[Senate Report 110-527]
[From the U.S. Government Publishing Office]



110th Congress                                                   Report
                                 SENATE
 2d Session                                                     110-527
_______________________________________________________________________

                                     



 
      RECOGNITION OF EXCELLENCE IN AGING RESEARCH COMMITTEE REPORT

                               ----------                              

                              R E P O R T

                                 of the

                       SPECIAL COMMITTEE ON AGING
                          UNITED STATES SENATE

                              pursuant to

               S. RES. 89, SEC. 17(d), FEBRUARY 28, 2007

  Resolution Authorizing a Study of the Problems of the Aged and Aging






               December 10, 2008.--Ordered to be printed

      RECOGNITION OF EXCELLENCE IN AGING RESEARCH COMMITTEE REPORT


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110th Congress 
 2d Session                      SENATE                          Report
                                                                110-527
_______________________________________________________________________

                                     

                                                                       


                   RECOGNITION OF EXCELLENCE IN AGING

                       RESEARCH COMMITTEE REPORT

                               __________

                              R E P O R T

                                 of the

                       SPECIAL COMMITTEE ON AGING

                          UNITED STATES SENATE

                              pursuant to

               S. RES. 89, SEC. 17(d), FEBRUARY 28, 2007

  Resolution Authorizing a Study of the Problems of the Aged and Aging






               December 10, 2008.--Ordered to be printed

                       SPECIAL COMMITTEE ON AGING

                     HERB KOHL, Wisconsin, Chairman
RON WYDEN, Oregon                    GORDON H. SMITH, Oregon
BLANCHE L. LINCOLN, Arkansas         RICHARD SHELBY, Alabama
EVAN BAYH, Indiana                   SUSAN COLLINS, Maine
THOMAS R. CARPER, Delaware           MEL MARTINEZ, Florida
BILL NELSON, Florida                 LARRY CRAIG, Idaho
HILLARY RODHAM CLINTON, New York     ELIZABETH DOLE, North Carolina
KEN SALAZAR, Colorado                DAVID VITTER, Louisiana
ROBERT P. CASEY, Jr., Pennsylvania   BOB CORKER, Tennessee
CLAIRE McCASKILL, Missouri           ARLEN SPECTER, Pennsylvania
SHELDON WHITEHOUSE, Rhode Island
                 Debra Whitman, Majority Staff Director
            Catherine Finley, Ranking Member Staff Director


110th Congress                                                   Report
                                 SENATE
 2d Session                                                     110-527

======================================================================




      RECOGNITION OF EXCELLENCE IN AGING RESEARCH COMMITTEE REPORT

                                _______
                                

               December 10, 2008.--Ordered to be printed

                                _______
                                

                Mr. Kohl, from the Committee on Aging, 
                        submitted the following

                              R E P O R T

                          I. Executive Summary

    The aging of the U.S. population is becoming an 
increasingly urgent issue for Congress to address. During the 
110th Congress, the oldest members of the baby boom reached the 
age of 62 and became eligible for Social Security benefits. By 
2029, the youngest baby boomers will have reached age 65 and 
will be eligible for Medicare. America's older population will 
double in the coming three decades, and even after the 
demographic impact of the baby boom has passed, the share of 
the population age 65 and over will grow due to longer life 
expectancies and declines in fertility. After remaining fairly 
constant for most of human history, average life expectancy has 
nearly doubled in the past century. Older Americans are able to 
spend these additional years working or by providing society 
with the benefit of their knowledge and experience through 
volunteerism or caregiving. As the nation's population ages, 
Congress will have the opportunity to help the growing number 
of older Americans contribute to and enrich the lives of their 
communities, and it will face the challenge of meeting the 
needs of the elderly who are poor, frail, or socially isolated.
    In fields as diverse as biomedical sciences, housing, and 
environmental protection, federal agencies are making important 
contributions to the body of aging-related knowledge and 
science. Collecting data about older people and conducting 
research on their health, economic status, and social support 
systems substantially improves the ability of community 
leaders, program administrators, and the Congress to develop, 
implement, and monitor public policies that are effective, 
efficient, and equitable. Aging-related research conducted by 
federal agencies has led to significant breakthroughs in 
science and medicine and to the development of public policies 
that help older Americans lead healthier and more productive 
lives. By continuing to support aging-related research, the 
Congress is committing the federal government to supporting 
public policies that enrich the lives of all Americans by 
improving the quality of life of older Americans.

              RECOGNITION OF EXCELLENCE IN AGING RESEARCH

    The U.S. Senate Special Committee on Aging (Committee) was 
established in 1961 to serve as a focal point in the Senate for 
discussion pertaining to the opportunities and challenges 
facing older Americans. The Committee has historically sought 
to recognize and promote the importance of aging research. 
Accordingly, this report describes federally-funded research 
that addresses the well-being of older adults in a wide range 
of areas, such as maintaining health, assuring adequate income, 
finding employment, engaging in productive and rewarding 
activity, securing proper housing, and obtaining long-term care 
services. The report demonstrates that the public sector is 
dedicated to improving the quality of life for older adults and 
their families and serves as a catalyst for continued progress 
in addressing the most pressing concerns of the nation's older 
population.
    In May 2008, the Committee asked all federal departments 
and agencies to identify federally-funded research projects 
that address the well-being of older adults. Agencies were 
asked to submit to the Committee examples of research projects 
that contributed significantly to policymakers' knowledge and 
understanding of social, economic, and medical issues related 
to aging. Agencies were asked to describe how each research 
project was deemed to be exceptional, relevant, effective, and 
innovative. Agencies responded by identifying a wide range of 
research projects, including efforts to promote interagency 
collaboration in aging-related research, strengthen research 
infrastructure, initiate or advance data collection efforts, 
and carry out demonstration projects that are testing new 
methods of resolving aging-related policy issues. All research 
projects submitted for inclusion in the report were conducted, 
administered, or sponsored by a federal department or agency 
within the past four years. Research submissions included both 
intramural and extramural research and research co-funded by 
multiple federal agencies and by federal agencies and 
nongovernmental organizations. The following is a summary of 
aging-related research findings submitted by federal agencies.

              II. Scope of Federal Aging-Related Research


       A LARGE NUMBER OF AGENCIES CONDUCT AGING-RELATED RESEARCH

    Twenty-seven agencies, ranging from the National Institutes 
of Health and the Department of Veterans Affairs to the 
Environmental Protection Agency and NASA, submitted over two 
hundred research projects to be included in this report.\1\ The 
research these agencies sponsor and conduct draws on the 
knowledge and expertise of individuals representing a broad 
range of disciplines and professions who are advancing our 
understanding of the aging process and developing improved 
strategies for providing services to older Americans.
---------------------------------------------------------------------------
    \1\See Appendix I for a full list of agencies.
---------------------------------------------------------------------------
    While many federal departments and agencies provide 
services to older Americans, four agencies focus on the needs 
of this population to a greater extent than most: the National 
Institute on Aging, the Administration on Aging, the Centers 
for Medicare and Medicaid Services, and the Social Security 
Administration. While the size, budget, and mission of each of 
these agencies differs substantially from that of the others, 
each conducts, administers, or sponsors aging-related research 
as part of its responsibilities to the public. For example:
     The National Institute on Aging (NIA) sponsors and 
conducts more aging-related research than any other agency of 
the federal government. NIA-sponsored research has contributed 
significantly to advancing scientific and medical understanding 
of the aging process and diseases of old age, including the 
identification of genes associated with a high risk of late-
onset Alzheimer's disease.
     The Administration on Aging (AoA) provides 
supportive services to older Americans, including nutrition 
services, preventive health services, and home and community-
based long-term care services. Recently, the AoA conducted an 
evaluation of supportive services provided under the Older 
Americans Act, including their role in planning, coordinating, 
and providing community services for older people.
     The Centers for Medicare and Medicaid Services 
(CMS) administers Medicare, Medicaid, and the State Children's 
Health Insurance Program. CMS research highlights the need for 
older Americans with multiple chronic diseases to receive 
recommended screening and preventive care services. Researchers 
have found that these services not only reduce mortality by one 
half, they may also reduce significant Medicare expenditures.
     The Social Security Administration (SSA) 
administers both Social Security and the Supplemental Security 
Income (SSI) program. Research conducted and sponsored by SSA 
has contributed greatly to our knowledge of the economic 
security of older Americans. Research findings from one recent 
SSA research project, for example, demonstrate how automatic 
enrollment in employer-sponsored 401(k) plans can boost 
participation in these plans increase workers' future 
retirement savings.
    In addition to these examples, many federal agencies that 
do not focus exclusively on the needs of older adults conduct 
research on issues of importance to older Americans and their 
families. Some federal agencies have undertaken research 
specifically targeted at issues related to aging and the needs 
of older persons, while others have incorporated aging-related 
issues into other research projects. For example:
     The Department of Transportation (DOT) examines 
the driving safety of older adults who take multiple 
medications by comparing the driving assessments of 
occupational therapists with in-vehicle video recordings of 
daily driving by older individuals.
     The Environmental Protection Agency (EPA) 
estimates the exposure of older persons to air pollution 
through tools that can be used to evaluate whether air 
pollution is associated with greater risk of heart attack, 
stroke, chronic obstructive pulmonary disease, and asthma.
     The National Aeronautics and Space 
Administration's (NASA) Human Research Program is undertaking 
biomedical research on human health, safety and performance 
during space exploration missions. Because some of the effects 
of space flight on astronauts have similarities to the effects 
of human aging, such as loss of bone mass, impaired nutrition, 
and reduced immunological response, NASA's research offers 
insights into improving medical treatment of older persons.
     The Substance Abuse and Mental Health Services 
Administration (SAMHSA) is comparing the effectiveness for 
older adults of an integrated primary health care approach to 
specialty mental health and substance abuse services.
    Several federal agencies that do not typically conduct 
research are undertaking projects that have added to our 
knowledge of the process of aging and the particular needs of 
older citizens. For example, the National Endowment for the 
Arts is evaluating the effects of active involvement in the 
arts on the physical and mental health and social functioning 
of older adults through a Creativity and Aging in America 
study. The Smithsonian Institution's Department of Anthropology 
is measuring bone density in 17th and 18th century human 
skeletons to determine whether low bone mass occurred in that 
era. The Appalachian Regional Commission, a federal-state 
partnership that works to create self-sustaining economic 
development and improved quality of life for people in 
Appalachia, is studying potential economic development 
opportunities for older persons in that area of the country.

      A WIDE RANGE OF AGING ISSUES ARE ADDRESSED THROUGH RESEARCH

    A majority of aging-related research currently being 
conducted by the federal government is focused on health care. 
The National Institutes of Health (NIH) conducts or sponsors 
most of the clinical research undertaken by the federal 
government, such as research on diseases and health conditions 
associated with the aging process. (Some of this research is 
described in following sections of this report). In addition to 
NIH; however, other federal agencies are involved in health 
care research on issues of importance for older adults. For 
example, the Agency for Healthcare Research and Quality (AHRQ) 
funds the Falls Prevention in Long Term Care Program that 
focuses on the prevention of injurious falls and related 
injuries and disabilities in nursing home and residential care 
settings and the Health Resources and Services Administration 
(HRSA) is examining access to home health care services among 
older people in rural areas. The Department of Veterans Affairs 
(VA) is working to improve end-of-life care through the Safe 
Harbor Palliative Care clinical demonstration project which 
strives to transfer the best practices of traditionally home-
based hospice and palliative care into VA inpatient settings.
    In addition to health care, federal aging-related research 
is also addressing social and economic concerns. For many older 
Americans their economic well-being depends greatly on their 
ability to continue working as they age. In addition to 
providing additional income, work at older ages can be a source 
of important social relationships. Older persons who continue 
to interact with others through work and volunteer activities 
tend to be healthier, both physically and mentally, than those 
who become socially isolated. Federal agencies are evaluating 
the benefits of volunteerism for older adults, the investment 
and management of technology to better assist older people 
living independently in their homes, and the availability and 
accessibility of transportation options for older adults and 
people with disabilities. Examples of these types of research 
projects include:
     The Department of Labor (DoL) uses data from the 
Health and Retirement Study, to examine the economic 
consequences for retirees of exiting the workforce gradually in 
stages. The analysis focuses on the types of ``bridge'' jobs 
that people choose, the reasons behind their choices, and their 
socioeconomic outcomes.
     The Corporation for National and Community Service 
(CNCS) uses data from the Census Bureau's Current Population 
Survey to trace the volunteer habits of the ``baby boom'' 
generation to help volunteer program administrators develop 
strategies that will attract and retain greater numbers of 
volunteers.
     Researchers at the National Science Foundation 
(NSF) are developing an integrated monitoring system called 
``smart home'' that will capture data in a noninvasive manner 
about elderly residents and their home environments in order to 
assess their changing needs and capabilities as they age.
     The National Council on Disability (NCD) utilizes 
a ``livable communities'' framework to enable older citizens to 
continue living in their homes, regardless of age or 
disability. The project assessed the needs of older community 
residents for safe and affordable housing, access to 
transportation, access to the political process, and access to 
services, programs, and activities offered by public and 
private entities.

                 III. Models of Federal Aging Research


 INVESTMENTS IN BASIC SCIENCE ARE LEADING TO SIGNIFICANT BREAKTHROUGHS 
                ON DISEASES THAT AFFECT OLDER AMERICANS

    With more than half of its funding allocated to basic 
research, the National Institutes of Health (NIH) conducts and 
sponsors more research on aging-related diseases and disorders 
than any other federal agency.\2\ While it is the mission of 
the National Institutes of Aging to provide leadership in 
aging-related research, the NIH Office of the Director and the 
other 26 NIH Institutes and Centers also invest heavily in 
research that contributes to greater understanding of the 
physical, mental, and sociological aspects of the aging 
process. For example, through NIH-sponsored research:
---------------------------------------------------------------------------
    \2\In fiscal year 2007, aging research accounted for almost nine 
percent of all spending on health research by agencies in the 
Department of Health and Human Services, including NIH. Data derived 
from HHS Budget Office cross-cutting table on aging-related programs, 
March 2008, and table on ``Federal Obligations for Health Research and 
Development by Federal Agency, FY 1997-2007, ``NIH Office of Extramural 
Research, available at: http://report.nih.gov/award/Research/
Fed_Obligations_By_Allocation_Agency_2007.xls.
---------------------------------------------------------------------------
     Investigators have demonstrated that restricting 
caloric intake may improve the body's metabolic efficiency, an 
effect that could contribute to the slowing of adverse changes 
that often accompany aging.
     Researchers have studied the ability of cells to 
repair damage to DNA caused by exposure to environmental 
toxins, which are a major cause of diseases associated with 
aging, such as cancer.
     A digital brain atlas of Alzheimer's disease was 
developed that correlates observations from many images to a 
single brain model. The research has led to novel methods to 
characterize and track Alzheimer's disease that are used at 
imaging centers worldwide.
     Investigators found that a daily, high-dose 
combination of antioxidant vitamins C, E, and beta-carotene and 
the trace element zinc reduced the risk of developing advanced 
age-related macular degeneration by 25 percent over a five-year 
period.
    Other federal agencies also conduct scientific research 
that contributes to improving the lives of older persons. The 
Department of Agriculture, for example, has studied the effects 
of improved nutrition on reducing the risk of heart disease, 
bone fractures, eye disease, and dementia in old age. The Food 
and Drug Administration's (FDA) has used a combination of 
experimental approaches to understand the growth and repair of 
tissues in the joints, which are particularly susceptible to 
injury among older persons. In addition, the Department of 
Commerce is collaborating with other government scientists at 
the National Institute of Standards and Technology, the FDA, 
and the National Cancer Institute to develop standards for 
benchmarking medical imaging algorithms used in the detection 
and measurement of disease.

   DATA COLLECTION EFFORTS PROVIDE VALUABLE INFORMATION ABOUT OLDER 
                               AMERICANS

    Many federal agencies conduct surveys and maintain data 
registries that are used to inform policymakers and planners 
about aging-related trends, including population projections, 
labor force participation, and the incidence and prevalence of 
specific health conditions among older people. Several federal 
agencies collect data through surveys of households, employers, 
hospitals, and nursing homes. Surveys of nationally 
representative samples of the population, conducted on a 
regular basis, are essential to enable researchers to monitor 
trends in the health, functional capacity, family status, and 
income of older Americans. National surveys of households and 
institutions conducted and sponsored by federal agencies are 
often the only surveys large enough to allow analysts to study 
the most vulnerable populations, such as racial and ethnic 
minority populations, residents of institutions, low-income 
households, and people aged 85 and older. Examples of important 
federal data collection efforts include:
     The Social Security Administration and the 
National Institute on Aging collaboratively conduct the Health 
and Retirement Study, which is the most comprehensive source of 
longitudinal data for research on health, income, wealth and 
well-being for older Americans.
     The Census Bureau's Current Population Survey 
(CPS) and Survey of Income and Program Participation (SIPP) 
collect data on employment, income, health insurance coverage, 
household wealth, and other economic and demographic 
characteristics of individuals, allowing researchers to measure 
these variables in the elderly population relative to the non-
elderly population.
     The National Science Foundation's (NSF) Panel 
Study of Income Dynamics (PSID) has collected data on a 
representative group of American families since 1968, allowing 
researchers to study the economic and social well-being of 
older Americans over time.
     The Agency for Healthcare Research and Quality 
(AHRQ) developed the Consumer Assessment of Health Providers 
and Services Hospital Survey to allow consumers to compare the 
experiences of adult inpatients' hospital care and services.
     The Office of the Assistant Secretary for Planning 
and Evaluation (ASPE) of the Department of Health and Human 
Services is conducting the first National Survey of Residential 
Care Facilities which will provide nationally representative 
data on residential care facilities and their residents.

             RESEARCH PROVIDES AN IMPORTANT LINK TO POLICY

    Data collected through surveys conducted or sponsored by 
federal agencies helps to inform Congress during the process of 
developing legislation, and guides executive branch agencies in 
implementing programs and policies. Federally-sponsored 
research also plays a crucial role in evaluating the 
effectiveness of federal programs and policies in achieving 
their stated goals. Objective analysis, guided by scientific 
methods and principles, is essential to ensuring that the 
public's needs are measured accurately, that the policies 
adopted by Congress to address those needs are executed 
effectively, and that the funds appropriated to implement these 
policies are expended efficiently.
    Examples of how research conducted by federal agencies can 
inform public policy include:
     The Assistant Secretary for Planning and 
Evaluation (ASPE) of the Department of Health and Human 
Services is studying the potential for reverse mortgages to 
play a greater role in financing long-term care. In addition, 
ASPE is studying factors that influence the purchase of private 
long-term care insurance, including the effect of tax 
incentives.
     The Congressional Budget Office (CBO) examined the 
potential effectiveness of identifying high-cost Medicare 
beneficiaries and focusing on early intervention strategies for 
these individuals as a way to reduce the program's costs.
     The Congressional Research Service (CRS) analyzed 
the effect of possible benefit reductions under Social Security 
reform proposals on poverty among the elderly and assessed the 
effectiveness of options to mitigate these effects.
     The Social Security Administration (SSA) estimated 
how much longer a typical worker aged 65 in 2030 would have to 
work for the same financial resources under a scenario of high 
taxes and high health costs compared to one of lower taxes and 
health costs.

                           IV. New Directions


   BUILDING NEW INFRASTRUCTURE FOR AGING RESEARCH IN FEDERAL AGENCIES

    In response to the growth of our nation's aging population, 
some federal agencies have recognized a need to change or 
restructure the programs that they lead to address the special 
circumstances facing an aging society. The examples listed 
below are indicative of how agencies have adapted their 
research agendas to address the needs of an aging population:
     The Department of Transportation is developing a 
system that will correlate driver performance to age-related 
functional deficits and use of medications, providing new 
insights into risk factors for older drivers. DOT will also 
conduct evaluations of changes to behavior that reduce the risk 
of accidents among older drivers.
     The Environmental Protection Agency developed the 
Aging Initiative to give the agency and the public the ability 
to anticipate, accommodate, and manage the environmental risks 
associated with an aging society. The program is generating 
data, models, and guidance to incorporate the older population 
into health promotion and intervention strategies and to reduce 
risks from environmental exposures.
     The National Institute on Aging's Edward R. Roybal 
Centers for Translational Research in the Social and Behavioral 
Sciences are designed to improve the health, quality of life, 
and productivity of middle-aged and older people by 
facilitating the translation of knowledge learned in the social 
and behavioral sciences into practical outcomes to benefit the 
health and well being of older Americans.

     INTERAGENCY COLLABORATION IS STRENGTHENING RESEARCH POTENTIAL

    Federal agencies work together and with state and local 
governments, community-based organizations, and private-sector 
businesses to integrate their research projects with each 
other. Federal agencies and other organizations collaborate on 
research projects and share the knowledge and expertise of 
their staffs and affiliated researchers. Collaboration allows 
agencies to share resources and prevent duplication of effort 
across agencies. Although agencies have diverse 
responsibilities and goals, working collaboratively allows them 
to use scarce resources efficiently and contributes to high-
quality research. The examples of interagency collaboration 
listed below show some of the ways federal agencies are working 
together to improve the lives of older Americans.
     The Agency for Healthcare Research and Quality 
(AHRQ) sponsors the Healthcare Cost and Utilization Project, a 
unique federal-state-industry partnership that brings together 
the data collection efforts of state data organizations, 
hospital associations, private data organizations, and the 
federal government to create a national information resource of 
patient-level health care data.
     The Administration on Aging (AoA), in 
collaboration with AHRQ, CDC, CMS, NIA and several national 
foundations, is promoting behavioral interventions that have 
been proven to reduce the risk of disease, disability and 
injury among the elderly.
     As part of a larger consortium, the Center for 
Disease Control's (CDC) National Center for Health Statistics 
operates the Federal Interagency Forum on Aging-Related 
Statistics (Forum) which brings together federal agencies that 
share a common interest in improving aging-related data. The 
Forum provides agencies with a venue to discuss data issues 
that cut across agency boundaries.
     The Centers for Medicare and Medicaid Services 
(CMS) collaborates with the National Cancer Institute to 
sponsor the Surveillance, Epidemiology, and End Results 
database to provide detailed information about older cancer 
patients.
     The National Institutes of Health's (NIH) 
Interdisciplinary Research Consortium in Geroscience fosters 
collaboration among biologists, biochemists, geneticists, 
physicians, physiologists, statisticians, and chemists that 
will help scientists to better understand age-related diseases 
and disorders. Examples include studies of the effects of diet 
on aging and why the aging brain recovers less easily from 
traumatic brain injury.

                     FUTURE FEDERAL AGING RESEARCH

    Never has it been more important to have knowledge about 
the aging process, including the characteristics and needs of 
the current and future older populations. In the decades to 
come, Congress and the executive branch will be responsible for 
developing policies to improve the nation's methods of 
financing and delivering health care and long-term care 
systems. This may include not just reforms to the Medicare and 
Medicaid programs, but possibly a comprehensive redesign and 
reform of the private health insurance market and the means by 
which long-term care services are provided and how they are 
funded. Additionally, as the first baby boomers reach 
retirement age and begin to rely on Social Security and pension 
benefits, policymakers must ensure that the systems created to 
support the economic well-being of older adults are secure. Now 
is the time for Congress to direct federal agencies to review 
their agendas for research on aging-related policy issues and 
to set priorities for their research that will most effectively 
aid the Congress as it develops legislation to address the 
needs of older Americans today and in the future.

                   V. Appendix I: Agency Submissions

    Administration on Aging
    Agency for Healthcare Research and Quality
    Appalachian Regional Commission
    Assistant Secretary for Planning and Evaluation
    Census Bureau
    Centers for Disease Control and Prevention
    Centers for Medicare and Medicaid Services
    Corporation for National and Community Service
    Department of Agriculture
    Department of Commerce
    Department of Labor
    Department of Transportation
    Department of Veterans Affairs
    Environmental Protection Agency
    Food and Drug Administration
    Health Resources and Services Administration
    Library of Congress/Congressional Research Service
    National Aeronautics and Space Administration
    National Council on Disability
    National Endowment for the Arts
    National Institute of Justice
    National Institutes of Health/National Institute on Aging
    National Science Foundation
    Smithsonian Institution
    Social Security Administration
    Substance Abuse and Mental Health Services Administration

    The Administration on Aging: Translating Disease and Disability 
  Prevention Research into State and Community Evidence-Based Service 
                                Systems

    AoA's Evidence-based Prevention Demonstration Initiative 
documented that community aging service organizations can 
successfully translate evidence-based interventions into 
practical, attractive, low cost programs that improve the 
health of older adults and are likely to reduce health care 
costs. The best of these programs are being replicated across 
the nation.
    Lead Agency: Administration on Aging.
    Agency Mission: The mission of the Administration on Aging 
(AoA) is to help elderly individuals maintain their dignity and 
independence in their homes and communities for as long as 
possible. AoA does this by serving as the Federal agency 
responsible for advancing the concerns and interests of older 
people, and by working with and through a nationwide network of 
29,000 community-based organizations, known as the Aging 
Services Network, to promote the development of comprehensive 
and coordinated systems of care at the community-level that 
respond to the needs and preferences of older people and their 
family caregivers.
    Principal Investigator: Donald Grantt, Director, Evidence-
Based Disease and Disability Prevention Program, U.S. 
Administration on Aging, Office of Planning and Policy 
Development, One Massachusetts Avenue, NW., Washington, D.C. 
20001.
    Partner Agencies: Agency for Healthcare Research and 
Quality (AHRQ), Centers for Disease Control and Prevention 
(CDC), National Institute of Health (NIH), Atlantic 
Philanthropies, Health Foundation of South Florida, Robert Wood 
Johnson Foundation, and John H. Hartford Foundation.
    General Description: In 2003, the Administration on Aging 
(AoA) launched a $6 million demonstration program, in 
collaboration with CDC, AHRQ, CMS, NIA and several national 
foundations, to promote the translation of science-based 
interventions into practice at the community-level that have 
proven effective in helping older individuals to make 
behavioral changes that reduce the risk of disease, disability 
and injury among the elderly.
    Chronic conditions currently limit activities for 12 
million older persons living in communities. These conditions 
collectively account for seven out of every 10 deaths, and more 
than three-quarters of all health expenditures in the United 
States. To address this growing chronic disease epidemic, 
federal and philanthropic investments have generated a body of 
scientific evidence on the efficacy of specific interventions 
that can help older people to improve their health and well-
bring by better managing their chronic diseases, being more 
physically active, avoiding falls, managing medications and 
improving nutrition and diet. In many cases, these tested 
interventions reached older adults in community, not clinical, 
settings. This is a critical point--if we can reach older 
adults with effective healthy aging programs without relying 
solely upon clinicians, we will save billions of dollars and 
reach many more people--especially those who are most 
vulnerable and lack access to medical care.
    The AoA demonstration was designed to test the 
effectiveness of delivering these ``evidence-based prevention 
programs'' though AoA's nationwide network of community-based 
aging service provider organizations. The evidence-based 
programs used for this demonstration include low-cost 
interventions, such as chronic-disease self-management 
training, fall prevention and exercise programs, that can be 
delivered by staff and volunteers who are not clinicians but 
are trained in specific tools and techniques that help people 
to modify unhealthy behaviors. Examples of organizations in 
AoA's network that provide sites for the delivery of such 
programs include senior centers, adult day care programs, 
congregate meal sites, senior housing projects and faith-based 
organizations. These organizations make up an existing nation-
wide infrastructure that the federal government can use to 
rapidly deploy new programs and services that have proven 
effective in helping seniors to remain healthy and independent 
in their homes and community. These organizations reach into 
every community in the county and each year provide a wide 
range of social and supportive services to nearly 10,000,000 
elderly individuals.
    In 2003, AoA awarded twelve demonstration grants to 
communities across the nation supporting local partnerships 
involving aging service providers, area agencies on aging, 
local health entities and research organizations, such as 
university research centers. A strong emphasis was placed on 
coordination with the CDC and NIA funded Academic Research 
Centers around the country. Over a four-year period, the 
community grant programs reached more than 4,000 older adults. 
Over half were members of minority groups and one in eight was 
non-English speaking. The community programs' success has since 
led to a strengthened collaboration between AoA and its 
partners to create statewide programs in 27 states across the 
country.
    Beyond the participation numbers, analysis of surveys 
conducted at baseline and then again 4-6 months after the 
program ended demonstrated that participants in these 
community-based demonstration projects achieved the same 
benefits as subjects in the randomized trials in much more 
controlled settings. Findings were especially powerful for the 
Matter of Balance fear of falling program, the Healthy IDEAS 
depression program, the Medication Management Program and the 
Stanford Chronic Disease Self-management Program. The programs 
reached diverse older adults and produced measurable and 
meaningful improvements in health and function. The attached 
list of references includes citations for relevant articles 
that detail the findings on these programs. (See Healy et al., 
Quijano et al., Casado et al., Alkema et al., and Gitlin et 
al.)
    All of the grantees worked to ensure that their programs 
faithfully replicated the intervention from the original 
research. Four of them worked with an academic expert to 
analyze various dimensions of ``fidelity'' (the label for 
faithful replication) in their projects and the results were 
also published. (See Frank et al.)
    Based on the success of these community-level grants, in 
2006 AoA launched a $14 million grants program designed to 
encourage state governments to play a leadership role in 
promoting the deployment of evidence-based programs for older 
adults within their states as part of their overall prevention 
agenda. This program that involves partnerships between the 
state aging and health departments is currently supporting 350 
community-level projects and has already provided evidence-
based prevention programs to an additional 8,600 older adults. 
States and local agencies have matched the 2003 and 2006 
federal investment with at least $6.5 million in non-federal 
funds. Additionally, federal agencies such as AHRQ, CDC, CMS, 
HRSA, NIA and others have contributed expertise and funds to 
this demonstration initiative. Nine prestigious universities in 
the CDC's Healthy Aging Research Network are contributing 
expertise in research, evaluation and training to support 
success at both the local and national levels.
    This collective effort has been bolstered by $8.4 million 
in grants from The Atlantic Philanthropies to the National 
Council on Aging (NCOA), AoA's National Technical Assistance 
Center and a leader in healthy aging. These funds are being 
used to further advance replication of the Stanford Chronic 
Disease Self-management Program in at least 27 states (24 
funded by AoA and 3 by NCOA) and to build sustainable systems 
for statewide access in at least eight states. Together, the 
Robert Wood Johnson Foundation and The John A. Hartford 
Foundation have provided over $3.5 million to NCOA to promote 
healthy aging programming in the aging services network.
    Additionally, The John A. Hartford Foundation awarded $1.7 
million to the Partners in Care Foundation to fund national 
expansion of the Medication Management Program developed under 
the 2003 AoA demonstration grant. And in May 2008, the Health 
Foundation of South Florida committed $7.5 million over five 
years to embed evidence-based programming for older adults into 
community care systems in three counties.
    Excellence: What makes this project exceptional?
    This demonstration initiative is exceptional because it 
creates a practical, low-cost way to translate the best science 
from NIH and other federal agencies into attractive, effective 
programs that improve the health and function of older adults 
and reduce costs. It promotes collaboration and partnerships at 
the federal and local levels that leverage expertise, resources 
and funding from multiple public and private organizations. And 
it provides an important, value-added role for community-based 
social services agencies in deploying interventions that can 
keep older people healthy and also reduce health care costs.
    Significance: How is this evidence-based demonstration 
relevant to older persons, populations and/or an aging society?
    Four out of five older adults have a chronic condition and 
many experience limitations in activities due to such 
conditions. Minority and disadvantaged elders are at greater 
risk for chronic illnesses and accompanying disability. Nearly 
40% of older adults living in the community reported 
limitations in function due to chronic conditions. Two-thirds 
of Medicare dollars are spent on people with 5 or more chronic 
conditions. The aging of the population alone is projected to 
increase health care costs by 25 percent between 2000 and 2030. 
Falls are the leading cause of both fatal and nonfatal injuries 
for those 65 and over. In 2005, over 1.8 million older adults 
were treated in emergency departments for injuries from falls, 
more than 433,000 were hospitalized, and nearly 16,000 died.
    Poor health is not an inevitable consequence of aging. 
Given the medical nature of these chronic illnesses, the search 
for interventions has been heavily medical, but an often 
overlooked set of programs is best delivered outside of the 
medical care system. These programs relate primarily to 
supporting healthy lifestyle choices including self-management 
of chronic conditions, increasing physical activity, reducing 
falls, improving eating habits, and managing depressive 
symptoms.
    Older adults--like everyone else--need support in making 
healthier choices. They often face unique challenges to 
engaging in preventive activities, such as having to endure 
arthritic pain that makes exercising difficult, or being 
discouraged about having so many chronic conditions, or not 
having good peer support. Proven chronic disease self-
management workshops help older adults to address the barriers 
to making healthier choices and build skills to effectively 
manage their conditions. Community aging service providers, 
working collaboratively with health care providers and other 
local prevention experts, are highly suited to address the 
prevention needs of the elderly.
    Effectiveness: What is the impact and/or application of 
this evidence-based demonstration to older persons?
    Every program that was replicated under this demonstration 
initiative was based upon an intervention that had proven 
efficacy in a rigorous scientific study. For example, the 
Stanford Chronic Disease Self-management Program, a six week 
workshop led by trained lay facilitators, has repeatedly 
produced powerful outcomes for people with chronic conditions. 
In the original trial, six months after the end of the 
intervention, participants reported significant:
         Improvement in self-rated health, disability, 
        social and role activities;
         More energy and less fatigue;
         Decreased disability;
         Increased exercise;
         Greater skill in coping strategies and symptom 
        management;
         Better communication with their physicians; 
        and,
         Fewer physician visits and hospitalizations.
    In the AoA demonstration projects offering the Chronic 
Disease Self-management Program in Western Michigan and 
Philadelphia, most of these findings were replicated when the 
program was offered to diverse populations, including Hispanics 
and African-Americans, by Area Agencies on Aging working with 
senior centers and other local sites.
    This program and many others in the AoA demonstration 
produced significant improvements in health that have been 
published in peer-reviewed journals. If taken to scale, these 
programs hold the promise of making dramatic improvements in 
the health and well-being of our older citizens.
    Innovativeness: Why is this evidence-based demonstration 
exciting or newsworthy?
    This AoA demonstration initiative is exciting and 
newsworthy because it did what is rarely done: It drew upon the 
billions of federal investment in high quality research to test 
practical, low-cost attractive programs that can reach millions 
of diverse elders and produce meaningful improvements in health 
and health care costs. It organized multiple public and private 
organizations into an effective results-focused collaborative.

    Streamlining Access to Long Term Care: The Aging and Disability 
                       Resource Center Initiative

    The vision of the ADRC program is to have Resource Centers 
in every community serving as highly visible and trusted places 
where people can turn for information on the full range of 
long-term support options. The goal is to empower individuals 
to make informed choices and to streamline access to long-term 
support. Long-term support refers to a wide range of in-home, 
community-based, and institutional services and programs that 
are designed to help individuals with disabilities.
    Lead Agency: Administration on Aging (AoA).
    Agency Mission: The mission of the Administration on Aging 
(AoA) is to help elderly individuals maintain their dignity and 
independence in their homes and communities for as long as 
possible. AoA does this by serving as the Federal agency 
responsible for advancing the concerns and interests of older 
people, and by working with and through a nationwide network of 
29,000 community-based organizations, known as the Aging 
Services Network, to promote the development of comprehensive 
and coordinated systems of care at the community-level that 
respond to the needs and preferences of older people and their 
family caregivers.
    Principal Investigator: Greg Case, U.S. Administration on 
Aging, Office of Planning and Policy Development, on 
Massachusetts Avenue, NW., Washington, D.C. 2001.
    Partner Agency: Centers for Medicare and Medicaid Services 
(CMS).
    General Description: The Aging and Disability Resource 
Center Program (ADRC), a collaborative effort of the 
Administration on Aging (AoA) and the Centers for Medicare & 
Medicaid Services (CMS), is designed to streamline access to 
long-term care.
    The ADRC initiative supports state efforts to develop 
``one-stop shop'' programs at the community level that will 
help people make informed decisions about their service and 
support options and serve as the entry point to the long-term 
support system. States are using ADRC funds to better 
coordinate and/or redesign their existing systems of 
information, assistance and access and are doing so by forming 
strong state and local partnerships.
    Resource Center programs provide information and assistance 
to individuals needing either public or private resources, 
professionals seeking assistance on behalf of their clients, 
and individuals planning for their future long-term care needs. 
Resource Center programs also serve as the entry point to 
publicly administered long term supports including those funded 
under Medicaid, the Older Americans Act and state revenue 
programs.
    Key Functions of an ADRC:
          Awareness & Information
                  Information on Options
          Assistance
                  Options Counseling
                  Benefits Counseling
                  Employment Options Counseling
                  Referral
                  Crisis Intervention
                  Planning for Future Needs
          Access
                  Eligibility Screening
                  Private Pay Services
                  Comprehensive Assessment
                  Programmatic Eligibility Determination
                  Medicaid Financial Eligibility Determination
                  One-Stop Assessment to all public programs
    ADRC demonstration grantee states target Resource Center 
services to the elderly and at least one additional population 
of people with disabilities (i.e., individuals with physical 
disabilities, serious mental illness, and/or mental 
retardation/developmental disabilities). Many ADRCs serve 
people with all disabilities regardless of their age and others 
are working towards this goal.
    In many communities, long-term services are administered by 
multiple agencies and have complex, fragmented, and often 
duplicative intake, assessment, and eligibility functions. 
Figuring out how to obtain services is difficult. A single, 
coordinated system of information and access for all persons 
seeking long-term support minimizes confusion, enhances 
individual choice and supports informed decision-making. It 
also improves the ability of state and local governments to 
manage resources and to monitor program quality through 
centralized data collection and evaluation.
    AoA and CMS launched the ADRC initiative in the fall of 
2003 through the funding of 12 grants to states to develop 
pilot programs. Additional grants were awarded in 2004 and 2005 
bringing the total number of states funded through the federal 
ADRC initiative to 43. Additional states have implemented. ADRC 
projects without federal funding.
    To support ADRC grant projects, AoA and CMS fund technical 
assistance providers. The AoA funded ADRC Technical Assistance 
Exchange (TAE) coordinates technical assistance efforts and 
collaborates closely with the CMS funded Community Living 
Exchange Collaborative. Technical assistance is provided 
through individual assistance to grantees, national meetings, 
monthly teleconferences, a weekly newsletter, the ADRC-TAE 
website and in other ways. Many of the technical assistance 
products developed for grantees are available to the public on 
the website www.adrc-tae.org.
    Excellence: What makes this project exceptional?
    Since its inception in 2003, states have embraced the ADRC 
initiative as they have come to understand the significant role 
single point of entry programs can play in helping consumers 
with disabilities remain in their homes and communities. Today, 
just four years since the first AoA and CMS funded ADRC opened 
its doors, there are 173 ADRC program sites serving nearly 30% 
of the U.S. population. Over half of the 43 states with 
federally funded ADRC programs have passed legislation, 
developed executive guidance, and/or contributed state funds to 
enhance and expand ADRCs. State investments in ADRCs/single 
entry point systems, independent of the federal initiative, now 
total over $45,000,000. A number of states including Alaska, 
Indiana, Kentucky, Louisiana, New Hampshire, and West Virginia 
have achieved statewide coverage with their ADRCs.
    On the Federal level, the ADRC initiative has also received 
significant support. With the 2006 reauthorization of the Older 
Americans Act, Congress directed the Assistant Secretary for 
Aging to implement ADRC programs in all states to serve as 
visible and trusted sources of information on the full range of 
long-term care options.
    Significance: How is this demonstration relevant to older 
persons, populations and/or on aging society?
    The American public has an overwhelming preference for care 
at home, but all too often must deal with a long term care 
system that is fragmented, confusing and often biased in favor 
of more expensive institutional care. A fragmented system with 
no easy point hinders informed decision-making on the part of 
people with disabilities and their families and may result in 
the unnecessary use of expensive forms of care and spend-down 
to Medicaid. About half of the elderly people who enter a 
nursing home as private pay end up exhausting their assets and 
spending down to Medicaid. The ADRC initiative is designed to 
reduce the confusion experienced by consumers and instead 
empower them with the information and assistance they need to 
make informed choices and, for those that need publicly funded 
services, to streamline the eligibility determination process 
to make it easier to access needed supports.
    One of the most significant outcomes of the ADRC initiative 
relates to the new partnerships that have formed as states and 
communities have developed single point of entry systems. One 
key example are the new partnerships that are forming across 
aging and disability networks as they work together to develop 
and implement ADRCs. While the aging network has always been a 
service network serving older adults, the disability network 
has developed primarily as an advocacy network assisting people 
with disabilities of all ages gain basic civil rights. In 
joining together to streamline access to long-term care, each 
of these networks bring unique skill sets to the table and the 
end result is that older adults and non-elderly adults with 
disabilities now gain benefit from the skill sets of both 
networks.
    Effectivness: What is the impact and/or application of this 
demonstration to older persons?
    The ADRC program impact on people with disabilities, 
including older people, is immeasurable as the program strives 
to simplify state systems for long-term care to make them more 
accessible. As ADRC projects become more visible in the 
community, sites are seeing an increase in the number of 
contacts they receive. From March 2004 to March 2008, the 
average number of contacts per month per site have increased 
20% from 929 to 1,118. By investing in IT and management 
information systems that support ADRC functions and building 
strong partnerships across aging and disability networks, ADRC 
program sites have been able to respond to this increase in 
service volume without significant increases in number of 
staff. ADRCs will be well positioned to respond efficiently and 
effectively to the needs of older adults even as demand for 
services increases over the next two decades.
    One important goal of the ADRC initiative is to get to 
consumers as they go through the most critical pathways to long 
term care: hospitals, physician's offices, and community health 
clinics. By getting to a consumer at that critical point when 
they are making decisions about long term care, the ADRC can 
help to ensure they have access to comprehensive information 
about the full range of supports available. Based on the most 
recent ADRC reports from March 2008, 36.7% of referrals to 
ADRCs were from these ``critical pathways.''
    Several characteristics differentiate ADRCs from other 
long-term care organizations and establish them as leaders in 
rebalancing systems of care historically oriented toward 
institutional care. These include:
           Delivery of efficient, simplified access to 
        a wide range of information and supports about 
        community-based options for an array of consumer groups 
        seeking information or access into the long-term care 
        system through diverse entry points;
           Commitment to providing resources based on 
        the values of consumer direction, person-centered 
        planning, and individual choice and autonomy, 
        particularly through options counseling;
           Capacity to facilitate effective linkages at 
        multiple junctures involving diverse stakeholders along 
        the long-term care continuum; and
           Ability to prevent institutional placement 
        by maximizing access to comprehensive, updated and 
        credible information about alternate resources in the 
        community including access to HCBS waiver services.
    Innovativeness: Why is this demonstration exciting or 
newsworthy?
    The ADRC program is exciting and newsworthy because it is 
being embraced by professional, consumers, and advocates alike 
as an initiative that helps to ensure that people with 
disabilities, regardless of income, in need of long-term 
supports and services have access to the full range of 
information to assist them in making informed decisions 
regarding the care they need. Any public hearing that has been 
held over the last decade to get consumer input on long-term 
care issues has been inundated by pleas from consumers to 
streamline the existing fragmented bureaucracy people are 
forced to deal with when they try to learn about and access 
existing care options. GAO's Means-Tested Programs: Information 
on Program Access Can be an Important Management Tool (March 
2005) documents the information and decision-making barriers 
that fragmentation in existing public programs creates for 
consumers. The AoA and CMS ADRC initiative is in direct 
response to this documented need to streamline access to long 
term care.

