” situation for 

society, replacing the image of dependence with 

one of active and productive citizens.

D-2 Understand how social, economic, 

and health system factors produce 

disparities in health at older ages and 

develop interventions to reduce disparities.

Health disparities continue to exist among racial, 

ethnic, and socioeconomic groups. Research is 

needed to understand the causes of these disparities 

and how they relate to social, economic, and health 

system factors and develop interventions to reduce 

the disparities. 

NIA will continue to:

Encourage cross-national, comparative and historic research as an approach to understanding 

the burden of disease and health disparities.

Cross-national, comparative research using 

microlevel data has proven very useful in 

understanding how the structure of pension 

systems affects work and savings decisions. 
34 Living Long & Well in the 21st Century: Strategic Directions for Research on Aging

Many countries have already reached the stage 

of population aging that is not expected in the 

United States until much later in the century, 

and many developing countries have populations 

that are aging faster than in the United States. 

Research on long-term trends in the burden of 

disease and risk factors can improve projections. 

Comparative research on the increasing burden 

of chronic diseases, and on ways in which families and health care systems cope with disease 

management and long-term care, could provide 

insights useful in the United States and globally.

Encourage interdisciplinary biodemographic, 

health systems, social, and economic perspectives 

to understand gender differences in health and 

disease at older ages. Recent demographic and 

economic trends have gender-specific implications 

for health and well-being at older ages. Nonmarried women, for example, are less likely than 

non-married 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. This research will inform development of targeted policies to achieve dual goals of 

increasing longevity and delaying the onset and 

severity of disability.

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THE SPEED OF POPULATION AGING

Number of years for population age 65+ to increase 

from 7% to 14%
Living Long & Well in the 21st Century: Strategic Directions for Research on Aging 35

D-3 Understand how social and 

economic factors throughout the 

lifespan affect health and well-being 

at older ages.

Individual differences in chances for a healthy and 

secure old age emerge in midlife. For example, 

NIA-supported research indicates that Americans 

in late middle age have much wider variation in 

wealth (i.e., total accumulated assets) than in 

current income (i.e., earnings). Furthermore, work 

and other decisions by people in their 50s and 60s 

are already affected by chronic conditions and 

disability. NIA-supported research will focus on 

both observational studies and interventions to 

improve function based on a life course perspective.

We will continue to:

Support research on social insurance and health 

insurance systems (e.g., Social Security and 

Medicare) to assist other agencies in promoting 

the health and well-being of the elderly while 

ensuring program efficiency. As record numbers 

of Americans reach retirement age, programs 

such as Social Security and Medicare will face 

unprecedented challenges. We will support 

research to assist these and related programs to 

work as effectively and efficiently as possible to 

safeguard the health and well-being of older 

Americans. Such research will include the 

measurement of the economic value of good 

health and the development of techniques 

to produce National Health Accounts. Our 

studies on the social, educational, public 

health, and biomedical variables that affect length 

of life and rates of disability, also will inform 

decisions related to social and health insurance 

systems. We will also support continued 

work to understand the biological, behavioral, 

economic, and social basis for decisions of 

individuals, employers, and families that affect 

income security in retirement and the financing 

of long-term care.

Support research that models and measures the 

economic risks of old age with the potential 

for developing interventions to insure against 

these risks. Demographic and retirement income 

trends are expanding economic risks in old age. 

Higher life expectancy can increase the likelihood 

of outliving retirement savings, and the shift 

in pensions from defined benefit to defined 

contribution plans suggests that more Americans 

will reach retirement with Social Security as their 

only annuity. Although homes often represent 

the most significant part of retiree wealth, relatively few retirees make use of reverse mortgages 

to insure against retirement income shortfalls. 

Many Americans will require long-term care, but 

few purchase private insurance to support formal 

care expenses. Research that seeks to understand 

the behavioral aspects of demand for insurance 

against these old age risks and developing interventions that translate findings from behavioral 

research to improve well-being will be encouraged.
36 Living Long & Well in the 21st Century: Strategic Directions for Research on Aging
Living Long & Well in the 21st Century: Strategic Directions for Research on Aging 37

Improve our ability to reduce health disparities and eliminate 

health inequities among older adults.