                    AGing Integrated Database (AGID)

    AGID is an on-line query system using AoA's performance 
measurement data and surveys, supplemented by information from 
the Census Bureau. AGID users can produce customized tables by 
selecting data elements and further results based on geographic 
locations or demographic stratifiers.
    Lead Agency: Administration on Aging, One Massachusetts 
Avenue, NW., Washington, DC 20001.
    Agency Mission: The mission of the Administration on Aging 
(AoA) is to help elderly individuals maintain their dignity and 
independence in their homes and communities for as long as 
possible. AoA does this by serving as the Federal agency 
responsible for advancing the concerns and interests of older 
people, and by working with and through a nationwide network of 
29,000 community-based organizations, known as the Aging 
Services Network, to promote the development of comprehensive 
and coordinated systems of care at the community level that 
respond to the needs and preferences of older people and their 
family caregivers.
    Principal investigator: Saadia Greenberg, Director, Office 
of Evaluation, U.S. Administration on Aging, One Massachusetts 
Avenue, NW., Washington, DC 20001.
    Partner agency: Social & Scientific Systems, Inc.
    General Description: AGID is an on-line query system that 
provides dynamic access to AoA-related program performance 
results, AoA-supported surveys and Census population data. The 
purpose of the system is to allow users to produce customized 
tables in a step-by-step process and output the results in 
print or spreadsheet form. AGID users have the ability to 
select only those data elements applicable to their needs, and 
to further refine their results based on geographic locations 
(such as individual states or AoA regions) or demographic 
stratifiers that are meaningful to their application. In 
addition, the results from user queries can be downloaded in 
spreadsheet form and, in turn, post-processed for graphical 
displays or more in-depth analyses.
    The system is based on aggregate statistics reports to 
speed up data access and protect individual records. Since 
there are many thousands of data elements available in the 
original databases, only the analytically relevant variables 
were carried over to AGID. If there is a query that the user 
would like to see but AGID does not support, the user can 
submit a request using the ``Submit Feedback'' link on the AGID 
homepage and the user will receive a prompt response. Although 
there are constructed variables and some restructuring of the 
database files, most of the data elements appearing in the 
system are in the form as reported by the states or survey 
participants.
    The databases that are currently available in the system 
are listed below:
    AoA Databases: State Program Reports (SPR) 2000-2006; 
National Ombudsman Reporting System (NORS) 2006-2006; National 
Surveys of Older Americans Act (OAA) Participants 2003-2005; 
National Survey of Area Agencies on Aging (AAA) 2005/2006.
    Census Databases: American Community Survey (ACS) Data 
which includes State-Level ACS Data 2004-2006; Population 
Estimates Data which includes State-Level Population Data 2000-
2006 and County-Level Population Data 2006.
    A unique feature of the AGID system is the ability to build 
your own customized database. The user has the option of 
selecting a single database in generating database-specific 
tables or combining data elements from multiple databases to 
build a customized table. The user is able to build state-level 
tables with data from multiple databases. AGID can be accessed 
at www.data.aoa.gov.
    Excellence: What makes this project exceptional?
    AGID provides dynamic access to aging population 
statistics, program performance reports, and surveys of OAA 
program participants. The system allows users to produce 
customized reports and statistics from multiple databases. It 
is user-friendly in that it provides a step-by-step process and 
outputs the results in print or spreadsheet form.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    AGID is significant because it improves the handling of 
data and provides multiple data sources related to aging. This 
enables the State and local decision makers to examine trends, 
compare themselves to others, and develop the best senior 
programs available to them. It can be used for the following 
analyses: compare to Census, compare to national averages, 
compare to other States, develop benchmarks, develop per capita 
ratio, compare over time, examine cost per unit, and examine 
usage per client.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    AGID improves data reporting, comparison, analysis, and 
timeliness.
    Innovativeness: Why is this research exciting or 
newsworthy?
    AGID is available to everyone. This database provides 
detailed information not previously available to the public and 
data can be queried from various sources. The system constantly 
adds new data and features.

National Aging Program Information System Comprehensive Aging Reporting 
                        and Data System (CARDS)

    The CARDS program is a web-based decision support system 
for NAPIS and houses all NAPIS data. It includes a web-based 
tool for SUAs to submit data and enable reporting for AoA.
    Lead Agency: Administration on Aging, One Massachusetts 
Avenue, NW., Washington, DC 20001.
    Agency Mission: The mission of the Administration on Aging 
(AoA) is to help elderly individuals maintain their dignity and 
independence in their homes and communities for as long as 
possible. AoA does this by serving as the Federal agency 
responsible for advancing the concerns and interests of older 
people, and by working with and through a nationwide network of 
29,000 community-based organizations, known as the Aging 
Services Network, to promote the development of comprehensive 
and coordinated systems of care at the community-level that 
respond to the needs and preferences of older people and their 
family caregivers.
    Principal Investigator: Saadia Greenberg, Director, Office 
of Evaluation, U.S. Administration on Aging, One Massachusetts 
Avenue, NW., Washington, DC 20001.
    Partner agency: Harmony Information Systems, Inc., State 
Agencies on Aging.
    General Description: The CARDS system houses the data 
warehouse and reporting tools for program information and 
services provided under the Older Americans Act (OAA). The OAA, 
administered by AoA, provides grant programs for an array of 
supportive services, as well as state and local efforts to 
develop comprehensive systems of car for older people and their 
family caregivers. Data and information on these programs is 
gathered through the National Aging Program Information System 
(NAPIS) in collaboration with an Aging Network that includes 56 
State Units on Aging (SUAs), 655 Area Agencies on Aging (AAAs), 
244 Tribal organizations, and over 29,000 local community 
service organizations.
    The NAPIS database system has multiple components. Review, 
analysis and infrastructure upgrades of each part of the system 
are crucial for continued stability, security and validity of 
the data and the elements contained within the database and web 
elements. The NAPIS data allows AoA to develop and dissect 
information about aging services to Congress, states and other 
stakeholders. NAPIS components include State Program Report 
(SPR), National Ombudsman Reporting system (NORS), title IV of 
the OAA, Senior Medicare Patrols Project (SMP), and the Census 
data.
    The CARDS system houses AoA's NAPIS data and provides the 
following benefits:
     One-stop shopping because the system is a web-
based portal using single ``Hub'' application.
     Easy-to-use single-click electronic report 
submission, which does not require any email or file transfer 
protocol.
     Simple method to capture, validate and report 
data.
     Decision support system and projections.
     Improve data timeliness, reliability, efficiency 
and effectiveness.
     24/365 availability.
     Automatic backup.
     Year-by-year, multi-year, state-by-state and 
multi-state reporting, allowing local and nationwide reports.
     Ad hoc analysis.
     Standardized reports and procedures.
     Cross-program reporting.
     Historical analysis including variance reporting.
     Single data repository.
     Automated tracking, notification and logs.
     Role-based use.
     Third-party data import allowing flexibility.
     Scalable.
     Streamlined support.
     Streamlined training.
    Excellence: What makes this project exceptional?
    The CARDS program is exceptional because it enables state 
and other grantees to electronically submit data and 
information to the NAPIS database. It captures, validates and 
reports on data, and serves as a decision-support system for 
AoA. It enhances the timeliness, reliability, efficiency and 
effectiveness with which AoA manages data; and it establishes a 
web-based, hosted database and decision-support system to be 
operational, initially for SPR, NORS and information from the 
U.S. Census Bureau.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    The CARDS data is designed to assist States and grantees to 
do reporting in a quick and efficient manner. The software is 
user-friendly and the system is designed to detect anomalies in 
data. As a result, the system can help reduce redundancy, lower 
costs, and maximize the level of care provided to consumers.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    The data makes it possible for AoA to develop and 
disseminate information about services for the aging to 
Congress, states and other stakeholders.
    Innovativeness: Why is this research exciting or 
newsworthy?
    The CARDS program provides an integrated environment to 
house AoA program and performance data. The data and 
information is gathered through NAPIS in collaboration with an 
Aging Network that includes 56 SUAs, 655 AAAs, 244 Tribal 
organizations, and over 29,000 local community service 
organizations.

   Recognition of Excellence in Aging Research Submission Form: AoA 
                        Performance Measurement

    AoA, in concert with State and local partners, uses 
performance measurement tools of GPRA to improve services. The 
results.aoa.gov website is designed to provide program results 
and evaluation information.
    Lead government department/agency conducting, sponsoring or 
administering the research: Administration on Aging.
    Mission of department/agency: The mission of the 
Administration on Aging (AoA) is to help elderly individuals 
maintain their dignity and independence in their homes and 
communities for as long as possible. AoA does this by serving 
as the Federal agency responsible for advancing the concerns 
and interests of older people, and by working with and through 
a nationwide network of 29,000 community-based organizations, 
known as the Aging Services Network, to promote the development 
of comprehensive and coordinated systems of care at the 
community-level that respond to the needs and preferences of 
older people and their family caregivers.
    Name, title, mailing address, email address, and phone 
number of principal investigator(s)/lead researcher(s) for the 
research project: Saadia Greenberg, Director, Office of 
Evaluation, U.S. Administration on Aging, One Massachusetts 
Avenue, NW., Washington, DC 20001.
    Partner agencies or organizations that participated in the 
research project: Office of Management and Budget, U.S. 
Department of Health and Human Services.
    General Description: For over ten years, AoA has developed, 
tested and implemented performance measurement indicators that 
measure the effectiveness of the Older Americans Act (OAA) 
program. AoA performance measurement indicators are required 
under the Government Performance and Results Act (GPRA), which 
requires federal agencies to establish standards measuring 
their performance and effectiveness. The AoA indicators are 
described in an Online Performance Appendix which can be found 
on the website results.aoa.gov.
    Since enacted in 1993, AoA has accepted GPRA as an 
opportunity to document each year the results that are produced 
through the programs we administer under the authority of the 
OAA. It is the intent and commitment of AoA, in concert with 
State and local program partners, to use the performance 
measurement tools of GPRA to continuously improve OAA programs 
and services for the elderly. The results are included in AoA's 
annual budget request to Congress.
    The Online Performance Appendix is part of AoA's annual 
budget request which provides detailed performance information. 
Fiscal year 2009 represents the fourth year that AoA aggregated 
all budget line items into a single GPRA program, AoA's Aging 
Services Program, for purposes of performance measurement. AoA 
program activities have a fundamental common purpose reflecting 
the primary legislative intent of the OAA: to make community-
based services available to elders who are at risk of losing 
their independence, to prevent disease and disability through 
community-based activities, and to support the efforts of 
family caregivers. It is intended that States, Tribal 
organizations and communities actively participate in funding 
community-based services and develop the capacity to support 
the home and community-based service needs of elderly 
individuals with particular attention to low-income, frail and 
isolated older individuals.
    These fundamental objectives led AoA to focus on three 
measurement areas to assess program activities through 
performance measurement:
          1. Improving efficiency;
          2. Improving client outcomes; and
          3. Effectively targeting to vulnerable elderly 
        populations.
    Each of these measures represents several activities across 
the Aging Services Program budget and progress toward 
achievement of the outcome is tracked using number indicators.
    The website results.aoa.gov was developed by AoA to measure 
program performance results. It includes:
           Annual reports on indicators of performance 
        measures of the OAA program;
           Performance Outcome Measurement Projects 
        which develop and test new and established performance 
        outcome measures at the state and sub-state levels;
           Reports of National Surveys of OAA 
        Participants;
           OAA program performance information reported 
        by the states under the State Program Report and the 
        National Ombudsman Reporting System;
           AoA compiled statistics on the older 
        population; and
           A series of past, current, and planned 
        program evaluations and related studies.
    These program evaluations and related reports ensure that 
the most relevant data are available to policy makers, 
demonstrate the value of programs to taxpayers, and track 
results. AoA strives to evaluate programs in an integrated 
manner combining process, outcome, impact and cost-benefit 
analysis of evaluation activities. This site provides links to 
reports and results from these evaluation efforts.
    Excellence: What makes this project exceptional?
    AoA's Aging Services Program received an ``Effective'' 
rating--the highest rating--from the Office of Management and 
Budget in the 2007 Program Assessment Rating Tool (PART) rating 
process for its clear purpose, good management, strong 
performance measures, and positive evaluations. The review 
found that AoA efficiently provides home and community-based 
services while maintaining high service quality. AoA continues 
to enhance program evaluation activities to improve program 
management.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    In concert with State and local program partners, AoA uses 
the performance measurement tools of GPRA to demonstrate the 
effectiveness of OAA programs and services for the elderly. 
AoA's three performance measurement categories of program 
efficiency, client outcomes, and effectively targeting to 
vulnerable elderly populations contribute to measuring of the 
success of the national aging services network. The States have 
mirrored these measures to gauge their impact and improve 
performance.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    The impact of AoA's Performance Measurement for older 
persons is that it has achieved the primary legislative intent 
of the OAA: to make community-based services available to 
elders who are at risk of losing their independence, to prevent 
disease and disability through community-based activities, and 
to support the efforts of family caregivers.
    Innovativeness: Why is this research exciting or 
newsworthy?
    The Performance Measurement enables the Executive branch, 
Congress, and decision makers to appreciate the value of the 
Aging Services programs. AoA's performance data shows that the 
national aging services network is providing high quality 
services to the most vulnerable older adults and doing so in a 
very efficient and cost-effective manner. Consumers believe 
these services contribute in an essential way to maintaining 
their independence, and they report a high level of quality for 
those services.

The Evaluation of Select Consumer, Program, and System Characteristics 
   Under the Supportive Services Program (Title III-B) of the Older 
       Americans Act (The Evaluation of the Title III-B Program)

    The Evaluation of the Title III-B Program found that the 
Title III-B program effectively served the targeted 
population--vulnerable older adults at risk for 
institutionalization. Program clients confirmed the benefits of 
the program.
    Lead Agency: Administration on Aging, One Massachusetts 
Avenue, NW., Washington, DC 20001.
    Agency Mission: The mission of the Administration on Aging 
(AoA) is to help elderly individuals maintain their dignity and 
independence in their homes and communities for as long as 
possible. AoA does this by serving as the Federal agency 
responsible for advancing the concerns and interests of older 
people, and by working with and through a nationwide network of 
29,000 community-based organizations, known as the Aging 
Services Network, to promote the development of comprehensive 
and coordinated systems of care at the community-level that 
respond to the needs and preferences of older people and their 
family caregivers.
    Principal Investigator: Saadia Greenberg, Director, Office 
of Evaluation, U.S. Administration on Aging, One Massachusetts 
Avenue, NW., Washington, DC 20001.
    Partner agency: Research Triangle Institute International.
    General Description: This study evaluated the Older 
Americans Act (OAA) Title III-B program including its role in 
planning, coordinating, and providing community services for 
older people. The OAA was established in 1965 to help provide 
older Americans with the supportive services they need to live 
independently in the community for as long as possible.
    The Title III-B program is one of the largest components of 
the OAA. Title III-B funds helped to develop the infrastructure 
that constitutes the Aging Network, the system of state 
agencies, called State Units on Aging (SUAs), Area Agencies of 
Aging (AAAs), and local community service providers that plan, 
coordinate and deliver services. The Title III-B program helped 
the Aging Network to serve as the entry point into the long-
term care system, providing critical information, case 
management services, and direct funding of long-term care 
services for individuals who otherwise might go without needed 
assistance.
    The overarching research question for this study was, 
``how, to what extent, and with what results has the Aging 
Network implemented Title III-B of the Older Americans Act?'' 
This study question was addressed through the following three 
sub-questions:
    1. What is the role/importance of providing information and 
assistance and care planning (case management) services for 
older persons through the Aging Network and what is the role/
importance of providing assessment and care planning for 
community-based long-term care services to the Aging Network?
    2. What is the role/importance of providing transportation 
and home care (personal care, chore, and homemaker) services 
for older persons through the Aging Network and what is the 
role/importance of providing transportation and home care 
services to the Aging Network?
    3. What is the role/importance of financing long-term care 
services for older persons (via home care, transportation, and 
other Title III-B in-home services) through the Aging Network 
and what is the role of financing and delivering long-term care 
services to the Aging Network?
    The project used a combination of quantitative and 
qualitative methods to evaluate the Aging Network's involvement 
with key services supported by the Title III-B program: case 
management, information and assistance, personal care, chore 
services, homemaker services, transportation, and assisted 
transportation services.
    Research Triangle Institute International (RTI) used 
several data sources to examine the characteristics of 
participants and Title III-B services and to evaluate the role/
importance and administration of Title III-B services for older 
persons and their families. The quantitative data sources used 
for this study included the 2003 and 2004 National Surveys of 
OAA Program Participants, the 2001 through 2004 National Aging 
Program Information System State Program Performance Report 
data, and the 2006 National Survey of AAAs. Information from 
the AARP and the Urban Institute also was used to help 
understand the financial role of Title III-B services within 
the universe of home and community-based services. In addition, 
RTI conducted six focus group sessions with AAA directors, SUA 
directors, and community-based providers in order to more fully 
examine the issues that could not be addressed by the 
quantitative data.
    The study found that the Title III-B program had 
successfully extended services to the targeted population--
vulnerable older adults at risk for nursing home placement. The 
percent of program participants that were at high risk of 
institutionalization increased. The population that received 
home care services was older (aged 75+), lived alone, and had 
three or more Activities of Daily Living (ADL) impairments. 
Users of transportation services relied heavily on these 
services, with over half reporting that the service was used 
for at least 75% of their trips. Most of these participants 
lived alone and were at least 75 years old. In addition to 
reaching the program's target population, participants were 
highly satisfied. For example, over 80% of survey respondents 
rated home care services as positive. Finally, Title III-B 
program funds were highly leveraged. Depending on the service, 
the study found that for every $1 of Title III-B funding, local 
programs leverage $2 to $6 from other sources. Overall, the 
Title III-B program was a key component of the OAA and it was 
performing as intended; assisting vulnerable older adults to 
remain independent and active in their communities.
    Excellence: What makes this project exceptional?
    This evaluation is the first time that the Title III-B 
program has been analyzed to examine the programs results, 
financing and characteristics of program implementation. 
Multiple years of data from a new annual performance survey at 
the participant level were now available and combined with 
annual program data and Aging Network data to provide a robust 
assessment of a program that is highly valued by participants 
and has helped the Aging Network serve as the entry point into 
the long-term care system. The Title III-B program helped the 
Aging Network to serve as the entry point into the long-term 
care system and provided critical information, case management 
services, and direct funding of long-term care services for 
individuals who otherwise might go without needed assistance.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Understanding the impact of the program and how it operates 
affects a significant number of older persons and their 
families. The Title III-B program services a substantial number 
of older adults and indirectly their families. Specifically, 
over 400,000 participants annually relied on Title III-B case 
management services during the years 2001 to 2004. Similarly, 
over 9 million hours of Title III-B personal care services were 
delivered annually, over 10 million hours of Title III-B 
homemaker services were provided, and over 1 million hours of 
chore services were supplied to older persons and their 
families during this 4-year period. In addition, over 34 
million one-way trips were provided to general transportation 
users, and approximately 2 million assisted transportation 
trips were supplied annually to individuals with physical or 
cognitive impairments needing help to get to their 
appointments.
    Title III-B transportation services facilitated access to 
health, wellness, and social activities, which were key factors 
to living a meaningful life in the community. Title III-B 
participants relied on these transportation services a great 
deal.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    This research evaluated how and with what results the Title 
III-B program achieves its purpose of promoting the economic 
independence and social well-being of individuals and families 
across the lifespan.
    The research found that Title III-B service participants 
valued these services highly. Over 80% of survey respondents 
rated aspects of homemaker service as good or better, while the 
vast majority of respondents rated Title III-B transportation 
services as good, very good, or excellent. Overall, Title III-B 
provided older Americans with a range of needed services and 
helped them navigate a complex and confusing long-term care 
system.
    Innovativeness: Why is this research exciting or 
newsworthy?
    The Evaluation of the Title III-B program is exciting and 
newsworthy because the grants by the AoA and the Centers for 
Medicare & Medicaid Services for Aging and Disability Resource 
Centers consciously built on the expertise and infrastructure 
developed by Title III-B on information and assistance and case 
management. The Aging and Disability Resource Center Program 
initiative supported state efforts to develop ``one-stop shop'' 
programs at the community level that would help people make 
informed decisions about their service use and support options 
and serve as the entry point to the long-term care system.

             Performance Outcome Measurement Project (POMP)

    AoA, in concert with State and local partners, uses 
performance measurement tools of GPRA to improve services. The 
results.aoa.gov website is designed to provide program results 
and evaluation information.
    Lead agency: Administration on Aging, One Massachusetts 
Avenue, NW., Washington, DC 20001.
    Agency Mission: The mission of the Administration on Aging 
(AoA) is to help elderly individuals maintain their dignity and 
independence in their homes and communities for as long as 
possible. AoA does this by serving as the Federal agency 
responsible for advancing the concerns and interests of older 
people, and by working with and through a nationwide network of 
29,000 community-based organizations, known as the Aging 
Services Network, to promote the development of comprehensive 
and coordinated systems of care at the community-level that 
respond to the needs and preferences of older people and their 
family caregivers.
    Principal Investigator: Cynthia Bauer, Project Officer, 
U.S. Administration on Aging, One Massachusetts Avenue, NW., 
Washington, DC 20001.
    Partner agency: Current participants in the both Standard 
and Advanced POMP include Arizona, Florida, Georgia, Iowa, 
Massachusetts, New York, North Carolina, Ohio and Rhode Island.
    Past participants include Alabama, California, Delaware, 
Hawaii, Indiana, Illinois, Maryland, Oklahoma, South Carolina 
and Virginia.
    General Description: The Government Performance and Results 
Act (GPRA) requires Federal agencies to use performance 
measurement, particularly outcome measurement, to improve the 
performance of Federal programs. Further, the Office of 
Management and Budget (OMB) has introduced the Program 
Assessment Rating Tool (PART), which they use to evaluate the 
performance of Federal programs. The PART places additional 
emphasis on assessing program performance through outcome 
measurement. Results from POMP projects have been instrumental 
in improving AoA's PART scores.
    POMP is a multi-agency collaboration involving AoA, state 
and local Agencies on Aging, a technical assistance contractor 
and consultants. POMP helps State and Area Agencies on Aging 
(AAAs) assess their own program performance, while assisting 
AoA to meet the accountability provisions of GPRA and OMB 
program assessment requirements. Over the past nine years, AoA 
has sponsored the Standard POMP project for the Older Americans 
Act (OAA), Title III programs. This project with State Units on 
Aging (SUAs) and AAAs has produced a core set of performance 
measurement instruments. The instruments have been developed to 
obtain consumer-reported outcomes and quality assessment for 
critical OAA services. The instruments also measure special 
needs characteristics of the people who receive services such 
as physical and social functioning. Other measurement tools 
address the adequacy and benefit of services that support 
family caregivers. Performance measurement tools developed 
under POMP can be located at www.grpa.net. Work on Standard 
POMP is nearing completion. Final validity/reliability testing 
of the POMP surveys will be completed by December 2008.
    In fiscal year 2004, AoA determined that while consumer 
assessment will continue to be an important component of 
program performance measurement, it was time for the POMP 
project to begin the process of evolving into a more 
sophisticated performance measurement system to assess program 
impacts in relation to costs. AoA collaborated with the 
grantees and technical assistance contractors to develop 
performance impact measures called ``Advanced POMP.'' The first 
Advanced POMP competition occurred in 2004. The first year of 
Advanced POMP was a planning year. Grantees developed a 
statement of the project's overarching goals as follows:
          Goal 1: Demonstrate Cost Savings or Cost Avoidance 
        Attributed to OAA programs;
          Goal 2: Demonstrate Efficiency of OAA programs; and
          Goal 3: Demonstrate Effectiveness of OAA programs.
    The grantees are working on statistical models predicting 
nursing home delay or diversion, the analysis of emergency room 
and hospital utilization data compared for OAA and non-OAA 
clients, and the effectiveness of senior centers or congregate 
meals programs in terms of improved nutrition, health, and 
social and emotional well-being. These projects are scheduled 
to be completed in September 2009. However, preliminary 
findings are very promising. Nursing home predictor modeling 
for four States has consistently shown that receipt of 
additional types of service yields increased time living in the 
community and a comparison of Medicaid home-delivered meal 
clients and non-clients shows fewer hospital admissions and 
emergency room visits for those older people receiving home-
delivered meals.
    AoA is currently launching a new project, the Next 
Generation: POMP, which will commence as a two-year planning 
and development grant. This project will establish the 
framework for Next Generation: POMP and will include as 
follows:
     The development and preparation of the toolkit 
``POMP TO GO,'' along with the redesigned POMP website, will 
provide user friendly performance measurement survey tools for 
the network and ``POMP TO GO'' will provide a protocol to be 
used for the future dissemination of more sophisticated POMP 
methodologies.
     The development of longitudinal survey 
instruments. The Standard POMP surveys will serve as a starting 
point but extensive developmental work is needed to identify 
performance data likely to show meaningful change over time.
     The review of the synthesis of nursing home 
predictors identified in Advanced POMP and the development of a 
specific strategy for cross-validating the ``generic'' model.
     The identification of key variables across earlier 
POMP surveys for consistency and development of an analytical 
protocol for testing the predictive value of survey items.
    Excellence: What makes this project exceptional?
    The POMP projects are exceptional because they represent a 
true collaborative effort between AoA, State Agencies on Aging 
and AAAs. The projects have successfully evolved over the years 
and the performance measurement capability throughout the Aging 
Network has also evolved. The results of the project are useful 
at all levels of the Aging Network. At the national level, the 
projects have enabled AoA to demonstrate program performance 
excellence.
    Standard POMP: The following areas have been studied under 
POMP:
          1. Case Management
          2. Congregate Nutrition Program
          3. Homemaker Service
          4. Home Delivered Nutrition Program
          5. Information and Assistance Assessment
          6. Senior Centers
          7. Transportation Service
          8. Family Caregiver Support
          9. Providers
    In addition, survey instruments were designed to document 
client characteristics. These include physical functioning, 
social functioning, emotional well-being, and demographic 
information.
    A website, www.gpra.net, was established to show the POMP 
activities and surveys, which include consumer reported 
outcomes and consumer-assessment of service quality.
    Consumer assessment surveys developed under POMP have 
enabled AoA and our State and AAA partners to demonstrate that 
services provided by the National Aging Services Network:
     Are highly rated by recipients.
     Are effectively targeted to vulnerable individuals 
and those who need services.
     Provide assistance to individuals and caregivers 
that is instrumental in allowing older persons to maintain 
their independence and avoid premature nursing home placement.
    Advanced POMP: The grantees are working on statistical 
models predicting nursing home diversions, the analysis of 
emergency room and hospital utilization data compared for the 
OAA and non-OAA clients, and the effectiveness of senior 
centers or congregate meals programs in terms of improved 
nutrition, health, and social and emotional well-being. 
Preliminary results are all positive. Nursing home predictor 
modeling for four States has consistently shown that receipt of 
additional types of service yields increased time living in the 
community and a comparison of Medicaid home-delivered meal 
clients and non-clients shows fewer hospital admissions and 
emergency room visits for those older people receiving home-
delivered meals.
    Next Generation: POMP: Building on the earlier results of 
the POMP demonstrations, AoA is launching a new project 
entitled ``Next Generation: POMP.'' The first phase of this 
project is developmental and will encompass the development and 
preparation of the ``POMP TO GO'' generic toolkit, the 
development of longitudinal performance measurement survey 
instruments, the development of a specific strategy to cross-
validate the ``generic'' nursing home predictor model under 
development in Advanced POMP, and the identification of key 
variables from Standard POMP surveys that are predictors of 
nursing home placement.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Demonstrating the effectiveness of OAA services at the 
Federal, State and AAA levels is of paramount importance during 
this time of fiscal constraints. The POMP is relevant to older 
persons, populations and/or an aging society because AoA works 
with the States and AAAs to document the benefits of OAA 
services. The results of POMP are then used to improve program 
management and leverage additional funding thereby improving 
services provided to older persons.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    AoA's annual performance measurement surveys demonstrate 
that services provided by the Aging Network are highly rated by 
recipients, effectively targeted to vulnerable populations and 
individuals, and provide assistance to individuals and 
caregivers that help older persons maintain their independence 
and remain in the community. Over the years, the Grantees have 
used the POMP project to leverage funding and improve program 
performance and management which benefits older persons.
    POMP documents the high quality of services provided under 
the OAA. For example, consumer ratings obtained from the AoA's 
annual performance measurement surveys consistently show high 
(over 90%) customer quality ratings of key OAA services, such 
as home delivered meals, transportation, and family caregiver 
support services.
    In addition, the results of POMP are used to directly 
benefit older persons as demonstrated by the following 
examples:
     Improve program performance and management. North 
Carolina expanded information collected, enhanced advocacy, and 
improved program management. New York used the transportation 
survey to improve service and provide in-service training for 
dispatchers, and used the nutrition survey to demonstrate that 
home delivered meals represent a substantial portion of elderly 
persons' daily food intake, resulting in a meal site, scheduled 
to be shut down, remaining open.
     Leverage funding. During the 2006 legislative 
session, South Carolina used results of Advanced POMP with 
partners to obtain a $2.9 million supplemental appropriation. 
This is the first new money that the SUA has been able to 
obtain in ten years. New York used POMP nutrition survey 
results to illustrate the impact of the Home Delivered Meal 
program on clients. As a result, additional funding from the 
county legislature was added in order to provide another Home 
Delivered Meal route in one AAA. Another New York AAA used POMP 
nutrition survey results to justify the need for an increase in 
county funds. With the increase in funding, the AAA did not 
have to create a waiting list for meals.
    Innovativeness: Why is this research exciting or 
newsworthy?
    The POMP is exciting and newsworthy because POMP is a true 
Federal/State/AAA partnership where the results are used 
effectively at all levels of the Aging Network. At the national 
level, AoA uses POMP to conduct national surveys using the POMP 
instruments. AoA uses the results of our national surveys to 
establish and report on performance measures that are included 
in the annual GPRA plan, the strategic plan and the PART 
assessment. The improvement in AoA's performance measurement 
capacity has resulted in improved PART assessments. In the 2007 
PART assessment, AoA received a rating of ``Effective,'' the 
highest possible rating, and AoA was cited in the OMB 
Director's memo for exemplary performance.
    At the State level, POMP results are used in various ways 
(e.g. developing performance measures in State plans and 
budgets, improving information systems, developing high risk 
assessment tools, developing provider ``scorecards,'' and 
justifying budget requests). At the AAA level, the results are 
used to improve program management, justify budgets, leverage 
funding from other sources, and justify the maintenance or 
expansion of OAA programs/services.

   U.S. Department of Health and Human Services: Assisted Living for 
                               Americans

    To develop tools and materials that help assisted living 
consumers, and consumer intermediaries (e.g., local Aging 
agencies) obtain uniform information on the characteristics, 
services and costs of individual AL/RC facilities--to aid 
consumers in determining which AL/RC community best meets their 
priorities and needs. Now known collectively as the AL 
Disclosure Collaborative (ALDC), the ALDC members--representing 
25 national organizations--have agreed to develop the tools 
(and eventually disseminate ALDC endorsed tools/materials) 
using a voluntary consensus process in partnership with AHRQ, 
the latter providing the research support to insure the 
resulting tools are based on sound scientific methods.
    Lead Agency: U.S. Department of Health and Human Services, 
Agency for Healthcare Research and Quality (AHRQ)
    Agency Mission: The mission of the Agency for Healthcare 
Research and Quality is to improve the safety, quality, 
effectiveness, and efficiency of health care for all Americans.
    Principal Investigators: D.E.B. Potter, M.S. (2005-
present), Senior Survey Statistician, Agency for Healthcare 
Research and Quality, 540 Gaither Road, Suite 500, Rockville, 
MD 20850; William Spector, PhD (2003-2005), Senior Social 
Science Researcher, Agency for Healthcare Research and Quality, 
540 Gaither Road, Suite 500, Rockville, MD 20850.
    Partner Agencies: AARP; Benjamin Rose Institute; University 
of Minnesota, Minneapolis (Division of Health Policy and 
Management, School of Public Health); University of 
Massachusetts (Gerontology Institute); Jessie F. Richardson 
Foundation (Clackamas, OR), National Academy of State Health 
Policy; Texas A&M Health Science Center at College Station 
(School of Rural Public Health)*; University of North Carolina 
at Chapel Hill; VA Puget Sound Health Care System (Health 
Services Research and Development); Westat, Inc.; University of 
Pittsburg (Center for Research on Health Care); National 
Academy of State Health Policy; Harvard Medical School, 
Massachusetts; RAND, California; American Institutes for 
Research; and Texas A&M Health Science Center at College 
Station (School of Rural Public Health).
    General Description: Assisted living/residential care (AL/
RC) is an important care option for people with health needs 
and functional impairments, especially for frail elders needing 
protective oversight, but not continuous nursing care. The 
typical assisted living resident is an 86-year-old woman who 
needs help managing medications and is in need of assistance 
with approximately two activities of daily living (i.e., help 
with bathing, dressing, toiling, transferring, or eating; NCAL, 
2008). With the capacity to serve over a million residents 
(Mollica et al., 2007), AL/RC is gradually approaching the size 
of the nursing home resident population (1.4 million residents; 
AHCA 2008).
    Currently, differences in State requirements and a wide 
variety of services and amenities offered by AL/RC providers 
make it difficult for consumers to obtain uniform information 
to determine which AL/RC setting best meets their priorities 
and needs. This is in contrast to information that is provided 
to nursing home and home health consumers on the national 
Medicare.gov web site (and maintained by U.S. Centers for 
Medicare and Medicaid Services), in part, as a result of 
federal regulations.
    The goal of the Agency for Healthcare Research and 
Quality's Assisted Living Initiative is to help AL/RC 
consumers, and consumer intermediates (e.g., local Aging 
agencies, hospital discharge planners), differentiate between 
individual AL/RC facilities to determine what best meets the 
consumer's priorities and needs.
    Phase I of the Initiative began by funding a working 
conference of AL researchers, consumers, providers and 
Government officials. The 2004 meeting developed a national AL 
research agenda (see references in Question II.5 for agenda); a 
key conclusion from the conference was ``Consumers lack 
information for making informed decisions concerning AL'' 
(Kane, Wilson and Spector, 2007).
    Subsequently (Phase II of the Initiative), AHRQ funded a 
research scan of available AL/RC consumer measures and state 
consumer tools, and conducted consumer and provider focus group 
research. Findings from these efforts were assessed and 
presented at a second AL/RC stakeholder meeting. The 2006 group 
recommended the development of uniform information that would 
describe the services and characteristics of individual AL/RC 
communities.
    Phase III of the project began late in 2006 with the 
establishment of a partnership between AHRQ and the Center for 
Excellence in Assisted Living. Jointly they invited key AL/RC 
stakeholders to work collaboratively through a voluntary, 
consensus process to develop a uniform instrument (based on 
evidence when available) that would be used to describe 
individual AL/RC communities. Efforts are focusing on: services 
available; pricing information for services; move-in and move-
out criteria; staffing information (RN staffing, 24/7 staffing, 
staff training and turnover); dementia services; and resident 
rights, house rules and life safety. Known as the Assisted 
Living Disclosure Collaborative, this national voluntary 
consensus body is now composed of 22 member organizations (with 
expectations of more) and several ad hoc federal and national 
organizations. Once the uniform instrument is developed 
(planned for fall 2009), a formal testing period (small and 
large scale) will ensue with consumers and providers, followed 
by dissemination of the ALDC endorsed instrument, associated 
materials and information.
    Excellence: What makes this project exceptional?
    The AL initiative from its outset has been a public/private 
partnership that involved key assisted living stakeholders in 
the AL research process. The research community, the AL 
provider community, organizations that advocate for older 
Americans and the disabled as well as consumers, have all 
voiced their need for consumer information on AL/RC.
    What is exceptional is that for very little federal 
investment and no federal regulation--in contrast to the 
spending and regulation required to obtain uniform public 
information about individual nursing homes and home health 
agencies--the resulting AL/RC tools (based upon science when 
available) could (after development and dissemination) aid 
consumers in their informed choice of an AL/RC communities by 
providing information on the characteristics, services and 
costs of individual AL/RC residences.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    The average age of an assisted living consumer is 85 years 
old (NCAL, 2008). The population age 85 and older is the 
fastest growing segment of the U.S. population, expected to 
grow from 8.5 million in 2006 to almost 21 million by 2050 
(Federal Interagency Forum on Aging Related Statistics, 2008). 
AL/RC is an important care option for people with health needs 
and functional impairments, especially for frail elders and 
those with dementia related problems not requiring continuous 
nursing care. Informed consumer choice, especially a choice 
that diverts older Americans from more costly care alternatives 
(while simultaneously meeting their needs and priorities), has 
the potential to reduce the pace of public long-term care 
spending (62 percent of nursing home care in 2005 was financed 
by either Medicare or Medicaid; Komisar and Thompson, 2007).
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    The goal of this project is to aid consumers and consumer 
intermediaries (e.g., local Aging agencies, hospital discharge 
planners) in their effective identification and choice of AL/RC 
residence(s) that meets their priorities and needs. Uniform 
information about the characteristics and costs of health care 
providers is an essential element of informed consumer choice. 
The tool in development is to be designed to obtain uniform 
information on the characteristics, services and costs of 
individual AL/RC facilities, using evidence-based information 
when available.
    Innovativeness: Why is this research exciting and 
newsworthy?
    Information (based on a national standard) about individual 
nursing homes and home health agencies was made available to 
the public, in part, due to federal regulation. The efforts of 
AHRQ's Assisted Living Initiative have the potential of 
providing consumers with uniform information as the result of a 
voluntary consensus process of key AL/RC industry stakeholders 
(see Question I.5 for a list of project partners) that work in 
partnership with the Federal government, i.e. AHRQ--supporting 
the development of AL/RC tools that are based on sound research 
principals that inform consumer decisionmaking.

Agency for Healthcare Research and Quality (AHRQ): Efficiency of Health 
                                  Care

    To understand how therapeutics' safety and effectiveness 
may vary with aging and its associated healthcare needs. 
Improve knowledge of ways to influence the effectiveness and 
optimal use of therapeutics in older adults. Improve 
healthcare's organization and delivery of therapeutics in 
healthcare for older adults.
    Lead Agency: Agency for Healthcare Research and Quality 
(AHRQ).
    Agency Mission: The mission of the Agency for Healthcare 
Research and Quality is to improve the safety, quality, 
effectiveness, and efficiency of health care for all Americans.
    Principal Investigator: Anne Trontell, MD, MPH, Program 
Director, Centers for Education and Research in Therapeutics 
(CERTs), Senior Advisor on Pharmaceutical Outcomes and Risk 
Management Center for Outcomes and Evidence, Agency for 
Healthcare Research and Quality, 540 Gaither Road, Suite 6222, 
Rockville, MD 20850.
    Partner Agencies: Brigham and Women's Hospital; Duke 
University Medical Center; HMO Research Network; Rutgers, The 
State University of New Jersey; University of Alabama at 
Birmingham; University of Arizona CERT at The Critical Path 
Institute (C-Path); University of Iowa; Cincinnati Hospital 
Children's Medical Center; University of Pennsylvania School of 
Medicine; University of Texas M.D. Anderson Cancer Center and 
Baylor College of Medicine; Vanderbilt University Medical 
Center; Weill Medical College of Cornell University; and 
University of Chicago.
    General Description: The Centers for Education and Research 
on Therapeutics (CERTs) research program is an on-going 
national research demonstration initiative to conduct research 
and provide education that advances the optimal use of 
therapeutics (i.e., drugs, medical devices, and biological 
products). Begun in 1999, the program currently consists of 14 
research centers and a Coordinating Center and is funded and 
run as a cooperative agreement by the Agency for Healthcare 
Research and Quality (AHRQ), in consultation with the U.S. Food 
and Drug Administration (FDA). A National Steering Committee 
includes at-large members from other Federal agencies such as 
CMS, CDC, and NIH and membership from consumers, the health 
care sector, and the therapeutics industry.
    The CERTs leverage their core public funding from AHRQ and 
FDA with other Federal and private resources. The research 
conducted by the CERTs program has three major aims which have 
significant impact, high relevance, and direct benefit to the 
elderly, who disproportionately use multiple and complicated 
therapeutic regimens:
    1. To increase awareness of both the uses and risks of new 
drugs and drug combinations, biological products, and devices, 
as well as of mechanisms to improve their safe and effective 
use.
    2. To provide clinical information to patients and 
consumers; health care providers; pharmacists, pharmacy benefit 
managers, and purchasers; health maintenance organizations 
(HMOs) and health care delivery systems; insurers; and 
government agencies.
    3. To improve quality while reducing cost of care by 
increasing the appropriate use of drugs, biological products, 
and devices and by preventing their adverse effects and 
consequences of these effects (such as unnecessary 
hospitalizations).
    As an AHRQ priority population, the elderly and their 
healthcare needs are a prominent research focus of the CERTs. 
The publications cited at the end of this form showcase the 
CERTs' examination of the special healthcare needs of older 
adults and their families, encompassing physiological, mental 
and social issues related to aging, elders' needs for 
therapeutics and for psychological and mental care, family and 
social supports, end of life care, financial challenges, and 
overall quality of life.
    Emblematic of the importance of therapeutics among the 
elderly, AHRQ solicited a new CERT Center with a thematic 
emphasis in aging, resulting in a 2006 award to the University 
of Iowa CERT, since designated as the ``elderly care CERT'' and 
focusing on research and education in therapeutics and optimal 
healthcare for the elderly. A significant portion of older 
adults consume many medications and also have symptoms due to 
aging that may be confused with medication side effects, 
placing them at high risk for harmful drug interations. Among 
its many projects, the Iowa CERT is developing a medication 
review tool that will assist pharmacists in identifying and 
remedying clinically significant medication problems and 
dangerous drug interactions among the elderly they serve.
    Excellence: What makes this project exceptional?
    The CERTs research program is exceptional in the breadth, 
depth, quality, and impact of its research products in 
improving the health and quality of life of the aging. Topics 
that have been addressed include the aging process itself, the 
special healthcare needs of the elderly surrounding 
therapeutics, the effectiveness, safety, and comparative 
effectiveness of different therapeutic choices, and the quality 
and efficiency of elderly health care involving therapeutics.
    Significance: How is this research relevant to older 
persons, populations and/or aging society?
    In addressing the optimal use of therapeutics, a 
significant component of elderly care, the CERTs Program is 
particularly relevant to an aging society and to older persons 
where the most extensive and complicated use of therapeutics 
occurs. Research by the CERTs has direct relevance to the 
elderly covered by Medicare and Medicaid, including the dually 
eligible who are especially vulnerable to adverse events from 
therapeutics.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Information developed by the CERTs program informs the 
elderly, their physicians, and policy and decisionmakers 
throughout the healthcare system in making informed choices 
among therapeutic options in order to promote the 
effectiveness, safety, efficiency, and quality of care received 
by the elderly. By developing research and translating it into 
educational products that will be used throughout the health 
care system, the CERTs enable the optimal use of therapeutics 
health care for all, but especially the elderly who use more 
drugs than any other age group of the population.
    Innovativeness: Why is this research exciting or 
newsworthy?
    In terms of innovativeness, CERTs research is exciting and 
newsworthy in addressing conditions among the elderly that are 
preventable through the optimal use of therapeutics. These 
include such important and timely topics as the prevention of 
medication errors in the elderly, the avoidance of 
hospitalization or death for treatable conditions among older 
adults, and the risk of inappropriate prescribing to the 
elderly outside of hospital settings.

   Agency for Healthcare Research and Quality: Effective Health Care 
                                Programs

    The Effective Health Care Program conducts and supports 
research with a focus on outcomes, comparative clinical 
effectiveness, and appropriateness of pharmaceuticals, devices, 
and health care services. The program focuses on issues of 
special importance to Medicare, Medicaid and the State 
Children's Health Insurance Program (SCHIP).
    Lead Agency: Agency for Healthcare Research and Quality 
(AHRQ).
    Agency Mission: The mission of the Agency for Healthcare 
Research and Quality is to improve the safety, quality, 
effectiveness, and efficiency of health care for all Americans.
    Principal Investigator: Jean R. Slutsky, Director, Center 
for Outcomes and Evidence, Agency for Healthcare Research and 
Quality, John M. Eisenberg Building, 540 Gaither Road, 
Rockville, MD 20850.
    Partner Agencies: Centers for Medicare & Medicaid Services 
(CMS), Food and Drug Administration (FDA), National Institutes 
of Health (NIH).
    General Description: AHRQ's Effective Health Care Program 
provides current, unbiased evidence about the comparative 
effectiveness of different health care interventions. The 
object is to help consumers, health care providers, and others 
make informed choices among treatment alternatives, including 
drugs. The program was created under Section 1013 of the 
Medicare Prescription Drug, Improvement, and Modernization Act 
of 2003 to conduct research regarding ``the outcomes, 
comparative clinical effectiveness, and appropriateness of 
health care items and services.'' The program was launched in 
2005 and focused initially on issues of special importance to 
Medicare but has been expanded to include Medicaid and the 
State Children's Health Insurance Program (SCHIP).
    The Effective Health Care Program employs three approaches 
to its comparative effectiveness research:
    Synthesize knowledge--AHRQ's 14 Evidence-based Practice 
Centers perform systematic reviews of published and unpublished 
scientific evidence. They produce reviews of comparative 
effectiveness, synthesizing what is known and where further 
research is needed.
    Generate knowledge--A 13-member research network (the 
Developing Evidence to Inform Decisions about Effectiveness 
[DEcIDE] network) carries out accelerated practical studies as 
well as research to improve analytic tools.
    Translate knowledge--The John M. Eisenberg Clinical 
Decisions and Communications Science Center distills research 
and presents results in a variety of useful and understandable 
formats. The Center also develops decision aid tools for 
consumers.
    In the Effective Health Care Program, AHRQ seeks an 
emphasis on timely and usable findings, building on the 
thoroughness and unbiased reliability that have been hallmarks 
of efforts so far. Equally important is broad ongoing 
consultation with stakeholders which helps ensure that the 
program responds to issues most pressing for health care 
decision makers. Collaboration is also a key principle of the 
program and AHRQ works closely with many agencies of DHHS to 
identify topics for research under the program and to 
communicate findings, including identified research gaps.
    All reports produced by the program are available on the 
Effective Health Care Web site, http://
www.EffectiveHealthCare.ahrq.gov. The Web site also includes 
features for the public to participate in the Effective Health 
Care Program. Users can sign up to receive notification when 
new reports are available. They can also be notified when draft 
reports and other features are posted for comment, and comments 
can be submitted through the Web site. The public is also 
invited to use the Web site to nominate topics for research by 
the Effective Health Care Program.
    Innovativeness: Why is this research exciting and 
newsworthy?
    Which medical treatments are most effective? Which carry 
the most risks? AHRQ's Effective Health Care Program is the 
Federal Government's leading effort to make evidence-based 
comparisons of health care interventions. The Effective Health 
Care Program, with funding that doubled to $30 million in 2008, 
is unique among comparative effectiveness initiatives. Research 
topics reflect Federal priorities to improve the health of all 
Americans and include critical issues facing today's elderly 
population.
    Pursuant to the legislate mandate and the impending 
implementation of the Medicare prescription drugs benefit, the 
Secretary in 2005 chose an initial set of 10 priority 
conditions focusing primarily on the needs of Medicare program. 
Through discussion with and extensive input from stakeholders, 
the Secretary in 2008 expanded the list of priority conditions 
to include conditions relevant not only to the Medicare 
program, but also Medicaid and SCHIP programs. This updated 
list of clinical conditions guides research, synthesis and 
translation and dissemination priorities for the Effective 
Health Care Program:
          --Arthritis and nontraumatic joint disorders (Muscle, 
        bone, and joint conditions)
          --Cancer (Cancer)
          --Cardiovascular disease, including stroke and 
        hypertension (Heart and blood vessel conditions)
          --Dementia, including Alzheimer's Disease (Brain and 
        nerve conditions)
          --Depression and other mental health disorders 
        (Mental health)
          --Developmental delays, attention-deficit 
        hyperactivity disorder and autism (Developmental 
        delays, ADHD, autism)
          --Diabetes Mellitus (Diabetes)
          --Functional limitations and disability (Functional 
        limitations and physical disabilities)
          --Infectious diseases including HIV/AIDS (Infectious 
        diseases and HIV/AIDS)
          --Obesity (Obesity)
          --Peptic ulcer disease and dyspepsia (Digestive 
        system conditions)
          --Pregnancy including pre-term birth (Pregnancy and 
        childbirth)
          --Pulmonary disease/Asthma (Breathing conditions)
          --Substance abuse (Alcohol and drug abuse)
    One part of the Effective Health Care Program, The John M. 
Eisenberg Clinical Decisions and Communications Science Center, 
is devoted to developing tools to help people make decisions 
about health care. The Eisenberg Center translates knowledge 
about effective health care into summaries that use 
understandable, actionable language. An important function of 
the Eisenberg Center is to transform complex scientific 
information into short, plain language materials that can be 
used to assess treatments, medications, and technologies. The 
Eisenberg Center develops information summaries for three 
audience groups--consumers, clinicians, and policymakers. The 
guides are designed to help people including older persons, 
populations and an aging society use scientific information to 
maximize the benefits of health care, minimize harm, and 
optimize the use of health care resources.
    The Effective Health Care Program has published a variety 
of research reviews, new research reports, and summary guides 
on a variety of topics relevant to the needs of people age 65 
or older. Selected research is listed below and all products 
are available online, some with audio links for the visually 
impaired (www.effectivehealthcare.arhq.gov).
    Comparative effectiveness research is changing practice. 
Our mission will be fulfilled when health care decision 
makers--including patients, clinicians, purchasers, and 
policymakers--use up-to-date, evidence-based information about 
their treatment options to make informed health care decisions.

           Agency for Healthcare Research and Quality (AHRQ)

    Three falls prevention projects are funded to study the 
feasibility of long term care facilities incorporating these 
evidence based programs into their day to day practice. The 
goal is to foster improved quality of care and quality of life 
and safety in residential settings by demonstrating feasibility 
of evidence-based models to ultimately foster the dissemination 
of these model programs on a broader scale.
    Lead Agency: Agency for Healthcare Research and Quality 
(AHRQ).
    Agency Mission: The mission of the Agency for Healthcare 
Research and Quality is to improve the safety, quality, 
effectiveness, and efficiency of healthcare for all Americans.
    Principal Investigators: William Spector, PhD (Agency 
Lead), Senior Social Scientist, Agency for Healthcare Research 
and Quality 540 Gaither Road, Rockville, MD 20850.
    Falls Management Project for Nursing Homes (Contract PI), 
Joseph Ouslander, MD, Professor, Department of Medicine, 
Division of Geriatric Medicine and Gerontology, Wesley Woods 
Health Center, Emory University School of Medicine, Atlanta, GA 
30329.
    Falls Prevention Program in Assisted Living (Contract PI), 
Sheryl Zimmerman, PhD, Professor, School of Social Work, 
University of North Carolina at Chapel Hill, 301 Pittsboro 
Street, Campus Box 3550, Chapel Hill, NC 27599.
    Preventing Disability Among Residents of Continuing Care 
Residential Communities (Contract PI), Helaine E. Resnick, PhD, 
Director of Research, Institute for the Future of Aging 
Services, American Association of Homes and Services for the 
Aging, 2519 Connecticut Avenue, NW., Washington, DC 20008-1520.
    Development of Injurious Falls Measures for Nursing Homes 
(Contract PI), Terry Moore, MPH, Principal Associate, Abt 
Associates Inc., 55 Wheeler St., Cambridge, MA 02138.
    Partner Agencies: National Institute for Aging (Preventing 
disability among residents of CCRC).
    General Description: The Falls Prevention in Long Term Care 
Program at AHRQ focuses on the prevention of injurious falls 
and related injuries and disabilities in nursing home and 
residential care settings. Three contracts have been funded (1) 
implementation of an evidence-based falls prevention program in 
nursing homes; (2) implementation of a falls prevention program 
in assisted living facilities; and (3) preventing disability 
among residents of Continuing Care Residential Community 
(CCRC). In addition, one contract develops a method for 
comparing case-mix adjusted rates of injurious falls across 
nursing homes. AHRQ staff research on fractures in nursing 
homes has contributed to the evidence base.
    The first project involved the implementation of the Falls 
Management Program (FMP) in 19 nursing homes owned and operated 
by a single nonprofit nursing home chain in Georgia. The FMP is 
based on work at the Vanderbilt University School of Medicine 
that has been developed, tested and refined over several years 
involving >250 facilities. FMP is an interdisciplinary, 
multifaceted approach to reducing fall risk that includes 
systematic screening, assessment, individualized care planning, 
resident monitoring, and the elimination of environmental 
safety hazards. The FMP is initiated by a self-assessment 
process that assists nursing homes in identifying areas that 
need improvement so that staff can tailor implementation to 
their own facility's needs. The FMP incorporates education on 
best practices and uses several quality improvement (QI) tools 
designed to assist nursing homes with program implementation. 
Core components of the program include administrative and 
clinical leadership, interdisciplinary teamwork using QI 
methodology, support by advance practice nurses, and an 8-step 
fall response system to facilitate the comprehensive 
investigation and documentation of falls, primary care provider 
involvement, and development of individualized fall risk 
reduction strategies.
    The second project is a multi-component falls intervention 
program that assesses the feasibility of carrying out this 
program in assisted living facilities. The falls intervention 
includes medication review, assessment, environmental 
modification, and exercise, to reduce risk factors for falls 
and fall and fracture rates among residents of assisted living 
facilities. The project involves the following activities: 
adapting a multi-faceted, evidence-based falls prevention 
program to a protocol tailored to the assisted living 
environment; implementing the pilot protocol and collecting 
clinical and process data pre-post intervention; and evaluating 
the results of interventions. This project is currently on-
going and being implemented in two assisted living facilities 
in North Carolina (with 2 control facilities).
    The third project focuses on preventing disability among 
residents of CCRCs. This project will test the feasibility of 
screening, providing an evidence-based exercise program, and 
counseling to encourage exercise program adherence. The 
screening tool is the Short Physical Performance Battery 
(SPPB), a tool developed by the National Institute of Aging, to 
detect sub-clinical disability in older adults who the study 
involves 300 residents in 6 CCRCs. The goals are to show that 
CCRCs can feasibly incorporate this program into their daily 
practice and reduce the disability risk of their residents. 
Falls rates, mortality and hospitalizations will also be 
monitored. Implementation challenges and lessons learned will 
be summarized. This project is scheduled to commence July 2008.
    The aim of developing an injurious falls measure in nursing 
homes is to help nursing homes and older consumers to compare 
nursing home on a measure of safety. With this measure, 
consumers can make better choices and facilities can monitor 
and improve the safety of the environment they provide to their 
residents. This project is being accomplished in collaboration 
with CMS and uses CMS data.
    Innovativeness: Why is this research exciting and 
newsworthy?
    This research program is ultimately designed to make long-
term care facilities safer for an aging population and to 
provide programs that reduce the risk of older persons falling. 
Falls are significant problems for elderly persons who reside 
in long-term care facilities because they are the primary cause 
of fractures and other physical injuries which in turn, result 
in reduced physical function and quality of life, increased 
morbidity and mortality, and related health care utilization 
and costs. In addition by preventing disability and serious 
falls this research will contribute to the reduction of 
avoidable health care costs. An injurious fall increases 
nursing home cost by $5,325 per year. In the year 2000, the 
direct medical costs for fatal and non-fatal fall injuries of 
elderly in the U.S. totaled $19.2 billion.
    The three implementation projects are exceptional in that 
they test evidence-based models of care in long term care 
settings to demonstrate that long term care facilities can 
incorporate best practices into their daily work flow. By 
testing models in the three main residential care settings that 
elderly live, this program provides evidence to help improve 
the safety of a wide range of housing options for older persons 
who need long term care services.
    These studies will facilitate the dissemination of these 
models to other comparable long term care facilities, providing 
them with information to help them decide if they want to adopt 
a model that has been tried by their peers.
    In nursing homes, where multiple interventions are often 
occurring at the same time, we have shown that when a restraint 
reduction program is being implemented, if the FMP was also 
implemented, the falls rate remained stable. Without the FMP 
the rate of falls increased.
    Spector et al. (2007) demonstrates the importance of 
monitoring prescription drug ordering practices in nursing home 
when trying to prevent avoidable falls and fractures, although 
the FMP implementation study indicated that it is difficult for 
nursing homes to influence physician prescription drug orders. 
FMP tools have been made available at the MedQIC web site that 
supports Medicare Quality Improvement Organizations (QIOs) and 
providers in finding, using, and sharing quality improvement 
resources.
    Successful translation of research into clinical practice 
that improves care is complex. These projects are identifying 
how to make evidence based practices available to aging 
consumers who need long term care services in residential 
settings. As the population ages there will be increased demand 
for these types of services and it is important to assure that 
these environments can be made as safe as possible and can 
encourage persons to age as disability-free as possible.

               Agency for Healthcare Research and Quality

    The CAHPS Hospital Survey, sometimes known as H-CAHPS or 
Hospital CAHPS, is a standardized survey of the experiences of 
adult inpatients with hospital care and services. Hospitals 
across the country are using this survey and voluntarily 
reporting data to the Centers for Medicare & Medicaid Services 
(CMS). CMS began public reporting of the results in March 2008.
    Lead Agency: Agency for Healthcare Research and Quality 
(AHRQ).
    Agency Mission: The mission of the Agency for Healthcare 
Research and Quality is to improve the safety, quality, 
effectiveness, and efficiency of health care for all Americans.
    Principal Investigators: Paul Cleary, PhD, Dean, Yale 
School of Public Health, 60 College Street, P.O. Box 208034, 
New Haven, CT 06520; Ronald Hays, Professor of Medicine, UCLA 
School of Medicine, Division of General Internal Medicine and 
Health Services Research, 911 Broxton Plaza, Box 951736, Los 
Angeles, CA 90095-1736, Steven Garfinkel, Managing Research 
Scientist, American Institutes for Research, 101 Connor Drive, 
Suite 301, Chapel Hill, NC 27514.
    Partner Agencies: Centers for Medicare and Medicaid 
Services, Hospital Quality Alliance (Member organizations 
include American Hospital Association, Federation of American 
Hospitals, American Nurses Association, AARP, AFL-CIO, The 
Disclosure Group, and others).
    General Description: In June 2002, the Centers for Medicare 
and Medicaid Services asked AHRQ to develop a questionnaire 
through which hospital patients could rate the care that they 
receive. They asked AHRQ to perform this work through the 
Consumer Assessment of Health Providers and Services project 
(CAHPS), which at that time was a consortium of three research 
organizations (RAND, Harvard and the American Institutes of 
Research) and a contractor (Westat). Though many hospital 
surveys exist, consumers can't compare hospital performance 
unless (1) all hospitals use the same survey and (2) survey 
results are routinely reported to a single organization and (3) 
these results are easily available to consumers. Development of 
the CAHPS Hospital Survey and aggregation/publication of the 
results by CMS has made these three things possible.
    Excellence: What makes this project exceptional?
    The HCAHPS project developed a rigorously tested, 
standardized questionnaire through which hospital patients can 
assess the care they receive in hospitals. To make sure that 
the survey included questions that people really want the 
answers to before they select a hospital, we conducted 16 focus 
groups with a variety of individuals across the country. This 
led us to develop questions that focused on provider 
communication skills, communication about medications, pain 
control, information for care after discharge, and many other 
areas. The great majority of American hospitals report HCAHPS 
data to CMS, who then publish the results on their Hospital 
Compare website. In the first week after publication of HCAHPS 
data, page views of this website increased from 161,000 to 1.4 
million, and people are continuing to consult this resource in 
large numbers. HCAHPS data are especially relevant to older 
persons since, as we age, the likelihood that we will need 
hospital care increases. Development of HCAHPS was an 
exceptional achievement since we faced extreme push-back from 
the hospital data vendor industry. Because AHRQ and CMS joined 
forces with the Hospital Quality Alliance, we were able to 
respond successfully to extreme public scrutiny of the 
instrument and our data collection methods.

Department of Health and Human Services: Agency for Healthcare Research 
                              and Quality

    The Healthcare Cost and Utilization Project (HCUP) is an 
important part of the research infrastructure for studies on 
the health care of older adults in the U.S. HCUP provides data 
and research software and tools that support a wide range of 
studies related to the health care of the elderly including 
cost and quality of health services, medical practice patterns, 
access to health care programs, and outcomes of treatments at 
the national, State, and local levels. HCUP is the only source 
of data on hospital care for the all elderly U.S. residents 
that can provide statistics at both the national and local 
levels.
    Lead Agency: Department of Health and Human Services, 
Agency for Healthcare Research and Quality.
    Agency Mission: The Agency for Healthcare Research and 
Quality (AHRQ) is the lead Federal agency charged with 
improving the quality, safety, efficiency, and effectiveness of 
health care for all Americans. As one of 12 agencies within the 
Department of Health and Human Services, AHRQ supports health 
services research that will improve the quality of health care 
and promote evidence-based decisionmaking.
    Principal Investigator: Jenny A. Schnaier, HCUP Project 
Officer, Center for Delivery, Organization and Markets (CDOM), 
Agency for Healthcare Research and Quality (AHRQ), 540 Gaither 
Road, Rockville, MD 20850.
    Partner Agencies: Arizona--Department of Health Services; 
Arkansas--Department of Health & Human Services; California--
Office of Statewide Health Planning & Development; Colorado--
Hospital Association; Connecticut--Integrated Health 
Information (Chime, Inc.); Florida--Agency for Health Care 
Administration; Georgia--Hospital Association; Hawaii--Health 
Information Corporation; Illinois--Health Care Cost Containment 
Council and Department of Public Health; Indiana--Hospital & 
Health Association; Iowa--Hospital Association; Kansas--
Hospital Association; Kentucky--Cabinet for Health and Family 
Services; Maine--Health Data Organization; Maryland--Health 
Services Cost Review Commission; Massachusetts--Division of 
Health Care Finance and Policy; Michigan--Health & Hospital 
Association; Minnesota--Hospital Association; Missouri--
Hospital Industry Data Institute; Nebraska--Hospital 
Association; Nevada--Division of Health Care Financing and 
Policy, Department of Health and Human Services; New 
Hampshire--Department of Health & Human Services; New Jersey--
Department of Health & Senior Services; New York--State 
Department of Health; North Carolina--Department of Health and 
Human Services; Ohio--Hospital Association; Oklahoma--Health 
Care Information Center for Health Statistics; Oregon--
Association of Hospitals and Health Systems; Rhode Island--
Department of Health; South Carolina--State Budget & Control 
Board; South Dakota--Association of Healthcare Organizations; 
Tennessee--Hospital Association; Texas--Department of State 
Health Services; Utah--Department of Health; Vermont--
Association of Hospitals and Health Systems; Virginia--Health 
Information; Washington--State Department of Health; West 
Virginia--Health Care Authority; and Wisconsin--Department of 
Health & Family Services.
    General Description: The Healthcare Cost and Utilization 
Project (HCUP) (http://www.hcup-us.ahrq.gov) is an important 
part of the research infrastructure for studies on the health 
care of older adults in the U.S. HCUP provides data and 
research software and tools that support a wide range of 
studies related to the health care of the elderly including 
cost and quality of health services, medical practice patterns, 
access to health care programs, and outcomes of treatments at 
the national, State, and local levels.
    The Healthcare Cost and Utilization Project (HCUP) is a 
unique Federal-State-Industry partnership and sponsored by the 
Agency for Healthcare Research and Quality (AHRQ) that brings 
together the data collection efforts of State data 
organizations, hospital associations, private data 
organizations, and the Federal government to create a national 
information resource of patient-level health care data. HCUP 
includes the largest collection of longitudinal hospital care 
data in the United States, with all-payer, encounter-level 
information beginning in 1988.
    In support of AHRQ's mission, the goals of HCUP are to:
     Create and enhance a powerful source of national 
and state all-payer health care data.
     Produce a broad set of software tools and products 
to facilitate the use of HCUP and other administrative data.
     Enrich a collaborative partnership with statewide 
data organizations aimed at increasing the quality and use of 
health care data.
     Conduct and translate research to inform decision 
making and improve health care delivery.
    The HCUP Databases contain encounter-level information for 
all payers compiled in a uniform format with privacy 
protections in place. HCUP databases contain a core set of 
clinical and nonclinical information found in a typical 
discharge abstract (or billing record) including all-listed 
diagnoses and surgeries, patient status at discharge, patient 
demographics, and billed charges. HCUP data also include 
information about the hospital to support aggregate research. 
HCUP include the following hospital inpatient and outpatient 
databases that are used for analyses of health care for older 
persons:
     The Nationwide Inpatient Sample (NIS) with 
inpatient data from a national sample of over 1,000 hospitals 
designed for making national estimates.
     The State Inpatient Databases (SID) contain the 
universe of inpatient discharge abstracts from participating 
states.
     The State Ambulatory Surgery Databases (SASD) 
contain data from ambulatory care encounters from hospital-
affiliated and sometimes freestanding ambulatory surgery sites.
     The State Emergency Department Databases (SEDD) 
contain data from hospital-affiliated emergency departments for 
visits that do not result in hospitalizations.
    The HCUP databases have been a powerful resource for the 
development of software and tools that can be applied to other 
similar databases by health services researchers and decision 
makers. These tools include an online query system (HCUPnet) 
for generating statistics in a table format using HCUP data 
(http://hcupnet.ahrq.gov/), software to measure quality of 
hospital care (AHRQ Quality Indicators) and software for 
classifying diagnoses or surgeries into clinically meaningful 
categories for ease of statistical reporting (Clinical 
Classification Software).
    HCUP also produces reports that summarize important 
findings from the databases. The HCUP Statistical Briefs 
present simple, descriptive statistics on a variety of 
specific, focused topics. Most of these topics have relevance 
to the elderly. And one focused specifically on the elderly--
(HCUP Statistical Brief #14 ``Trends in Elderly 
Hospitalizations, 1997-2004'').
    Excellence: What makes this project exceptional?
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Innovativeness: Why is this research exciting or 
newsworthy?
    HCUP includes the largest collection of longitudinal 
hospital care data in the United States, with all-payer, 
encounter-level information beginning in 1988. Unlike the 
hospital files maintained by the Centers for Medicare and 
Medicaid, HCUP files include records for Medicare patients who 
are enrolled in managed care and it includes records for 
elderly who are not covered by Medicare (primarily foreign-born 
who were not part of the Social Security system). Because of 
the unique Federal, State, industry partnership in data, HCUP 
can support both national and local analyses of health care 
among the elderly. As a result, HCUP is the only source of data 
on hospital care for elderly residents that can provide 
statistics at both the national and local levels.
    HCUP databases capture the hospital inpatient experience of 
the 32.7 million people who are 65 years and older and who 
reside in the 39 HCUP Partner states (88% of all persons age 65 
and older in the U.S.). In 2006, this represents approximately 
11.3 million hospital inpatient records.
    HCUP not only provides access to data files for 
researchers, but it also has an online query system (HCUPnet) 
that is designed for both researchers and non-researchers. 
Using this online query system, the average person has easy 
access to statistics on the care of elderly almost 
instantaneously. Options are available for statistics on older 
patients for individual diagnoses or surgeries broken down by 
hospital characteristics. Available statistics include the 
average cost and length of hospital stays, the percentage 
admitted through the emergency room, discharged to nursing 
homes or those who died. The following is an example of 
information that can be generated from HCUPnet within seconds:
     Congestive heart failure was the single most 
common condition primarily responsible for the hospitalization 
of persons age 65 and older in 2006 (about 810,000 
hospitalizations); pneumonia was the second most common reason 
for hospitalization (about 700,000 hospitalizations).
    HCUP data are used to support many of the measures used for 
the Congressionally-mandated National Healthcare Quality Report 
and National Healthcare Disparity Report. HCUP supplies all 
quality and disparity statistics for these annual reports 
separately for the elderly population. Thus, HCUP statistics 
are being used to monitor quality of care for the older 
population. Below is an example table for the National 
Healthcare Quality Report that shows the decline in hospital 
deaths for acute myocardial infarction (heart attack) since 
2000.

  DEATHS PER 1,000 ADMISSIONS WITH ACUTE MYOCARDIAL INFARCTION (AMI) AS
                           PRINCIPAL DIAGNOSIS
------------------------------------------------------------------------
                                              2005      2004      2000
------------------------------------------------------------------------
Total............  .......................      77.5      83.0     105.8
Age..............  18-44..................      16.8      20.9      21.1
                   45-64..................      35.1      35.3      45.5
                   65 and over............     107.9     115.5     144.9
Age..............  65-69..................      58.1      68.5      88.6
                   70-74..................      81.1      83.6     113.2
                   75-79..................     102.2     106.6     140.6
                   80-84..................     124.5     132.7     161.2
                   85 and over............     150.7     165.9     207.5
------------------------------------------------------------------------
Source: HCUP Nationwide Inpatient Sample.

    HCUP can support a wide-range of research and health policy 
topics that can improve the health of the elderly. In the last 
decade, over 600 peer-reviewed articles have been written based 
on HCUP data and related software tools, with 160 professional 
journal articles published in 2007 alone. In addition, there 
are many health care journalists who rely on HCUPnet for quick 
statistics to support their news stories. In 2007 there were 
nearly 400 non-journal publications (e-journals, magazines and 
newspapers) that featured HCUP. Most of these articles were on 
topics that focused on the elderly or on health care topics of 
relevance to the elderly.

  Agency for Healthcare Research and Quality: The Rural Oregon Adult 
                              Memory Study

    Researchers and clinicians in the Rural Oregon Adult Memory 
Study (ROAM), a pilot study with seven rural primary care 
practices, designed, implemented, and evaluated the feasibility 
of a universal screening program for dementia in adults over 75 
years.
    Lead Agency: Agency for Healthcare Research and Quality 
(AHRQ).
    Agency Mission: The mission of the Agency for Healthcare 
Research and Quality is to improve the safety, quality, 
effectiveness, and efficiency of health care for all Americans.
    Principal Investigator: Linda Boise, PhD, Principal 
Investigator, Oregon Health & Science University, 3181 SW Sam 
Jackson Park Rd. (CR131), Portland, OR 97239.
    Partner Agencies: Agency for Healthcare Research and 
Quality; Oregon Health Sciences University; Oregon Rural 
Practice-based Research Network.
    General Description: The purpose of this small feasibility 
study, the Rural Oregon Adult Memory Study (ROAM) was to 
improve the recognition, diagnosis and care for persons with 
dementia in rural communities through innovative support for 
rural primary care offices. The study team, in close 
collaboration with rural physicians, adapted a set of tools 
that had not been studied in rural communities in order to 
allow systematic dementia screening, evaluation, and patient 
and family education for patients age 75 and over. The goals of 
the study were to implement and test this newly developed 
clinical practice model in a small set of rural practices and 
to gather pilot data on whether the practices could 
successfully implement the model and the outcomes of universal 
screening and follow-up evaluation. The team studied the 
satisfaction of patients and families as well as clinicians and 
office staff to the program. The study is the first piece in a 
long range program, the goal of which is to utilize effective 
education and practice change strategies to improve healthcare 
for older persons with dementia in rural Oregon communities. 
The study was conducted in four phases over 12 months, 
including intervention adaptation to rural practice, training, 
conduction of screening, and analysis. The model for ROAM was 
the Assessing Care of the Vulnerable Elders model (ACOVE), 
developed by geriatric experts at University of California, Los 
Angeles and Rand. This model, which utilizes efficient 
collection of condition-specific clinical data, physician 
education and decision supports, and patient and caregiver 
education materials to encourage activation of the patient's 
role in follow-up, was designed to be effectively and 
efficiently implemented in primary care practice. Until now, 
the model had only been evaluated in urban and suburban 
practices, often in communities with access to specialized 
evaluation and treatment centers and other community supports. 
The ROAM study was intended to build on the ACOVE model, 
introducing into practice a system to efficiently screen for 
possible dementia, encouraging the performance of clinical 
follow-up for patients who screen positive through guided 
memory evaluation forms, and provision of patient education and 
resource materials.
    Seven clinics recruited from among Oregon Rural Practice-
based Research Network participated in ROAM involving 19 
clinicians and over 20 staff members. 436 or 94% of eligible 
patients over 75 years of age where screened during the 
intervention with 49% having a positive screen. Of 66 patients 
who received a full evaluation during the intervention period, 
21 were diagnosed with mild cognitive impairment or dementia. 
The intervention was very favorably reviewed by clinicians and 
staff members and the ROAM tools were revised based on 
feedback. Patients were very pleased to have been asked about 
their memory, with over 90% reporting that they believed it was 
good idea for primary care clinicians to assess older patients' 
memory and thinking.
    With the success of this feasibility study, the team is 
moving forward with other step in their plan to improve 
healthcare for older persons with dementia in rural 
communities.
    Excellence: What makes this project exceptional?
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Innovativeness: Why is this research exciting and 
newsworthy?
    The ROAM study brought together academic researchers and 
rural primary care practices to jointly refine an existing 
evidence-based model for universal screening for dementia for 
use in rural communities.
    Dementia is one of the most challenging conditions to 
diagnose and manage and is also one of the most common 
conditions affecting older Americans. The prevalence of 
dementia in persons 75 or older is estimated to be 15% and up 
to 50% for those aged 85 or older. The most common form of 
dementia in the elderly is Alzheimer's disease. For most older 
adults, the primary healthcare provider is the first clinician 
to be contacted by patients suffering from Alzheimer's disease 
or related dementias and in many cases is the only clinician 
involved in the person's care. The challenges of effectively 
diagnosing and caring for Alzheimer's patients are even greater 
in rural practices. Specialty clinical diagnostic and 
management services are often remote or not available and 
community resources are generally limited.
    Numerous studies, however, have found that a considerable 
number, as many as 50% of cognitively impaired patients, have 
not been evaluated or diagnosed especially, though not 
exclusively, at earlier stages of the disease.
    Improved patient-centered outcomes for people with dementia 
will require engagement of primary care practices for the 
screening, evaluation, management, and patient and family 
education and support. This is especially true in rural 
communities where specialized resources are often not 
available.
    This project included the adaptation and implementation of 
an evidence-based clinical model for screening and evaluation 
for dementia in rural primary care practices. It is the first 
known testing of the ACOVE model in a rural setting.
    The results of this pilot study, which found that the model 
can be successfully implemented in rural primary care practices 
and that rural elders are eager to talk with their primary care 
teams about their memory function, support the team's plans to 
move forward with their larger effort to utilize effective 
education and practice change strategies to improve healthcare 
for older persons with dementia in rural Oregon communities. 
Their accomplishments will have value to rural clinicians and 
communities across the country and already have produced an 
adapted and revised set of tools that rural primary care 
practices may use to screen and evaluate adults over 75 years 
old for dementia.

 Agency for Healthcare Research and Quality: The Pressure Ulcer Program

    The Pressure Ulcer program is an innovative program 
designed to improve day-to-day practice in nursing homes, 
improve and redesign workflow, improve productivity of direct-
care workers, and reduce pressure ulcers.
    Lead Agency: Agency for Healthcare Research and Quality 
(AHRQ).
    Agency Mission: The mission of the Agency for Healthcare 
Research and Quality is to improve the safety, quality, 
effectiveness, and efficiency of health care for all Americans.
    Principal Investigators: William Spector, PhD, Senior 
Social Scientist, Agency for Healthcare Research and Quality, 
540 Gaither Road, Rockville, MD 20850; Susan Horn, PhD 
(Contract PI), Vice President, Research, Institute for Clinical 
Outcomes Research, International Severity Information Systems, 
Inc., 699 E. South Temple, Suite 100, Salt Lake City, UT 84102-
1282.
    Partner Agencies: New York State Department of Health; 
California and District of Columbia QIO (Centers for Medicare 
and Medicaid Services); California Health Care Foundation.
    General Description: The Pressure Ulcer Prevention and 
Healing Research Program is carried out under the leadership of 
AHRQ staff working with contractors and partner organizations. 
The major activity, ``On-Time Quality Improvement (QI) for 
Long-Term Care'' has been the development of a pressure ulcer 
and healing quality improvement program to help nursing home 
staff identify high risk residents and to integrate evidence-
based tools and documentation tools into daily workflow and 
care planning structures. This project applies and extends 
knowledge that had been learn in ``Real Time Optimal Care Plans 
for Nursing Home QI'', grant funded by AHRQ, to new nursing 
homes using Health Information Technology (HIT).
    The ``On-Time'' model integrates clinical guidelines and 
clinical information into each nursing home's daily routine and 
processes for assessment, care planning, care delivery, 
communication and reassessment using HIT. The ``On-Time'' model 
streamlines Certified Nursing Aide (CNA) documentation and 
focuses their documentation on critical data. Using HIT, CNAs 
spend less time documenting (redundancies are eliminated), but 
they document more information in a standardized way and it is 
more accurate, meaningful, and useful to them in their daily 
assignments. New work is integrated into daily routines rather 
than added on to them. The model facilitates timely information 
flow that informs weekly monitoring of resident status and on-
going care planning. The communication mechanisms used in the 
``On-Time'' model are effective and efficient and provide staff 
with current and accurate information on the resident on a 
weekly or more frequent basis. Ultimately, the project aimed to 
redesign clinical workflow--instead of concentrating on 
improving existing processes only--to reduce the incidence of 
pressure ulcers among nursing homes residents.
    ``On-Time'' has been implemented, tested and refined in 30+ 
nursing homes across the nation. Twenty-One nursing facilities 
across the country have completed the prevention program. 
Fifteen of the participating facilities are in California. 
Sixteen facilities have begun implementing in 2008 in New York 
State. All facilities in the District of Columbia plan are 
planning to participate beginning in 2008 and 2009. The ``On-
Time'' has also expanded it scope by including pressure ulcer 
healing. Ten of the facilities in California are currently 
implementing pressure ulcer healing tools that supplements on-
going work on pressure ulcer prevention.
    Excellence: What makes this project exceptional?
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Innovativeness: Why is this research exciting and 
newsworthy?
    The elderly are at greatest risk of developing pressure 
ulcers because of age-related changes in soft tissues and 
decreases in skin perfusion and subcutaneous fat. Pressure 
ulcers in elderly can be extremely painful and can lead to 
other complications if left untreated. It has been estimated 
that over $355 million are spent annually on pressure ulcer 
treatment in long-term care settings.
    This project has developed a quality improvement model that 
can be applied to all aspects of care, not just care for 
pressure ulcers, through better documentation of all aspects of 
resident care and through on-time feedback reports to inform 
care planning. Of all nursing home staff, CNAs spend the most 
time with residents. It integrates and uses CNA clinical 
reports to enhance communication across disciplines, and 
promote teamwork. The ``On-Time'' reports, designed with input 
from multiple disciplines, identify residents at highest risk 
for pressure ulcer development, show trends in multiple 
outcomes for these residents over time, and help staff monitor 
the effectiveness of care in a timely fashion. By documenting 
key observations on every shift, and using these data 
summarized in weekly reports focusing on high risk residents, 
critical information is made available for decision making by 
the entire care team.
    The initial grant pilot facilities achieved an average 33% 
annual reduction in pressure ulcer prevalence among 11 
participating nursing homes. Some facilities reduced prevalence 
by up to 73% and incidence by up to 65%. In this project (21 
facilities completing the program), for facilities with a high 
level of implementation there was a 30.7% decline (from 13.1% 
to 9.1%) in the CMS pressure ulcer quality measure and a 42% 
decline in in-house pressure ulcer rates (from 4% to 2.3%). 
Seven HIT vendors have now programmed the ``On-Time'' 
specifications into their products making these tools available 
to their customers.

  U.S. Preventive Services Task Force: Clinical Preventive Strategies

    This research project aims to develop innovative approaches 
to reviewing the evidence on clinical preventive strategies in 
older adults and making recommendations to physicians for 
prevention in older adults. Evidence on clinical strategies to 
prevent falls will be reviewed. Additional outcomes of interest 
to older adults will be reviewed including the prevention of 
fall-related injuries, quality of life, maintenance of 
independence, and prevention of disability.
    Lead Agency: U.S. Preventive Services Task Force Program at 
the Agency for Healthcare Research and Quality (AHRQ).
    Agency Mission: The mission of the Agency for Healthcare 
Research and Quality is to improve the safety, quality, 
effectiveness, and efficiency of health care for all Americans. 
The mission of the U.S. Preventive Services Task Force (USPSTF) 
is to evaluate the benefits of individual services based on 
age, gender, and risk factors for disease; make recommendations 
about which preventive services should be incorporated 
routinely into primary medical care and for which populations; 
and identify a research agenda for clinical preventive care.
    Principal Investigators: Evelyn Whitlock, MD, MPH, 
Principal Investigator, Oregon Evidence-Based Practice Center, 
3800 North Interstate Avenue, Portland, OR 97227 and Yvonne 
Michael, ScD, MS, Project Lead Investigator, Oregon Health and 
Sciences University, Evidence-Based Practice Center, 3181 SW 
Sam Jackson Park Rd, CB 669, Portland, OR 97239-3098.
    Partner Agency: Oregon Evidence-Based Practice Center.
    General Description: This research project aims to develop 
innovative approaches to reviewing the evidence on clinical 
preventive strategies in older adults and making 
recommendations to physicians for prevention in older adults. 
The U.S. Preventive Services Task Force (USPSTF), first 
convened by the U.S. Public Health Service in 1984, and since 
1998 sponsored by the Agency for Healthcare Research and 
Quality (AHRQ), is the leading independent panel of private-
sector experts in prevention and primary care. The USPSTF 
conducts rigorous, impartial assessments of the scientific 
evidence for the effectiveness of a broad range of clinical 
preventive services, including screening, counseling, and 
preventive medications. Its recommendations are considered the 
``gold standard'' for clinical preventive services. The USPSTF 
recently began work to update its recommendation on fall 
prevention in older adults. Preliminary work revealed that the 
usual methods of reviewing evidence may not be the most 
appropriate for addressing prevention in older adults. This is 
because: (a) some interventions (for example, vision screening) 
cut across several topics; (b) prevention may not be the only 
purpose of screening (care management may be another reason); 
and (c) falls are not the result of one ``disease'' but may 
result from myriad causes. Another very important reason that 
traditional review methods may not work for preventive 
strategies in older adults is the different outcomes in older 
adults compared to younger adults. While preventing or 
forestalling death may be the goal, other important outcomes 
are quality of life, maintenance of independence, and 
prevention of disability. Future plans for this work include 
the application of the newly-developed methods to the review of 
other prevention strategies in older adults.
    Excellence: What makes this project exceptional?
    Falls are an important cause of morbidity and mortality in 
older adults. This project has developed methods that have 
forced researches and policy makers to ``think outside the 
box.''
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    The U.S. Census Bureau projects that the number of persons 
65 years and older will more than double by 2030. Falls and 
fall-related injuries increase with age. Between 30 and 40 
percent of community-dwelling persons aged 65 years and older 
fall at least once per year. Falls are the leading cause of 
injury in people 65 years of age or older. In 2004, more than 
1.8 million older adults were treated for fall-related injuries 
in U.S. hospital emergency departments, and more than 433,000 
were hospitalized. In 2003, the Centers for Disease Control and 
Prevention (CDC) reported that falls were the leading cause of 
injury deaths and the ninth leading cause of death from all 
causes among those 65 years of age and older. Twenty to thirty 
percent of those who fall incur moderate to severe injuries 
that result in decreased mobility that subsequently impacts the 
individual's independence. These limitations will likely 
decrease the injured person's quality of life. In addition to 
these limitations, this degree of injury increases an older 
adult's risk of premature death, and mortality from falls is 
significantly higher in older adults.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    The results of this project will be used by the USPSTF to 
make recommendations to primary care doctors about what is 
effective to prevent falls and fall-related outcomes in older 
adults. Many professional organizations and other guideline-
making organizations consider the USPSTF the gold-standard for 
prevention recommendation and these organizations often use the 
USPSTF reviews as a basis for their own recommendations.
    Innovativeness: Why is this research exciting and 
newsworthy?
    Falls are an important cause of morbidity in older adults--
between 30 and 40 percent of community-dwelling older adults 
fall at least once per year. Traditional methods of 
synthesizing evidence may not be appropriate for older adults. 
In contrast to the traditional USPSTF methods of reviewing 
evidence for improvements in morbidity and mortality this 
project will also review evidence on outcomes that may be of 
most importance to older adults: quality of life, maintenance 
of independence, and prevention of disability.