During the 21st century, the United States will experience a dramatic increase in the proportion and diversity of racial and ethnic minorities 

in its older population. Life expectancy at older 

ages has increased significantly over the past 25 

years but unacceptable disparities continue to exist 

in terms of disease burden and lifespan among 

racial and ethnic groups in the United States. 

Socioeconomic factors such as work, retirement, 

education, income, and wealth can have a serious 

impact on health and well-being. Economic circumstances can determine whether an individual 

can afford health care and proper nutrition from 

early life into old age. Individual and family financial resources and health insurance can determine 

whether an older adult enters a nursing home or 

stays at home to be cared for by family and friends.

Health disparities are associated with a broad, complex, and interrelated array of factors. Diagnosis, 

progression, response to treatment, caregiving, and 

overall quality of life may each be affected by race, 

ethnicity, gender, socioeconomic status (SES), age, 

education, occupation, and other as-yet-unknown 

lifetime and lifestyle differences. For example, a 

multi-ethnic epidemiological study supported by 

NIA indicated that prevalence rates for Alzheimer’s 

disease may be higher for African Americans and 

Hispanics than for other ethnic groups. Another 

study found striking relationships between SES and 

both health and longevity. Gender differences in 

health and longevity also are observed across racial 

and ethnic groups. 

We will continue to support essential research to 

increase our understanding of and reduce health 

disparities and inequities among older adults. 

We will support research to establish the scientific 

basis for redressing differences and inequities 

affecting older adult populations. We will work to 

understand the extent to which genetic, behavioral, 

social, and other factors that show variation across 

racial and ethnic groups influence health and longevity. In addition, we will use new knowledge to 

develop behavioral and public health interventions 

for reducing disparities and increasing quality of life 

for all older adults.

Our objectives in this area are to:

E-1 Understand health differences and health 

inequities among older adults.

E-2 Develop strategies to promote active life 

expectancy and improve the health status 

of older adults in minority and other underserved populations.

E-3 Use research insights and advances to inform 

policy on the health, economic status, and 

quality of life of all older adults.

E-1 Understand health differences and 

health inequities among older adults.

There are many complex and interacting factors 

related to race, ethnicity, gender, environment, SES, 

geography, place of birth, recency of immigration, 

and culture that can affect the health and quality of 

life of older adults. Socioeconomic factors related to 

work, retirement, education, income, and wealth can 

have a serious impact on the health and well-being 

Research Goal E
38 Living Long & Well in the 21st Century: Strategic Directions for Research on Aging

of the elderly. Biological and genetic factors can 

also affect the course and severity of disease 

and disability. Furthermore, a person’s culture 

can have a tremendous influence on healthrelated factors such as diet and food preferences 

and attitudes toward exercise. All of these factors 

and their interactions must be understood in order 

to design effective interventions to improve health 

equity among various ethnic/racial and low SES 

population groups.

To support this objective, NIA will continue 

research to:

Understand normal aging processes across 

various ethnic/racial and low SES populations.

We will characterize normal processes of 

aging in minority and low SES populations 

to increase our understanding of the course 

of disease and disability, and to identify the 

similarities and differences among racial and 

ethnic groups and among groups living in 

different geographic locations.

Determine the effects of early life factors on 

adult health. Early life events can play an 

important role in the aging process. Differences 

in nutrition, education, disease incidence, 

environmental exposure and health care in fetal 

development and early life can affect disease and 

disability in later life. Research into the influence 

of early and midlife experience on the health of 

the aging will advance our ability to predict the 

health status of older adults in the future.

Gather data that further classify patterns of 

health differences, inequities, and causes.

• Compile data from multiple sources to assemble 

the necessary volume and types of information 

needed. Research to understand health disparities requires data that are accessible to researchers 

on a national level as well as appropriate ways 

to utilize multiple small data sets collected by 

many different researchers. NIA will support 

the use of these data to discover new scientific 

knowledge and to help in the evaluation and 

design of policies to deal with an aging society. 

This approach will allow data from several 

sources to be linked by a common identifier 

and analyzed in ways not previously possible.

• Use ongoing data collection programs to oversample 

minority populations. These data will provide 

important information on living arrangements, 

income, health care needs, and other topics.

• Continue to support surveys focused on specific 

groups and concentrated on issues of illness and 

well-being. NIA will continue to support and 

expand surveys of racial, ethnic, and language 

minority groups in order to provide the data 

needed by researchers and public policy makers.

Determine the influences of and interactions 

among race, culture, ethnicity, economic 

status, education, and work experiences in 

health. Health and quality of life, particularly 

in later years, are affected by many interrelated 

factors. NIA will 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, which 

provide information about individuals across 

their lifespans, to untangle the multitude of 

factors that affect health and well-being.

E-2 Develop strategies to promote active 

life expectancy and improve the health 

status of older adults in minority and 

other underserved populations. 

As life expectancy increases among all population 

groups, there are more adults living with one or 

more chronic conditions that may not affect the 

length of life but may dramatically affect quality of life. Research shows that these differences 
Living Long & Well in the 21st Century: Strategic Directions for Research on Aging 39

in active life expectancy are more marked among 

the medically underserved. Genetic, lifestyle, and 

socioeconomic factors also play an important role 

in the time of onset or severity of disease and disability. NIA’s efforts to understand the special needs 

of minority older adults will facilitate the design of 

effective interventions to improve health status and 

quality of life for our entire aging population.

NIA will continue research to:

Track and analyze disease prevalence and course 

in diverse older adult populations.

• Determine the causes of disparities in the prevalence of diseases and conditions such as heart 

disease, obesity, hypertension, frailty, diabetes, 

comorbidities, and certain types of cancer among 

minority and underserved populations. For 

example, African Americans suffer from hypertension and prostate cancer at higher rates 

than their white counterparts. Hispanics suffer 

more from diabetes but less from heart disease. 

NIA-supported researchers will explore socioeconomic factors such as education, language, 

and access to health care as well as how genetic, 

molecular, and cellular factors contribute to 

differences across populations. 

• Determine the reasons for variation in the 

prevalence of cognitive decline and AD across 

population groups. We will support research 

to better understand the differences in the 

prevalence of AD among African Americans, 

Asians, and Hispanics compared to non-Hispanic 

whites. For example, Japanese Americans living 

in Hawaii have lower prevalence of strokerelated dementia and higher rates of AD 

than Japanese nationals. We will continue to 

examine a range of possible causes of these 

disparities, including the impact of diseases 

such as hypertension, cardiovascular disease, 

and diabetes; health behaviors; and disease 

processes in minority populations. This 

research will draw on culturally appropriate, 

equivalent, and standardized measures to 

better understand these differences and to 

suggest culturally appropriate interventions.

Research Suggests a Positive

Correlation between

Social Interaction and Health

Several research studies have shown a strong correlation

between social interaction and health and well-being

among older adults and have suggested that social isolation

may have significant adverse effects for older adults. For

example, study results indicate that:

 Social relationships are consistently associated with

biomarkers of health.

 Positive indicators of social well-being may be associated

with lower levels of interleukin-6 in otherwise healthy

people. Interleukin-6 is an inflammatory factor implicated

in age-related disorders such as Alzheimer’s disease,

osteoporosis, rheumatoid arthritis, cardiovascular disease,

and some forms of cancer.

 Some grandparents feel that caring for their grandchildren

makes them healthier and more active. They experience

a strong emotional bond and often lead a more active

lifestyle, eat healthier meals, and may even reduce or

stop smoking.

 Social isolation constitutes a major risk factor for

morbidity and mortality, especially in older adults.

 Loneliness may have a physical as well as an emotional

impact. For example, people who are lonely frequently

have elevated systolic blood pressure.

 Loneliness is a unique risk factor for symptoms of

depression, and loneliness and depression have a

synergistic adverse effect on well-being in middle-aged

and older adults.

More research is needed to understand the actual links to

positive health and determine the importance of social interactions as they relate to disability, falls, memory, and overall

health benefits for older adults.
40 Living Long & Well in the 21st Century: Strategic Directions for Research on Aging

Develop appropriate health strategies for disease, 

illness, and disability prevention and healthy 

aging among the underserved. Aging Americans 

need understandable, culturally appropriate 

interventions they can use to maintain and 

improve their well-being. For example, adults 

with low levels of education and limited fluency 

in English may need specially adapted assessments 

of cognitive function for the diagnosis of AD. 