          The Appalachian Commission: The Aging of Appalachia

    This report uses data from Census 2000 to show how and why 
the age structure of the Appalachian population differs from 
the national average and varies within the Region. The report 
examines implications for the region and argues that they are 
not all negative. The changing age structure will be an 
important fact of life for decision-makers in both the public 
and private sectors in Appalachia in coming years.
    Lead Agency: Appalachian Regional Commission.
    Agency Mission: The Appalachian Regional Commission's 
mission is to be an advocate for and partner with the people of 
Appalachia to create opportunities for self-sustaining economic 
development and improved quality of life.
    Principal Investigator: John Haaga, Deputy Director of the 
Behavioral and Social Research Program, National Institute on 
Aging, Building 31, Room 5C27, 31 Center Drive, MSC 2292 
Bethesda, MD 20892.
    Partner Agency: Population Reference Bureau.
    General Description: The Aging of Appalachia, by John 
Haaga, Population Reference Bureau, July 2004. This report uses 
data from Census 2000 to show how and why the age structure of 
the Appalachian population differs from the national average 
and varies within the Region. The report examines implications 
for the region and argues that they are not all negative. The 
changing age structure will be an important fact of life for 
decisionmakers in both the public and private sectors in 
Appalachia in coming years. In 2000, 14.3 percent of 
Appalachian residents were ages 65 and over, compared with 12.4 
percent of all U.S. residents. Northern Appalachia had the 
oldest population among the subregions, with 16.0 percent ages 
65 and over. Pennsylvania and West Virginia ranked second and 
third among states in 2000 in the percentage of their 
population ages 65 and over; only Florida ranked higher. The 
major reason for the difference in age structure between the 
Appalachian population and that of the United States as a whole 
is the net out-migration of young adults from Appalachia to 
other parts of the country, and Appalachia's relatively low 
share of immigrants from other countries. Three of the four 
Appalachian subregions analyzed here had disability rates--
overall, mobility, and self-care--generally somewhat higher 
than those for elderly people in the nation as a whole. The 
sub-regions of Appalachia vary widely in poverty rates among 
older people. High poverty rates among elderly people living 
alone are a particular problem for the Appalachian region, 
where higher proportions of older people live alone than the 
national average. Poverty rates for the over-65 population were 
fairly close to the national average in southwestern 
Pennsylvania, southern West Virginia, and western North 
Carolina, but poverty rates were higher for the over-65 
population as a whole and for all subgroups in eastern 
Kentucky. The oldest-old, those ages 85 and over, were more 
likely to be poor than the entire over-65 population. 
Demographic projections prepared by Regional Economic Models, 
Inc., show that, with current trends, the Appalachian region 
will be home to over 5 million people ages 65 and over in 2025, 
just under 20 percent of the total population. One of every 40 
Appalachian residents will be among the oldest old, those ages 
85 and over, in 2025. As is currently the case, Northern 
Appalachia is expected in 2025 to have a significantly older 
population than the rest of the region and the nation as a 
whole, with 23.5 percent of its population ages 65 and over. 
The report assesses both the service and fiscal demands of the 
higher regional proportion of older people on state and local 
governments, but also looks at the economic development 
potential of the ``young old'' (those ages 60 to 75) who may 
actually bring more retirement assets than demands to 
localities, and who may bring skills and experience into 
regional labor markets through ``bridge jobs'' in their 
retirement.
    Excellence: What makes this project exceptional?
    The report examines the regional dynamics of population 
change and aging in place and the economic development 
implications for a high poverty region.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    It examines both the regional actuarial demands of an aging 
population and the potential economic development opportunities 
of the younger cohort of the senior population.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    It has been used by the Local Development Districts for 
policy and planning purposes in both retirement destination 
communities, as well as fiscally strapped communities in the 
northern sub-region of Appalachia.
    Innovativeness: Why is this research exciting or 
newsworthy?
    It examines both the regional actuarial demands of an aging 
population and the potential economic development opportunities 
of the younger cohort of the senior population. This finding 
is, by and large, lacking in most journalistic and policy 
discussions of the implications of aging.

 Office of the Assistant Secretary for Planning and Evaluation: Adult 
                              Day Services

    This study of adult day services (ADS) examined the role of 
ADS in state long-term care systems and identified operational 
and regulatory issues facing providers.
    Lead Agency: Office of the Assistant Secretary for Planning 
and Evaluation, U.S. Department of Health and Human Services.
    Agency Mission: The Assistant Secretary for Planning and 
Evaluation advises the Secretary of the Department of Health 
and Human Services on policy development in health, disability 
and aging, human services, and science and data policy, and 
provides advice and analysis on economic policy. The Office of 
the Assistant Secretary for Planning and Evaluation (OASPE) 
leads special initiatives, coordinates the Department's 
evaluation, research and demonstration activities, and manages 
cross-Department planning activities such as strategic 
planning, legislative planning and review of regulations. 
Integral to this role, OASPE conducts research and evaluation 
studies, develops policy analyses, and estimates the cost and 
benefits of policy alternatives under consideration by the 
Department or Congress.
    Principal Investigator: Janet O'Keeffe, Dr. P.H., R.N., 
Program on Aging, Disability, and Long-Term Care, Research 
Triangle Institute, 3040 Cornwallis Road, Research Triangle 
Park, NC 27709-2194.
    General Description:

  ADULT DAY SERVICES: A KEY COMMUNITY SERVICE FOR OLDER ADULTS AND A 
                REGULATORY REVIEW OF ADULT DAY SERVICES

    Adult Day Services (ADS) are community long-term services 
provided outside an individual's home that consist of 
therapeutic activities and assistance with activities of daily 
living. These services often also meet family caregivers' needs 
for respite care or to enable them to work. States are 
interested in the potential of adult day services to reduce 
health care costs, and prevent or delay nursing home placement. 
Although promoted as community-based service for older persons, 
little was known about the provision, use, or outcomes of adult 
day services prior to this study. This research identified 
operational and regulatory issues facing adult day service 
providers, and provided information to guide future research 
and policy analysis.
    The purpose of this study was threefold: to inform 
policymakers about the current and potential role of ADS in the 
health care and long-term care systems as determined by state 
regulation; to identify operational and regulatory issues 
facing ADS providers under different ADS models and in 
different regulatory and financing environments; and to provide 
information that can guide future research and policy analysis 
on ADS for elderly persons.
    The study used several qualitative research methods, 
including: an in-depth review of state approaches to regulating 
ADS; consultation with a Technical Advisory Group, subject 
experts, state regulatory and Medicaid staff, and state 
provider associations; and site visits to ADS providers in five 
states: Georgia, Illinois, Maryland, North Carolina, and 
Washington.
    Excellence: What makes this project exceptional?
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Innovativeness: Why is this research exciting or 
newsworthy?
    While State and Federal long-term care spending on home and 
community services has increased significantly in recent years, 
most of the research and policy literature on home- and 
community-based services for elderly persons has focused on 
home care and residential care. Less attention has been paid to 
adult day services (ADS)--a nonresidential community service 
provided outside the home.
    Little is known about the provision, use, or outcomes of 
ADS, particularly the medical model, and the ADS industry's 
capacity to provide health services. Research has been hampered 
by the considerable variation in the characteristics of ADS 
programs both within and across States, and by a lack of data.
    ADS programs are of interest to States because of their 
potential to delay or prevent nursing home placement, in large 
part by supporting informal caregiving. Informal caregivers are 
the backbone of the nation's long-term care system. Over seven 
million Americans provide 120 million hours of care to about 
4.2 million elderly persons with functional limitations each 
week. The estimated economic value of this care ranges from 
$45-$96 billion a year. Research has found that caregivers who 
experience stress and burden are more likely to 
institutionalize relatives suffering from dementia. Once the 
physical resources of caregivers decline and other home and 
community resources (paid or unpaid) are unavailable, nursing 
home placement is more likely. Many caregivers who use ADS are 
providing care to family members with dementia who need 
constant supervision to assure their safety. The respite 
provided by ADS is thought to lessen the caregiving burden, 
making it possible to delay nursing home admission.
    All States fund some form of ADS through a Medicaid State 
plan or a waiver programs States are interested in the 
potential of ADS to reduce health care costs by providing 
health monitoring, preventive health care, and timely provision 
of primary care, particularly for individuals at risk for 
incurring high medical costs. These include elderly individuals 
who are dually eligible for Medicare and Medicaid--called dual 
eligibles--who comprised 18 percent of all Medicare 
beneficiaries in 2000, but accounted for 24 percent of total 
Medicare spending. Similarly, in 2002, they represented 16 
percent of all Medicaid enrollees but 42 percent of program 
spending.
    Adult day services are relatively inexpensive compared to 
home care or nursing home care. However, the study identified a 
number of barriers to the use of these services. High cost or 
the lack of transportation is a major impediment to the use of 
adult day services. The study also found that adult day service 
providers have difficulty covering their costs solely through 
private payments and public program reimbursements. Nearly all 
providers receive a significant portion of their operating 
revenue through Medicaid or other public funding sources, but 
these reimbursements generally do not cover providers' costs. 
Many programs rely on volunteers, in-kind contributions and 
charitable donations to subsidize their operations.

 Office of the Assistant Secretary for Planning and Evaluation: Pilot 
                     Study of Technology and Aging

    This project developed an 8-10 minute modular survey to 
measure the existence, addition, and use of assistive devices 
and home modifications by older adults. The survey instrument 
was determined to have good statistical properties (i.e., good 
validity and reliability) and a version of the survey was 
included as part of the 2006 Health and Retirement Study.
    Lead Agency: Office of the Assistant Secretary for Planning 
and Evaluation, U.S. Department of Health and Human Services.
    Agency Mission: The Assistant Secretary for Planning and 
Evaluation advises the Secretary of the Department of Health 
and Human Services on policy development in health, disability 
and aging, human services, and science and data policy, and 
provides advice and analysis on economic policy. The Office of 
the Assistant Secretary for Planning and Evaluation (OASPE) 
leads special initiatives, coordinates the Department's 
evaluation, research and demonstration activities, and manages 
cross-Department planning activities such as strategic 
planning, legislative planning and review of regulations. 
Integral to this role, OASPE conducts research and evaluation 
studies, develops policy analyses, and estimates the cost and 
benefits of policy alternatives under consideration by the 
Department or Congress.
    Principal Investigator: Vicki A. Freedman, Ph.D., 
Professor, Department of Health Systems and Policy, School of 
Public Health, University of Medicine and Dentistry of New 
Jersey, 683 Hoes Lane West, P.O. Box 9, Room 312, Piscataway, 
NJ 08854.
    Partner Agency: National Center for Health Statistics, 
Centers for Disease Control and Prevention, National Institute 
on Aging, University of Medicine and Dentistry of New Jersey, 
Johns Hopkins University, and The Urban Institute.
    General Description:

                  PILOT STUDY OF TECHNOLOGY AND AGING

    Assistive technologies and home modifications can help 
older Americans with disabilities and chronic illnesses live 
independently in the community. Having good information on the 
home environment and the prevalence and use of assistive 
devices is therefore critical to policymakers seeking to 
promote the independence of the elderly; however, national 
surveys have rarely collected this type of information and we 
have little knowledge about the extent to which technology 
mitigates disability and enhances the lives of older persons.
    In 2003, the Office of the Assistant Secretary for Planning 
and Evaluation, in conjunction with the National Center for 
Health Statistics and the National Institute on Aging, began a 
project to develop, pilot, and disseminate a new survey on 
assistive technology use and the home environment. The goal was 
to develop a set of questions that could be easily added to 
existing or new surveys that would better capture the 
population at-risk for a disability because of an environmental 
barrier or lack of modification to the home, and track the 
adoption and use of assistive devices and technology. The new 
instrument could better address key questions such as: what 
role do assistive technologies and home modifications play in 
the lives of older Americans?; how extensively are they used?; 
and ultimately, how effective is assistive technology in 
increasing older American's well-being, social engagement, and 
participation in valued activities?
    After extensive design, pilot testing, and evaluation, a 
final 8-10 minute survey instrument was developed that included 
five modules: home environment, mobility and other devices, 
effectiveness, information and communication technology, and 
residual activity of daily living/ instrumental activity of 
daily living difficulty. A shorter version of the survey 
instrument that could be administered in 2-3 minutes was also 
developed. The full instrument was included as part of a module 
on the 2006 Health and Retirement Study (HRS), a nationally 
representative survey of the noninstitutionalized population 
age 50 and older living in the U.S. Preliminary findings 
indicate that a substantial portion of the HRS sample has 
access to or uses assistive devices/home modifications. For 
example, approximately two-thirds of the sample report having 
at least one assistive home feature (e.g., a ramp at their 
home's entrance, emergency call system, grab bars in shower/
tub, raised toilet seat, etc.); one-third reported adding at 
least one of these features to their home; and assistive home 
features were shown to enable independent performance of 
activities. A final report more fully describing the findings 
form the HRS will be available in late 2008.

 Office of the Assistant Secretary for Planning and Evaluation: Report 
                   to Congress on Advance Directives

    The Report to Congress on Advance Directives will provide a 
set of recommendations based on findings from the literature 
review, in-depth commissioned papers and the roundtable 
discussions on how best to improve advance directive use and 
advance care planning as a means of expressing wishes for end-
of-life care.
    Lead Agency: Office of the Assistant Secretary for Planning 
and Evaluation, U.S. Department of Health and Human Services.
    Agency Mission: The Assistant Secretary for Planning and 
Evaluation advises the Secretary of the Department of Health 
and Human Services on policy development in health, disability 
and aging, human services, and science and data policy, and 
provides advice and analysis on economic policy. The Office of 
the Assistant Secretary for Planning and Evaluation (OASPE) 
leads special initiatives, coordinates the Department's 
evaluation, research and demonstration activities, and manages 
cross-Department planning activities such as strategic 
planning, legislative planning and review of regulations. 
Integral to this role, OASPE conducts research and evaluation 
studies, develops policy analyses, and estimates the cost and 
benefits of policy alternatives under consideration by the 
Department or Congress.
    Principal Investigator: Lisa R. Shugarman, Ph.D., Health 
Policy Researcher, RAND Corporation, 1776 Main Street, PO Box 
2138, Santa Monica, CA 90094.
    Partner Agency: ABA Commission on Law and Aging, Center for 
Practical Bioethics, Yeshiva University.
    General Description:

                REPORT TO CONGRESS ON ADVANCE DIRECTIVES

    Over the past century, the experience of dying has changed 
tremendously. At the beginning of the 1900s, the majority of 
people died at home, usually from a sudden illness or injury. 
Now, the majority of Americans die of chronic, progressive 
illnesses often with prolonged periods of physical dependency 
(Peres & Kaplan, 2002). Over a decade of research has 
documented that dying in America is painful, isolating and 
costly (SUPPORT, 1995; IOM, 1997; Hogan et al., 2001). A key 
predictor of good end-of-life care is whether people have 
articulated about their preferences ahead of a crisis. This is 
known as advance care planning. Advance directives are the 
cornerstone of advance planning and these directives consist of 
a person's oral and written instructions about his or her 
future medical care in the event that he or she becomes unable 
to communicate or becomes incompetent to make health care 
decisions. There are two types of advance directives: a living 
will and a health care power of attorney/health care proxy. 
Living wills (sometimes called medical directives) are written 
instructions for care in the event that a person is not able to 
make medical decisions for him or herself (Fagerlin, 2004). The 
health care proxy or surrogate is a document by which the 
patient appoints a trusted person to make decisions about his 
or her medical care if he or she cannot make those decisions.
    Congress enacted the Patient Self-Determination Act (PSDA) 
in 1990 to encourage competent adults to complete advance 
directives. The PSDA requires all health care facilities 
receiving Medicare or Medicaid reimbursements to ask if 
patients have advance directives, to provide information about 
advance directives, and to incorporate advance directives into 
the medical record (PSDA, 1990). Unfortunately, waiting until 
the crisis of admission to a facility is not the ideal setting 
for developing an advance care plan.
    In recognition of the need for greater understanding of 
advance care planning, the Health Education and Labor Committee 
2006 Appropriations provided for the Secretary of Health and 
Human Services (HHS) to develop a Report to Congress on advance 
directives. As provided, Public Law 109-149 ``* * * directs the 
Secretary to conduct a study to determine the best way to 
promote the use of advance directives among competent adults as 
a means of specifying their wishes about end-of-life care and 
provide recommendations to Congress on changes to federal law 
needed to ensure appropriate use of advance directives.'' The 
Secretary is instructed to involve persons with disabilities 
and identify options for people with cognitive disabilities as 
well.
    The Office of the Assistant Secretary for Planning and 
Evaluation contracted with RAND to commission a literature 
review, topic-specific papers on: (1) the historical and 
current legal issues with advance directives; (2) advance care 
planning among persons with intellectual and physical 
disabilities; and (3) public engagement with advance 
directives. In addition, we held Roundtable Discussion meetings 
with advance care planning experts, and included an emphasis on 
people with disabilities. This background work will form the 
basis for the report from the Secretary of HHS to Congress 
outlining the recommendations on how best to promote advance 
directives.
    Excellence: What makes this project exceptional?
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Innovativeness: Why is this research exciting or 
newsworthy?
    The literature review examines the empirical evidence about 
the degree to which advance directives and advance care 
planning have met their intended goals. The report is one of 
the most comprehensive reviews of what the medical literature 
reports concerning the use of advance directives and advance 
care planning, disparities among groups in their use, and 
interventions to enhance the use and value of advance 
directives and advance care planning.
    Of the 2.5 million people who die in the U.S. each year, 
about 85 percent are Medicare beneficiaries (Hogan et al., 
2001). A recent Centers for Medicare and Medicaid Services 
(CMS) report on Medicare spending in the last year of life 
indicated that expenditures have steadily increased from 26% of 
total expenditures in 1994 to 29% in 1999 (CMS, 2005). Although 
considerable sums are spent on prolonging life, relatively 
little is spent for pain relief, quality of remaining life and 
emotional support for older persons and their families.
    In addition, the concerns, perspectives, and values of 
people with disabilities have often been overlooked in the 
research, programs, and policies regarding advance directives, 
advance care planning, and end-of-life care more generally. 
While the process for advance care planning for people with 
physical and intellectual disabilities is the same as for non-
disabled people, there are unique community perspectives and 
issues to be addressed in policies seeking to promote such 
plans.
    The Patient Self-Determination Act (PSDA) requires that all 
health care facilities receiving Medicare or Medicaid 
reimbursements must inform patients of their rights to make 
choices about the treatment they receive and to prepare advance 
directives. Advance directives are not only focused on what 
treatments one does not want, they are equally applicable and 
viable to indicate all of the treatments that one wants. Our 
Report to Congress will recommend strategies to help strengthen 
the advance care planning process for elders, people with 
disabilities and their families.
    Generally, the research suggests that even when advance 
directives are executed, physicians are frequently unaware of 
them, advance directives are not easily available to surrogates 
when needed, advance directives are too general and/or are 
inapplicable to clinical circumstances, and/or they are invoked 
late in the dying process or are at times over-ridden by 
providers and families. Only in the context of a comprehensive 
community effort do advance directives and advance care 
planning appear to substantially change care at the end of 
life. Despite the weakness of advance directives as an 
individual intervention, research points to promising 
interventions.

Office of the Assistant Secretary for Planning and Evaluation, Ensuring 
 a Qualified Long-Term Care Workforce: From Pre-Employment Screens to 
                         On-the-Job Monitoring

    This study examined different state approaches to screening 
and monitoring long-term care workers for criminal background 
and history of elder abuse and the efficacy of these 
approaches.
    Lead Agency: Office of the Assistant Secretary for Planning 
and Evaluation, U.S. Department of Health and Human Services.
    Agency Mission: The Assistant Secretary for Planning and 
Evaluation advises the Secretary of the Department of Health 
and Human Services on policy development in health, disability 
and aging, human services, and science and data policy, and 
provides advice and analysis on economic policy. The Office of 
the Assistant Secretary for Planning and Evaluation (OASPE) 
leads special initiatives, coordinates the Department's 
evaluation, research and demonstration activities, and manages 
cross-Department planning activities such as strategic 
planning, legislative planning and review of regulations. 
Integral to this role, OASPE conducts research and evaluation 
studies, develops policy analyses, and estimates the cost and 
benefits of policy alternatives under consideration by the 
Department or Congress.
    Principal Investigator: Karen W. Linkins, Ph.D., Vice 
President, The Lewin Group, 3130 Fairview Park Drive, Suite 
800, Falls Church, VA 22042.
    Partner Agencies: HHS Office of the Inspector General, 
Centers for Medicare and Medicaid Services (CMS), Federal 
Bureau of Investigations (FBI), U.S. Department of Justice, 
Nursing Home Initiative, U.S. Health Resources and Services 
Administration (HRSA), Kansas Department of Health and 
Environment, San Diego Prosecutors Office.
    General Description:

  ENSURING A QUALIFIED LONG-TERM CARE WORKFORCE: FROM PRE-EMPLOYMENT 
                    SCREENS TO ON-THE-JOB MONITORING

    There has been renewed focus on reducing the incidence of 
elder abuse, especially in long-term care facilities. One 
commonly suggested solution is more rigorous background 
screenings and monitoring of long-term care workers. However, 
the efficacy and cost effectiveness of such interventions is 
not known.
    This project examined the efficacy of various approaches to 
pre-employment screening and on-the-job monitoring of nurse 
assistants to prevent resident abuse in nursing homes. The goal 
was to inform policymakers, providers, consumers and other 
interested parties about the relative contributions and 
perceived effectiveness of existing federal mandates and state 
and provider-based strategies for preventing or reducing the 
abuse of vulnerable adults.
    Federal and state governments, education and training 
centers, and employers have created a variety of formal 
mechanisms aimed at preventing incidences of abuse, neglect and 
exploitation in nursing homes and other long-term care 
settings. These mechanisms can include certification and 
licensure of paraprofessional long-term care workers, various 
pre-employment screenings, (e.g., nurse aide registries, 
criminal background checks and drug tests), and on-the-job 
training and monitoring.
    The two primary methods used for pre-employment screening 
include checking nurse aide registries and conducting criminal 
background checks. Federal guidelines require each state to 
establish and maintain a registry of nurse aides that includes 
certification information and substantiated findings of abuse, 
neglect, or financial exploitation in nursing homes. Federal 
guidelines require nursing facilities to check their State 
nurse aide registry to ensure that hired nurse aides are 
certified to work and meet all state requirements, and that 
they do not have any substantiated findings of abuse, neglect 
or misappropriation associated with their license. In addition, 
long-term care facilities may check other relevant databases 
they believe will include any information on the potential 
employee (e.g., criminal background database).
    Some states, either through law or by choice, collect data 
beyond the scope mandated by federal requirements for 
maintaining nurse aide registries. For example, states 
registries may include data on certified and non-certified 
health care workers in addition to nurse aides, along with 
additional demographic information such as race/ethnicity, 
education level, or current employer.
    Previous studies have examined rates of abuse in nursing 
facilities, direct service worker capacity issues, and 
compliance of states to maintain nurse aide registries. This 
study looked across all of these issues, by examining the 
process states go through to collect and maintain information 
in their registries, state and employer mandated background 
check procedures, reporting and investigating policies/
practices when abuse allegations are made, and the impact of 
such processes on the direct service workforce, employers and 
state agencies.
    Excellence: What makes this project exceptional?
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Innovativeness: Why is this research exciting or 
newsworthy?
    Examining the efficacy of long-term care worker employment 
screening mechanisms (such as state nurse aide registries and 
criminal background checks) comes at a particularly relevant 
time. Recent federal studies highlight the urgency for the 
study from both a long-term care staffing perspective and from 
a quality care perspective. The Medicare Prescription Drug, 
Improvement, and Modernization Act (MMA) authorized a 
background check pilot program in seven states. Additionally, 
there have been numerous legislative proposals in recent years 
to address long-term care worker screenings to prevent elder 
abuse in long-term care. However, the efficacy and cost 
effectiveness of such interventions is not clear. Nor is there 
information on the impact that more rigorous background 
screenings might have on the supply of long-term care workers.
    The goal of this study was to examine current practices at 
the state and facility levels regarding pre-employment 
screening and on-the-job monitoring, and how these influence 
the quality of the long-term care workforce.
    Extensive variation across states affected the ability of 
the researchers to make a definitive statement about the 
efficacy of these strategies to ensure a qualified workforce. 
The study's in-depth examination of four states revealed that 
some aspects of these systems work well, but limitations exist 
in each state that affects the overall utility of these 
practices. The technology, coordination capabilities and 
infrastructure exist through on-line registries, fingerprint 
databases and abuse registries to help employers make the best 
hiring decisions possible to protect the elderly in their care. 
States are building on their knowledge, experience, and 
capabilities to streamline these processes, but there is still 
room for improvement while balancing the resource intensiveness 
of making these changes.
    Key findings from the study:
    Criminal background checks are a valuable tool for 
employers during the hiring process and their use does not 
limit the pool of potential job applicants. None of the nursing 
facilities experienced any negative impact on their applicant 
pool as a result of this requirement.
    A correlation exists between criminal history and 
incidences of abuse. Based on data from Arizona and Kansas, it 
does appear that nurse aides who had a previous criminal 
conviction (non-disqualifying offense) had higher rates of 
substantiated abuse than nurse aides without a criminal 
history.
    Criminal background checks are only one component of 
preventing abuse. Other effective strategies for preventing 
abuse include: adequate supervision/monitoring, presence of 
managers on the floor, decreasing staff burnout, adequate 
staffing levels, rotating nurse aides on the floor to alleviate 
pressure of difficult residents, increased education and 
training, obtaining meaningful employment references (beyond 
verification of employment dates), instituting a drug-free 
workplace policy, minimizing temporary hires, and pointing out 
negative behaviors in the moment and using them as a staff 
development opportunity.
    There are fewer policies in place that support or reinforce 
post-employment strategies to ensure a qualified workforce. 
Most states have no process in place to notify employers if an 
active employee commits a crime that would have prohibited them 
from working during their background check prior to employment. 
One innovative state program monitors criminal behavior of 
individuals working in positions of direct care and service of 
potentially vulnerable populations (nursing facilities, home 
health, child care agencies, etc.) While the program is an 
exemplar, it also illustrates that such on-going monitoring 
requires significant commitment of resources and participation 
across agencies.
    Previous studies on this issue have examined rates of abuse 
in nursing facilities, direct service worker capacity issues, 
and compliance of states to maintain nurse aide registries. 
This study is unique because it looked across all of these 
issues and provides valuable information to states considering 
changes to their long-term care worker requirements to prevent 
elder abuse.

    Office of the Assistant Secretary for Planning and Evaluation: 
 Specification of the Long Term Care Nursing Home (LTC-NH) Electronic 
            Health Record System (EHR-S) Functional Profile

    This project, sponsored by the Office of the Assistant 
Secretary for Planning and Evaluation (ASPE), in conjunction 
with significant private support, identified the LTC-NH EHR-S 
Functional Profile. The Functional Profile has been shared with 
HL7 and CCHIT.
    Lead Agency: Office of the Assistant Secretary for Planning 
and Evaluation, U.S. Department of Health and Human Services.
    Agency Mission: The Assistant Secretary for Planning and 
Evaluation advises the Secretary of the Department of Health 
and Human Services on policy development in health, disability 
and aging, human services, and science and data policy, and 
provides advice and analysis on economic policy. The Office of 
the Assistant Secretary for Planning and Evaluation (OASPE) 
leads special initiatives, coordinates the Department's 
evaluation, research and demonstration activities, and manages 
cross-Department planning activities such as strategic 
planning, legislative planning and review of regulations. 
Integral to this role, OASPE conducts research and evaluation 
studies, develops policy analyses, and estimates the cost and 
benefits of policy alternatives under consideration by the 
Department or Congress.
    Principal Investigator: Jennie Harvell, M. Ed., Senior 
Policy Analyst, Department of Health and Human Services, Office 
of the Assistant Secretary for Planning and Evaluation, 200 
Independence Ave., SW., Room 424E, Washington, DC 20201; 
Michelle Dougherty, MA, RHIA, CHP, Director, Practice 
Leadership, American Health Information Management Association; 
Nathan Lake, RN, BSN, MSHA, Director, Clinical Design, American 
HEALTHTECH; Sue Mitchell, RHIA, Director of Clinical Systems, 
Omnicare Information Solutions, 5148 Blacklick Eastern Rd. NW, 
Baltimore, OH 43105; and Hugh McDonough, Senior Associate, Abt 
Associates, 55 Wheeler Street, Cambridge, MA 02138.
    Partner Agencies: American Association of Homes and 
Services for the Aging/Center for Aging Services Technology 
(AAHSA/CAST), American Health Care Association/National Centers 
for Assisted Living (AHCA/NCAL), American Health Information 
Management Association (AHIMA), and National Association for 
the Support of Long Term Care (NASL).
    General Description: Specification of the Long Term Care 
Nursing Home (LTC-NH) Electronic Health Record System (EHR-S) 
Functional Profile.
    Consensus has emerged that interoperable health information 
technology (HIT) and electronic health records (EHRs) are 
needed to improve quality, safety, and effectiveness of health 
care while simultaneously enhancing efficiency and reducing 
costs.
    The HHS 2004 report entitled, ``The Decade of Health 
Information Technology--Framework for Strategic Action'' 
recommended establishing private sector certification of HIT 
products to reduce the risk of product failure and increase the 
uptake of EHR implementation. HHS subsequently authorized and 
funded the Certification Commission for Healthcare Information 
Technology (CCHIT) to specify certification criteria for 
electronic health records (EHRs) and to implement a process 
through which EHR products would be certified as meeting the 
certification criteria. In late 2006, HHS authorized and funded 
the CCHIT to expand its certification scope to begin addressing 
EHR products for nursing homes. In March 2007, CCHIT announced 
that nursing homes would be included in their ``Roadmap'' for 
expansion of product certifications. In specifying 
certification criteria for nursing home EHR products, CCHIT 
will draw heavily on the requirements published in the 2007 HL7 
EHR-System Functional Model (EHR-S FM) standard (also developed 
with ASPE funding), and industry specific requirements that are 
specified in a nursing home-specific Functional Profile.
    With the funding provided by ASPE and significant staff 
resources provided by the long-term care community, the public 
and private sector sectors specified the Long Term Care Nursing 
Home (LTC-NH) Electronic Health Record System (EHR-S) 
Functional Profile. The LTC-NH EHR-S Functional Profile 
identifies the subset of functions from the HL7 EHR-S FM that 
reflects the unique aspects and needs for EHR systems in the 
long term care-nursing home setting. The LTC-NH EHR-S 
Functional Profile identifies needed EHR functions and criteria 
in the domains of direct care, supportive services, and 
information infrastructure.
    The LTC-NH EHR-S Functional Profile has been registered by 
HL7 and will be balloted as an industry standard.
    The LTC-NH EHR-S Functional Profile has also been sent to 
CCHIT to help inform their efforts related to certification of 
nursing home EHR products. CCHIT will use the LTC EHR-S 
Functional Profile as a reference as they develop the 
functionality, interoperability, and security requirements for 
certified nursing home EHR system products.
    Excellence: What makes this project exceptional?
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Innovativeness: Why is this research exciting or 
newsworthy?
    The LTC-NH EHR-S Functional Profile represents the best 
efforts of a broad array of long term care professionals and 
stakeholders from the public and private sectors to derive 
functional requirements and timelines for these requirements 
for EHR systems in nursing homes using the HL7 EHR-S Functional 
Model. The LTC-NH EHR-S Functional Profile will be undergoing 
balloting by HL7 Electronic Health Record Technical Committee 
to become an industry standard. The LTC-NH EHR-S Functional 
Profile has been sent to the Certification Commission for 
Health Information Technology (CCHIT) to help inform their 
efforts as they specify certification criteria for nursing home 
EHR products and begin to certify nursing home EHRs as meeting 
these criteria. CCHIT is expected to begin certifying NH EHRs 
in 2009.
    The development of the Functional Profile, the anticipated 
recognition by HL7 of the LTC-NH EHR-S Functional Profile as an 
industry standard, and the use of the LTC-NH EHR-S Functional 
Profile by CCHIT in specifying the certification criteria for 
NH EHRs is expected to inform nursing home providers of the EHR 
functionality they could acquire, and will provide a roadmap 
for nursing home HIT vendors as to the type of functionality 
that certified products will be required to meet and when. Such 
information is expected to encourage and accelerate 
implementation of interoperable EHRs by nursing home providers. 
Use of interoperable EHRs is expected to support needed quality 
and continuity of care improvements, efficiency gains, and cost 
reductions.

Office of the Assistant Secretary for Planning and Evaluation: National 
                          Data on Elder Abuse

    This research will inform a report to Congress from the 
Secretary of Health and Human Services, which will address the 
feasibility of collecting uniform national data on elder abuse.
    Lead Agency: Office of the Assistant Secretary for Planning 
and Evaluation, U.S. Department of Health and Human Services.
    Agency Mission: The Assistant Secretary for Planning and 
Evaluation advises the Secretary of the Department of Health 
and Human Services on policy development in health, disability 
and aging, human services, and science and data policy, and 
provides advice and analysis on economic policy. The Office of 
the Assistant Secretary for Planning and Evaluation (OASPE) 
leads special initiatives, coordinates the Department's 
evaluation, research and demonstration activities, and manages 
cross-Department planning activities such as strategic 
planning, legislative planning and review of regulations. 
Integral to this role, OASPE conducts research and evaluation 
studies, develops policy analyses, and estimates the cost and 
benefits of policy alternatives under consideration by the 
Department or Congress.
    Principal Investigator: Karen Linkins, Project Director, 
Sharon Zeruld, Project Manager, Bernadette Wright, Associate, 
Sarah Lash, Associate, The Lewin Group, 3130 Fairview Park Dr., 
Suite 800, Falls Church, VA 22042.
    Partner Agencies: Department of Justice, Administration on 
Aging, and Centers for Disease Control.
    General Description: Congress directed the Secretary of the 
Department of Health and Human Services (HHS) to conduct a 
study, in consultation with the Attorney General, assessing 
current elder abuse data collection systems and examining the 
feasibility of establishing a uniform national elder abuse 
database to improve the quality and accessibility of data (P.L. 
109-432). To develop the basis for its report to Congress, the 
HHS Office of the Assistant Secretary for Planning and 
Evaluation (ASPE) contracted with The Lewin Group, and 
subcontractor Dr. Catherine Hawes, to conduct research to 
address these issues.
    A focused literature review and inventory of existing elder 
abuse data collection and reporting efforts represents one 
component of that research. Findings are based on a review of 
the published literature on elder abuse data collection and 
reporting as well as information gleaned from telephone 
discussions with over 30 experts in related fields. This review 
addresses the following questions:
    a. How is elder abuse currently defined in Federal and 
state laws and by researchers and other organizations?
    b. How have studies measured the prevalence and incidence 
of elder abuse, and what are the strengths, challenges and 
limitations of these studies?
    c. What are the current practices in investigating, 
substantiating, and reporting elder abuse at the Federal, 
state, and local levels?
    d. How do confidentiality laws and policies affect the 
sharing of information about elder abuse among agencies?
    e. What are the shortcomings and strengths of existing data 
collection and reporting efforts?
    f. How are data collected on child abuse and intimate 
partner violence? How have these fields addressed challenges 
such as underreporting, differing definitions, and difficulties 
in detecting abuse?
    g. What state practices have been developed to enhance 
elder abuse reporting, investigation, and data collection?
    Based on the findings, the report identifies areas that 
will need to be addressed in determining the feasibility of a 
national elder abuse database. The project's other major 
activities include: developing a memorandum that outlines key 
issues and approaches for establishing a uniform national 
dataset on elder abuse; obtaining input from government, 
research, advocacy, and industry experts; and preparing a 
report that synthesizes all findings and discusses implications 
for implementing a uniform national database on elder abuse.
    This project will inform a report to Congress to be issued 
by the Secretary of HHS.
    Older adults can be vulnerable to abuse, neglect, and 
financial exploitation perpetrated by caregivers, others in 
positions of trust, and relative strangers, as well as self-
neglect. The true incidence of elder abuse in the United States 
is unknown, although several studies have attempted to measure 
the scope of the problem. Chronic underreporting and a lack of 
a standard definition are commonly reported problems that make 
it difficult to report precise figures. However, most experts 
agree that elder mistreatment is a large and growing problem 
that has only recently begun to attract the public attention it 
deserves.
    The scope and purpose of definitions of elder abuse vary 
across states and local agencies, and data collection methods 
are similarly diverse, complicated by the involvement of many 
autonomous agencies operating under different mandates.
    A national database or consistent national data collection 
strategy on elder abuse data have been recommended as possible 
solutions to the problems associated with varying and 
uncoordinated state and local data collection and reporting 
systems. As early as 1992, the Department of Health and Human 
Services (HHS) Secretary's Task Force on Elder Abuse 
recommended the development and funding of a national elder 
abuse research and data collection strategy. More recently, a 
number of studies have recommended increased standardization of 
elder abuse definitions and data collection systems.
    This study will inform a report to Congress from the 
Secretary of Health and Human Services on the feasibility of 
collecting uniform national data on elder abuse. It will inform 
an important debate among policymakers and lawmakers currently 
considering strategies for tackling the growing societal 
problem of elder abuse and mistreatment in the United States.

    Office of the Assistant Secretary for Planning and Evaluation: 
             Preventing Costly Falls Among Older Americans

    This demonstration, sponsored by the Office of the 
Assistant Secretary for Planning in conjunction with Bankers 
Life and Casualty Company and the John Hancock Life Insurance 
Company, will test whether a comprehensive falls prevention 
program will reduce the incidence of falls among older 
Americans and use of subsequent acute health and long-term care 
services.
    Lead Agency: Office of the Assistant Secretary for Planning 
and Evaluation, U.S. Department of Health and Human Services.
    Agency Mission: The Assistant Secretary for Planning and 
Evaluation advises the Secretary of the Department of Health 
and Human Services on policy development in health, disability 
and aging, human services, and science and data policy, and 
provides advice and analysis on economic policy. The Office of 
the Assistant Secretary for Planning and Evaluation (OASPE) 
leads special initiatives, coordinates the Department's 
evaluation, research and demonstration activities, and manages 
cross-Department planning activities such as strategic 
planning, legislative planning and review of regulations. 
Integral to this role, OASPE conducts research and evaluation 
studies, develops policy analyses, and estimates the cost and 
benefits of policy alternatives under consideration by the 
Department or Congress.
    Principal Investigator: Jessica Miller, Director of 
Analytic Services, LifePlans, Inc., 51 Sawyer Road, Suite 340, 
Waltham, MA 02453.
    Partner Agencies: Abt Associates, LifePlans, Inc., Bankers 
Life and Casualty Company, and John Hancock Life Insurance 
Company.
    General Description:

             PREVENTING COSTLY FALLS AMONG OLDER AMERICANS

    Falls constitute one of the most significant and common 
causes of injury and disability for the elderly. One in every 
three people age 65 and older living in the community falls 
during a year and fall-related injuries cost an estimated $17 
billion annually. Falls are also associated with subsequent 
admission to a nursing home and use of long-term care services. 
While there are numerous studies identifying the major risk 
factors associated with falling (e.g., poor muscle strength/
gait and balance, cognitive impairment, polypharmacy, and 
unsafe physical environment), there is virtually no research 
demonstrating the cost-effectiveness of comprehensive programs 
designed to reduce the incidence and impact of falls. This 
project will fill a significant research gap and answer a 
critical question posed by policymakers: can an affordable 
falls prevention program reduce the incidence of falls in the 
elderly and lower spending for acute health and long-term care 
services?
    The Office of the Assistant Secretary for Planning and 
Evaluation (OASPE) contracted with Abt Associates and 
LifePlans, Inc. in 2003 to design a demonstration to determine 
the cost-effectiveness of a fall prevention program for older 
Americans. After further refinement of the intervention, 
methodological approach and assessment instruments, OASPE began 
the next phase of the demonstration with LifePlans in 2006--the 
actual implementation and evaluation of the program. The 
demonstration uses a classic experimental design where a random 
sample of older persons receives a full falls-risk assessment 
and intervention (treatment) and others do not (control). 
Unlike other falls prevention programs, the demonstration will 
provide a comprehensive falls risk assessment (both via the 
telephone and in-person), clinical review of assessment 
findings, individualized action plan with specific 
recommendations, and periodic follow-up and case management. 
One of the unique aspects of the project is the partnership 
between the federal government and two well-known and 
established providers of long-term care insurance: Bankers Life 
and Casualty Company, and the John Hancock Life Insurance 
Company. Persons age 75 and older who have a long-term care 
insurance policy with one of the two companies will have the 
opportunity to participate in the demonstration, with 
approximately 5,600 persons divided into a treatment group and 
various control groups. Medicare claims data will be used as 
part of the demonstration, thereby allowing researchers to 
determine whether or not the falls prevention program reduces 
acute health care cost as well as long-term care expenses.