Diet and exercise recommendations may need 

to be adjusted to take into account religious, 

ethnic, and cultural sensitivities. Adults are more 

likely to use their medication appropriately if the 

labels and instructions are printed in their native 

language.

 To address these and other concerns, NIA will:

• 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.

• Design and promote interventions appropriate 

for older adults in diverse populations to more 

effectively prevent, diagnose, or reduce the effects 

of disease.

• Design and promote culturally appropriate 

strategies for self management of chronic diseases.

• Investigate the factors affecting medication 

misuse and culturally appropriate strategies for 

enhancing proper use and compliance with 

medication regimens.

Develop interventions to improve culturally 

appropriate health care delivery.

• Design interventions to facilitate communication 

between health care professionals and Asian, 

Hispanic, and other elderly who have come to 

the United States with a range of educational 

and language skills. Interactions with health 

care professionals can be difficult if there are 

language and cultural barriers. If the elderly 

individual is hospitalized or placed in a nursing 

home, communication becomes a critical issue 

in ensuring appropriate health care. NIA will 
Living Long & Well in the 21st Century: Strategic Directions for Research on Aging 41

increase efforts to develop evidence-based 

practices that will facilitate communication of 

symptoms and care instructions between the 

patient and the health care provider.

• Develop interventions to reduce health disparities 

and inequities associated with poor providerpatient 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 evidencebased interventions regardless of race, ethnicity, 

or cultural background.

Develop strategies to increase inclusion of 

minorities and other underserved populations 

in research.

• Investigate novel approaches for increasing representation and retention of minorities in research 

careers. We will work to identify the best 

strategies for training and attracting a diverse 

workforce of new, mid-career, and senior 

researchers for research on aging. We will 

continue programs to assemble a cadre of 

high-quality researchers through flexible 

training mechanisms that reflect the rapidly 

changing needs of science and provide crossdisciplinary training. We will 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 women and men—including 

minorities and individuals with disabilities—

for careers in biomedical science. We will work 

to stimulate the training of investigators who 

can translate the findings of basic research into 

medical benefits for older people and expand 

the pool of clinical geriatric investigators.

• Continue to support training for clinical staff in 

message development, recruitment strategies, and 

community and media outreach. Our ability 

to involve adults representative of the total 

population in research studies is essential to sound 

research and to obtaining the results needed 

for evidence-based intervention development. 

However, historically, members of minority 

populations have been underrepresented in 

clinical trials. Outreach efforts, such as involving 

faith-based and community organizations in 

emphasizing the importance of medical research 

and in recruiting study participants, have had 

varied success in minority populations. NIA 

will search for more effective ways to mitigate 

the difficulties associated with enrollment of 

minority individuals in research studies and 

clinical trials. For example, we will address 

cultural and language barriers and encourage 

effective communication of the potential benefits 

of studies and trials for improvement in health.

Develop training programs to prepare culturally 

proficient service providers and researchers.

We will facilitate training of researchers in the 

biomedical, behavioral, and social sciences as well 

as service providers working with older adults to 

help them better understand the medical implications of the growing diversity of our population. 

These training programs will help prepare the 

next generation of our health workforce by incorporating new materials sensitive to these issues.

Conduct research to better understand effective 

strategies for communicating health messages 

that are culturally appropriate in various racial/

ethnic and low SES populations. Because of 

language, educational, and cultural differences, 

underserved groups do not always receive the 

information they need about healthy lifestyle 

behaviors. NIA-supported communication 

research with specific target audiences will assist 

the development of appropriate health messages 

and dissemination channels. 
42 Living Long & Well in the 21st Century: Strategic Directions for Research on Aging

E-3 Use research insights and advances 

to inform policy on the health, economic 

status, and quality of life of all older adults.

A key resource for understanding health disparities 

and inequities that exist among older adults is 

data on trends and patterns that can explain the 

interaction between financial assets and health 

outcomes in different racial and ethnic groups and 

within economically disadvantaged groups. Data 

that increase our understanding of the role of 

educational status in improving health behaviors 

and health status will also inform the development 

of more effective policies.

Minority and underserved elders depend more 

heavily on Social Security, receive little support 

from private pensions, derive less income from 

accumulated assets, and rely to a larger extent on 

earnings from employment in old age. Challenges 

for policy makers include finding ways to encourage 

individual savings and home ownership and 

facilitate continued employment. 

To support this objective, NIA will continue to:

Study population changes and underlying causes 

of health and function of older adults across the 

lifespan. Many studies have identified significant 

risk factors for the development of chronic 

diseases that pre-date onset of symptoms by at 

least a decade. Population-based studies in which 

individuals are tracked from birth and across the 

lifespan help researchers understand the changes 

in health over time and the large variations in 

health across racial and ethnic populations. 

NIA-supported research will continue to develop, 

maintain, and analyze longitudinal data sets. 

Track and analyze patterns of aging and the 

burden of disease within and across diverse 

populations.

• Gather and analyze data on burdens and costs 

of illness, healthy life expectancy, longevity, and 

mortality trajectories. Determining the 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 direct and indirect medical costs. These 

difficulties are compounded in minority populations by differences in use of formal medical 

care and informal family caregiving. Projections 

of future active 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 provide 

valuable information for projecting the specific 

needs for health care services within various 

population groups.

• Develop cross-national and sub-national databases on health outcomes, risk factors, and SES 

structural factors, such as societal inequality.

Although many of the disparities in adult 

health and life expectancy across national, 

racial, occupational, and social class boundaries 

are well documented, causal mechanisms are 

less well understood. NIA-supported research 

to understand these differences will be critical 

to the development of behavioral and public 

health interventions. 

Provide information useful for policy discussion 

and decision making. We will continue to collect 

nationally representative longitudinal data on 

retirement, health insurance, savings, and family 

variables and share these data and trends with 

researchers, policy analysts, and program planners. 

Research findings of reduced disability among 

the elderly have become prominent in the public 

policy debate regarding Medicare and Social 

Security. NIA will investigate whether disability is 

being prevented or postponed, identify contributors to disability decline, determine the impact of 

changes in health care, and examine the economic 

implications of reduced rates of disability.
Living Long & Well in the 21st Century: Strategic Directions for Research on Aging 43

The NIA research portfolio is broad

based and includes research related

to a variety of diseases and conditions

relevant to the work of other NIH and

outside organizations. This provides us

with numerous opportunities to build

synergy and leverage resources by partnering with other NIH Institutes and

Centers (ICs), other government agencies,

academic institutions, and professional

and advocacy organizations.

We work closely with a number of other

NIH ICs to co-fund research initiatives,

support meetings and conferences,

and develop educational materials. For

example, we:

 Co-sponsor funding opportunity

announcements across the full range

of common programmatic themes.

 Collaborate with other NIH ICs on the

NIH Roadmap for Medical Research

initiatives such as the NIH Director’s

New Innovator Award Program and

an interdisciplinary program in the

behavioral and social sciences.

 Partner with other NIH ICs on NIH

Blueprint for Neuroscience Research

initiatives.

 Co-sponsor the Osteoarthritis Initiative

with the National Institute of Arthritis

and Musculoskeletal and Skin Diseases.

 Partner with the National Institute

of Mental Health and the National

Institute of Neurological Disorders and

Stroke on the Cognitive and Emotional

Health Project.

 Support the Study of Women’s Health

Across the Nation, a study of the

menopausal transition, along with the

NIH Office of Research on Women’s

Health.

 Partner with the National Library of

Medicine to develop and maintain the

NIHSeniorHealth Web site.

NIA also partners with other government agencies on several projects

including:

 Interagency agreements with the Center for Medicare and Medicaid Services

and the Social Security Administration

for collection and sharing of data

through longitudinal studies such as

the Health and Retirement Study.

 Collaborations with the National

Center for Health Statistics, the Census

Bureau, and others to compile and

disseminate statistical information

about aging.