    Office of the Assistant Secretary for Planning and Evaluation: 
  Standardizing Assessments and Supporting Health Information Exchange

    This project, sponsored by the Office of the Assistant 
Secretary for Planning and Evaluation (ASPE), in conjunction 
with FORE/AHIMA and several collaborating experts will link 
required and recognized HIT standards to the MDSv3 and OASIS-C.
    Lead Agency: Office of the Assistant Secretary for Planning 
and Evaluation, U.S. Department of Health and Human Services.
    Agency Mission: The Assistant Secretary for Planning and 
Evaluation advises the Secretary of the Department of Health 
and Human Services on policy development in health, disability 
and aging, human services, and science and data policy, and 
provides advice and analysis on economic policy. The Office of 
the Assistant Secretary for Planning and Evaluation (OASPE) 
leads special initiatives, coordinates the Department's 
evaluation, research and demonstration activities, and manages 
cross-Department planning activities such as strategic 
planning, legislative planning and review of regulations. 
Integral to this role, OASPE conducts research and evaluation 
studies, develops policy analyses, and estimates the cost and 
benefits of policy alternatives under consideration by the 
Department or Congress.
    Principal Investigator: Michelle Dougherty, MA, RHIA, CHP, 
Director, Practice Leadership, American Health Information 
Management Association.
    Partner Agencies: Alschuler Associates, LLC, College of 
American Pathologists--SNOMED Terminology Solutions, Indiana 
University of Regenstrief Institute, Inc., Apelon, Inc., 
TerraStar Consulting, and Center for Aging Services Technology 
(CAST).
    General Description: Standardizing Assessments and 
Supporting Health Information Exchange.
    Consensus has emerged that interoperable health information 
technology (HIT) and electronic health records (EHRs) are 
needed to improve quality, safety, and effectiveness of health 
care while simultaneously enhancing efficiency and reducing 
costs. The use of HIT standards is needed to make 
interoperability a reality.
    Much of the national HIT policy focus has not considered 
the standards and HIT applications needed in long-term care, 
including nursing facilities (NFs) and home health agencies 
(HHAs).
    Each year in the U.S., thousands of NFs and HHAs provide 
services to millions of patients--many of whom are medically 
complex and frail requiring either short-term (post-acute) or 
long-term care. Caring for these individuals involves inter-
disciplinary teams of health care professionals and 
paraprofessionals in NFs and HHAs, millions of physician 
encounters each year, and frequent transitions in care in and 
out of NFs and HHAs and to other health care settings.
    Timely access to complete and useable health information is 
important in providing and improving quality and continuity of 
care provided to persons receiving NF and HHA services, and for 
increasing efficiencies in and the cost effectiveness of health 
care delivery to these individuals.
    CMS requires NFs and HHAs complete and electronically 
transmit federally-developed patient assessments: the Minimum 
Data Set (MDS) assessment and the Outcome and Assessment 
Information Set (OASIS), respectively. CMS will be updating 
these instruments to the MDSv3 and OASIS-C.
    Federally-required assessments are the backbone of HIT 
products available to NF/HHA providers. Presently, these 
assessments are not linked with HIT standards and HIT products 
used by most of these providers are not standardized. Linking 
accepted HIT standards to federally-required assessments is 
expected to enable NF/HHA providers to engage in interoperable 
health information exchange with hospitals and doctors to 
improve critical information sharing between the sectors, 
support quality and continuity of care improvements, increase 
efficiencies, and reduce costs.
    The Office of the Assistant Secretary for Planning and 
Evaluation has contracted with the Foundation of Research and 
Education (FORE) of the American Health Information Management 
Association (AHIMA) to apply recognized and required HIT 
standards to the MDSv3 and OASIS-C. FORE/AHIMA has convened 
several persons with expertise in HIT content and messaging 
standards, and expertise in the MDS and OASIS instruments to 
link required/recognized HIT standards to these patient 
assessment instruments.
    Excellence: What makes this project exceptional?
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Innovativeness: Why is this research exciting or 
newsworthy?
    The project to link accepted HIT standards to the emerging 
NF MDSv3 and HHA OASIS-C patient assessment instruments is 
exceptional in its focus on applying HIT standards to a key 
business function in NFs and HHAs. Much of the national HIT 
policy focus has not taken into account long-term care.
    This project will leverage standards that have been (i) 
recognized by the public and private sectors for use in 
exchanging health information, and (ii) required for use by the 
Secretary of HHS for Federal health care programs. Certain 
Federal health care programs (including Medicare) are required 
to use HIT systems and products that meet ``recognized 
interoperability standards'' as designated by the Secretary of 
HHS. This project will re-use and link applicable ``recognized 
interoperability standards'' to the MDSv3 and OASIS content and 
for the exchange of these assessments.
    In addition, the Secretary of HHS has required the use of 
accepted CHI (Consolidated Health Informatics) Standards by 
``all federal agencies in implementing new, and as feasible, 
updating existing health information technology systems.'' The 
accepted CHI standards include HIT standards for assessment 
content and for the exchange of assessment instruments. The CHI 
standards are consistent and compatible with the standards that 
have emerged from HITSP and recognized by the Secretary of HHS. 
This project will also link CHI-required standards to the MDSv3 
and OASIS-C.
    The LTC Community (NF and HHA providers, physicians, and 
vendors) have requested that LTC be included in the emerging 
Nationwide Health Information Network (NHIN) and have 
specifically requested the linkage to and use of these HIT 
standards of the MDSv3 and OASIS-C.
    Linking and using accepted and recognized HIT standards to 
federally-required assessments is a critical step that will 
enable NF/HHA providers to engage in interoperable health 
information exchange in the emerging NHIN, support quality and 
continuity of care improvements, increase efficiencies, and 
decrease costs.

Office of the Assistant Secretary for Planning and Evaluation: Modeling 
       the Decision To Purchase Private Long-term Care Insurance

    This project estimated how the purchase of private long-
term care insurance is influenced by various economic and 
demographic factors, including the effect of tax incentives. If 
all taxpayers could fully deduct premium expenses from income 
subject to federal income taxes, the number of older adults 
with coverage would increase by about 36 percent.
    Lead Agency: Office of the Assistant Secretary for Planning 
and Evaluation, U.S. Department of Health and Human Services.
    Agency Mission: The Assistant Secretary for Planning and 
Evaluation advises the Secretary of the Department of Health 
and Human Services on policy development in health, disability 
and aging, human services, and science and data policy, and 
provides advice and analysis on economic policy. The Office of 
the Assistant Secretary for Planning and Evaluation (OASPE) 
leads special initiatives, coordinates the Department's 
evaluation, research and demonstration activities, and manages 
cross-Department planning activities such as strategic 
planning, legislative planning and review of regulations. 
Integral to this role, OASPE conducts research and evaluation 
studies, develops policy analyses, and estimates the cost and 
benefits of policy alternatives under consideration by the 
Department or Congress.
    Principal Investigator: Richard W. Johnson, The Urban 
Institute, 2100 M Street, NW., Washington, DC 20037.
    General Description:

   MODELING THE DECISION TO PURCHASE PRIVATE LONG-TERM CARE INSURANCE

    Long-term care spending is expected to soar in coming 
decades as the population ages. Enhanced private insurance 
coverage of long-term care needs might ease the looming crisis. 
Raising private insurance coverage rates would increase the 
pool of funds set aside to finance future services and would 
reduce reliance on public resources. Enhanced private coverage 
could also protect families from catastrophic long-term care 
costs. Some policymakers have proposed expanding tax incentives 
for private long-term care coverage to stimulate demand.
    Like traditional medical insurance, private long-term care 
insurance is a financial contract whereby the insurer agrees to 
provide covered benefits in exchange for regular premium 
payments by the policyholder. Policies are guaranteed 
renewable, and premiums remain fixed over the life of the 
contract. However, rates can rise for an entire class of 
policyholders if insurers can demonstrate that their costs 
exceed premium revenue, and rate increases have been common in 
recent years.
    The analysis estimated hazard models of time to purchase 
private long-term care insurance as a function of the net 
benefit that individuals expect to derive from the policy. The 
net expected benefit is the difference between what 
policyholders expect to receive in benefit payouts from the 
plan over their lifetimes, in present value terms, and what 
they expect to pay into the plan in the form of premiums. The 
measure, which accounted for state-level fluctuations in 
premiums and Medicaid eligibility rules, varied widely across 
individuals.
    Data came primarily from the Health and Retirement Study 
(HRS), a nationally representative longitudinal survey of older 
Americans. The sample consisted of person-year observations 
between 1992 and 2004 on adults ages 51 to 61 in 1992 who did 
not have coverage in the previous year. The sample was 
restricted to respondents likely to satisfy long-term care 
insurers' underwriting restrictions and thus able to purchase 
private coverage.
    The net expected benefit of coverage significantly 
increased the likelihood of taking-up private long-term care 
insurance coverage, although the impact was modest. Every 
$1,000 increase in the net expected benefit of coverage would 
raise purchase probabilities by about 2.3 percent. Take-up 
rates also increased with age, education, health status, and 
the self-assessed probability of using nursing home care in the 
next year. They declined with the number of children, perhaps 
because children help with their parents' home care or help 
finance nursing home costs.
    Creating additional federal tax incentives for the purchase 
of private long-term care insurance would modestly boost take-
up rates. Take-up rates would rise to 19 percent if all 
taxpayers could fully deduct premium expenses from income 
subject to federal income taxes, representing about a 36 
percent boost in the number of older adults with coverage. The 
impact of tax incentives on private long-term care insurance 
would be concentrated among high-income taxpayers. Tax breaks 
would have very little impact on coverage rates for adults in 
the bottom half of the income distribution.

   Office of the Assistant Secretary for Planning and Evaluation: A 
 Profile of Medicaid Institutional and Community-Based Long-Term Care 
                                Service

    This project estimated how Medicaid long-term care is 
balanced between institutional and community-based care. 
Significant variation across states and age groups was found. 
The proportion of Medicaid long-term care expenditures that are 
for community-based services declines with age.
    Lead Agency: Office of the Assistant Secretary for Planning 
and Evaluation, U.S. Department of Health and Human Services.
    Agency Mission: The Assistant Secretary for Planning and 
Evaluation advises the Secretary of the Department of Health 
and Human Services on policy development in health, disability 
and aging, human services, and science and data policy, and 
provides advice and analysis on economic policy. The Office of 
the Assistant Secretary for Planning and Evaluation (OASPE) 
leads special initiatives, coordinates the Department's 
evaluation, research and demonstration activities, and manages 
cross-Department planning activities such as strategic 
planning, legislative planning and review of regulations. 
Integral to this role, OASPE conducts research and evaluation 
studies, develops policy analyses, and estimates the cost and 
benefits of policy alternatives under consideration by the 
Department or Congress.
    Principal Investigator: Audra T. Wenzlow, Ph.D., 
Mathematica Policy Research, Inc., 555 S. Forest Ave., Suite 3, 
Ann Arbor, MI 48104.
    General Description:

A PROFILE OF MEDICAID INSTITUTIONAL AND COMMUNITY-BASED LONG-TERM CARE 
SERVICE USE AND EXPENDITURES AMONG THE AGED AND DISABLED USING MAX 2002

    Since 1982, states have increasingly utilized Medicaid 
Section 1915(c) waivers and optional state community-based 
programs to shift long-term care for the aged and disabled from 
institutions to the community. New rules introduced under the 
Deficit Reduction Act (DRA) of 2005 provide states with even 
more flexibility to provide home and community-based long-term 
care services to their low-income populations. Two overarching 
goals underlie these policies: (1) to provide long-term care 
services more cost-effectively; and (2) to give aged and 
disabled people more options in how they receive their care.
    As baby boomers enter their senior years and increase the 
need for long-term care services nationally, information about 
how Medicaid community long-term care programs have functioned 
in the past will be critical for assisting states in choosing 
how to utilize the new options provided under the DRA. Until 
recently, only limited aggregate data and some national surveys 
have been available to examine Medicaid community-based long-
term care service use and compare it with use of institutional 
care. The Medicaid Analytic eXtract (MAX) data system produced 
by Centers for Medicare & Medicaid Services now enables much 
more detailed analyses of long-term care utilization and 
expenditures at the person level.
    This study evaluates the potential of using MAX Person 
Summary files to examine how successfully states have 
rebalanced their long-term care systems and how Medicaid 
enrollees who utilize community-based long-term care services 
differ from people in institutions. Data for 2002 were analyzed 
for 37 states that have reliable MAX long-term care data.
    In 2002, only 34 percent of Medicaid long-term care 
expenditures paid for persons served were for community-based 
services in 2002, while almost 59 percent of long-term care 
users used community-based services. National estimates mask 
significant variation across states. Community-based services 
accounted for over 60 percent of long-term care expenditures in 
Alaska and New Mexico but less than 12 percent in the District 
of Columbia and Mississippi. Use of community-based services 
among long-term care users ranged from 87 percent in Alaska to 
23 percent in Indiana.
    Institutional and community long-term care expenditures 
were much more balanced among young disabled Medicaid enrollees 
than their aged counterparts in 2002. Over half of long-term 
care expenditures were for community-based services among 
disabled enrollees but less than 20 percent were for community-
based care among those over 65. Community-based service 
expenditures as a share of total long-term care expenditures 
ranged from 50 percent for people under age 65, 31 percent for 
people between ages 65 and 74, 21 percent for people between 
ages 75 and 84, and 13 percent for those age 85 and older. 
Rates of community-based service utilization were higher but 
followed a similar pattern by age.
    People using both institutional and community-based 
services (6 percent of long-term care users) had higher average 
total Medicaid expenditures ($46,055) than users of 
institutional care only ($38,844) or community care only 
($24,966). Aged and disabled enrollees using Medicaid long-term 
care services accounted for 7.7 percent of all full-benefit 
Medicaid enrollees in our 37 sample states but represented over 
50 percent of their total Medicaid expenditures.

   Office of the Assistant Secretary for Planning and Evaluation: A 
 Profile of Medicaid Institutional and Community-Based Long-Term Care 
Service Use and Expenditures Among the Aged and Disabled Using MAX 2002

    This project estimated how Medicaid long-term care is 
balanced between institutional and community-based care. 
Significant variation across states and age groups was found. 
The proportion of Medicaid long-term care expenditures that are 
for community-based services declines with age.
    Lead Agency: Office of the Assistant Secretary for Planning 
and Evaluation, U.S. Department of Health and Human Services.
    Agency Mission: The Assistant Secretary for Planning and 
Evaluation advises the Secretary of the Department of Health 
and Human Services on policy development in health, disability 
and aging, human services, and science and data policy, and 
provides advice and analysis on economic policy. The Office of 
the Assistant Secretary for Planning and Evaluation (OASPE) 
leads special initiatives, coordinates the Department's 
evaluation, research and demonstration activities, and manages 
cross-Department planning activities such as strategic 
planning, legislative planning and review of regulations. 
Integral to this role, OASPE conducts research and evaluation 
studies, develops policy analyses, and estimates the cost and 
benefits of policy alternatives under consideration by the 
Department or Congress.
    Principal Investigator: Audra T. Wenzlow, Ph.D., 
Mathematica Policy Research, Inc., 555 S. Forest Ave., Suite 3, 
Ann Arbor, MI 48104.
    General Description:

A PROFILE OF MEDICAID INSTITUTIONAL AND COMMUNITY-BASED LONG-TERM CARE 
SERVICE USE AND EXPENDITURES AMONG THE AGED AND DISABLED USING MAX 2002

    Since 1982, states have increasingly utilized Medicaid 
Section 1915(c) waivers and optional state community-based 
programs to shift long-term care for the aged and disabled from 
institutions to the community. New rules introduced under the 
Deficit Reduction Act (DRA) of 2005 provide states with even 
more flexibility to provide home and community-based long-term 
care services to their low-income populations. Two overarching 
goals underlie these policies: (1) to provide long-term care 
services more cost-effectively; and (2) to give aged and 
disabled people more options in how they receive their care.
    As baby boomers enter their senior years and increase the 
need for long-term care services nationally, information about 
how Medicaid community long-term care programs have functioned 
in the past will be critical for assisting states in choosing 
how to utilize the new options provided under the DRA. Until 
recently, only limited aggregate data and some national surveys 
have been available to examine Medicaid community-based long-
term care service use and compare it with use of institutional 
care. The Medicaid Analytic eXtract (MAX) data system produced 
by Centers for Medicare & Medicaid Services now enables much 
more detailed analyses of long-term care utilization and 
expenditures at the person level.
    This study evaluates the potential of using MAX Person 
Summary files to examine how successfully states have 
rebalanced their long-term care systems and how Medicaid 
enrollees who utilize community-based long-term care services 
differ from people in institutions. Data for 2002 were analyzed 
for 37 states that have reliable MAX long-term care data.
    In 2002, only 34 percent of Medicaid long-term care 
expenditures paid for persons served were for community-based 
services in 2002, while almost 59 percent of long-term care 
users used community-based services. National estimates mask 
significant variation across states. Community-based services 
accounted for over 60 percent of long-term care expenditures in 
Alaska and New Mexico but less than 12 percent in the District 
of Columbia and Mississippi. Use of community-based services 
among long-term care users ranged from 87 percent in Alaska to 
23 percent in Indiana.
    Institutional and community long-term care expenditures 
were much more balanced among young disabled Medicaid enrollees 
than their aged counterparts in 2002. Over half of long-term 
care expenditures were for community-based services among 
disabled enrollees but less than 20 percent were for community-
based care among those over 65. Community-based service 
expenditures as a share of total long-term care expenditures 
ranged from 50 percent for people under age 65, 31 percent for 
people between ages 65 and 74, 21 percent for people between 
ages 75 and 84, and 13 percent for those age 85 and older. 
Rates of community-based service utilization were higher but 
followed a similar pattern by age.
    People using both institutional and community-based 
services (6 percent of long-term care users) had higher average 
total Medicaid expenditures ($46,055) than users of 
institutional care only ($38,844) or community care only 
($24,966). Aged and disabled enrollees using Medicaid long-term 
care services accounted for 7.7 percent of all full-benefit 
Medicaid enrollees in our 37 sample states but represented over 
50 percent of their total Medicaid expenditures.

Office of the Assistant Secretary for Planning and Evaluation: National 
                        Nursing Assistant Survey

    Our nation is facing a major shortage of health care 
workers who provide for the long term care needs of residents 
in nursing homes and other places. The National Nursing 
Assistant Survey is the first nationally representative study 
of nursing assistants working in U.S. nursing homes. This new 
survey provides information that can inform state and federal 
initiatives to recruit, retain, and expand the workforce, and 
could be used to examine the important role of workers in 
providing care to a growing elderly and chronically ill 
population.
    Lead Agency: Office of the Assistant Secretary for Planning 
and Evaluation, U.S. Department of Health and Human Services.
    Agency Mission: The Assistant Secretary for Planning and 
Evaluation advises the Secretary of the Department of Health 
and Human Services on policy development in health, disability 
and aging, human services, and science and data policy, and 
provides advice and analysis on economic policy. The Office of 
the Assistant Secretary for Planning and Evaluation (OASPE) 
leads special initiatives, coordinates the Department's 
evaluation, research and demonstration activities, and manages 
cross-Department planning activities such as strategic 
planning, legislative planning and review of regulations. 
Integral to this role, OASPE conducts research and evaluation 
studies, develops policy analyses, and estimates the cost and 
benefits of policy alternatives under consideration by the 
Department or Congress.
    Principal Investigator: Marie R. Squillace, Ph.D., Social 
Science Analyst, Office of the Assistant Secretary for Planning 
and Evaluation, Hubert H. Humphrey Building, Room 424E.20, 200 
Independence Avenue, SW., Washington, DC 20201.
    Partner Agency: National Center for Health Statistics, 
Centers for Disease Control and Prevention, Mathematica Policy 
Research, Inc., and Westat, Inc.
    General Description:

                   NATIONAL NURSING ASSISTANT SURVEY

    Our nation is facing a major shortage of health care 
workers who provide for the long-term care needs of residents 
in nursing homes and other places. Many direct care workers are 
leaving the field and too few are entering. Projections of a 
substantial health care workforce imbalance have motivated 
policymakers, providers, private foundations, and others to 
seek immediate and sustainable solutions to stabilize the 
health care workforce. Current demographic, economic and policy 
trends suggest that without serious intervention, the supply of 
health care workers could significantly worsen in the coming 
decades.
    The National Nursing Assistant Survey is the first 
nationally representative survey of nursing assistants working 
in U.S. nursing homes. This new survey provides information 
that will inform state and federal initiatives to recruit, 
retain, and expand the long-term care workforce. It also 
provides important information about the role of workers in 
caring for a growing elderly and chronically ill population. 
The survey collected information on whether workers plan to 
continue working in their present positions and what factors 
affect their decisions, including job satisfaction, nature of 
the work environment, training, advancement opportunities, 
benefits, working conditions, and personal or family demands. 
By identifying the priorities of nursing assistants, the survey 
can help identify ways to meet those priorities and how to 
prevent staffing shortages in the future.
    The survey design and implementation were made possible 
through collaborations with two independent research 
organizations, a national advisory group, and a sustained 
partnership with the National Center for Health Statistics, 
Centers for Disease Control and Prevention.
    Excellence: What makes this project exceptional?
    The National Nursing Assistant Survey represents a major 
advance in the data available about health care workers in U.S. 
nursing homes and provides a rich resource for evidence-based 
policy, practice and applied research initiatives. This survey 
can be linked to other existing data sets thereby expanding the 
usefulness of the data by enabling researchers to examine more 
comprehensive and complex relationships between worker, 
facility, resident, and community characteristics.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    The care of 1.5 million elderly and chronically ill persons 
in the United States is largely in the hands of nursing 
assistants--the individuals who provide eight out of every ten 
hours of care residents receive in nursing homes. Turnover of 
these direct care workers is high which profoundly decreases 
the quality of life and care of the residents. This research 
provides industry and policy leaders with information that is 
useful for improving the attractiveness of caregiving jobs and 
for reducing worker turnover.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    As at least 36 states currently consider workforce 
vacancies to be a serious issue, results from this research 
will provide an invaluable resource in federal and state labor, 
welfare and health policy discussions on expanding the pool of 
workers, and on reimbursement, regulation and program design. 
Ultimately, this will result in improvements in the quality of 
life and care of older Americans in U.S. nursing homes.
    Innovativeness: Why is this research exciting or 
newsworthy?
    The major advance of this survey over other studies is its 
use of a nationally representative sample of certified nursing 
assistants within a nationally representative sample of nursing 
homes. Previous studies have been of local or regional samples 
that were not representative of the country as a whole.

Office of the Assistant Secretary for Planning and Evaluation: Nursing 
              Home Divestiture and Corporate Restructuring

    Analyses of large national nursing home chains indicated a 
trend towards consolidation, with smaller chains operating in 
fewer states and, in some states, emergent regional chains 
replacing the national chains, particularly in Florida and 
Texas where malpractice litigation has been particularly acute.
    Lead Agency: Office of the Assistant Secretary for Planning 
and Evaluation, U.S. Department of Health and Human Services.
    Agency Mission: The Assistant Secretary for Planning and 
Evaluation advises the Secretary of the Department of Health 
and Human Services on policy development in health, disability 
and aging, human services, and science and data policy, and 
provides advice and analysis on economic policy. The Office of 
the Assistant Secretary for Planning and Evaluation (OASPE) 
leads special initiatives, coordinates the Department's 
evaluation, research and demonstration activities, and manages 
cross-Department planning activities such as strategic 
planning, legislative planning and review of regulations. 
Integral to this role, OASPE conducts research and evaluation 
studies, develops policy analyses, and estimates the cost and 
benefits of policy alternatives under consideration by the 
Department or Congress.
    Principal Investigator: David Stevenson, Ph.D., Department 
of Health Care Policy, Harvard Medical School, 180 Longwood 
Avenue, Boston, MA 02115.
    General Description:

          NURSING HOME DIVESTITURE AND CORPORATE RESTRUCTURING

    Over the past two decades, the nursing home industry has 
experienced changes in the financial, regulatory, and 
competitive environments. Nursing homes have been greatly 
impacted by federal and state policies, such as the regulatory 
reforms of the Omnibus Budget Reconciliation Act of 1987 and 
the payment reforms of the Balanced Budget Act of 1997. 
Occupancy rates have fallen in the context of shortened lengths 
of stay for residents and increased competition from assisted 
living facilities and other home and community-based care. 
Medicaid payment rates vary substantially across states and 
have gone through periods of relative generosity and parsimony. 
Nursing home malpractice litigation has increased, leading to 
an increase in overall operating costs, especially in a handful 
of states.
    Responding to these and other policy and market factors, 
the nation's largest nursing home chains have undergone periods 
of considerable expansion, contraction, and retrenchment. The 
role of chain providers, which represent more than half of all 
facilities, is significant in the nursing home industry. To 
investigate these issues further, the Assistant Secretary of 
Planning and Evaluation (ASPE) contracted with Harvard Medical 
School to study recent trends in nursing home divestiture and 
corporate restructuring of the nation's largest nursing home 
chains.
    After a review of the literature and analyses of On-line 
Survey, Certification, and Reporting (OSCAR) data, the final 
report describes the trends in nursing home ownership by 
national chains over the past decade and discusses policy 
implications. The literature review identified the policy and 
market incentives that led the nursing home industry and 
especially national chains to expand substantially. The 
generous cost-based reimbursement policies attracted investment 
in the industry and encouraged substantial merger and 
acquisition activities. The review highlighted several 
challenges that followed when market conditions were less 
favorable, leading highly leveraged chains to bankruptcy, 
divestiture, and corporate restructuring.
    The outcome of these challenges is a national chain sector 
that is smaller and has a different focus than 10 years ago. 
Government financing remains vital, with corporate structure 
also heavily influenced by factors such as litigation, state 
reimbursement climates, and geographic considerations. The 
industry today maintains a moderately healthy capital 
structure. The industry's reemergence and relatively better 
financial condition are attributed to more rational portfolios 
of nursing home ownership, improved access to capital, and 
improved Medicare reimbursement.
    Guided by the literature review, analysis of OSCAR data 
from 1993-2004, and review of information on public companies, 
the report describes the nursing home industry and documents 
ownership trends over the last decade. The focus was on the 
characteristics and activities of the nation's largest nursing 
home chain providers. Analyses of these data nationally, within 
states, and across specific chains, revealed several broad 
themes. Nationally, nursing home chains have consistently owned 
or operated half of all facilities. Chains sold nursing homes 
in high litigation states to regional chains, sold assets to 
real estates investment trusts (REITs), and restructured 
corporation with private equity firms. Importantly, these 
aggregate findings mask important state- and chain-specific 
trends.
    Excellence: What makes this project exceptional?
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Effectiveness: What is the impact or application of this 
research to older persons?
    Innovativeness: Why is this research exciting or 
newsworthy?
    This study is the only analysis of the corporate 
divestiture and restructuring of the large national nursing 
home chains that represent the majority of over 16,000 nursing 
homes in the country. The analyses show that there is 
substantial variation across national chain providers in the 
strategies with which they navigate policy and market 
conditions, and highlights the need to investigate more about 
the specific characteristics and practices of the parent 
company. As the population over 85 years of age continue to 
grow, continuity of care from stable nursing home industry is 
essential.
    Some of the restructuring and financing trends that were 
identified have unclear implications for the quality of care 
received by nursing home residents. Although further research 
into some topics is made difficult by the lack of comprehensive 
data on facility ownership, further analytic work is ultimately 
needed to investigate these trends more thoroughly and to 
analyze whether they have had any impact on nursing home 
residents' quality of care. Several congressional hearings have 
been conducted in the past year on this subject.

  Office of the Assistant Secretary for Planning and Evaluation: The 
         National Survey of Residential Care Facilities (NSCRF)

    The National Survey of Residential Care Facilities (NSCRF) 
will fill a gap in federal long-term care data collection and 
provide nationally representative data on residential care 
facilities and their residents.
    Lead Agency: Office of the Assistant Secretary for Planning 
and Evaluation, U.S. Department of Health and Human Services.
    Agency Mission: The Assistant Secretary for Planning and 
Evaluation advises the Secretary of the Department of Health 
and Human Services on policy development in health, disability 
and aging, human services, and science and data policy, and 
provides advice and analysis on economic policy. The Office of 
the Assistant Secretary for Planning and Evaluation (OASPE) 
leads special initiatives, coordinates the Department's 
evaluation, research and demonstration activities, and manages 
cross-Department planning activities such as strategic 
planning, legislative planning and review of regulations. 
Integral to this role, OASPE conducts research and evaluation 
studies, develops policy analyses, and estimates the cost and 
benefits of policy alternatives under consideration by the 
Department or Congress.
    Principal Investigator: John D. Loft, Ph.D., Principal 
Scientist, Survey Research Division, RTI International, 230 W. 
Monroe Street, Suite 2100, Chicago, IL 60606.
    Partner Agencies: National Center for Health Statistics 
(NCHS), Agency for Health Research and Quality (AHRQ), CDC 
National Center for Chronic Care and Disease Prevention and 
Health Promotion--Division of Heart Disease and Stroke 
Prevention, and Veterans' Administration (VA).
    General Description: Unlike nursing homes and home and 
hospice care, the federal government does not currently collect 
data on residential care. Without this data it is impossible to 
understand the entire spectrum of long-term care options. 
States are responsible for regulating residential care and 
state policies, licensure requirements, and terminology vary 
widely across states. This makes accurate national estimates of 
facility services and the total number of residents 
challenging.
    To address this issue the Office of the Assistant Secretary 
for Planning and Evaluation (ASPE) with the National Center for 
Health Statistics (NCHS) is conducting a National Survey of 
Residential Care Facilities (NSRCF). This will be the first 
nationally representative sample survey of residential care in 
the United States. The survey will determine the 
characteristics of residential care facilities, such as their 
structure and environment, types of services offered, the staff 
they employ, and the requirements for admission, retention, and 
discharge. Additionally the survey will determine the 
characteristics of residents living in residential care 
settings, such as demographics, levels of functional disability 
and cognitive impairment, service needs, and the types of 
services used.
    A general shift in state Medicaid long-term care policy 
toward community-based care over the past 25 years, and 
independent growth in private-pay residential care (e.g., 
assisted living) since the late 1980s have led to a burgeoning, 
yet still not clearly delineated, set of residential care 
alternatives to home care and traditional skilled nursing 
facilities. Residential care facilities, such as assisted 
living facilities or board and care homes, are a critical 
component of long-term care systems, serving individuals who 
cannot live at home without assistance, but who do not require 
the level of skilled nursing care found in nursing homes.
    Collecting information on residential care is critical 
because it is impossible to understand the changing dynamics of 
publicly financed long-term care (i.e., Medicare home health, 
Medicaid Home and Community Based Services (HCBS), and nursing 
home care) without a complete picture of the entire spectrum of 
residential care options available to persons with 
disabilities. Without an accurate source of information on the 
characteristics of all residential care facilities, the 
services they provide, and their residents, policymakers and 
providers will be unable to fully understand the current long-
term care system and the likely impact of policy changes.
    This essential national study will help policymakers have a 
more complete picture of the long term care spectrum and of the 
residential care industry and residents. The pretest will be 
administered in Fall 2008, and the national survey will be 
fielded in early 2010.

Office of the Assistant Secretary of Planning and Evaluation: Long-Term 
                         Care Reverse Mortgage

    This project features the development of special reverse 
mortgages for persons likely to need long-term care within a 
year. The mortgages will be cheaper than those on the market 
today and targeted at home values of $175,000 and less.
    Lead Agency: Office of the Assistant Secretary of Planning 
and Evaluation, U.S. Department of Health and Human Services.
    Agency Mission: The Assistant Secretary for Planning and 
Evaluation advises the Secretary of the Department of Health 
and Human Services on policy development in health, disability 
and aging, human services, and science and data policy, and 
provides advice and analysis on economic policy. The Office of 
the Assistant Secretary for Planning and Evaluation (OASPE) 
leads special initiatives, coordinates the Department's 
evaluation, research and demonstration activities, and manages 
cross-Department planning activities such as strategic 
planning, legislative planning and review of regulations. 
Integral to this role, OASPE conducts research and evaluation 
studies, develops policy analyses, and estimates the cost and 
benefits of policy alternatives under consideration by the 
Department or Congress.
    Principal Investigator: Barb Stucki, National Council on 
Aging, 1901 L Street, NW., 4th Floor, Washington, DC 20036.
    Partner Agency: U.S. Administration on Aging and U.S. 
Department of Housing and Urban Development.
    General Description:

                    LONG-TERM CARE REVERSE MORTGAGE

    As the population ages and more and more people need long-
term care, it is critical to understand the potential of 
different financing options. Reverse equity mortgages have been 
around for some time, but they have yet to play a significant 
role in financing long-term care. Home equity is considered an 
asset for Medicaid eligibility, and states have begun to 
explore helping older adults tap into this equity in order 
finance long-term care while remaining at home.
    This project will investigate the potential for reverse 
equity mortgages to assume a greater role in financing long-
term care in three states: Minnesota, New Jersey, and Georgia. 
The Office of the Assistant Secretary for Planning and 
Evaluation, in conjunction with the U.S. Department of Housing 
and Urban Development, the U.S. Administration on Aging, and 
state leaders is developing special reverse mortgages 
structured specifically for use by persons likely to need long-
term care with in a year's time. These reverse mortgages will 
be less expensive than current products and be targeted at home 
values of $175,000.
    Before expanding such reverse mortgages to a larger number 
of states, it is critical to understand whether consumers are 
interested in such arrangements, and how effective this 
financial tool is at keeping elders in the community. Staff 
from the aging networks will serve as reverse mortgages 
counselors, and assist consumers in determining whether their 
situation is appropriate for a reverse mortgage. The reverse 
mortgages resources will then be used in combination with 
public case management and public services to serve older 
persons in their homes for as long as possible. The reverse 
mortgage funds have the flexibility to provide those services 
which are not otherwise available, and are expected to extend 
the time an individual can receive less-costly care in a 
setting they prefer--home.
    Excellence: What makes this project exceptional?
    This project is exception in its use of an existing asset 
to finance long-term care. Many long-term care financing 
proposals require a new funding source while this one taps an 
existing source in a way that maximizes consumer direction. It 
also expands this potential funding source to people with lower 
home equity who are more likely to utilize costly Medicaid 
services.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    This project is significant because it features the 
conversion of previously unavailable (for most homeowners) 
assets for the purpose of financing long-term care. Many older 
persons want to remain in their homes but have no way to pay 
for the care they require. This project has the potential to 
release billions of dollars for long-term care financing while 
facilitating continued residence at home. Without this project 
these resources are unlikely to be converted for this purpose, 
particularly given the high cost of existing reverse mortgages 
and a mortgage structure that does not favor frail older 
persons.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    This project has the potential for immediate effectiveness 
upon completion because it includes a financing approach that 
has been demonstrated in three states. Other states can readily 
replicate the approach and thereby expand this option to a 
large number of vulnerable elders in need of long-term care.
    Innovativeness: Why is this research exciting or 
newsworthy?
    This project is innovative in its use of an existing asset 
to financing consumer directed care in a new way. Budget 
constraints will limit the ability of Medicaid to fund all of 
the long-term care that the baby boomers will need. This 
research supports another financing option that facilitates the 
ability of older adults to purchase their own care, remain in 
their own homes while making use of public services when 
appropriate.

                           U.S. Census Bureau

    LEHD's Older Worker Profile series is an innovative use of 
a unique new data source, which covers the employment history 
and characteristics of workers (including older workers) and 
the firms that employ them in the United States while their 
confidentiality is protected.
    Lead Agency: The U.S. Census Bureau.
    Agency Mission: The Census Bureau serves as the leading 
source of quality data about the nation's people and economy. 
We honor privacy, protect confidentiality, share our expertise 
globally, and conduct our work openly. We are guided on this 
mission by our strong and capable workforce, our readiness to 
innovate, and our abiding commitment to our customers.
    Principal Investigator: Matthew Graham, Longitudinal 
Employer-Household Dynamics Program, Center for Economic 
Studies, U.S. Census Bureau, Room 6H141, 4600 Silver Hill Road, 
Suitland, Maryland 20746.
    Partner Agencies: Employment and Training Administration, 
U.S. Department of Labor and National Institute on Aging (NIA), 
National Institutes of Health.
    General Description: The Longitudinal Employer-Household 
Dynamics (LEHD) Program is in the process of producing a series 
of reports on Older Worker Profiles and associated tables by 
state.
    To date, reports for 15 states have been issued, covering 
Arkansas, Colorado, Delaware, Hawaii, Indiana, Iowa, Kentucky, 
Maine, Maryland, Montana, New Jersey, Oklahoma, South Carolina, 
Vermont, and Wisconsin. Reports for about 15 more states under 
the Local Employment Dynamics (LED) partnership will be 
released in the coming months.
    Drawing on the unique collection of databases developed by 
LEHD, the Older Worker Profiles highlight the age composition 
of the state's workforce, job gains and losses for older 
workers by industry, industries in which older workers are 
concentrated, and their job stability and earnings.
    In addition, forty-two (42) different supplementary and 
appendix tables are provided for additional details. These 
reports and tables are made available from the LEHD website 
located at http://lehd.did.census.gov.
    The unique collection of databases developed by LEHD is 
also known as a job frame, designed to cover the employment 
history and characteristics of every worker in the United 
States and the employment history and characteristics of every 
job-linked employer in the nation.
    The job frame is created by integrating historical and 
current data from state agencies, the Census Bureau, and sister 
federal agencies. It currently contains over 6 billion records 
and is growing with new records of recent data every 90 days.
    Additional products have been derived from this job frame 
for older workers, including:
     OnTheMap. An interactive mapping and reporting 
application that shows where people live and work with 
companion reports on age, earnings, industry, and cross-state 
patterns of residence and workplace. OnTheMap also allows for 
mapping and reporting for older workers only.
     Quarterly Workforce Indicators. A set of 30 
indicators that describe the dynamics of local employment, 
earnings, turnover, and job changes by geography, gender, 
industry and time in year and quarter for all workers and older 
workers only.
    Excellence: What makes this project exceptional?
    The Older Worker Profiles produced by LEHD are exceptional 
because they provide unique and valuable information on the 
labor market outcomes for the aging population that are useful 
for both research and policy evaluation. Each Older Worker 
Profile, which consists of a report and a series of 
supplementary and appendix tables for a single state, 
identifies key features of the local (to the Metropolitan and 
County areas) employment dynamics for older workers. Because 
the underlying microdata is tagged with a number of 
socioeconomic variables (including age and industry), detailed 
answers about local labor market conditions can be reported.
    Specifically, the Older Worker Profile exposes lay 
audiences to a new set of statistics called Quarterly Workforce 
Indicators (QWIs). These data describe--at quarterly intervals 
with a historical sequence back to 1990 for some states--
various statistical aspects of local labor markets, including 
but not limited to: Employment, New Hires, Job Separations, 
Turnover, and Average Earnings. QWIs for older workers in the 
report portion of the Profile are available at the 2-digit 
NAICS industry sector level and in the downloadable tables at 
the 3-digit NAICS industry subsector level. Using the QWI, the 
Older Worker Profiles generate information on the types of jobs 
that older workers are leaving and being hired.
    Additionally, the Older Worker Profiles are exceptional 
because they are only the tip of the iceberg with respect to 
the data source from which they were extracted. The LEHD data 
infrastructure provides opportunities for a comprehensive and 
longitudinal analysis of older workers across the nation and 
down to the county level. Extensions of this research are 
expected to bring further detail to the database through the 
addition of external data sources and the application of more 
advanced confidentiality protection systems, which should allow 
greater geographic/characteristic detail while maintaining 
strict confidentiality protection and increasing analytical 
validity.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    The research on older workers goes right to the heart of 
questions of the economic health of the United States in the 
coming decades. As older workers--specifically of the aging 
Baby Boom generation--move through the traditional retirement 
age, outcomes of their employment opportunities and choices 
will have significant impacts on policy choices and options at 
every level of government and private industry. Whether or not 
older workers choose to move directly to retirement, continue 
to work full time, or move into semi-retirement; which jobs 
older works choose or are forced into holding because of their 
economic resources; and whether or not older workers continue 
to be compensated for their experience are all questions whose 
answers will have important consequences for the national and 
local economies. These are all questions that can be 
illuminated by the data and research that underlie LEHD's Older 
Worker Profile series.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    The primary impact of this research is to lead the way in 
making use of a unique dataset for the purposes of evaluating 
the consequences of an important change coming in the workforce 
as the Baby Boom generation moves through the traditional 
retirement age. This research and these data can guide programs 
and policy to address the needs of and support older workers 
who continue to participate in the workforce. In addition, the 
dataset provides the ability to answer questions about 
potential gaps in knowledge as a large cohort of experienced 
workers faces retirement. What are the industries in which 
there will most likely be knowledge/experience gaps? In which 
industries will older workers continue on through retirement, 
reaping the rewards of their long experience? In which 
industries will we expect to find those older Americans who did 
not plan adequately for retirement and how will their 
compensation compare with their younger colleagues? The 
research being done and the research to come on older workers 
will have a significant impact on how these questions are 
interpreted and how they are answered by economic and labor 
force policy at all levels.
    Innovativeness: Why is this research exciting or 
newsworthy?
    The Older Worker Profiles are exciting and newsworthy 
because they report on a much-needed dataset at exactly the 
right time. As communities see their labor forces age and 
retire, local, regional, state, and national leaders are 
looking for information to help them understand how to respond. 
At the same time, business and industry want to know how many 
jobs they will need to fill in the coming years. These reports 
begin the process of uncovering the answers to these questions.
    This research is also exciting and newsworthy because it 
makes use of a relatively new dataset that has the opportunity 
to open up whole new lines of research into the labor force 
dynamics of older workers. The Older Worker Profiles (reports 
and supplementary tables) report on public-use data that has 
been cleared by the Census Bureau's Disclosure Review Board. 
These data are available in a number of extended forms (the 
Older Worker Profiles are merely one slice of it) that extend 
the information on the QWIs as well as show more detailed 
geographical distributions of the data. Additionally, a rich 
series of confidential microdata is available through approved 
research projects, and the possibilities for this research and 
almost limitless.

                 National Center for Health Statistics

    The goal of the Federal Interagency Forum on Aging-Related 
Statistics (Forum) is to bring together Federal agencies that 
share a common interest in improving aging-related data. The 
Forum provides agencies with a venue to discuss data issues 
that cut across agency boundaries
    Lead Agency: National Center for Health Statistics.
    Agency Mission: The mission of the National Center for 
Health Statistics (NCHS) is to provide statistical information 
that will guide actions and policies to improve the health of 
the American people. As the Nation's principal health 
statistics agency, NCHS leads the way with accurate, relevant, 
and timely data.
    Principal Investigator: Jennifer Madans, Co-Acting Deputy 
Director/Associate Director for Science, National Center for 
Health Statistics, 3311 Toledo Road, Room 7207, Hyattsville, MD 
20782.
    Partner Agencies: Administration on Aging, Agency for 
Healthcare Research and Quality, Bureau of Labor Statistics, 
Centers for Medicare and Medicaid Services, Department of 
Housing and Urban Development, Department of Veterans Affairs, 
Employee Benefits Security Administration, Environmental 
Protection Agency, National Institute on Aging, Office of 
Management and Budget, Office of the Assistant Secretary for 
Planning and Evaluation, HHS, Social Security Administration, 
Substance Abuse and Mental Health Services Administration, and 
U.S. Census Bureau.
    General Description: The Federal Interagency Forum on 
Aging-Related Statistics, established in 1986 by the National 
Center for Health Statistics, National Institute on Aging, and 
the U.S. Census Bureau, fosters collaboration among Federal 
agencies that produce or use statistical data on the older 
population.
    The Forum plays a key role in improving aging-related data 
by critically evaluating existing data resources and 
limitations, stimulating new database development, encouraging 
cooperation and data sharing among Federal agencies, and 
preparing collaborative statistical reports. In 1998, the Forum 
was reorganized and expanded to include several new members. In 
addition to the original three core agencies, the members of 
the Forum now include the Administration on Aging, Agency for 
Healthcare Research and Quality, Bureau of Labor Statistics, 
Centers for Medicare and Medicaid Services, Department of 
Housing and Urban Development, Department of Veterans Affairs, 
Employee Benefits Security Administration, Environmental 
Protection Agency, Office of Management and Budget, Office of 
the Assistant Secretary for Planning and Evaluation in the 
Department of Health and Human Services, Social Security 
Administration, and Substance Abuse and Mental Health Services 
Administration.
    Excellence: What makes this project exceptional?
    The Federal Interagency Forum on Aging-Related Statistics 
(Forum) is an interagency committee dedicated to improving the 
quality of Federal statistics on older Americans. It is a 
collection of 15 Federal government agencies that collect, 
analyze, and report data on issues related to people age 65 and 
over. The Forum is exceptional because it brings together such 
a wide variety of Federal agencies with the primary purpose of 
improving both the quality and utility of data on the aging 
population. The specific goals of the Forum are to:
           widen access to information on the aging 
        population through periodic publications and other 
        means;
           promote communication among data producers, 
        researchers, and public policymakers;
           coordinate the development and use of 
        statistical databases among Federal agencies;
           identify information gaps and data 
        inconsistencies;
           investigate questions of data quality;
           encourage cross-national research and data 
        collection on the aging population; and
           address concerns regarding collection, 
        access, and dissemination of data.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Americans age 65 and over are an important and growing 
segment of our population. Many Federal agencies provide data 
on aspects of older Americans' lives, but it can be difficult 
to fit the pieces together. Thus, it has become increasingly 
important for policymakers and the general public to have an 
accessible, easy to understand portrait that shows how older 
Americans are faring. The Forum's periodic report Older 
Americans: Key Indicators of Well-Being monitors the health and 
well-being of older Americans through a broad range of 
indicators in five important areas: population, economics, 
health status, health risks and behaviors, and health care. It 
provides data on 37 key indicators carefully selected by the 
Forum to portray important aspects of the lives of older 
Americans and their families.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    The Forum's periodic report, Older Americans: Key 
Indicators of Well-Being, provides the Nation with a summary of 
national indicators of well-being and monitors changes in these 
indicators over time. By following these data trends, more 
accessible information becomes available to target efforts that 
can improve the lives of older Americans and their families. 
Older Americans reflects the Forum's commitment to advancing 
our understanding of where older Americans stand today and what 
they may face tomorrow.
    Innovativeness: Why is this research exciting or 
newsworthy?
    The Forum's mission is to encourage cooperation and 
collaboration among Federal agencies to improve the quality and 
utility of data on the aging population. To accomplish this 
mission, the Forum provides agencies with a venue to discuss 
data issues and concerns that cut across agency boundaries, 
facilitates the development of new databases, improves 
mechanisms currently used to disseminate information on aging-
related data, invites researchers to report on cutting-edge 
analyses of data, and encourages international collaboration. 
The work of the Forum is newsworthy because in an era of 
agencies competing for research funds, the Forum members work 
together on projects that cross agency boundaries to share 
resources and enhance the work of the Federal statistical 
system.

        The Prevention Research Center: 10 Keys to Healthy Aging

    The University of Pittsburgh's Center for Healthy Aging 
created the 10 Keys to Healthy Aging program to encourage 
healthy living among older adults. Research combines learning 
about the ``10 keys'' with education and physical activity to 
find the best combination for reducing participants' risk for 
stroke, heart failure, cancer, disability, 
institutionalization, and suicide. Preliminary results showed 
the 10 keys led to health improvements, and the information has 
been shared across Pennsylvania and in Europe.
    Lead Agencies: Centers for Disease Control and Prevention, 
National Center for Chronic Disease Prevention and Health 
Promotion, Division of Adult and Community Health, Prevention 
Research Centers Program.
    Agency Mission: The Prevention Research Centers work as an 
interdependent network of community, academic, and public 
health partners to conduct prevention research and promote the 
wide use of practices proven to promote good health.
    Principal Investigator: Anne P. Newman, M.D., M.P.H., 
University of Pittsburgh Center for Healthy Aging, 130 N. 
Bellefield Avenue, Room 550, Pittsburgh, PA 15213.
    Partner Agency: PRC Healthy Aging Research Network.
    General Description: The 10 Keys to Healthy Aging, based on 
epidemiological, clinical, and laboratory studies, address 10 
conditions essential for maintaining health in older adults: 
(1) prevent bone loss and muscle weakness, (2) control blood 
pressure, (3) increase physical activity, (4) regulate blood 
sugar, (5) stop smoking, (6) maintain social contact, (7) 
participate in cancer screening, (8) get regular immunizations, 
(9) lower cholesterol, and (10) combat depression. Researchers 
are collaborating with community partners to refine 
interventions around several of these conditions.
    Project staff are implementing and evaluating two 
interventions for about 1,000 older adults: a healthy lifestyle 
intervention and a brief education intervention. After 
completing an initial 4-hour assessment related to the ten 
keys, participants are randomly assigned to an intervention 
group. Participants in both groups meet with a health counselor 
who explains the results of their assessments and offers 
recommendations. Participants identify one or two goals for 
improving their results and are referred to their doctors as 
needed. People in the brief education group are referred to 
community resources and receive follow-up calls from a health 
counselor every 3 months.
    Adults in the healthy lifestyle intervention join in 
walking groups and attend group sessions about healthy food 
choices for controlling blood pressure and diabetes, and 
exercises to improve strength, flexibility, and endurance. In 
social activities, participants can get support from peers; 
practice techniques to maintain and enhance memory and other 
mental abilities; and learn about the risk factors conditions 
associated with aging. All participants will complete the 
assessments after the intervention and every year thereafter 
for 3-4 years. Post-intervention results of the 2 groups will 
be compared with each other and with individuals' initial 
assessments. Evaluators will analyze the extent to which the 
interventions decreased participants' risk for stroke, heart 
failure, cancer, disability, institutionalization, and suicide.
    Excellence: What makes this project exceptional?
    The 10 Keys to Healthy Aging intervention is a portable and 
simple method to address the leading causes of illness in older 
adults. The research involves older adults in every step of its 
development. Laypersons are recruited from the community, learn 
about how to prevent disease and promote health, and become 
Community Health Ambassadors. They work with researchers to 
design and test interventions and spread health messages among 
their peers.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Older adults are at risk for heart disease and stroke, 
diabetes, influenza, pneumonia, disability, suicide, and other 
preventable conditions. However, those who engage in physical 
activity, healthy diets, socially and mentally stimulating 
activities, cancer screening, and other positive health 
behaviors can often maintain active and healthy lives.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Community Health Ambassadors have shared the research 
across the state of Pennsylvania and through a partnership with 
a multinational corporation, with corporation employees working 
in Europe. One thousand older adults are participating in the 
second-round trials of the research project.
    Innovativeness: Why is this research exciting or 
newsworthy?
    Older adults are bombarded by health messages about every 
aspect of life. The 10 keys intervention simplifies health 
messages to a consistent, evidence-based set of priorities that 
helps without overwhelming the audience. Older adults work 
alongside researchers to develop and test the 10 keys, and can 
attest to its effectiveness and ease of use.

 The Prevention Research Center: PEARLS (Program to Encourage Active, 
                      Rewarding Lives for Seniors)

    PEARLS reduces minor depression among older adults by 
teaching participants behavioral techniques during in-home 
counseling sessions. The program has been proven to reduce 
depression and hospital visits, and has been recognized in the 
National Registry of Evidence-Based Programs and Practices.
    Lead Agency: Prevention Research Centers Program.
    Agency Mission: The Prevention Research Centers work as an 
interdependent network of community, academic, and public 
health partners to conduct prevention research and promote the 
wide use of practices proven to promote good health.
    Principal Investigator: Sheryl Schwartz, Principal 
Investigator, University of Washington, Health Promotion 
Research Center, 1107 NE 45th St., Suite 200, Seattle, WA 
98105.
    Partner Agencies: Centers for Disease Control and 
Prevention, National Center for Chronic Disease Prevention and 
Health Promotion, Division of Adult and Community Health, City 
of Seattle Aging and Disability Services, Senior Services of 
Seattle/King County, Washington State Unit on Aging, Washington 
State Aging and Disability Services Administration, and 
Substance Abuse and Mental Health Services Administration.
    General Description: PEARLS aims to reduce minor depression 
and resulting disability among older adults by teaching them 
depression management techniques. It consists of eight in-home 
counseling sessions followed by monthly telephone calls for 6 
months. The counseling covers three behavioral approaches to 
managing depression: (1) Participants are taught a set of steps 
they can use to solve their problems--from clearly defining the 
problem to implementing their chosen solution. These steps help 
participants recognize symptoms of depression and understand 
the link between unsolved problems and depression. (2) 
Participants are encouraged to meet recommended levels of 
social and physical activity by using community settings, such 
as senior centers. (3) Participants are taught to identify and 
participate in activities pleasurable to them. The intervention 
was shown to significantly reduce depression and has been 
listed in the National Registry of Evidence-Based Programs and 
Practices, a service of the Substance Abuse and Mental Health 
Services Administration. King County now offers the program to 
seniors who receive social services and have minor depression, 
and the program is available via an online toolkit for wide 
dissemination.
    Excellence: What makes this project exceptional?
    Local participants report having benefited from the 
program. It has the potential to substantially improve health 
and quality of life for older adults who suffer from minor 
depression or dysthymia, and are receiving social case 
management services. Because dissemination can occur within 
existing community social services programs, eligible older 
adults could be readily identified and enrolled in the program. 
Moreover, because most social services agencies have access to 
mental health experts who could supervise training of staff and 
the implementation of PEARLS, the program does not require 
large increases in local funding. Thus PEARLS has the potential 
to benefit many ill, disabled, and frail older adults.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Minor depression affects 15%-20% of older adults and is 
known to profoundly compromise health and quality of life. 
People who are socially isolated and in frail health are 
especially at risk for depression. Doctors and their older 
patients often incorrectly assume that depression is an 
unavoidable consequence of aging, and many depressed elders do 
not receive treatment.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    After one year, 43% of seniors in the intervention group 
reported at least a 50% decline in depressive symptoms. Only 
15% of seniors in the control group reported the same decline. 
Depression resolved completely for 36% of PEARLS participants, 
compared with 12% of nonparticipants. PEARLS participants 
experienced significant improvements in functional and 
emotional well-being. Current efforts are focused on 
replicating the PEARLS program, making it available to a broad 
range of older adults and to all adults with chronic medical 
conditions.
    Innovativeness: Why is this research exciting or 
newsworthy?
    Researchers have made a PEARLS Toolkit available online, so 
the program can be implemented in any community in the United 
States.

            The Prevention Research Centers: Enhance Fitness

    EnhanceFitness is a physical activity program for adults, 
aged 60 years or older, that emphasizes activities to increase 
endurance, strength, balance, and flexibility. Participants 
improve in physical and social functioning as well as levels of 
pain and depression. Their health care costs are also 
significantly reduced.
    Lead Agency: The Prevention Research Center.
    Agency Mission: The Prevention Research Centers work as an 
interdependent network of community, academic, and public 
health partners to conduct prevention research and promote the 
wide use of practices proven to promote good health.
    Principal Investigator: Sheryl Schwartz, Principal 
Investigator, University of Washington, Health Promotion 
Research Center, 1107 NE 45th St., Suite 200, Seattle, WA 
98105.
    Partner Agencies: Group Health Cooperative of Puget Sound 
and Senior Services of Seattle/King County Administration on 
Aging, National Council on Aging.
    General Description: Researchers collaborated to develop a 
physical activity program for adults aged 60 years or older. 
The program emphasizes activities to increase endurance, 
strength, balance, and flexibility. The pilot study showed that 
participants improved significantly in almost every area 
tested--from physical and social functioning to levels of pain 
and depression. The health care costs for participants 
attending at least once a week were significantly reduced. Now 
the program is offered at 158 community sites in 17 states, and 
the researchers continue to dissemination research. In 2003, 
the National Council on Aging recognized the physical activity 
program as one of the top ten physical activity programs for 
U.S. seniors.
    Excellence: What makes this project exceptional?
    EnhanceFitness is feasible and well-attended when offered 
in senior centers and other community-based settings. It is 
sustainable and portable. The number of participants continues 
to increase--by 76% in a recent calendar year.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    An analysis of Group Health Cooperative Medicare enrollees 
showed that people who participated in EnhanceFitness at least 
once per week had significantly fewer hospitalizations (by 
7.9%), and lower health care costs (by $1,057) than 
nonparticipants. The availability of such a successful program 
becomes more and more pertinent as the U.S. population ages, 
disability prevention among the elderly becomes a higher 
national priority, and health care costs continue to climb.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    The program was adapted for dissemination and portability 
by developing standards; manuals for instructors, 
administrators, and participants; and procedures for monitoring 
outcomes. Now in development as a ``train-the-trainer'' program 
and pilot programs in Hispanic and American Indian communities. 
It also receives funding from local foundations to help defray 
the cost of the program for low-income older adults of color.
    Innovativeness: Why is this research exciting or 
newsworthy?
    The decline in strength, endurance, flexibility, and 
balance that occurs with aging contributes to diminished 
independence, diminished vitality, and increased likelihood of 
disabling injury. EnhanceFitness has been proven to enhance 
physical and psychosocial function. Such gains can help ensure 
that older adults retain independence and a high quality of 
life.

  Center for Disease Control and Prevention: Special Projects Branch: 
                            Linked Medicare

    The Special Projects Branch, Data Linkage Team completed a 
comprehensive data enhancement and research infrastructure 
project by linking several important NCHS surveys with Medicare 
enrollment and claims records collected from the Centers for 
Medicare and Medicaid Services (CMS). Linkage of the NCHS 
survey participants with the CMS Medicare data provides the 
opportunity to study changes in health status, health care 
utilization, and expenditures in the elderly and disabled U.S. 
population.
    Lead Agency: Center for Disease Control and Prevention/
National Center for Health Statistics/Office of Analysis and 
Epidemiology.
    Agency Mission: The mission of the National Center for 
Health Statistics (NCHS) is to provide statistical information 
that will guide actions and policies to improve the health of 
the American people. As the Nation's principal health 
statistics agency, NCHS leads the way with accurate, relevant, 
and timely data.
    Principal Investigator: Christine S. Cox, M.S., Chief, 
Special Projects Branch, Centers for Disease Control and 
Prevention, National Center for Health Statistics, 3311 Toledo 
Road, Room 6317, Hyattsville, MD 20782.
    Partner Agencies: Centers for Medicare and Medicaid 
Services (CMS).
    General Description: NCHS has linked its population based 
survey data with Medicare enrollment and claims data collected 
from the Centers for Medicare and Medicaid Services (CMS). 
These linked survey files provide the data needed to formulate 
and answer vital research questions by profiling Medicare 
service use and assessing health care costs.
    Medicare enrollment and claims data are available for those 
NCHS survey participants who agreed to provide personal 
identification data to NCHS and for whom NCHS was able to 
validate and match with Medicare administrative records. CMS 
provided NCHS with Medicare benefit claims data for 1991 
through 2000 for all successfully matched NCHS survey 
participants.
    The following NCHS surveys were linked to Medicare 
enrollment and claims files:
          --1994-1998 National Health Interview Survey (NHIS)
          --NHANES I Epidemiologic Follow-up Study (NHEFS)
          --Second National Health and Nutrition Examination 
        Survey (NHANES II)
          --Third National Health and Nutrition Examination 
        Survey (NHANES III)
          --The Second Longitudinal Study of Aging (LSOA II)
    For successfully matched NCHS survey participants, Medicare 
enrollment and claims information are available from the 
following CMS files:
          --Denominator
          --MedPAR Hospital Stay
          --MedPAR Skilled Nursing Facility
          --Carrier file (formerly the Physician/Supplier Part 
        B file)
          --Outpatient
          --Home Health Agency
          --Hospice
          --Durable Medical Equipment
    Excellence: What makes this project exceptional?
    The Special Projects Branch within OAE is responsible for 
conducting record linkage projects, developing linked data 
files for analytic use, evaluating the linked data and 
promoting the data for public health and health policy 
research. Demand for more comprehensive data from the research 
and public health policy communities coupled with the need for 
cost-effective data collection efforts, indicates the 
importance of the development of linked data sets. This project 
demonstrates the successful collaboration and cooperation 
between federal agencies to enhance the research infrastructure 
for aging research.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Medicare administrative records provide one of the most 
valuable sources of information on health events, health care 
utilization and costs for the U.S. population aged 65 years or 
older. However, Medicare data alone does not provide a complete 
picture of beneficiary's health status. NCHS population based 
surveys linked to Medicare data can provide a more 
comprehensive view of health status, not only for specific 
chronic conditions or functioning, but also can provide a 
longitudinal component to the beneficiary's health status.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    By linking Medicare administrative data with NCHS survey 
data, researchers and policy makers can improve understanding 
of the health status, utilization, and expenditure patterns of 
the Medicare population.
    Innovativeness: Why is this research exciting or 
newsworthy?
    The linkage of NCHS survey participants to their individual 
administrative records on Medicare enrollment and claims 
provide a cost-effective means to enrich and expand the 
available information on health status, functional limitations, 
medical care utilization and costs. The linked NCHS-Medicare 
files provide a single source of data on various domains of 
interest to researchers that, in general, are difficult to 
find. For each of the NCHS surveys linked to Medicare 
administrative records, there are approximately 80 different 
files available for researchers.

        National Center for Health Statistics: Nursing Home Care

    The 2004 National Nursing Home Survey (NNHS) is the latest 
in a continuing series of surveys of United States nursing 
homes, their services, their staff, and their residents. The 
NNHS is the only periodic nationally representative survey of 
nursing home facilities. As the U.S. population ages and people 
are living longer with chronic diseases, the 2004 NNHS permits 
researchers, policy makers, and the nursing home industry to 
assess the adequacy of current nursing home care and future 
long-term care needs.
    Lead Agency: National Center for Health Statistics (NCHS), 
Centers for Disease Control and Prevention (CDC).
    Agency Mission: The mission of the National Center for 
Health Statistics (NCHS) is to provide statistical information 
that will guide actions and policies to improve the health of 
the American people. As the Nation's principal health 
statistics agency, NCHS leads the way with accurate, relevant, 
and timely data.
    Principal Investigator: Robin E. Remsburg, PhD, RN, GCNS-
BC, FNGNA, FAAN, Deputy Director, Division of Health Care 
Statistics, National Center for Health Statistics, 3311 Toledo 
Road, Hyattsville, MD 20782.
    Partner Agencies: United States Department of Veterans 
Affairs, Office of the Assistant Secretary for Planning and 
Evaluation (ASPE), United States Department of Health and Human 
Services.
    General Description: The 2004 National Nursing Home Survey 
(NNHS) is the latest in a continuing series of nationally 
representative sample surveys of United States nursing homes, 
their services, their staff, and their residents. The 2004 NNHS 
was redesigned and expanded to collect many new data items. The 
2004 NNHS will permit researchers, policy makers, and the 
nursing home industry to assess the adequacy of current nursing 
home care and future long-term care needs.
    Data collected about the facilities include characteristics 
such as bed size, number of residents, ownership, top 
management training and tenure, staffing levels, turnover, 
Medicare/Medicaid certification, geographic region, services 
provided and specialty programs offered, and charges. Data 
collected about the residents include information such as 
demographic characteristics, functional and cognitive status, 
continence, diagnoses, length of time since admission, services 
received, pain management, pressure ulcers, vaccinations, 
physical restraints, advance directives, falls, fractures, 
weight management, emergency department visits, 
hospitalizations, medications taken, and sources of payment. 
Data for the 2004 NNHS were obtained through in-person 
interviews with facility administrators and designated staff 
that used administrative records to answer questions about the 
facilities, staff, services and programs, along with interviews 
with staff familiar with the medical records to answer 
questions about the sampled residents.
    All nursing homes that participated in the 2004 NNHS had at 
least three beds and were either certified by Medicare or 
Medicaid or had a State license to operate as a nursing home. A 
representative sample of nursing homes was selected from 
nursing home facilities in the United States. The 2004 survey 
sample consisted of about 1,500 facilities throughout the 
United States and up to 12 current residents from each 
facility.
    The 2004 NNHS was administered using a computer-assisted 
personal interviewing (CAPI) system and included a supplemental 
survey of nursing assistants employed by nursing homes, the 
National Nursing Assistant Survey (NNAS). The NNAS, sponsored 
by the Office of the Assistant Secretary for Planning and 
Evaluation (APSE), is the first-ever nationwide survey of 
nursing assistants, the group of health care workers who 
provide the majority of direct care (such as assistance with 
bathing or showering, dressing, getting in or out of bed or a 
chair, using the toilet, and eating) to the country's almost 
1.5 million nursing home residents. A sample of up to eight 
nursing assistants was selected from about half of the nursing 
home sample at the time of the facility interview. The NNAS was 
administered after the nursing home visit, using a computer-
assisted telephone interview (CATI) system.
    For the 2004 NNHS: 1,174 nursing facilities participated, 
representing 16,100 nursing homes and 1,492,200 residents 
nationally. For the NNAS, 3,017 nursing assistants 
participated, representing 702,500 nursing assistants working 
in U.S. nursing homes in 2004. The next NNHS is currently 
scheduled to be fielded in 2011.
    Excellence: What makes this project exceptional?
    The 2004 NNHS was significantly re-designed from previous 
years, including a four-fold increase in survey content, sample 
design modifications, and migrating from paper-and-pencil to 
CAPI data collection to facilitate data collection and improve 
data quality. The content enhancements include measures of 
quality of care, safety, staffing characteristics, outcomes of 
care, and palliative and end-of-life care. The sample design 
enhancements include increasing the sample size, enabling new 
subgroup analyses by selected diagnosis and race groups. The 
re-designed survey also enables linkage to other Federal data 
sets to enable access to and analysis of more clinical 
information.
    The data from the 2004 NNHS are available on the Internet 
as public-use files. For the first time in 2004, the public-use 
files include the sample design variables that improve the 
accuracy of the results produced through the public-use files.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    The NNHS is the only periodic nationally representative 
survey of nursing home facilities. The public health impact of 
this project is to improve the public's health by monitoring 
care and outcomes of care provided to elderly residents in 
nursing home settings and to provide data for research that can 
assist health services researchers, federal stakeholders, 
policy analysts, and the long-term care industry. As the U.S. 
population ages, these data are especially important to explore 
the relationship between the services provided in these 
settings with patient safety, quality of care, and desired 
clinical outcomes.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Today, nursing facilities continue to provide much needed 
long-term care services to a large segment of the country's 
disabled and elderly population. As the nation's total 
population of older adults grows and the average lifespan 
continues to increase, we need to continue to assess the 
availability and adequacy of these services. Data from the NNHS 
will have a direct impact on the health and well being of 
individuals residing in long-term care settings. The NNAS will 
provide extremely valuable information, which will guide future 
policy initiatives to increase the supply of nursing assistants 
in long-term care.
    Innovativeness: Why is this research exciting or 
newsworthy?
    Conducting the NNAS as part of the 2004 NNHS reduced 
duplication of data collected on nursing homes, reduced 
respondent burden, reduced costs, increased efficiency of data 
collection and dissemination, and increased the analytical 
potential for both the NNHS and the NNAS. The successful 
fielding of a health care worker survey, as a component of a 
health care provider survey, will serve as a model for future 
surveys of these types of workers including home health aides 
and aides working in other non-nursing home residential care. 
The NNAS will provide extremely valuable information, which 
will guide future policy initiatives to increase the supply of 
nursing assistants in long-term care. Data from the NNHS will 
have a direct impact on the health and well being of 
individuals residing in long-term care settings.

  Center for Disease Control's National Center for Health Statistics 
                          Healthy People 2010

    Assess the progress of The Healthy People 2010 goal to 
increase the quality and years of healthy life in the U.S. by 
measuring expected years in good or better health, expected 
years free of activity limitation, and expected years free of 
selected chronic diseases.
    Lead Agency: Center for Disease Control's National Center 
for Health Statistics--Office of Analysis and Epidemiology.
    Agency Mission: The mission of the National Center for 
Health Statistics (NCHS) is to provide statistical information 
that will guide actions and policies to improve the health of 
the American people. As the Nation's principal health 
statistics agency, NCHS leads the way with accurate, relevant, 
and timely data.
    Principal Investigator: Richard J. Klein, MPH, Chief, 
Health Promotion Statistics Branch, Centers for Disease Control 
and Prevention, National Center for Health Statistics, 3311 
Toledo Road, Room 6317, Hyattsville, MD 20782.
    General Description: The concept of healthy life expectancy 
reflects the fact that not all years of a person's life are 
lived in perfect health. As the prevalence of chronic disease 
and disability tend to increase with age, a population with a 
higher life expectancy may not actually be the healthiest.
    One of the goals of Healthy People 2010 is to increase the 
quality and years of healthy life in the U.S. Progress towards 
this goal is assessed by 3 healthy life expectancy measures: 
expected years in good or better health; expected years free of 
activity limitation; and expected years free of selected 
chronic diseases. These measures can provide an indication of 
expected years of healthy life remaining at birth or other ages 
such as 55 years, 65 years, or 85 years.
    Analysis completed for the Healthy People 2010 Midcourse 
Review revealed a slight overall increase in both expected 
years remaining in good or better health and years free of 
activity limitation at birth and at age 65, and an overall 
decrease in expected years remaining free of selected chronic 
conditions at birth and at age 65; gender and racial 
differences were present in all three of these measures. Future 
plans include the development of additional measures, focus on 
additional domains including mental health and health 
behaviors, and improving the understanding and interpretation 
of healthy life expectancy.
    The use of healthy life expectancy in Healthy People 2010 
was recently presented to the European Commission's Task Force 
on Health Expectancies. Plans for continued discussions on 
international comparability between the U.S. and European 
measures are in progress.
    Excellence: What makes this project exceptional?
    There is currently no consensus on how to measure the 
quality and years of healthy life.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    The concept of healthy life expectancy reflects the fact 
that not all years of a person's life are lived in perfect 
health. As the prevalence of chronic disease and disability 
tend to increase with age, a population with a higher life 
expectancy may not actually be the healthiest.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    If healthy life expectancy is increasing more quickly than 
general life expectancy within the population, then the aging 
population is living a greater portion of life free of chronic 
diseases and disabilities. If not, then education of policy 
makers could result in re-allocation of resources to promote a 
healthier life at later stages.
    Innovativeness: Why is this research exciting or 
newsworthy?
    This research provides the opportunity for international 
comparability between the healthy life expectancy measures 
being used in the U.S. and by the European Commission.

               The National Center for Health Statistics

    This project investigates the trends in functional 
limitations for Americans age 65 and over from 1992 to 2003 and 
found decreases in years spent with functional limitations.
    Lead Agencies: Centers for Disease Control and Prevention, 
National Center for Health Statistics (NCHS).
    Agency Mission: The mission of NCHS is to provide 
statistical information that will guide actions and policies to 
improve the health of the American people. As the Nation's 
principal health statistics agency, NCHS leads the way with 
accurate, relevant, and timely data.
    Principal Investigator: Liming Cai, Ph.D., Senior Service 
Fellow, National Center for Health Statistics, 3311 Toledo 
Road, Rm. 6330, Hyattsville, MD 20782.
    General Description: Background. Life expectancy for older 
Americans has risen substantially over the past five decades 
due to reductions in mortality from chronic diseases, 
especially cardiovascular disease. Whether these added years 
are mostly free of disability has been the focus of debate. 
Different hypotheses of trends in population aging have been 
proposed: compression of morbidity, expansion of morbidity and 
dynamic equilibrium (an increase in moderate disability and a 
decrease in severe disability, as medical advances increase 
survival from chronic diseases and lessen their effects).
    This study uses functional status (activities of daily 
living and instrumental activities of daily living (ADLs and 
IADLs), e.g., ability to perform tasks of everyday life like 
bathing, dressing, housework) to measure morbidity among 
Americans age 65 and over. We investigate whether the years 
spent with functional limitations have decreased (compression 
of morbidity), increased (expansion of morbidity) or if the 
picture is mixed (dynamic equilibrium) in the period 1992 to 
2003.
    Data. We used data from the Medicare Current Beneficiary 
Survey (MCBS), a nationally representative, multistage, 
longitudinal survey of the Medicare population, sponsored by 
the Centers for Medicare and Medicaid Services. Based on a 
person's difficulty or inability to perform ADLs and IADLs due 
to health problems, we constructed four mutually exclusive 
states:
          1. Active health (no difficulty with IADLs or ADLs)
          2. Moderate disability (difficulty with at least one 
        or more IADLs and/or two or less ADLs)
          3. Severe disability (difficulty with at least three 
        ADLs)
          4. Death (the fourth and absorbing state)
    The analysis sample consists of 40,320 beneficiaries of age 
65 and over, including 23,958 women, with 131,141 person-year 
observations and 90,821 pairs of observations.
    Method. This project applied a multi-state life table model 
to longitudinal person-level data to develop probability 
estimates for incidence of and recovery from disability, as 
well as death. After age-specific transition probabilities are 
estimated, the authors simulate a large cohort of 65-year-olds, 
by year and sex, and record their complete trajectories of 
changes in disability status until death. Simulation is a 
powerful computation technique that facilitates estimation of 
those statistics that are difficult to obtain otherwise.
    Results. This project found that all of the increase in 
life expectancy during 1992-2003 period was accounted for by an 
increase in life spent without functional limitations. The time 
spent with severe limitations decreased due to a combination of 
factors, including delayed onset, reduced incidence, shorter 
episodes and increased probability of recovery.
    During the study period, elderly men spent more years 
without limitations than elderly women; this may reflect the 
greater gains in total life expectancy for men in the last 
decade. In addition, all persons 85 years of age experienced 
gains in time spent without limitations and reductions in time 
spent with severe limitations.
    Conclusion. These trends are consistent with elements of 
both the theory of compression of morbidity and the theory of 
dynamic equilibrium. We will continue monitoring these trends 
using the latest MCBS data to see if time spent with functional 
limitations continues to decrease.
    Excellence: What makes this project exceptional?
    This project is the first U.S. study to comprehensively 
evaluate the latest trends in functional health to test whether 
they support the two most popular theories predicting the 
future health of the elderly population--expansion versus 
compression of morbidity. It used innovative statistical 
methods, including multi-state life table approaches and micro-
simulation to gain insights that are otherwise hidden. For 
example, it finds that the recent decrease in life spent with 
severe functional limitations is due to a combination of 
factors, including delayed onset of limitations, reduced 
incidence, shorter episodes and increased probability of 
recovery. It has advanced our knowledge of the nature of trends 
in the health of older persons and has developed methods that 
will be used to track future trends.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    This project focuses exclusively on the American elderly of 
age 65 and over. Its analysis revealed the complex pattern of 
trends in functional health among the elderly, and identified a 
number of factors associated with the recent improvement. This 
provides critical background information for policy makers to 
assess the direction of future trends in elderly health as the 
first wave of baby boomers enter Medicare. It may also assist 
the development of a range of health and public policies to 
reduce health disparities among the elderly and improve the 
overall well-being of the nation's older population.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    The finding may lead to policies affecting the lives of 
older persons. The findings demonstrate that a combination of 
improved risk factor profiles and medical advances has likely 
increased health life expectancy for older persons. The 
findings support increased emphasis on health promotion 
activities among the middle aged and older populations. The 
findings also support policies to encourage work force 
participation by the 65 and over population as a way to ease 
pressure on Social Security and Medicare, since the proportion 
of the older population with limitations that might hinder 
employment is decreasing.
    Innovativeness: Why is this research exciting or 
newsworthy?
    It demonstrates that the older Americans have experienced 
an increase in years without functional limitations and 
highlights the importance and the feasibility of following 
future trends to see if the good news continues.

 Centers for Disease Control and Prevention: Trends in Health and Aging

    This project provides reliable up-to-date information on 
trends in the health and health care utilization of the elderly 
population, using data primarily from the National Center for 
Health Statistics and the Centers for Medicare and Medicaid 
Services.
    Lead Agency: Centers for Disease Control and Prevention, 
National Center for Health Statistics (NCHS).
    Agency Mission: The mission of NCHS is to provide 
statistical information that will guide actions and policies to 
improve the health of the American people. As the Nation's 
principal health statistics agency, NCHS leads the way with 
accurate, relevant, and timely data.
    Principal Investigators: Yelena Gorina, M.S., Aging and 
Chronic Disease Statistics Branch, Centers for Disease Control 
and Prevention, National Center for Health Statistics, 3311 
Toledo Road, Room 6331, Hyattsville, MD 20782 and Ellen 
Kramarow, Ph.D., Aging and Chronic Disease Statistics Branch, 
Centers for Disease Control and Prevention, National Center for 
Health Statistics, 3311 Toledo Road, Room 6332, Hyattsville, MD 
20782.
    General Description: The Trends in Health and Aging (THA) 
project uses the statistical resources of NCHS and other 
federal agencies to provide current, policy-relevant 
information on the health and well-being of the older 
population in the United States. The core of the project has 
been the THA web-site (www.cdc.gov/nchs/agingact.htm), which 
allows access to a wealth of data presented in a consistent 
manner. The compilation, analysis and dissemination of these 
data are coordinated by staff of the Aging and Chronic Disease 
Statistics Branch of the Office of Analysis and Epidemiology 
(OAE) of NCHS. This branch brings together researchers with 
expertise in epidemiology, demography, and economics, assuring 
that the data are of high quality and presented in a manner 
useful to policy-makers and researchers. These researchers have 
used the data to produce a series of simple, policy relevant, 
topical reports on a range of topics relating to health and 
aging. (See: www.cdc.gov/nchs/about/otheract/aging/research-
publications.htm)
    In the near future, NCHS plans to merge the THA website 
with another web-based interactive data system--Health Data for 
All Ages--to produce a system that has consistent data across 
the lifespan. This new system will allow for the tracking of 
trends in the health and health care utilization of the future 
elderly.
    Excellence: What makes this project exceptional?
    Trends in Health and Aging is a powerful web-based resource 
that employs user-friendly software to provide access to up-to-
date trend data on the health of the elderly population. By 
distilling data from complex surveys and data systems into 
user-friendly tools and reports, it provides a model of data 
and research dissemination for other federal agencies.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    The entire focus of the project is to provide information 
on trends in the health of the elderly population.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    THA provides reliable, readily accessible information on 
the health of the elderly to policymakers, educators, 
researchers, and the public resulting in more informed decision 
making and better training tools.
    Innovativeness: Why is this research exciting or 
newsworthy?
    The project represents a powerful use of web-based tools to 
disseminate complex data in a user-friendly way.

 National Center for Health Statistics: Disability Statistics and Care

    With a focus on the equalization of opportunities and 
social participation, this project provides a universal 
approach to the measurement of disability and functioning that 
is of particular relevance to an aging population that is often 
restricted by chronic and disabling conditions.
    Lead Agency: Centers for Disease Control and Prevention, 
National Center for Health Statistics (NCHS).
    Agency Mission: The mission of NCHS is to provide 
statistical information that will guide actions and policies to 
improve the health of the American people. As the Nation's 
principal health statistics agency, NCHS leads the way with 
accurate, relevant, and timely data.
    Principal Investigators:
    Jennifer H. Madans, Ph.D., Co-Acting Deputy Director, 
Associate Director for Science, Office of the Center Director, 
Centers for Disease Control and Prevention, National Center for 
Health Statistics, 3311 Toledo Road, Room 7207, Hyattsville, MD 
20782.
    Julie Dawson Weeks, Ph.D., Health Statistician, Office of 
Analysis and Epidemiology, Aging and Chronic Disease Statistics 
Branch, Centers for Disease Control and Prevention, National 
Center for Health Statistics, 3311 Toledo Road, Room 6327, 
Hyattsville, MD 20782.
    Mitchell Loeb, M.Sc., Research Fellow, Office of Analysis 
and Epidemiology, Aging and Chronic Disease Statistics Branch, 
Centers for Disease Control and Prevention, National Center for 
Health Statistics, 3311 Toledo Road, Room 6325, Hyattsville, MD 
20782.
    Cordell Golden, Health Statistician, Office of Analysis and 
Epidemiology, Special Projects Branch, Centers for Disease 
Control and Prevention, National Center for Health Statistics, 
3311 Toledo Road, Room 6426, Hyattsville, MD 20782.
    Partner Agencies: The United Nations Statistical Commission 
and representatives from National Statistical Offices from over 
50 countries have been involved in this project.
    General Description: Internationally comparable disability 
measures are being developed by the Washington Group on 
Disability Statistics (WG), a ``city group'' established by and 
operating under the aegis of the United Nations Statistical 
Commission. The WG was established in response to the United 
Nations International Seminar on the Measurement of Disability 
held in June 2001 to develop questions and instruments that 
could be used in national surveys and censuses to measure 
disability among a variety of populations. It is a cooperative 
effort among national statistical offices of developed and 
developing countries, international statistical organizations, 
and international organizations representing persons with 
disabilities.
    The primary objective of the WG is to promote and 
coordinate international cooperation in the area of disability 
statistics, focusing on measures that will provide basic, more 
comparable information on disability throughout the world. 
Activities include the development of a small set of general 
disability measures suitable for use in censuses, sample 
surveys, or other statistical formats; the design of one or 
more extended sets of survey items intended to be used as 
components of population surveys or as supplements to specialty 
surveys; and the conduct of methodological studies.
    In keeping with its purpose, the WG has developed a small 
set of questions on disability that address the issue of 
assessing equalization of opportunity. In developing these 
questions, special attention was directed to international 
comparability of the resulting data. Cognitive and field tests 
have been conducted in 17 countries to determine how well the 
questions perform across different cultures. The results of the 
tests demonstrated that the questions were being interpreted as 
intended in countries in Africa, South America, North America, 
and Asia. The approach to data collection developed by the WG 
has also been incorporated into the UN Principles and 
Recommendations for the 2010 Census. At its eighth annual 
meeting, scheduled for October 2008, the WG will produce 
batteries of extended sets of questions on disability for use 
on surveys. These question sets will undergo cognitive and 
field testing over the next 12 months. All papers and products 
of the WG are available at www.cdc.gov/nchs/citygroup.htm.
    In January, 2008, a disability module that is consistent 
with the approach and conceptualization outlined in the United 
Nations' recommendations was incorporated into the American 
Community Survey (ACS). The ACS questions will also be added to 
the Current Population and the National Crime Victimization 
Survey in 2008. In addition, a joint research project is under 
way that will add the ACS disability questions to the National 
Health Interview Survey (NHIS). This project is part of a 
broader interagency effort to improve the collection and 
interpretation of information on disability. The NCHS will also 
be undertaking a review of the disability and functioning 
measures currently on the NHIS to identify design changes that 
would enhance its comparability with other national and 
international data collections and provide the more detailed 
information necessary to fully understand the complexities of 
disability.
    Excellence: What makes this project exceptional?
    The approach of the Washington Group on Disability 
Statistics to the operationalization and measurement of 
disability is unique and represents a milestone in recognizing 
the shift in attitudes and approaches to persons with 
disabilities that have been evolving over the past few decades. 
The WG recognizes the changing nature of disability and that it 
is manifested as a result of the interaction between persons 
with impairments and the barriers (both attitudinal and 
environmental) that hinder their full and effective 
participation in society on an equal basis with others.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    While the focus of the research is on producing global, 
comparable measures of disability and functioning, an aging 
society bears the burden of many chronic and disabling 
conditions. By focusing on the needs of this particular sub-
population and their level of participation in society we can 
improve both their quality of life and their continued 
contribution to society.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    It has been demonstrated that life expectancy among the 
elderly has been improving for many decades, and there is also 
evidence to indicate that health among the elderly is also 
improving; however, while life expectancy at older ages has 
increased, so has the prevalence of chronic diseases and the 
associated effects of deceased functioning.
    By providing a universal measure of disability and 
functioning that focuses on the equalization of opportunities 
it would be possible to focus efforts on improving the quality 
of life of the older population that is overburdened by the 
effects of chronic, disabling conditions.
    Innovativeness: Why is this research exciting or 
newsworthy?
    The project represents a novel approach to the 
conceptualization and measurement of disability--that builds 
the model of disability proposed by the World Health 
Organization's International Classification of Functioning, 
Disability and Health.

    The Prevention Research Centers: Healthy Aging Research Network

    The Healthy Aging Network is made up of 9 universities with 
expertise in the health of older adults. Member universities 
collaborate on research to identify best practices for physical 
activity programs for older adults and to set a research for 
studying healthy aging.
    Lead Agency: The Prevention Research Centers.
    Agency Mission: The Prevention Research Centers work as an 
interdependent network of community, academic, and public 
health partners to conduct prevention research and promote the 
wide use of practices proven to promote good health.
    Principal Investigator: Basia Belza, Ph.D., R.N., 
Professor, Aljoya Endowed Professor in Aging, School of 
Nursing, Box 357266, Health Science Building, T618D, University 
of Washington, Seattle, WA 98195-7266.
    Partner Agencies: Centers for Disease Control and 
Prevention, National Center for Chronic Disease Prevention and 
Health Promotion, Division of Adult and Community Health, 
Robert Wood Johnson Foundation, National Council on Aging, 
National Association of Chronic Disease Directors, Alzheimer's 
Association, American Society on Aging, Administration on 
Aging, CDC's Division of Nutrition and Physical Activity, and 
CDC's Prevention Research Centers.
    General Description: The Healthy Aging Research Network is 
developing a research agenda around the public health aspects 
of healthy aging. The nine universities participating in the 
network are a subset of 33 Prevention Research Centers the CDC 
funds.
    The prevention research agenda is intended to increase 
understanding of the determinants of healthy aging, identify 
interventions that promote healthy aging, and translate 
research into sustainable community-based programs that can be 
used throughout the nation. The researchers are identifying the 
key health-promoting skills and behaviors as well as the organ 
systems and syndromes that can affect healthy aging. The 
network members are also consulting with federal and state 
organizations on establishing local programs for healthy aging 
and working with national organizations to identify the most 
effective physical activity programs. The network members and 
other stakeholders are also conducting a literature review 
about the effectiveness and cost-effectiveness of cross-cutting 
interventions for older adults that can affect multiple health 
outcomes. The results are intended as recommendations to be 
used by researchers in the network and the U.S. Task Force on 
Community Preventive Services to create a chapter for the 
Community Guide to Preventive Services on evidence-based 
interventions for promoting health in older adults.
    Excellence: What makes this project exceptional?
    The project is a collaboration of leading researchers in 
aging from across the country, spanning academia, government, 
and private foundations, who have come together to review and 
set a research agenda for healthy aging.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    The U.S. aging population is growing, and this research is 
vital to maintaining health and quality of life for this large 
subset of the U.S. population.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Three national demonstration projects have been completed.
    (1) An in-depth, evidence-based review and statement of 
public health's role in addressing physical activity for older 
adults.
    (2) A network-wide survey and report of community-based 
physical activity opportunities for older adults at seven 
national sites.
    (3) An environmental audit to assess the built environment 
as it relates to physical activity for older adults.
    Innovativeness: Why is this research exciting or 
newsworthy?
    The network is unique in fostering collaboration among 
researchers on the issue of aging.