 Partnerships to support meetings and

conferences such as an international

summit on global aging co-sponsored

with the Department of State.

NIA’s private-sector partners include:

 Nonprofit foundations and advocacy

organizations. These include the Alliance

for Aging Research, the Alzheimer’s

Association, the Alzheimer’s Drug

Discovery Foundation, the Alzheimer’s

Foundation of America, the American

Academy of Orthopaedic Surgeons, the

American College of Sports Medicine,

the American Federation for Aging

Research, the American Geriatrics

Society, the American Society of

Hematology, the Federation of American

Societies for Experimental Biology, the

Foundation for the National Institutes

of Health, the Friends of NIA, the

Gerontological Society of America, the

National Coalition for Osteoporosis

and Related Bone Diseases, and the

Population Association of America and

Association of Population Centers.

 Pharmaceutical, biotech, and related

private-sector companies. These

partnerships make tissues and

other specimens, microarrays, rodent

models, and other research resources

available to investigators and support

major initiatives such as the Alzheimer’s Disease Neuroimaging Initiative, a

joint effort involving NIA, the National

Institute of Biomedical Imaging and

Bioengineering, non-profit groups,

and a number of pharmaceutical and

biotech companies.

NIA also works closely with collaborators

outside the United States to support

studies to better understand the aging

experience on a global level. For

example, in the ongoing SardiNIA

study, Italian and NIA intramural

investigators have a unique opportunity

to identify genetic and other risk factors

for aging-associated conditions in a

very stable population on the secluded

island of Sardinia in the Mediterranean.

NIA also co-funds more than two

dozen cross-national, aging-related

datasets and single-country studies

of aging with partners like the World

Health Organization.

Partnerships Strengthen NIA Research Programs
44 Living Long & Well in the 21st Century: Strategic Directions for Research on Aging
Living Long & Well in the 21st Century: Strategic Directions for Research on Aging 45

The availability of the infrastructure and resources needed to support present and future 

research, program management, and information 

dissemination is critical to the NIA mission. 

NIA must 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, 

and facilitate the dissemination of research results 

to scientists, health professionals, and the public. 

We have five objectives to support this goal.

F-1 Foster interdisciplinary exchange 

and encourage collaborative research 

across disciplines. 

Sponsor workshops and conferences that bring 

together scientists from various disciplines for 

discussion and planning.

Provide funding opportunities that encourage 

interdisciplinary efforts with co-principal 

investigators and/or partnerships across two or 

more institutions or organizations. 

F-2 Engage in partnerships to create 

synergy and leverage resources 

within and among institutions and 

organizations.

Work closely with other NIH Institutes and 

Centers, and other government agencies, to 

collaborate across the continuum of research from 

basic science through translational research to 

clinical studies and to disseminate information 

about proven interventions (research translation).

Continue to participate in trans-NIH efforts such 

as the NIH Roadmap for Medical Research 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. 

F-3 Train and attract the diverse 

workforce of new, mid-career, and 

senior investigators necessary for 

research on aging.

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 

from basic to translational to applied. 

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 efforts to recruit, train, and retain 

scientists across the full spectrum of research 

on aging, especially targeting under-represented 

groups.

Encourage the training of investigators to translate 

the findings of basic research into benefits for 

older people. 

Support the infrastructure and resources needed to promote 

high-quality research and communicate its results.

Goal F
46 Living Long & Well in the 21st Century: Strategic Directions for Research on Aging

F-4 Develop and distribute research 

resources.

Support colonies of aged animal models, including 

genetically altered animals. These colonies are 

necessary for research on aging processes and 

specific age-related diseases. 

Make cell cultures and tissue, cell, and blood 

banks available 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 

data sets, especially from longitudinal studies,

suitable for analysis of biological, behavioral, and 

social factors affecting health, well-being, and 

functional status through the lifecourse.

Support data archiving and data sharing, with 

adequate protections for confidentiality and 

privacy of research participants and their families.

Support the development of internationally 

harmonized social and behavioral longitudinal 

data on aging to foster cross-national research.

Support computer technologies to record 

and analyze interdisciplinary research findings 

on basic biological studies and long-term, 

population-based data. 