   National Center for Health Statistics: Long Term Residential Care

    The goal of this project was to develop a national 
typology, or classification system, of long-term residential 
care places. Making state-to-state comparisons regarding long-
term care availability, use, and related research and policy 
questions is extremely difficult because states differ in their 
licensing and labeling practices for these residences. A 
national typology that classifies similar places in different 
states by a common set of characteristics, such as size, 
services provided, or population served will allow researchers 
and policymakers to compare the supply, distribution, and 
characteristics of the full continuum of long-term care 
residential places and facilities.
    Lead Agency: National Center for Health Statistics (NCHS), 
Centers for Disease Control and Prevention (CDC).
    Agency Mission: The mission of the National Center for 
Health Statistics (NCHS) is to provide statistical information 
that will guide actions and policies to improve the health of 
the American people. As the Nation's principal health 
statistics agency, NCHS leads the way with accurate, relevant, 
and timely data.
    Principal Investigators: Robin E. Remsburg, PhD, RN, GCNS-
BC, FNGNA, FAAN, Deputy Director, Division of Health Care 
Statistics, National Center for Health Statistics, 3311 Toledo 
Road, Hyattsville, MD 20782, and Amy Bernstein, Sc.D., National 
Center for Health Statistics, 3311 Toledo Road, Hyattsville, MD 
20782.
    Partner Agency: National Institute on Aging.
    General Description: The well-documented aging of the 
population, particularly those aged 85 and older, will lead to 
an increase in the number of people who need long-term care 
services. While most people who need long-term care services 
receive them in their own home, personal care received outside 
both the home and traditional nursing facilities is an 
important and growing service option. This is especially the 
case for people who can no longer live alone but do not require 
the skilled level of care provided by a nursing home. This type 
of care--broadly referred to here as residential care--includes 
congregate settings that provide both housing and supportive 
services.
    In 2002, states reported a total of 36,399 licensed long-
term care residential facilities with 910,486 units or beds, a 
14.5% increase over 2000. However, there is no existing agreed-
upon classification system that allows one to distinguish the 
different types of long-term care residential places across the 
country. In 2003, the Assisted Living Workgroup (ALW), formed 
by the U.S. Senate Special Committee on Aging in 2001, 
recommended that places designated as assisted living 
facilities provide 24-hour supervision, provision and oversight 
of personal and supportive services (assistance with activities 
of daily living (ADLs)) and instrumental activities of daily 
living (IADLs), health-related services (e.g., medication 
management services), social services, recreational activities, 
meals, housekeeping and laundry, and transportation services.
    The precursor to the Typology project--the 2001 Inventory 
of Long-Term Care Residential Places (ILTCRP) project--was 
sponsored by the National Center for Health Statistics (NCHS), 
the Agency for Healthcare Research and Quality (AHRQ), and the 
Office of the Assistant Secretary for Planning and Evaluation 
(ASPE) of the U.S. Department of Health and Human Services 
(HHS). Based on state licensing criteria and state regulations 
obtained in the ILTCRP, relevant literature review, and expert 
opinions, a typology of long-term care residential places in 
the U.S. was developed.
    The typology proposed includes any place licensed, 
registered, or officially listed by a state that houses older 
adults and provides residential care, such as 24-hour 
supervision/responsibility, provision and oversight of personal 
and supportive services (ADLs and IADLs), medication 
management, meals, housekeeping, and laundry. The typology 
excludes: (1) nursing homes, (2) hospitals, (3) facilities for 
only mentally ill, mentally retarded, or developmentally 
disabled; (4) places that house military population; (5) HUD 
section 202 subsidized housing; (6) senior citizen 
cooperatives; (7) naturally-occurring retirement communities 
(NORC); (8) commercial retirement communities (that do not 
include licensed or certified places described above); and (9) 
other places for independent living.
    On January 12-13, 2004, the National Center for Health 
Statistics (NCHS) conducted an expert meeting of about 50 long-
term care researchers, residential care providers, industry 
representatives, and colleagues from various federal agencies. 
The objectives of the meeting were to: review, critique, and 
refine a proposed typology of long-term care residential 
places; discuss issues related to surveying these places; 
confirm the need for a survey of long-term care residential 
places; discuss the challenges of developing a sampling frame 
and classifying long-term care residential places; identify the 
places that should be included in a survey of long-term care 
residential places; and offer recommendations for refining the 
proposed typology of residential care places. Subsequent 
initiatives associated with this project have included the 
design of a national survey of residential care facilities, the 
development of an unduplicated sampling frame from which the 
sample for the national survey will be drawn, and preparations 
for conducting a nationally representative survey of 
residential care facilities and their residents.
    Excellence: What makes this project exceptional?
    Creating a uniform classification system or typology for 
long-term care residential places would enable the federal 
government to monitor long-term care policy and payment 
initiatives more effectively. A sampling frame that covers the 
full continuum of existing long-term care residences in the 
U.S. could be established. A typology would enable researchers 
to tailor their sampling methodologies and data collection 
strategies for the different types of long-term care 
residential places, direct care workers, and residents. The 
typology development has served as one of the precursor 
activities to the design of a national survey of residential 
care facilities and preparations for conducting a nationally 
representative survey of residential care facilities and their 
residents. This project has been part of a larger effort 
characterized by collaboration among multiple Federal agencies 
within the U.S. Department of Health and Human Services (HHS) 
to enable a better understanding of long-term care residential 
places.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    There are various types of ``long-term care'' residential 
places in the U.S. States differ in their licensing and 
labeling practices for long-term care residential places and 
services, making cross state comparisons extremely difficult. 
The term ``assisted living'' is used in the regulations or 
statutes in 32 states and the District of Columbia in 2002, 
however the characteristics of facilities labeled as assisted 
living vary dramatically across states. Even within states, the 
labeling among various hybrid facilities or residential 
communities that provide long-term care services but are not 
certified nursing homes is inconsistent. Facility licensing, 
regulation, and payment policy also vary considerably across 
states. Places licensed as board and care facilities in one 
state may be licensed as assisted living facilities in another 
state.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Creating a uniform classification system or typology for 
long-term care residential places would enable the federal 
government to monitor long-term care policy and payment 
initiatives more effectively. A sampling frame that covers the 
full continuum of existing long-term care residences in the 
U.S. could be established. A typology would enable researchers 
to tailor their sampling methodologies and data collection 
strategies for the different types of long-term care 
residential places, direct care workers, and residents.
    Innovativeness: Why is this research exciting or 
newsworthy?
    The experts convened for this two-day meeting concluded 
that a nationally representative survey of long-term care 
residential places is needed. Many consumers are confused about 
the different types of residential care places and the services 
they provide. Researchers and policy makers need to understand 
how services and populations change among residential care 
settings and be able to track the evolution of residential care 
over time. Given survey costs and budgetary constraints, most 
participants recognized that the scope of a survey may need to 
be limited to residential care places licensed/registered and 
listed by the state.
    Most participants recommended conducting a provider-based 
survey, which will provide more information on characteristics 
of the selected types of residential care places than a 
population-based survey. This project was a precursor to the 
National Survey of Residential Care Facilities being conducted 
by the National Center for Health Statistics in partnership 
with the Office of the Assistant Secretary for Planning and 
Evaluation (ASPE), United States Department of Health and Human 
Services, the Agency for Healthcare Quality and Research 
(AHRQ), United States Department of Health and Human Services, 
and the United States Department of Veterans Affairs.

 Centers for Medicare & Medicaid Services (CMS) & the National Cancer 
             Institute (NCI): Cancer Epidemiology Research

    The NCI sponsors the SEER program, which contracts with 15 
tumor registries to provide selected information on all newly 
diagnosed cancers in their reporting areas; CMS provides 
Medicare claims and enrollment records for the elderly and 
disabled populations. The linked database has been used to 
study a wide variety of issues related to cancer epidemiology 
and health services research.
    Lead Agency: The research data project is a joint effort 
between the Centers for Medicare & Medicaid Services (CMS) and 
the National Cancer Institute (NCI).
    Agency Mission: The mission of CMS is to administer the 
Medicare, Medicaid, and State Children's Health Insurance 
Programs and to promote quality care for beneficiaries.
    Principal Investigators: Gerald F. Riley, M.S.P.H., Senior 
Researcher, Centers for Medicare & Medicaid Services, 7500 
Security Blvd., Mail stop C3-21-27, Baltimore, MD 21244 and 
Joan L. Warren, Ph.D., National Cancer Institute, EPN Room 
4005, 6130 Executive Blvd., MSC 7344, Bethesda, MD 20892-7344.
    General Description: The Surveillance, Epidemiology, and 
End Results (SEER)-Medicare database is the linkage of two 
large population-based data sources that provide detailed 
information about elderly persons with cancer. The CMS 
collaborates with the NCI to link SEER data to Medicare claims 
and enrollment records for elderly and disabled populations. 
NCI sponsors the SEER program, which contracts with 15 tumor 
registries to provide selected information on all newly 
diagnosed cancers in their reporting areas. These areas 
currently include about 25 percent of the U.S. population. The 
SEER data collected about each new cancer case includes site of 
cancer, month and year of diagnosis, data about the cancer 
(e.g., histology, stage, and grade), type of surgical 
treatment, radiation therapy, patient demographics, follow-up 
of vital status, and cause of death. National statistics on 
cancer incidence, survival, and mortality are generated from 
the SEER database.
    The CMS provides Medicare claims and enrollment data for 
the SEER-Medicare linked database, including information on 
specific procedures like cancer screening services, 
chemotherapy, and post-treatment surveillance. Diagnoses 
reported on the claims can be used to identify comorbid 
conditions, and costs of care can be estimated from payment 
data. Enrollment records indicate enrollment and disenrollment 
from managed care. Medicare records for a 5 percent sample of 
cancer-free beneficiaries residing in SEER reporting areas are 
also included in the database for comparison purposes.
    The SEER-Medicare linked database includes cancer cases 
diagnosed from 1973 to 2002, and cases diagnosed from 2003-2005 
are currently being added. Medicare data are available from 
1991 to 2006. The database has been used to study a wide 
variety of issues related to cancer epidemiology and health 
services research. Several studies have addressed patterns of 
care by cancer site, as well as outcomes of care. Costs of 
cancer care have been estimated by phase of care, as well as on 
a lifetime basis from diagnosis to death. Effects of 
comorbidities on treatment and outcomes have been studied, and 
comparisons made of treatment under managed care and fee-for-
service. Additional topics include volume-outcome studies and 
disparities in cancer treatment and outcomes.
    The linked database has been used by CMS and NCI 
researchers to study numerous policy issues related to cancer 
epidemiology and health services. The data have also been made 
available on a de-identified basis to epidemiologists and 
health services researchers outside these two agencies for 
research purposes, subject to strict confidentiality rules, and 
appropriate reviews and approvals. To date, over 250 articles 
have appeared in the peer-reviewed literature based on SEER-
Medicare data. The agencies intend to continue updating the 
linkage on a biannual basis for the foreseeable future.
    Excellence: What makes this project exceptional?
    The SEER and Medicare data have complemented each other to 
produce a unique powerful tool for examining issues related to 
cancer care for the elderly. The linked database has made 
possible a broad range of studies that have resulted in more 
than 250 published articles in peer-reviewed journals. The 
project has required close collaboration between CMS and NCI, 
as well as with the participating SEER registries.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Cancer greatly affects the elderly, as 60 percent of new 
cancers and 70 percent of cancer deaths now occur in the 
population of those over the age of 65. The SEER-Medicare 
linked data provide a powerful tool for studying patterns of 
care, outcomes, and costs of cancer care among the elderly 
population.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Research based on SEER-Medicare data has provided important 
information to policymakers, providers, and beneficiary 
organizations concerned with cancer care for the elderly.
    Innovativeness: Why is this research exciting or 
newsworthy?
    The linked database provides a unique wealth of 
information, not available in other databases, on a very large 
number of cancer cases among the elderly population. SEER data 
on cancer incidence, survival, and mortality are linked to 
Medicare data on cancer screening services, chemotherapy, and 
post-treatment surveillance.

                    Medicare Psychiatric Admissions

    In 2005, Medicare implemented a new prospective payment 
system for inpatient psychiatric facilities (IPF PPS). This 
project analyzed Medicare psychiatric admissions between 1987 
and 2004. Special attention was given to differences in use of 
inpatient psychiatric care by aged and non-aged disabled 
Medicare beneficiaries. Analysis of Medicare psychiatric 
inpatient claims for 1987-2004 provides insights into future 
experience post-IPF PPS.
    Lead Agency: Centers for Medicare & Medicaid Services 
(CMS).
    Agency Mission: The mission of CMS is to administer the 
Medicare, Medicaid, and State Children's Health Insurance 
Programs and to promote quality care for beneficiaries.
    Principal Investigator: Philip G. Cotterill, Ph.D.. 
Economist, Centers for Medicare & Medicaid Services, 7500 
Security Blvd., Mail stop C3-21-28, Baltimore, MD 21244.
    General Description: In 2005, Medicare implemented a new 
prospective payment system for inpatient psychiatric facilities 
(IPF PPS). This analysis of Medicare psychiatric hospital stays 
begins in 1987, soon after the 1983 implementation of the DRG-
based inpatient hospital prospective payment system (IPPS). It 
continues through 2004--the last year in which freestanding 
psychiatric hospitals and psychiatric units within short-stay 
general hospitals were paid under the cost-based TEFRA system. 
The factors that influenced utilization of psychiatric 
inpatient care in the pre-IPF PPS past provide the basis for 
hypotheses about the impact of the IPF PPS and future trends in 
this Medicare benefit.
    Medicare pays for psychiatric inpatient care in three 
provider settings--freestanding psychiatric hospitals, short 
stay general hospital certified psychiatric units, and short 
stay general hospital beds (either as ``scatterbeds'' or 
uncertified psychiatric units). As noted earlier, the first two 
types of providers were exempted from the IPPS and paid under 
the cost-based TEFRA system until 2005. Uncertified units and 
scatterbeds have been paid under the DRG-based IPPS from its 
inception. Hospitals and units specializing in alcohol and drug 
treatment were exempt from the IPPS until 1988 when, following 
some refinement of the alcohol and drug DRGs, they were brought 
under the IPPS.
    Medicare payment policy has the potential to affect the 
utilization of psychiatric inpatient care in several ways. The 
use of different Medicare inpatient payment systems for 
different provider settings is very likely to affect how 
providers organize care. Differences in payment units, such as 
per case payments under the IPPS and per diem payments under 
the IPF PPS, provide different incentives. Differences in 
relative payment levels for these settings may also influence 
their relative utilization. Broader impacts are also possible. 
Relative Medicare payments for inpatient versus outpatient care 
may influence care choices between inpatient and community-
based services. Finally, Medicare coverage and payment for 
psychiatric inpatient care may encourage its utilization versus 
comparable utilization in long-term care residential settings 
not covered by Medicare.
    Medicare payment policy was only one of many factors that 
influenced psychiatric admissions between 1987 and 2004. In 
order to identify other factors, the study first decomposes 
admission trends into components representing changes in the 
number of beneficiaries, the rate of service use by 
beneficiaries, and the number of admissions per user. This part 
of the analysis also determines how various groups of Medicare 
beneficiaries were differentially affected by these factors. 
Second, the study examines the changes in care delivery 
patterns that resulted from the interaction of Medicare payment 
incentives and the factors identified in the first part of the 
study. The paper concludes with a discussion of the potential 
implications of these results for the delivery of Medicare 
psychiatric inpatient care in the future.
    Excellence: What makes this project exceptional?
    The study uses analysis of trends over 17-year period to 
pose questions about future developments in inpatient 
psychiatric care for Medicare beneficiaries.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Psychiatric care for the elderly has received less 
attention than psychiatric care for the chronically mentally 
ill population. This study highlights differences between the 
elderly and the chronically mentally ill in terms of their 
mental health conditions and care delivery patterns.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    The study shows that the growth of psychiatric units within 
general hospitals was a significant source of inpatient care 
for elderly dementia patients. The study asks whether 
Medicare's inpatient psychiatric facility payment system 
implemented in 2005 will alter the care delivery pattern that 
developed under the earlier payment system.
    Innovativeness: Why is this research exciting or 
newsworthy?
    This study is the first publication to summarize trends in 
inpatient psychiatric care during recent decades in a way that 
provides a context for future research.

                  Medicare Current Beneficiary Survey

    The MCBS is a longitudinal study, continually collected 
since 1991, that takes a comprehensive look at the Medicare 
population. Linked to Medicare claims data, this database is 
used to manage the Medicare program and help formulate future 
changes.
    Lead Agency: Centers for Medicare & Medicaid Services 
(CMS).
    Agency Mission: The mission of CMS is to administer the 
Medicare, Medicaid, and State Children's Health Insurance 
Programs and to promote quality care for beneficiaries.
    Principal Investigator: Franklin Eppig, J.D., Director, 
Medicare Current Beneficiary Survey, Centers for Medicare & 
Medicaid Services, 7500 Security Blvd., Mail stop C3-16-27, 
Baltimore, MD 21244.
    General Description: The MCBS is a continuous, multipurpose 
survey of a representative sample of the Medicare population 
designed to aid the Centers for Medicare & Medicaid Service's 
(CMS) administration, monitoring and evaluation of the Medicare 
program. The survey is focused on health care use, cost and 
sources of payment. Data from the MCBS enables CMS to determine 
sources of payment for all medical services used by Medicare 
beneficiaries, including co-payments, deductibles, and non-
covered services; develop reliable and current information on 
the use and cost of services not covered by Medicare (such as 
prescription drugs and long-term care); ascertain all types of 
health insurance coverage and relate coverage to sources of 
payment; and monitor the financial effects of changes in the 
Medicare program. Additionally, the MCBS is the only source of 
multi-dimensional person based information about the 
characteristics of the Medicare population and their access to 
and satisfaction with Medicare services and information about 
the Medicare program.
    Sample Characteristics:
    Universe: Medicare enrollees, both aged and disabled, 
whether in the community or in an institution.
    Periodicity: Three rounds per year, each 4 months in 
length.
    Unit of Analysis: Persons / Medicare beneficiaries.
    Sample Design: Multi-stage stratified random list sample.
    Survey Design: Rotating Panel / Each panel followed for 12 
interviews.
    Survey Methodology: In-person interviews using computer 
assisted personal interviewing (CAPI).
    Sample Strata: The MCBS sample is stratified by age group 
within the Medicare aged and disabled sub-populations. Both the 
disabled and the very old are over sampled to achieve a desired 
number of sample persons in each age strata. The over sample 
insures sufficient cases for analysis by age strata and 
increases the number of institutionalized persons in the 
sample. Approximately 16,000 sample persons are interviewed in 
each round. However, because of the rotating panel design, only 
12,000 sample persons receive all three interviews in a given 
calendar year.

------------------------------------------------------------------------
                                                       Sample size
                 Age group per                 -------------------------
                                                   Round        Annual
------------------------------------------------------------------------
0-44..........................................        1,334        1,000
45-64.........................................        1,334        1,000
65-69.........................................        2,667        2,000
70-74.........................................        2,667        2,000
75-79.........................................        2,667        2,000
80-84.........................................        2,667        2,000
85+...........................................        2,667        2,000
------------------------------------------------------------------------

    Questionnaire Content: The MCBS collects information on: 
health care use, cost and sources of payment; health insurance 
coverage; household composition; socio-demographic 
characteristics; health status and physical functioning; income 
and assets; access to care; satisfaction with care; usual 
source of care; and how beneficiaries get information about 
Medicare.
    Availability of Data: Information collected in the survey 
is combined with information from CMS' administrative data 
files and made available through data files. The Access to Care 
data file combines survey responses from the fall round of the 
MCBS with complete calendar year Medicare claims data. ``Access 
to Care'' data files are available within a year of the close 
of the subject calendar year. The complete medical use, cost 
and source of payment data file takes twice as long to produce 
because it requires complex editing and imputation activities 
which are built upon an event level match of survey collected 
information with Medicare claims and administrative data.
    For More Information Visit The MCBS Web Site: 
www.cms.hhs.gov/mcbs.
    Excellence: What makes this project exceptional?
    The MCBS is in a unique position to monitor effects of the 
Medicare program on its beneficiaries and provide the basic 
information needed to estimate the benefits and costs of 
program changes and expansions. The MCBS is used as a program 
management tool to assess legislative proposals (e.g., proposed 
expansion of home health care). Once decisions on health care 
reforms are made, the MCBS is in position to monitor their 
effects upon the Medicare population (e.g., enacted 
prescription drug benefit).
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    The MCBS is identified to assist policy makers and 
researchers in monitoring and evaluating the Medicare program 
and produce statistics and linked data files. This function is 
generalized, but not limited to the following tasks:
          1. responses to MCBS questions on access to care are 
        used to measure our beneficiaries' ability to get the 
        health care services in a timely manner in both fee-
        for-service and managed care settings;
          2. responses to questions on satisfaction from the 
        MCBS are used to measure the degree to which a 
        beneficiary's perception of care received meets or 
        exceeds his or her expectation for care, in both fee-
        for-service and managed care settings;
          3. responses to questions on utilization from the 
        MCBS and the associated Medicare claims are used to 
        track the percent of Medicare beneficiaries who receive 
        preventative health services to include but not be 
        limited to:
                  --an annual vaccination for influenza and a 
                lifetime vaccination for pneumococcal;
                  --a screening or diagnostic mammogram within 
                a 2-year period; and
                  --diabetic eye exam for beneficiaries 
                diagnosed with diabetes.
          4. responses to questions on beneficiary needs 
        measure the effectiveness of CMS' dissemination of 
        Medicare information to it's beneficiary population; 
        and
          5. responses to questions on beneficiary knowledge 
        measures the effectiveness of CMS' initiative to 
        increase beneficiary understanding of basic features of 
        the Medicare program.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Research based on MCBS data has provided important 
information to program managers and policymakers concerned with 
the Medicare program. Most recently data from the MCBS helped 
shape and inform the crafting of the 2003 Medicare Prescription 
Drug, Improvement and Modernization Act--MCBS was the only 
source of self-reported prescription drug utilization by the 
Medicare population. The MCBS continues to serves as a 
collection tool for non-covered prescription drugs as well as 
to measure the impact of the legislation on the Medicare 
program.
    Innovativeness: Why is this research exciting or 
newsworthy?
    In 2006, nearly 37 million people age 65 and over lived in 
the United States, accounting for just over 12% of the total 
population. To give historical perspective, over the 20th 
century the 65 and over population grew from 3 million to 35 
million. The Baby Boom Generation will start turning 65 in 2011 
causing a dramatic increase in this population over the 
following two decades. In 2030, this 65 and over population is 
projected to be twice as large as their counterparts in 2000, 
growing from 35 million to 72 million and representing 20% of 
the total U.S. population. From 2030 onward the proportion of 
aged 65 and over will remain relatively stable, at around 20%. 
While this demographic shift is interesting what truly makes 
this change exciting and newsworthy is that the 2008 Annual 
Trustees Report states that costs will exceed income, excluding 
interest, for the Medicare Hospital Insurance Trust Fund 
beginning in 2008. Beginning in 2010, costs are projected to 
exceed income including interest. It is projected that by 2019 
the trust fund will be exhausted.
    Over the next few years the Medicare program will most 
likely undergo increasing scrutiny. The MCBS will continue to 
play an active role in shaping and informing public debate. If 
and when changes to the program are enacted, the MCBS will 
again serve to measure the affects of those changes on the 
program and on the Medicare population.

     End-Stage Renal Disease Clinical Performance Measures Project

    This submission pertains to studies of quality of care for 
End-Stage Renal Disease (ESRD) patients, the majority of which 
are over the age of 65 years. Several of these studies use the 
Centers for Medicare & Medicaid Services' (CMS's) ESRD Clinical 
Performance Measures (CPM) Project data, either stand alone or 
linked with other CMS administrative data. These data have been 
used to study a wide variety of issues related to the quality 
of care for ESRD patients.
    Lead Agency: Centers for Medicare & Medicaid Services 
(CMS).
    Agency Mission: The mission of CMS is to administer 
Medicare, Medicaid, and the State Children's Health Insurance 
Program and to promote quality of care for beneficiaries.
    Principal Investigator: Diane L. Frankenfield, DrPH, MPH, 
BSPharm., Senior Researcher, Centers for Medicare and Medicaid 
Services, 7500 Security Blvd., Mail stop C3-21-28, Baltimore, 
Md. 21244.
    Partner Agencies: National Institutes of Health, National 
Institute of Diabetes & Digestive & Kidney Diseases, The United 
States Renal Data System, Kidney Epidemiology and Cost Center, 
Wake Forest University, Section on Nephrology, University of 
Wisconsin, Department of Pharmacy, Henry Ford Hospital, 
Department of Nephrology, Emory University, School of Public 
Health, and Duke Clinical Research Institute, Duke University 
Medical Center.
    General Description: End-Stage Renal Disease (ESRD) 
represents a significant disease and economic burden on the 
elderly. The CMS research program has emphasized studies of 
patterns of quality of care for ESRD patients.
    Several studies have explored patterns of care by sex, 
race, Hispanic ethnicity, and geographic location to determine 
if disparity in care exists for different patient groups. In 
addition, studies have been conducted to examine patterns of 
care by facility characteristics, such as profit-status, chain 
affiliation, and size. Different clinical outcomes examined 
have included intermediate outcomes such as dialysis adequacy, 
anemia management, type of vascular access in use, and 
nutritional factors, as well as outcomes such as 
hospitalization and mortality.
    On-going studies include (1) examining the association of 
erythropoietin stimulating agents (ESAs) dose and route of 
administration (intravenous vs. subcutaneous) with subsequent 
hospitalization and death; and (2) trending of anemia 
management among dialysis patients over time in response to 
changing FDA recommendations and clinical practice guidelines.
    Excellence: What makes this project exceptional?
    CMS, NIH, and other research organizations have 
collaborated to produce a series of policy-relevant studies of 
ESRD care in the elderly Medicare population. The studies have 
used several data sources, most notably CMS's ESRD CPM Project 
database and CMS administrative data. Analyses have addressed 
many facets of ESRD care, including treatment, outcomes, and 
costs.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    ESRD is largely a disease of the elderly. Research on 
patterns and costs of care inform Medicare policies in these 
areas. Analyses of patterns of care may result in improvements 
to beneficiary health as well as reducing/eliminating 
disparities in care for different patient groups.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Research on patterns of ESRD care has provided important 
information to policymakers, providers, and beneficiary 
organizations.
    Innovativeness: Why is this research exciting or 
newsworthy?
    The use of special databases has enabled researchers to 
conduct unusually detailed analyses of ESRD care that elderly 
Medicare beneficiaries are receiving.

        Medicare Beneficiaries With Multiple Chronic Conditions

    This project found that although diabetes care services 
decreased and the odds of dying increased among those with 
multiple chronic conditions as compared to diabetes only, the 
receipt of these diabetes care services was associated with 
half the odds of dying and lower costs to Medicare.
    Lead Agency: Centers for Medicare & Medicaid Services 
(CMS).
    Agency Mission: The mission of CMS is to administer 
Medicare, Medicaid, and the State Children's Health Insurance 
Program and to promote quality of care for beneficiaries.
    Principal Investigators: A. Marshall McBean, M.D., M.Sc., 
Professor, University of Minnesota School of Public Health, 420 
Delaware St., SE Mayo A369, Minneapolis, MN 55455.
    General Description: The purpose of Activity #1 of this 
study was to examine the extent to which elderly Medicare 
beneficiaries with multiple chronic conditions received 
recommended care and preventative services and to determine 
whether each additional condition had an impact on whether the 
beneficiaries received those services. The following chronic 
diseases and disease combinations were considered: diabetes; 
diabetes and depression; diabetes and chronic obstructive 
pulmonary disease (COPD); and diabetes and depression and COPD. 
The study outcomes included three diabetes care measures (serum 
hemoglobin A1c (HbA1c) and lipid (LDL-C) testing, and eye 
examination) as well as three preventive care measures that are 
recommended for all elderly beneficiaries (or one gender): 
influenza immunization, mammography and screening prostate 
specific antigen (PSA) testing. Rates of screenings and 
preventative care services were determined and multivariate 
logistic regression analyses were carried out to examine the 
effect of additional disease burden on the rate of receipt 
diabetes care and preventive care services. Baseline age-
adjusted rates among Medicare beneficiaries with diabetes were 
as follows: HbA1c test (72.9%), lipid testing (66.5%), eye 
examination (50.7%), influenza vaccination (54.7%), mammogram 
among women (45.4%), and prostate specific antigen (PSA) test 
among men (42%). Across all measures, rates generally became 
lower among beneficiaries with diabetes and COPD, and even 
lower among those with diabetes, COPD and depression, a set of 
findings that was also supported by the regression analyses. 
Results were more variable among those with diabetes and 
depression, but not COPD.
    The purpose of Activity #2 of this study was to examine 
costs of care and likelihood of mortality among elderly 
Medicare beneficiaries with multiple chronic conditions. The 
following chronic diseases and disease combinations were 
considered: diabetes; diabetes and depression; diabetes and 
chronic obstructive pulmonary disease (COPD); and diabetes and 
depression and COPD. Multivariate regression analyses were 
carried out for each disease cohort, as well as all cohorts 
combined, in order to examine the effect of adding additional 
disease burden on mortality and costs. The mean per beneficiary 
cost to Medicare in 2003 varied almost three fold between the 
cohort with diabetes only ($9,052) and diabetes, COPD and 
depression ($26,707) with intermediate cost burdens of $14,647 
for those with diabetes and depression and $18,756 for those 
with diabetes and COPD. A key cost-related finding is that the 
receipt of diabetes care services was strongly and linearly 
related to lower costs to Medicare for all four cohorts of 
beneficiaries. Compared with those diagnosed with diabetes 
only, there was a 75% greater likelihood of dying within two 
years among those with diabetes and COPD, and the risk was more 
than double for those with diabetes, COPD and depression. As 
the number of diabetes care services increased, a beneficiary's 
odds of dying decreased. Those who had received all three 
diabetes care measures (serum hemoglobin A1c (HbA1c) and lipid 
(LDL-C) testing, and eye examination) slashed their odds of 
dying in half, compared with those who had received none of 
these services.
    Excellence: What makes this project exceptional?
    This project is the first to look at the additional burden 
of multiple chronic diseases in conjunction with likelihood of 
receipt and health and cost impact of preventive healthcare 
services that are recommended for persons with diabetes and 
other chronic diseases.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    This project is relevant to aging populations because it 
not only focuses on Medicare beneficiaries who are sixty five 
years of age and older, but also it hones in on issues of 
particular importance to this group of older Americans. 
Specifically, it addresses the experience of those suffering 
multiple chronic conditions as opposed to those with zero to 
one chronic disease. Sixty five percent of Medicare 
beneficiaries in this age group suffer two or more chronic 
conditions, 43 percent have three or more chronic conditions, 
and 24 percent have four or more chronic conditions.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    This highlights the need for older Americans with one or 
more chronic disease to receive all the recommended screening 
and preventive care services. Not only do these reduce the odds 
of dying by one half, but also they are significantly 
associated with reduced cost to Medicare.
    Innovativeness: Why is this research exciting or 
newsworthy?
    This research is exciting because the screenings have been 
associated with both reduced mortality and decreased cost to 
Medicare. This is a win-win for patient care and Medicare cost 
containment.

   Effects of Disease Management Demonstrations on Elderly Medicare 
                              Populations

    CMS has conducted seven disease management (DM) 
demonstrations, social experiments on whether and how DM 
approaches by various health care providers affects the cost, 
access to, and the quality of care provided to groups of frail 
elderly with Medicare coverage. Evaluations have been 
conducted, results together constituting a significant body of 
knowledge on effects on DM programs on frail elderly Medicare 
populations.
    Lead Agency: Centers for Medicare & Medicaid Services 
(CMS).
    Agency Mission: The mission of CMS is to administer 
Medicare, Medicaid, and the State Children's Health Insurance 
Program and to promote quality of care for beneficiaries.
    Principal Investigators: David Bott, Mary Kapp, Lorraine 
Johnson, Carol Magee, CMS, Baltimore, 7500 Security Boulevard, 
Baltimore, MD 21244,
    Partner Agencies: Contractors included Mathematica Policy 
Research, RTI International.
    General Description: During the last decade, CMS has 
conducted seven disease management (DM) demonstrations, 
involving approximately 300,000 fee-for-service Medicare 
beneficiaries served by 35 programs. Programs include provider-
based, third party, and hybrid models, located in different 
geographic regions across the country. CMS staff, assisted by 
funded contractors, have conducted evaluations of these 
demonstrations. These analyses constitute a significant 
contribution to knowledge on effects on DM programs on frail 
elderly Medicare populations.
    Excellence: What makes this project exceptional?
    The volume of high-quality work underlying the evaluations 
of DM on the Medicare fee-for-service population.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Results improve understanding of effects of DM for frail 
Medicare populations and point to future research opportunities 
that will have direct relevance to the Medicare program.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Research contributes to understanding of policy makers in 
shaping the Medicare program, which impacts cost, quality, and 
access to care of the elderly.
    Innovativeness: Why is this research exciting or 
newsworthy?
    Research focuses on the application of DM activities to 
sicker Medicare populations, whereas these DM activities were 
previously applied to under-age-65-populations. Thus, findings 
potentially improve the understanding of policy makers in 
shaping the Medicare program.

Medicare Fee-for-Service Beneficiaries' Transitions Through Home Health 
                                  Care

    The authors selected a 5% random sample of Medicare fee-
for-service (FFS) beneficiaries and analyzed their 
administrative data (enrollment, claims, and OASIS assessments) 
from 2004 to document the substantial health needs and medical 
complexity of home health patients.
    Lead Agency: Centers for Medicare & Medicaid Services 
(CMS).
    Agency Mission: The mission of CMS is to administer the 
Medicare, Medicaid, and State Children's Health Insurance 
Programs and to promote quality care for beneficiaries.
    Principal Investigators: Jennifer L. Wolff, Ph.D., 
Department of Health Policy and Management, Johns Hopkins 
University, 624 N. Broadway, Room 692, Baltimore, MD 21205.
    Partner Agencies: Johns Hopkins University, Johns Hopkins 
School of Medicine, Johns Hopkins Bayview Center for Innovative 
Medicine.
    General Description: The purpose of this research was to 
describe Medicare fee-for-service (FFS) beneficiaries' 
transitions through home health care within the context of 
other acute and post-acute services, to examine health 
indicators among home health services patients, and to examine 
agreement within administrative claims and Outcome and 
Assessment Information Set (OASIS) measures of health services 
use. To conduct this study, the authors exploited a new CMS 
data resource, the Chronic Condition Data Warehouse (CCW). The 
CCW was created pursuant to Section 723 of the Medicare 
Modernization Act of 2003, whose intent was to improve the 
quality of care and reduce the cost of care for chronically ill 
Medicare beneficiaries.
    Excellence: What makes this project exceptional?
    This project contributes knowledge to an important but less 
well understood area of the health care continuum. Existing 
home health quality initiatives are setting-specific and 
limited to information generated by providers that submit OASIS 
assessments to the government. The authors found that 
approximately two-thirds of home health patients incurred acute 
or post-acute services in the 2 weeks preceding entry into home 
health, and that one-third incurred further acute and/or post-
acute services during the month after discharge. This result 
suggests there would be merit in articulating patient-specific 
rather than setting-specific measures of home health care 
quality.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Approximately 7.4% of beneficiaries in 2004 used home 
health care. According to this study, home health users' 
average age is five years higher than the age of beneficiaries 
generally (77.0 vs. 71.9 years), and more than one-quarter are 
at least 85 years old. More than one-quarter used Medicaid as 
well as Medicare. Upon initial assessment, nearly 1 in 3 
participants were dependent on others for help with activities 
of daily living; virtually all were disabled in instrumental 
activities of daily living. Claims-based indicators of chronic 
illness from the CCW suggested that one-quarter of home health 
users in 2004 had Alzheimer's disease or senile dementia, and 
one quarter had an indication of major depression within the 
last year. High rates of neurological and emotional disorder in 
this population of Medicare beneficiaries suggest substantial 
challenges are inherent in caring for ill elders at home, often 
shortly following a stay at an acute hospital.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    The study documents the substantial health needs and 
medical complexity of Medicare home health patients, as well as 
the high frequency of their transitions through the health care 
system. Findings substantiate the practical importance of CMS 
current efforts to develop a new, psychometrically sound, 
uniform post-acute assessment tool to improve information 
transfer between care settings, coordination of care, and 
patients' transitions across health care delivery settings.
    Innovativeness: Why is this research exciting or 
newsworthy?
    This study documents an important but less well understood 
area of the home health care continuum as it affects elderly 
Americans. The research also demonstrates the utility of 
enhancing traditional administrative data with a relatively new 
routine data resource, provider-submitted assessments, and with 
longitudinal summary data that facilitate efficient analysis.

  Characteristics of Enrollees and Enrollment in Medicare Part D Plans

    Projects provide insights related to Part D and drugs 
including beneficiary enrollment, enhanced benefits offered 
among Part D plans, medication therapy management, and 
transitioning dual eligibles and other low-income subsidy 
beneficiaries into Part D.
    Lead Agency: Centers for Medicare & Medicaid Services 
(CMS).
    Agency Mission: The mission of CMS is to administer 
Medicare, Medicaid, and the State Children's Health Insurance 
Program and to promote quality care for beneficiaries.
    Principal Investigators:
    Aman Bhandari, Economist, Centers for Medicare & Medicaid 
Services, Office of Research, Development and Information, 7500 
Security Blvd, MS C3-19-26, Baltimore, MD 21244
    Steve Blackwell, Social Science Research Analyst, Centers 
for Medicare & Medicaid Services, Office of Research, 
Development and Information 7500 Security Blvd, MS C3-19-26, 
Baltimore, MD 21244.
    Gerald Riley, Senior Social Science Research Analyst, 
Centers for Medicare & Medicaid Services, Office of Research, 
Development and Information 7500 Security Blvd, MS C3-19-26, 
Baltimore, MD 21244.
    Iris Wei, Social Science Research Analyst, Centers for 
Medicare & Medicaid Services, Office of Research, Development 
and Information 7500 Security Blvd, MS C3-19-26, Baltimore, MD 
21244.
    Partner Agencies: Research Triangle Institute, Mathematica 
Policy Research, and Abt Associates.
    General Description: The Medicare Part D benefit, 
established in the Medicare Prescription Drug, Improvement and 
Modernization Act (MMA) of 2003 represents the largest 
expansion of Medicare benefits since the program's inception in 
1965. CMS has undertaken several Part D and drug related 
research in the areas of enrollment, payment, and medication 
therapy management. All of these research projects together 
provide a picture of some aspects of the early implementation 
years of Part D that is valuable for any future decisions 
relating to the program.
    CMS has several research projects relating to 
characteristics of enrollees and enrollment in Part D plans. 
One study provides information on characteristics of 
beneficiaries who obtained coverage in 2006 through Part D, the 
retiree drug subsidy, other creditable coverage arrangements, 
or who had no known source of coverage. Preliminary analyses 
suggest that Part D enrollees do not have unusually high 
prescription drug costs, but had high out-of pocket drug costs 
prior to Part D enrollment. Prescription drug plans, especially 
those offering gap coverage appeared to have enrolled 
beneficiaries with higher baseline drug costs. Another study 
examined enrollment in plans with enhanced benefits. CMS 
launched the Part D payment demonstration allowing plans to 
choose alternative payment methods for re-insurance and to 
increase beneficiaries' choices of and access to supplemental 
drug coverage. CMS evaluated enrollment in the demonstration 
versus, selection bias for the demonstration plans, and impact 
of the demonstration on overall Part D enrollment. In general, 
the study found that the majority of enrollees in enhanced Part 
D plans were in non-demonstration plans and there was little 
evidence of selection bias among the plan types. Both of these 
studies have possible implication on the long-term financial 
impact of Part D on Medicare financing.
    CMS also evaluated the demonstration to transition 
unassigned full dual eligibles and other low-income subsidy 
(LIS) beneficiaries to a Medicare Part D plan at the point-of-
sale (POS). CMS put in place a contract with a prescription 
drug plan to provide temporary drug coverage at the pharmacy 
counter for beneficiaries who were eligible but who were not 
yet enrolled in a Part D plan. States also took temporary 
action to provide emergency coverage for dual eligibles and 
other low-income beneficiaries during the transition of having 
drug coverage from Medicaid to Medicare. This study documented 
gains in administrative efficiency within the point-of sale 
facilitated enrollment process and highlighted pitfalls to 
avoid and options to pursue for future efforts that States and 
CMS may undertake to facilitate access to Part D benefits for 
dual eligibles.
    The MMA also required prescription drug plans (PDPs) and 
Medicare Advantage plans that offer prescription drug coverage 
(MA-PDs) to have a Medication Therapy Management Program 
(MTMP), to improve medication use and reduce adverse events for 
high-risk beneficiaries. CMS conducted a study to explore the 
evolving field of MTM in order to identify and understand the 
attributes of MTM that may be most effective for the Medicare 
prescription drug program.
    Excellence: What makes this project exceptional?
    The collection of research studies provides a wide range of 
topics related to Part D and drugs. The findings from these 
studies provide some of the earliest information about 
enrollment, benefits, payment and some aspects of service 
delivery relating to Part D.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    As of January 2008, over 25.4 million Medicare 
beneficiaries are receiving drug coverage through private 
plans, either through stand-alone prescription drug plans or 
Medicare Advantage plans with prescription drug coverage. The 
research findings and possible implications from these findings 
affect these 25.4 million beneficiaries enrolled in Part D and 
millions more who may enroll in the program.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Since the Medicare program serves the population of those 
who are 65 and older, the research has implications for the 
enrollment and plan experience, and service delivery to older 
persons who are in the Medicare program.
    Innovativeness: Why is this research exciting or 
newsworthy?
    These studies present the earliest findings and insights to 
several aspects of the Part D program. The studies relating to 
enrollment in Part D provide information on the plans and 
benefits offered and utilized by beneficiaries. Information 
about improving the transition of dual eligibles and other low-
income beneficiaries to Part D is valuable for decision makers 
and for those serving this vulnerable segment of the 
population. Finally, while the information on medication 
therapy management still has many gaps, the CMS research on MTM 
provides the information for how it is being utilized for the 
Medicare population and provides some relevant information for 
future research.