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 people. 

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.

Make results of research on patient recruitment 

strategies widely available to the research community.

Support studies on the ethical aspects of research 

in older populations.
Living Long & Well in the 21st Century: Strategic Directions for Research on Aging 47

NIA and NIH Web Sites Are Valuable

Sources of Health Information

NIA Home Page – www.nia.nih.gov

NIH Home Page – www.nih.gov

NIA Publications – www.nia.nih.gov/HealthInformation

Alzheimer’s Disease Education and Referral (ADEAR)

Center – www.nia.nih.gov/Alzheimers

NIHSeniorHealth – www.nihseniorhealth.gov

NIA Spanish Home Page – www.nia.nih.gov/Espanol

F-5 Disseminate information 

to the public, medical and scientific 

communities, and policy makers.

Rapidly and effectively disseminate the latest 

advances in geriatric medicine, research on aging, 

and related health data through publications, 

professional education materials, public service 

announcements, and videos.

Make available health information and reports of 

new research findings on the NIA Web site and 

through the NIA Information Center.

Maintain and promote the NIA Alzheimer’s 

Disease Education and Referral (ADEAR) Center 

and the NIHSeniorHealth Web sites. 

Develop materials for special audiences and 

diverse populations including non-English 

language materials and materials for people 

with limited literacy. Support national education 

campaigns to encourage healthy practices among 

older adults. 

Support innovative programs to promote positive 

attitudes toward older people’s health needs on 

the part of health care and other service providers 

and the public at large.
48 Living Long & Well in the 21st Century: Strategic Directions for Research on Aging

Acknowledgements

The content of this document was developed under the guidance of staff in the NIA Office of Planning, Analysis, and Evaluation who 

worked closely with the leadership of the Institute to identify and carefully articulate the present and future priorities and strategic 

directions of NIA. NIA staff in turn looked to members of the National Advisory Council on Aging, the NIA Board of Scientific 

Counselors, research and advocacy organizations, and the general public for input on the draft document. In response to a request for 

input to our draft strategic directions issued in June of 2007, we received suggestions from 47 individuals and groups. Each provided 

an important perspective, and several led us to further revise the document to make it more comprehensive. We recognize below those 

who contributed in various ways to the content, writing, design, and production of this document.

NIA Staff Contributors

Richard Hodes, Judy Salerno, and Kathie 

Reed provided leadership for development 

of the document.

Felipe Sierra, Richard Suzman, Marcelle 

Morrison-Bogorad, Evan Hadley, Michele 

Evans, Neil Buckholtz, Vicky Cahan, John 

Haaga, Taylor Harden, Ron Kohanski, 

Dan Longo, Andy Monjan, Winnie Rossi, 

and Molly Wagster provided scientific and 

technical review in consultation with their 

program staff members.

Kathie Reed, Jeannie Borger, Kate Nagy, 

Sam Speciale, Zita Givens, Loan Ta, Tamara 

Jones, and Ellen Silva did most of the writing and synthesis of the information along 

with editorial assistance from Kathy Sorrow 

of KLS Writing.

Karen Pocinki and Jeannie Borger coordinated the design and final production of the 

printed document.

National Advisory Council 

on Aging – 2007

Kenneth Brummel-Smith, John Cacioppo, 

Peggye Dilworth-Anderson, Carl Eisdorfer, 

Larry Friedman, Mary Ganguli, Alan Garber, 

Paul Greengard, Michal Jazwinski, Sundeep 

Khosla, Virginia Lee, Terry Mills, John 

Morris, Orien Reid, Gary Ruvkun, Gerald 

Schatten, Albert Siu, Mary Tinetti.

NIA Board of Scientific 

Counselors – 2007

Lisa Berkman, Karen Ashe, Avery August, 

Barbara Bierer, Rafael Lantigua, Gordon 

Lithgow, Ron Petersen, Arlan Richardson, 

David Siscovick, Rudolph Tanzi, Keith 

Whitfield, Ellen Wijsman.

Members of Our Research 

and Advocacy Communities

Individuals with the following organizations 

responded to our invitation to provide input to 

the NIA Strategic Directions during May and 

June of 2007: Alliance for Aging Research. 

Alzheimer’s Disease and Other Dementias 

Registry, New York State Department of Health. 

American Academy of Orthopaedic Surgeons. 

American Heart Association. American 

Psychological Association. American Society 

for Bone and Mineral Research. Association 

of Directors of Geriatric Academic Programs. 

Colorado State University. Directors of the 

NIA P30 Demography of Aging Centers. 

Harvard Medical School. Institute for Health 

Research - Kaiser Permanente. Institute for 

the Advancement of Social Work Research. 

Johns Hopkins University. National Association of Social Workers. National Sleep 

Foundation. Oregon Health and Science 

University. Orthopaedic Research Society. 

Population Association of America and the 

Association of Population Centers. Portland 

Veterans Affairs Medical Center. Saginaw 

Valley State University. School of Medicine - 

Virginia Commonwealth University. Sleep 

Research Society. Society of Clinical Geropsychology. Stanford University. The American Geriatrics Society. The American Society 

of Hematology. University of California. 

University of California - Davis. University 

of California - San Francisco. University of 

Illinois at Chicago. University of Maryland, 

Baltimore County. University of Massachusetts. 

University of North Carolina at Charlotte. 

University of Pennsylvania School of Medicine. 

University of Pittsburgh. University of Rochester Medical Center. University of Southern 

California. University of Washington. Veterans 

Administration Palo Alto Health Care System. 

West Virginia University. Western Suffolk/

Eastern Nassau Counties, Long Island, New 

York, Assisted Living Communities. Yale 

University.

Credits

Design

Kim Pollock, Jeffrey Dever, Dever Designs

Project Coordinator

David M. Burton, JBS International, Inc.

Photography

Cover, top, photographs 1 and 3; page 4, bottom; inside

front cover; inside back cover; page 22; page 24, top – 

courtesy of Stacy Jannis

Cover, top, photograph 2; page 14, bottom – courtesy 

of J. Bone Miner. Res., 1986; 1:16-21 with 

permission from the American Society for 

Bone and Mineral Research, from the National 

Institute on Aging: Aging Under the Microscope, 

A Biological Quest

Cover, top, photograph 4; page i, left; page 4, top; inside

back cover, bottom; page 30, top – DigitalVision

Cover, top, photograph 5; page i, right; page 7, right;

pages 8-9, page 14, top; page 33; page 36, top – 

courtesy of Marty Katz

Cover, middle; page 19 – ThinkStock

Cover, lower right; page 44 – Dynamic Graphics, 

with scans on screen courtesy of William Jagust, 

M.D., University of California, Berkeley, from 

the National Institute on Aging: Progress Report 

on Alzheimer’s Disease 2005-2006

Cover, background; page ii; page iii; back cover – 

courtesy of Dr. David Teplow, Harvard Medical 

School, from the National Institute on Aging: 

Progress Report on Alzheimer’s Disease 2003

Inside front cover, left; page iv, top; page iv, bottom;

inside back cover, center right – Blue Moon

Inside front cover, top; inside back cover, top left – 

Photo Researchers Inc.

Inside front cover, center right; pages 2-3; page 22, top;

page 26; page 47; inside back cover, center left – 

PhotoDisc

Inside front cover, bottom; page 40 – Getty Images

Page 7, left; page 24, bottom – courtesy of Christy 

Krames

Page 10 – Photos.com

Page 12; page 46 – courtesy of David M. Burton

Page 28; back cover, left – courtesy of National 

Institutes of Health

Page 29 – courtesy of Rick Brady

Page 30, bottom; page 34 – courtesy of Levine and 

Associates, from the National Institute on Aging: 

Why Population Aging Matters, A Global Perspective

Page 36, bottom – courtesy of Levine and Associates, 

from the National Institute on Aging: Aging 

Hearts and Arteries, A Scientific Quest

Page 44, bottom – courtesy of Dr. Minoru Ko, 

Laboratory of Genetics, National Institute on 

Aging, from: Aging Under the Microscope, A 

Biological Quest

U.S. Department of Health and Human Services

National Institutes of Health

National Institute on Aging

NIH Publication Number: 07-6252

November 2007