 Corporation for National and Community Service: Keeping Baby Boomers 
                              Volunteering

    Lead Agency: Corporation for National and Community 
Service.
    Agency Mission: The mission of the Corporation for National 
and Community Service is to improve lives, strengthen 
communities, and foster civic engagement through service and 
volunteering.
    Principal Investigator: John Foster-Bey, Senior Advisor, 
Office of Research and Policy Development, Corporation for 
National and Community Service, 1201 New York Avenue NW, Room 
10909, Washington, DC 20525.
    General Description: The Baby Boomer generation is more 
educated, experienced, and larger than any previous U.S. 
generation. As they begin to retire, they will leave the 
workforce with unprecedented knowledge and skills. Engaging 
Boomers through volunteerism represents a tremendous 
opportunity for nonprofits. To ensure their participation, it 
is imperative to understand how best to capture their 
experience and energy in initial recruiting efforts. Secondly, 
organizations must understand what factors will impact their 
decision to continue volunteering from year-to-year.
    ``Keeping Baby Boomers Volunteering'' used data obtained 
from the Current Population Survey (CPS) from 1974, 1989, and 
each year from 2002-2006. The CPS is a monthly national 
household survey administered by the U.S. Census Bureau and is 
the primary source of employment information on our nation's 
labor force. The CPS volunteer supplement provides reliable 
data on volunteering behavior among American households. The 
data trace the volunteer habits of the same sample of Baby 
Boomers over two consecutive years, as well as a similar sample 
of pre-Boomers (the 1974 and 1989 surveys).
    ``Keeping Baby Boomers Volunteering'' highlights several 
trends that ultimately will help nonprofits design volunteer 
management programs to generate more volunteer opportunities 
for Boomers and improve retention. These findings include:
     The number of volunteers age 65 and older in the 
U.S. will increase 50% by 2020, from just under 9 million in 
2007 to over 13 million. The number of senior volunteers will 
double by 2036.
     Boomers volunteer today at higher rates than past 
generations did at a similar age. Boomers between the ages 46 
to 57 volunteer at a rate of 30.9%, compared to 25.3% recorded 
by that age cohort in 1974 (the Greatest Generation, born 1910-
1930) and 23.2% recorded in 1989 (the Silent Generation, born 
1931-1945).
     Education and having children are two key 
predictors of volunteer levels. Boomers' high education rate 
and propensity to have children later in life explain their 
high volunteer rate. This accounts in part for the fact that 
the volunteer rate for Baby Boomers is peaking later in life 
than past generations.
     Baby Boomers have different volunteer interests 
than past generations. Volunteers ages 41 to 59 were most 
likely to volunteer with religious organizations in both 1989 
and 2005. However, in 1989, the second most popular type of 
volunteer organizations were civic, political, business, and 
international. By 2005, the second most popular type of 
volunteer organization for Baby Boomers were educational and 
youth services.
     The type of volunteer activities done by Boomers 
affects retention. Baby Boomers who engage in professional or 
management activities are the most likely to keep volunteering 
(74.8% retention). Baby Boomers who engage in general labor or 
supply transportation are the least likely to volunteer the 
following year (55.6% retention).
    Excellence: What makes this project exceptional?
    As more and more Baby Boomers reach retirement age over the 
next several decades, they will have a dramatic and costly 
impact on Social Security, Medicare, and other social services. 
``Keeping Baby Boomers Volunteering'' emphasizes their 
importance to society, viewing Baby Boomers as valuable assets 
to public service in America. The report describes the 
volunteering characteristics of this highly educated and 
skilled generation and uses this information to develop a plan 
for nonprofits to efficiently utilize their abilities for the 
next three to four decades.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    ``Keeping Baby Boomers Volunteering'' describes the 
volunteering characteristics of Baby Boomers, who are poised to 
become the most highly educated and skilled generation of older 
Americans in history, and the reasons why so many of them 
volunteer one year but drop out in the next. The report uses 
this information to help nonprofit organizations develop a plan 
to harness the abilities and skills of Baby Boomer volunteers 
for the next three to four decades.
    For organizations to effectively utilize Baby Boomers as 
volunteers, they must be aware of certain trends. Baby Boomers 
are more active in volunteering activities then their 
predecessors, but like other age groups, a large proportion 
(over 30%) of volunteers drop out the following year. The 
report outlines possible volunteer management practices that 
will reduce this attrition. Organizations must recognize that 
Baby Boomers have different volunteering preferences than 
previous generations. Additionally, they serve for different 
motivations and prefer specific activities for service 
(professional management work as opposed to physical labor). To 
harness Baby Boomers' experience and energy, the study proposes 
several recommendations to develop a meaningful volunteering 
experience for volunteers and organizations.
    1. Rethink how to attract and utilize Baby Boomers as 
volunteers.
    2. To improve retention, put Boomers' skills to use through 
challenging projects.
    3. Treat volunteers in the same fashion as employees and 
donors. The more positive experience a volunteer has, the more 
likely (s)he will return, just like an employee or donor.
    4. Adopt progressive management practices, such as matching 
volunteers with appropriate assignments and providing 
professional development opportunities for volunteers. This can 
build organizational capacity and sustain volunteer 
participation.
    5. Because volunteering and giving are related, find ways 
to encourage substantial volunteering. This could produce 
considerable monetary contributions.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    The bulk of the Baby Boomer population is rapidly 
approaching retirement age. Boomers have accumulated 
exceptional wealth, education, and experience, and many of them 
will look to continue to have a positive impact on society. 
Other studies, including one by CNCS, have demonstrated the 
health benefits of volunteering. By engaging more Boomers in 
volunteering, they are improving their health, maintaining 
connections with the community, and contributing their 
knowledge to the rest of society.
    Innovativeness: Why is this research exciting or 
newsworthy?
    The research suggests the relationship between Baby Boomers 
and nonprofit organizations is symbiotic: by engaging Baby 
Boomers in volunteering, both the organization and the 
volunteers can benefit. Boomers are leaving the workforce with 
unprecedented skills and knowledge, and millions of them are 
able and willing to make positive contributions to their 
communities. By understanding how Boomers like to volunteer, 
nonprofits can both improve the experience of Boomer 
volunteers, while at the same time maximizing the benefits of 
the service provided by the volunteers. This in turn provides 
society with more help in addressing critical areas of need--
for example, health care for the aging population. The ability 
to live independently is one of the primary concerns of 
retiring Boomers; older volunteers can help their neighbors 
live at home longer, while preserving their own health by 
staying active within their communities.

Corporation for National and Community Service: The Health Benefits of 
                              Volunteering

    Numerous studies have found that when older adults 
volunteer, they not only help their community but also 
experience better physical and mental health in later years. 
These findings suggest Baby Boomers and older Americans who 
volunteer may be more likely to maintain their health and 
independence as they age.
    Lead Agency: Corporation for National and Community 
Service.
    Agency Mission: The mission of the Corporation for National 
and Community Service is to improve lives, strengthen 
communities, and foster civic engagement through service and 
volunteering.
    Principal Investigator: Robert Grimm, Jr., Director of 
Research and Policy Development, Corporation for National and 
Community Service, 1201 New York Avenue, NW., Room 10909, 
Washington, DC 20525.
    General Description: A growing body of research finds that 
volunteering provides individual health benefits to those 
donating their time. This research has found that those who 
volunteer have lower mortality rates, greater functional 
ability, and lower rates of depression later in life than those 
who do not volunteer. ``The Health Benefits of Volunteering: A 
Review of Recent Research,'' describes some key findings from 
this research, along with a state-level analysis of the 
relationship between volunteering and incidence of mortality 
and heart disease.
    To produce the report the CNCS Office of Research and 
Policy Development conducted a literature review of peer-
reviewed studies that have researched the relationship between 
volunteering and health. These studies were analyzed and 
summarized for the report. Additionally, the office obtained 
state-by-state data from the U.S. Census Bureau's Current 
Population Survey (CPS) and the Center for Disease Control to 
conduct an analysis of volunteer rate in comparison to 
mortality rates and incidences of heart disease for each state. 
The CPS is a monthly national household survey that is the 
primary source of employment information on our nation's labor 
force. The CPS volunteer supplement provided up-to-date data on 
volunteering behavior among American households for each state.
    Some of the key findings of ``The Health Benefits of 
Volunteering,'' include:
     States with a high volunteer rate have lower rates 
of mortality and incidences of heart disease. Health problems 
are generally more prevalent in states where volunteer rates 
are lowest.
     Individuals who volunteer have greater functional 
ability and better health outcomes and lower mortality rates, 
even after controlling for physical health, age, socioeconomic 
status, and gender. Additionally, when chronically or seriously 
ill patients volunteer, they appear to receive some benefits 
beyond what can be achieved through medical care.
     The health benefits of volunteering, including 
improved physical and mental health and greater life 
satisfaction, are more pronounced among older volunteers than 
among younger volunteers.
     Volunteering often enhances the social networks of 
citizens of all ages, reducing stress and the risk of disease.
      Volunteering and health are positively 
reinforcing. One study found that those who volunteered in 1986 
reported higher levels of happiness and physical health in 
1989, while those in 1986 who reported higher levels of 
happiness and physical health were more likely to volunteer in 
1989.
    These findings are particularly relevant today as Baby 
Boomers reach retirement age. Baby Boomers are volunteering at 
a higher rate than earlier generations did at the same age. 
With their demonstrated commitment to volunteerism combining 
with medical advances that keep them serving later into life, 
Baby Boomers may develop exceptional life expectancy over the 
next three or four decades. Efforts should be made to keep Baby 
Boomers serving in the future to enhance the health of the 
growing number of older adults.
    Excellence: What makes this project exceptional?
    A number of studies have evaluated the correlation between 
health and volunteering, but this report is a comprehensive 
review of research that illustrates the robustness of the 
findings. This report determines that many previous studies 
have found a positively reinforcing relationship between health 
and volunteering. Clearly, those in better health are more 
likely to volunteer, but these studies demonstrate that 
volunteering also leads to improved physical and mental health: 
volunteering keeps healthy people healthy. Several studies show 
that volunteering also can improve health of those battling 
chronic or serious illness.
    This study also is the first to compare mortality rates and 
incidences of heart disease to volunteer data for every state. 
Using the volunteer supplement to the monthly Current 
Population Survey data produces reliable volunteering 
information that can display the relationship between 
volunteering and health. Breaking the data down by state allows 
the researchers to graph these variables and use a line of 
best-fit to display this relationship. This study demonstrates 
yet another method to determine that volunteering has a 
positive correlation to better health for older Americans.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    These studies find that older volunteers are more likely to 
receive significant health benefits from volunteering than 
younger volunteers. As Baby Boomers become eligible to retire, 
the U.S. will have to find ways to care for the health of the 
aging. This report suggests that volunteering may constitute a 
low-cost solution to maintaining health among seniors. For 
older adults, volunteering each week may be just as effective 
as other recognized preventive measures to ensure a healthy 
retirement. Additionally, seniors can volunteer to aid other 
seniors, creating a double positive effect. This ethos provides 
numerous positive effects for society as a whole.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    This research demonstrates the importance of engaging Baby 
Boomers in volunteering activities as they reach retirement 
age. With the costs of healthcare rising, these studies show 
that volunteering is one of the most cost-effective ways to 
stay physically and mentally healthy while also participating 
in public service. Seniors looking for a healthy activity 
should consider volunteerism. Organizations in need of 
volunteers, particularly nonprofits, can utilize this 
information to target volunteer management programs towards 
senior citizens that will engage them in service while also 
meeting organizational needs. Independent living, identified by 
CNCS in other studies as a salient concern among seniors, can 
benefit from seniors serving with each other to ensure those 
dependent on others are not without aid.
    Innovativeness: Why is this research exciting or 
newsworthy?
    Evidence suggests the possibility that the best way for 
Baby Boomers and older Americans to remain physically and 
mentally healthy as they age is to volunteer. While there have 
been studies about the health benefits of volunteering, this 
document assembles recent significant studies in an easily 
comparable format and finds that they are constant in their 
conclusions: there is a strong relationship between 
volunteering and health benefits, particularly lower mortality 
rates, greater functional ability, and lower rates of 
depression later in life among those who volunteer as opposed 
to those who do not. For those interested in adopting 
volunteering as a method to stay healthy, this report 
summarizes the theorized ``thresholds'' that a person must 
cross to receive health benefits. There is also information 
that finds state volunteer rates are strongly connected with 
the physical health of the state's population, and this fact 
may spark interest from localities around the nation.

    The Corporation for National and Community Service: The Senior 
                           Companion Program

    ``The Final Report of the Senior Companion Quality of Care 
Evaluation'' finds that by pairing senior volunteers with 
homebound seniors in frail health, the Senior Companion Program 
improves the quality of life and care for both the clients and 
primary caregivers being served. It also builds the capacity of 
the organization sponsoring the program.''
    Lead Agency: Corporation for National and Community 
Service.
    Agency Mission: The mission of the Corporation for National 
and Community Service is to improve lives, strengthen 
communities, and foster civic engagement through service and 
volunteering.
    Principal Investigator: Donna Rabiner, Ph.D., RTI 
International, 3040 Cornwallis Road, P.O. Box 12194, Research 
Triangle Park, NC 27709-2194.
    Partner Agencies: Senior Corps and AmeriCorps.
    General Description: The Senior Companion Program provides 
grants to organizations that partner low-income senior 
volunteers with homebound elderly people in frail physical and/
or mental health, most of whom live alone.
    The ``Final Report of the Senior Companion Quality of Care 
Evaluation'' examines the impact of the Senior Companion 
Program on quality of life and quality of care outcomes for 
clients and families/caregivers served. The study also examines 
the value of individual Senior Companions to organizations 
serving older Americans. To obtain a well-rounded understanding 
of the program's impacts, the study surveyed clients, clients' 
families/caregivers, and volunteer supervisors.
    To examine the impact of the Senior Companion Program on 
quality of life and quality of care outcomes for clients and 
the clients' families/caregivers, interviews were conducted 
over three time periods (at program entry, after three months, 
and after nine months). Interviews were also conducted with two 
comparison groups, one composed of potential clients on the 
Senior Companion Program waiting list, the other of adults who 
received care with other agencies, but not from Senior 
Companions.
    Overall, nine-month results reported by clients and/or 
family members over time included:
           The relative increase in Senior Companion 
        Program client self-reported health improvements;
           The reduction in the number of depressive 
        symptoms reported by clients;
           The reduction in client unmet needs for 
        assistance with various activities of daily living;
           The increased ability of family members/
        caregivers to remain employed as a result of having 
        Senior Companions care for their frail relatives at 
        home;
           Fewer unmet needs for transportation 
        services, according to families/caregivers;
           The relative increase in the likelihood of 
        families/caregivers being very satisfied with the 
        reliability of their Senior Companion.
    Surveys of volunteer supervisors found that Senior 
Companions played an important function in enabling 
organizations to expand services to clients. Supervisors valued 
the assistance that the Senior Companions provided to their 
staff, and they were ``very satisfied'' with the roles that 
Senior Companions performed at their various locations. 
Supervisors also felt that other senior service providers, as 
well as the broader community-at-large, valued the Senior 
Companion Program.
    Finally, the ``Final Report of the Senior Companion Quality 
of Care Evaluation'' submits recommendations to address 
qualitative feedback from those surveyed. Recommendations 
include improving the overall quality of service by refining 
existing training and screening programs. Additionally, clients 
and family members perceive there to be a shortage of Senior 
Companions who are available to serve. The report recommends 
recruiting additional Senior Companions to serve the increasing 
number of frail older adults who are eligible for program 
services.
    Excellence: What makes this project exceptional?
    The impending retirement of the Baby Boomer generation has 
created an impetus for policies that meet health, social, 
transportation, and other needs of the aging population. The 
``Final Report of the Senior Companion Quality of Care 
Evaluation'' finds that Senior Companions improve the quality 
of life for the clients they serve, as well as the quality of 
care that their host organizations are able to provide.
    The study, conducted by RTI (Research Triangle Institute), 
is one of the most rigorous studies ever conducted on the 
impacts volunteering has on the health and independent living 
ability of older Americans. To measure the benefits received by 
clients, it compares outcome data for a sample of Senior 
Companion clients with data collected from random samples from 
two comparison groups individuals on the SCP wait list and 
individuals who received care from other providers--and 
followed up with these groups over time. To measure client 
impacts, the study examined ``adjusted'' differences in several 
outcome measures, controlling for prior health status and many 
other factors. To measure program impacts on other 
beneficiaries, the study also surveyed Senior Companion 
participants, family caregivers, and SCP host agencies.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    The Senior Companion Program enables low-income persons 
aged 60 and over to remain active through continued 
participation in needed community service. It also provides 
support primarily to homebound seniors with physical, 
emotional, or mental health limitations, most of whom live 
alone, in an effort to achieve and maintain their highest level 
of living. With the large Baby Boomer population reaching 
retirement age, the Senior Companion Program provides an 
opportunity for well intentioned, low-income seniors to provide 
necessary support for seniors who are homebound, typically live 
alone, and often have mental and physical health problems.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Overall, the evidence suggests the Senior Companion Program 
is responsible for a number of positive benefits, controlling 
for other factors. The program has helped many senior citizens 
retain their dignity and independence in spite of failing 
health or disabilities. This program gives seniors the 
opportunity to continue to live in their home with only 
periodic assistance. Additionally, homebound seniors can build 
social connections with other seniors, a very important aspect 
of strong mental and physical health.
    The ``Final Report of the Senior Companion Quality of Care 
Evaluation'' also demonstrates the need for more volunteers in 
the program, and recommends extending the Senior Companion 
Program so more seniors can benefit from it. As the population 
ages, the number of available volunteers aged 45 to 64 is 
expected to increase by 34 percent over the next two decades. 
By offering individuals new and expanded opportunities to serve 
their communities, larger numbers of Baby Boomers would begin 
to participate in this service program.
    Innovativeness: Why is this research exciting or 
newsworthy?
    With the number of Americans over age 65 projected to 
increase from 4.2 million in 2000 to 8.9 million in 2030, there 
is a pressing need for policy makers to meet the needs of frail 
seniors in the community. The Senior Companion Program is part 
of the solution; it is composed of over 200 volunteer stations 
around the country that support 15,000 Senior Companions and 
61,000 elderly clients. This rigorous study examines the impact 
of this program and finds that its relatively low-cost and 
``low-tech'' approach has had a positive impact on the 
agencies, clients, and family members/caregivers served by the 
program.

USDA Agricultural Research Service: Improving Nutrition and Health for 
                                Seniors

    The Center has made pioneering discoveries about the role 
of nutrition in improving the health and quality of life for 
elderly Americans, including ways to reduce risk of heart 
disease, bone fractures, eye disease, and dementia.
    Lead Agency: USDA Agricultural Research Service (ARS).
    Agency Mission: ARS conducts research to develop and 
transfer solutions to agricultural problems of high national 
priority and to provide information access and dissemination in 
order to:
           Ensure high-quality, safe food and other 
        agricultural products,
           Assess the nutritional needs of Americans,
           Sustain a competitive agricultural economy,
           Enhance the natural resource base and the 
        environment, and
           Provide economic opportunities for rural 
        citizens, communities, and society as a whole.
    Principal Investigator: Robert Russell, MD, Center 
Director, Jean Mayer USDA Human Nutrition Research Center on 
Aging at Tufts University, 711 Washington Street, Boston, MA 
02111.
    Partner Agencies: Tufts University, National Institutes of 
Health.
    General Description: The Jean Mayer USDA Human Nutrition 
Research Center on Aging at Tufts University (the Center) was 
established by an Act of Congress 30 years ago. It quickly 
became the premier institution in the world conducting research 
on nutrition in the prevention of age-related chronic diseases. 
The Center's accomplishments have greatly contributed to the 
health of the American people. Select examples of recent 
pioneering research that has impacted public health and served 
to establish Federal nutrition policy include the discoveries 
that:
     High vitamin D levels in the elderly are 
associated with fewer falls.
     Dietary omega-3 fats are a means of preventing 
dementia.
     Lutein, a pigment found in corn, spinach, and egg 
yolks, protects the eye against age-related macular 
degeneration, the leading cause of blindness in the elderly.
     Saturated and trans fats increase serum 
cholesterol and the risk of heart disease.
     Higher protein intake and exercise can decrease 
the loss of muscle normally seen in aging.
     Adequate intake of zinc can reduce the incidence 
of pneumonia in elderly residents of nursing homes.
     Vitamin K--not just calcium and vitamin D--is 
critical for bone health.
     The requirement for vitamin A is partially met by 
plant sources of beta-carotene.
     Folic acid can reduce the level of homocysteine in 
the blood, which is a risk factor for heart and brain disease.
    Excellence: What makes this project exceptional?
    The Center is widely acknowledged as the premier research 
institution studying the relationship between nutrition and 
aging. What makes this project exceptional are the breadth and 
strength of the scientists who staff it along with their 
discoveries. The staff are routinely recognized with 
prestigious awards from national and international nutrition 
and health organizations.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Because nutrition is one of the few factors for health 
under our complete control, this field offers people the 
ability to manage their own health. Many of the discoveries 
from the Center have stimulated other nutrition scientists to 
investigate the same questions, and other scientists often 
replicate the work of the Center. This is an acknowledgement by 
peers that the studies carried out here are of high impact in 
the field.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Nutrition research is relatively easily translated into 
practical applications for older persons. From work done at the 
Center, we know that vitamin D is more important than calcium 
for bone health in the elderly. In addition, we know that 
adequate intake of yellow and dark green vegetables can help 
prevent both cataracts and age-related macular degeneration. 
Small changes in the diet can improve health and reduce costs 
associated with avoidable causes of morbidity and mortality and 
have led the scientists to recently produce a food guide 
pyramid specifically for older Americans.
    Innovativeness: Why is this research exciting and 
newsworthy?
    This research is both exciting and newsworthy because a 
series of dietary recommendations can be made for older people 
to improve their health simply by substituting healthier 
choices for the foods they commonly consume. Specific 
recommendations can be made that have the potential for 
improving bone health, the immune system, the cardiovascular 
system, brain function (cognition), and the musculoskeletal 
system. In other words, virtually every system in the body can 
benefit from the work done at the Center.

  United States Department of Commerce: Computer Assisted Orthopaedic 
                                Surgery

    This research promotes the establishment of standard 
calibration and performance testing procedures for automated 
surgical systems within the operating room to ensure more 
predictable and successful hip replacement operations.
    Lead Agency: National Institute of Standards and Technology 
(Department of Commerce).
    Agency Mission: To promote U.S. innovation and industrial 
competitiveness by advancing measurement science, standards, 
and technology in ways that enhance economic security and 
improve our quality of life.
    Principal Investigator: Dr. Nicholas Dagalakis, Mechanical 
Engineer, 100 Bureau Drive MS 8230, Gaithersburg, MD 20899.
    General Description: The nominee and his team are 
developing state-of-the-art measuring techniques, similar to 
those used in making aerospace components fit together 
precisely, that soon could improve success rates for hip 
replacement surgery. At the request of a group of prominent 
orthopaedic surgeons and the American Academy of Orthopaedic 
Surgeons (AAOS), the NIST researchers are working to improve 
calibrations and operating room testing of the Computer 
Assisted Orthopaedic Surgery (CAOS) tracking instruments 
surgeons use to plan the delicate, highly complex joint 
replacement surgery. As the U.S. population ages, the number of 
hip replacement surgeries is increasing rapidly. According to 
HCUPnet-2004, 225,900 hip replacements and 37,115 revision hip 
surgeries were performed in the U.S. in 2004.
    To be completely successful, CAOS hip replacement surgery 
must take into account minute human skeletal differences. 
Imprecise measurements, which could result from conditions 
seemingly unrelated to the surgery, such as operation room 
noise or temperature, can lead to poor positioning of implants, 
leaving some patients with discomfort during walking and, in 
rarer cases, a need to redo the operation.
    The researchers have built a lightweight device called a 
``phantom'' that resembles the artificial socket, ball and 
femur substitutes that surgeons use to replace the joint and 
bone in hip operations. They drilled tiny holes at precisely 
measured intervals into the phantom and made cuts at precisely 
measured angles, favored by surgeons for CAOS operations. 
Because the precise coordinates of the mechanical (magnetic) 
ball and socket joint center of rotation have been measured, 
manufacturers of CAOS tracking sensors can use the phantom to 
test the accuracy of their measuring instruments. Surgeons also 
will be able to test the accuracy of their CAOS devices, just 
before making their first incision, to measure ball and socket 
joint center of rotation coordinates, angles for cuts into the 
bone and places for the insertion of screws, all critical to a 
successful outcome.
    Currently, no standardized approach to the evaluation of 
CAOS technology exists, but an ASTM International committee is 
working on the establishment of such standards. In the coming 
months NIST has submitted its hip CAOS phantom to orthopaedic 
surgeons for review and has begun receiving very positive 
feedback. Clinical trials could follow. If the device wins 
Federal Drug Administration (FDA) approval, it can be expected 
to find its way into operating rooms across the country and 
world. The researchers look forward to extending the 
application of the technology to surgical procedures on the 
knee and shoulder, which are also becoming more prevalent for 
older patients.
    Excellence: What makes this project exceptional?
    Significance: How is this research relevant to older 
persons, populations, and/or an aging society?
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Innovativeness: Why is this research exciting or 
newsworthy?
    This work is an excellent example of innovative use of NIST 
precision engineering and dimensional metrology experience to 
address a difficult biomedical engineering problem, which 
affects the quality of life of hundreds of thousands of people 
worldwide. Approximately one million joint reconstruction 
operations are performed every year throughout the world. One 
of the fastest-growing procedures is hip replacement, which has 
grown 80% since 2000. With an aging population, the number of 
hip replacements is expected to continue increasing for the 
foreseeable future. According to HCUPnet-2004, 225,900 hip 
replacements and 37,115 revision hip surgeries were performed 
in the U.S. in 2004. A revision surgery is significantly more 
risky and painful than the original operation. A significant 
cause for revision hip surgery is malpositioning of the 
implant. The effectiveness and reliability of joint-replacement 
surgeries has been shown to improve through the use of 
Computer-Assisted Orthopedic Surgery (CAOS). However, CAOS 
requires precise measurements of position and angles in order 
to fully realize these advantages. NIST contributed an artifact 
that enables calibration and performance tests of CAOS tools 
prior to an operation to ensure the accuracy of their position 
measurements. Attaining greater measurement precision will 
remove a critical barrier to wider use of computer-aided 
surgery, which would increase the success rate of the initial 
operations.
    Critical measurements of patient dimensions must be taken 
prior to and during the hip-replacement operation to ensure 
that the prosthesis is properly sized and aligned. Otherwise, 
the patient's leg length may not be correct or the prosthesis 
could fail due to dislocation and premature wear. The 
measurements are defined with respect to the patient pelvis 
frontal and transverse coordinate planes, which are difficult 
to locate while the patient is lying on the operating table. To 
address these measurement problems during operations, surgeons 
adopted robot calibration and performance measurement tracking 
sensors, giving birth to Computer-Aided Orthopedic Surgery. The 
tracking sensors use cameras to determine coordinates of active 
or passive targets, which are usually attached to surgical 
tools, helping surgeons precisely measure positions and 
distances. The tracking sensors have accuracy problems, 
however, that result in positioning errors. Sources of errors 
include camera optics, camera position and orientation 
determination, operating conditions (e.g., temperature, non-
uniform radiation field, distance from camera sensors), and 
different sampling rate frequency for multiple targets. 
Recognizing these challenging metrology errors, the American 
Academy of Orthopaedic Surgeons asked NIST for help with the 
calibration and performance testing of CAOS systems. NIST 
responded by establishing a research project to mitigate the 
measurement errors through calibration of the sensor tracking 
system, which led to invention of the CAOS calibration artifact 
hereafter referred to as the ``phantom.'' NIST researchers had 
to work closely with surgeons to determine requirements and 
constraints.
    The NIST team defined requirements that: any metrology 
solution had to be ``clinically relevant,'' meaning suitable 
within an operating room, lightweight, have low coefficient of 
thermal expansion, imitate the operation of human skeleton 
parts, and allow the simulation of critical phases of 
orthopaedic operations. NIST addressed these challenges by 
designing an artifact that resembles the artificial prosthesis, 
yet supports dimensional metrology calibration. The phantom is 
made of a femur-like bar, a magnetic ball and socket, and an L-
shaped XY coordinate frame. Inherent in the design of the 
phantom are easily-measured target features. The materials used 
are suitable for both operating room environments and for 
precision engineering dimensional metrology operations. 
Surgeons use the phantom to calibrate their CAOS systems prior 
to every operation to ensure that their measurements and 
positioning of the implant are correct.
    A prototype of the phantom was built and calibrated by 
NIST. This prototype was tested by leading CAOS surgery 
researchers in the operating room. They responded 
enthusiastically to the phantom in terms of its design, 
applicability, potential to improve their surgical procedures, 
and reduce the need for revision surgeries. Dr. James B. 
Stiehl, Columbia St. Mary's Hospital, a world-renowned CAOS 
researcher, was the first to test the NIST CAOS phantom. His 
reaction was ``The hip phantom that we worked on is an 
important project for me. I have a new idea that I am trying to 
work on and the phantom will be a critical tool to evaluate 
that new approach.'' Industry is very interested in 
commercializing the phantom: CAOS tracking experts from 
Medtronic Navigation, the leading provider of integrated 
navigation and intra-operative imaging solutions, are testing a 
prototype.

     United States Department of Commerce: Home Lift, Position and 
                          Rehabilitation Chair

    The HLPR chair is a testbed for developing assistive 
mobility technology concepts for wheelchair-dependent people. A 
prototype design has been developed that offers much greater 
independence in safely transferring from the chair to other 
locations.
    Lead agency: National Institute of Standards and Technology 
(Department of Commerce).
    Agency Mission: To promote U.S. innovation and industrial 
competitiveness by advancing measurement science, standards, 
and technology in ways that enhance economic security and 
improve our quality of life.
    Principal Investigators: Roger Bostelman, Electronics 
Engineer, Intelligent Systems Division, 100 Bureau Drive MS 
8230, Gaithersburg, MD 20899; Dr. James Albus (retired), 
Intelligent Systems Division, 100 Bureau Drive MS 8230, 
Gaithersburg, MD 20899.
    Partner agency: University of Delaware (through a National 
Science Foundation Grant).
    General Description: Engineers at the National Institute of 
Standards and Technology (NIST) have developed a robotic system 
that may offer wheelchair-dependent people independent, powered 
mobility and the ability, depending on patient status, to move 
to and from beds, chairs and toilets without assistance.
    The lifting ability of the system, which is called the 
``HLPR Chair'' (for Home Lift, Position and Rehabilitation), 
also should significantly reduce caregiver and patient 
injuries.
    The HLPR chair draws on mobile robotic technology developed 
at NIST for manufacturing and defense applications. It is built 
on an off-the-shelf forklift with a U-frame base on wheel-like 
casters and a rectangular vertical frame. The frame is small 
enough to pass through the typical residential bathroom. The 
user drives the chair using a joystick and other simple 
controls.
    The HLPR chair's drive, steering motors, batteries and 
control electronics are positioned to keep its center of 
gravity--even when carrying a patient--within the wheelbase. 
This allows a person weighing up to 300 pounds, to rotate out, 
from the inner chair frame, over a toilet, chair or bed while 
supported by torso lifts. The torso lifts lower the patient 
safely into the new position. The chair frame can even remain 
in position to continue supporting the patient from potential 
side, back or front falls.
    In addition, the proof-of-concept prototype HLPR Chair 
would allow stroke victims and others to keep their legs active 
without supporting their entire body weight. Retractable seat 
and foot rests, padded torso lifts for under arms (that, when 
raised, act like crutches) and an open frame at the bottom of 
the chair facilitate leg exercises. The patient, once lifted 
and supported by the torso lifts, can walk as the HLPR Chair 
moves forward at a slow pace. The current maximum speed is 27 
inches per second (0.7m/s).
    Future research possibilities include defining the sensing 
and control requirements that would enable the HLPR to 
autonomously dock with toilets, provide voice-activation 
capability so patients can call the HLPR from another location, 
and provide dial-in leg loading to limit leg forces during 
rehabilitation.
    Excellence: What makes this project exceptional?
    Significance: How is this research relevant to older 
persons, populations, and/or an aging society?
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Innovativeness: Why is this research exciting or 
newsworthy?
    There has been an increasing need for wheelchairs over 
time. Independent mobility is fundamental to health, social 
integration and individual well-being of humans. Hence, 
mobility must be viewed as being essential to the outcome of 
the rehabilitation process of wheelchair-dependent persons and 
to their successful (re-) integration into society and to a 
productive and active life. The quality of the wheelchair, the 
individual work capacity, the functionality of the wheelchair/
user combination, and the effectiveness of the rehabilitation 
program do indeed determine the freedom of mobility.
    Just as important as wheelchairs are the lift devices and 
people who lift patients into wheelchairs and other seats, 
beds, automobiles, etc. The need for patient lift devices will 
also increase as generations get older. Beyond providing the 
patient greater independence, lift devices can prevent numerous 
injuries to both the patient and their care-givers. Example 
statistics are: one in three nurses becomes injured while 
moving non-ambulatory patients and one in two non-ambulatory 
patients are injured from falls while being transferred between 
a bed and a wheelchair.
    Based on a survey of patient lift and mobility devices, 
NIST researchers discovered a need for technology that includes 
mobility devices that can lift and maneuver patients to other 
seats and technology that can provide for rehabilitation to 
help the patient become independent of the wheelchair. Their 
study also determined there are no standards nor performance 
metrics for such devices should they become available in the 
commercial sector. Nursing home caregivers will develop back 
injuries totaling 200,000 incidents this year alone from 
transferring patients and cost the U.S. $2 Billion. Based on 
these compelling needs, NIST designed a HLPR Chair testbed to 
investigate patient transfer including specific areas of 
mobility, lift and rehabilitation toward safety standards, 
performance measurements of such devices, and advanced 
autonomous controls.
    The HLPR Chair testbeds are based on a manual, inexpensive, 
off-the-shelf, sturdy forklift. The forklift includes a U-frame 
base with casters in the front and rear and a rectangular 
vertical frame. The lift and chair frame's dimensions allow it 
to pass through even the smallest, typically 61 cm (24 in) wide 
x 203 cm (80 in) high, residential bathroom doors. 



    The HLPR chair design is innovative in several ways. It is 
designed to explore key challenges in wheelchair-bound 
mobility, transfer to other surfaces, ability to reach high 
objects, rehabilitation, and autonomous assistive navigation 
for wheelchairs. The HLPR chair provides a seat/stand mechanism 
that provides lift and rotation to the patient allowing 
transfer to other chairs, beds, or toilets while maintaining 
safety by having the center of gravity remain within the 
wheelbase even if the patient is outside of it. See Figure 1 
for a graphic illustrating a transfer. To place a HLPR Chair 
user on another seat, they can drive to for example, a toilet, 
seat, or bed. Once there, the HLPR Chair rotates the footrest 
up and beneath the seat and the patients feet are placed on the 
floor personally or by a caregiver. The HLPR Chair inner L-
frame can then be rotated manually with respect to the chair 
frame allowing the patient to be above the toilet. Padded torso 
lifts then lift the patient from beneath his/her arm joints 
similar to crutches. The seat, with the footrest beneath, then 
rotates from horizontal to vertical behind the patients back 
clearing the area beneath the patient to be placed on the 
toilet, seat, bed, etc. Patient lift is designed into the HLPR 
Chair to allow user access to high shelves or other tall 
objects while seated. The HLPR Chairs' patient lift is 
approximately 1 m (36 in), equivalent to the reach of a 
standing 2 m (6 ft) tall person. This is a distinct advantage 
over marketed chairs and other concepts. The additional height 
comes at no additional cost of frame and only minimally for 
actuator cost.
    The HLPR Chair enhances patient rehabilitation through a 
load sensor and control on the lift actuator. The researchers 
designed rehabilitation into the HLPR Chair, as shown in Figure 
2, to allow, for example, stroke patients to keep their legs 
active without supporting the entire load of the patients body 
weight. The patient, once lifted, could walk while supported by 
the HLPR Chair driving at a slow walking pace towards regaining 
leg control and eliminating the need for a wheelchair.
    Autonomous mobility control using a sophisticated control 
architecture and advanced 3D imagers is nearly complete through 
a teaming arrangement with the University of Delaware. 
Commercialization is now being considered by the healthcare 
industry.

     United States Department of Commerce: NIST Biomedical Imaging

    Today the information content of biomedical imaging, such 
as in the reading of lung computed tomography (CT), is not 
fully exploited. By using computer-assistive algorithms in 
measuring the extent of disease and the response to therapy, 
physicians could more rapidly identify effective treatments. 
The Biomedical Imaging Project is researching measures and 
standards for benchmarking medical imaging algorithms for use 
in the measurement of disease.
    Lead agency: National Institute of Standards and Technology 
(NIST).
    Agency Mission: To promote U.S. innovation and industrial 
competitiveness by advancing measurement science, standards, 
and technology in ways that enhance economic security and 
improve our quality of life.
    Principal Investigator: Charles Fenimore, Mathematician, 
Information Technology Laboratory, National Institute of 
Standards and Technology, 100 Bureau Drive, MS 8940, 
Gaithersburg, MD 20899-8940.
    Partner Agency: NIST ITL is collaborating with other 
organizations, both inside and outside NIST.
           NIST: The following organizations have 
        contributed assistance with measurements related to the 
        Biomedical Imaging Project: Polymers Division (Contact: 
        Marcus Cicerone); Precision Engineering Division 
        (Contact: Steve Phillips)
           FDA : Center for Devices and Radiological 
        Health (CDRH, Contact: Nicholas Petrick)
           National Cancer Institute including 
        sponsorees: Cancer Imaging Program (CIP, Contact: 
        Laurence Clarke); University of Michigan (Contact: 
        Charles Meyer); Cornell University (Contact: Anthony 
        Reeves)
           Kitware Inc. (Contact: Rick Avila)
    General Description:
    Excellence: What makes this project exceptional?
    Significance: How is this research relevant to older 
persons, populations, and/or an aging society?
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Innovativeness: Why is this research exciting or 
newsworthy?
    The Biomedical Imaging Project engages with the medical 
imaging community and with other government scientists at NIST, 
the FDA, and NCI in a broad-based investigation of the 
performance of algorithms and computer-assisted diagnostic 
(CAD) tools for reading biomedical imaging. Medical imaging 
systems are widely used in the detection and staging of 
disease, the assessment of response to therapy, and other 
health-critical applications. Today, expert radiologists 
provide subjective interpretation, often using computer-
assisted diagnostic (CAD) tools. Such measurements depend on 
the expert, the software tools used, and the conditions of 
imagery acquisition. The variation, even with computer 
assistance, can be comparable in magnitude to clinically 
significant change criteria. The lack of reliable ``ground 
truth'' is a fundamental challenge in measuring CAD and 
algorithm performance. Determining performance metrics is an 
important area of investigation in the Project.
    The Biomedical Imaging Project develops methods for 
assessing the performance of algorithms and computer-assisted 
diagnostic (CAD) tools. Currently, we are conducting a 
multifaceted investigation of the performance of change 
analysis algorithms applied to computed tomography (CT) imagery 
of lung lesions. The principal elements of the project are the 
design and the conduct of benchmarking trials of algorithm 
performance, with the direct aim of developing reliable 
algorithm assessment methods and the study, implementation, and 
application of various change analysis algorithms, in order to 
better understand and compare their performance. In addition, 
the availability of a large number of CT scans with known 
lesion characteristics is essential in conducting benchmarking 
trials. We are investigating the production of synthetic 
imagery, intended to eventually provide a robust set of imagery 
for use in benchmarking evaluations.
    This research is significant for aging populations because 
it applies to the detection, staging, and measurement of 
clinical response to therapy in cancers. As recently observed, 
``Cancer in the older person is an increasingly common problem, 
due to the progressive prolongation of life expectancy * * *'' 
(Carreca, I; Balducci, L; Extermann, M; Cancer in the older 
person, Cancer treatment reviews [2005]). At the same time, 
mortality from some cancers, particularly those of the lung, 
have proven to be stubbornly resistant to modern medical 
diagnostic and treatment methods.
    The research focuses on the use of medical imaging 
algorithms as part of the development of reliable systems for 
measuring patient response to therapy. Today, there is rather 
high uncertainty associated with the assessment of response.
    A high reliability measurement of a patient's response to 
therapy is expected to have impact on improving the 
determination of malignancy and improving treatment options. 
The result would improve the clinical practice of cancer 
therapy. In addition, it promises to shorten clinical trials 
used in the development of new pharmaceuticals, by giving the 
pharmaceutical researcher more rapid indication of 
effectiveness or lack of response.
    Today, the standard method for measuring the extent of 
disease using imagery, known as RECIST, does not use the full 
potential of the CT data. We are in the early stages of 
building a consensus on how to improve the measurement of 
response to therapy. Measuring the performance of algorithms 
and CAD tools through benchmarking has proven to be an 
effective method for improving performance of algorithms in 
biometrics for detection and identification. Because of our 
long involvement in such measurements, the medical imaging 
community is very welcoming of NIST's leadership.

     United States Department of Commerce: NIST Health Informatics 
                             Infrastructure

    NIST research is contributing to the President's goals of 
having electronic health records for most Americans, as well as 
a nationwide health information network, by 2014, which will 
improve quality and accessibility and reduce costs of 
healthcare for older Americans.
    Lead Agency: National Institute of Standards and Technology 
(NIST).
    Agency Mission: To promote U.S. innovation and industrial 
competitiveness by advancing measurement science, standards, 
and technology in ways that enhance economic security and 
improve our quality of life.
    Principal Investigator: Bettijoyce Lide, Scientific 
Advisor, Health IT, Information Technology Laboratory, National 
Institute of Standards and Technology, 100 Bureau Drive, Mail 
Stop 8900, Gaithersburg, MD 20899-8900.
    Partner Agency: Department of Health and Human Services, 
American Telemedicine Association, Center for Aging Services 
Technologies, Healthcare Information Technology Standards 
Panel, Certification Commission for Healthcare Information 
Technology, Integrating the Healthcare Enterprise, Continua, 
among others.
    General Description: The National Institute of Standards 
and Technology (NIST) has a long and effective history for 
contributing to the technical direction of health IT, which has 
potential to improve the quality and accessibility of 
healthcare for older Americans, while reducing costs. 
Activities include supporting the efforts of the Department of 
Health and Human Services Office of the National Coordinator 
for Health IT and collaborations with a host of other public 
and private organizations including the American Telemedicine 
Association (ATA) and the Center for Aging Services 
Technologies (CAST). NIST's laboratories are contributing to 
this research and to the healthcare industry by providing 
standards, measurement science, security technology, and 
testing expertise. NIST collaborates with major standards 
development organizations, professional societies, and the 
public sector in fostering secure, interoperable, standards-
based solutions for the exchange of health information. NIST 
focuses on advancing healthcare information standards that are 
complete and testable, and by providing the necessary 
conformance tests, interoperability tools, and techniques where 
appropriate. These activities, when integrated into standards, 
software, and certification processes, raise the quality of the 
clinical outcomes, lower cost of health IT implementation, and 
foster adoption of healthcare systems.
    Excellence: What makes this project exceptional?
    Significance: How is this research relevant to older 
persons, populations, and/or an aging society?
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Innovativeness: Why is this research exciting or 
newsworthy?
    This project is exceptional in that it brings together key 
government departments and agencies such as those listed in 
section I, response 5, to fulfill the President's Executive 
Order, Number 13335, which calls for most Americans having 
electronic health records and for our country to have a 
nationwide health information network by 2014. Each public and 
private entity brings its expertise to contribute to the goal.
    This research is relevant to all Americans, but of 
particular importance to our aging society. People are living 
longer, and the demographic tidal wave will swell the ranks of 
the elderly in America from approximately 12.5 today to 18.8 
percent in 2025, a 50 percent increase. By 2030, the proportion 
of the U.S. population 65 years old or greater will double to 
71 million. By 2030, healthcare spending will increase 25 
percent, largely due to an aging population. Unfortunately, 
also, chronic conditions disproportionally affect older adults, 
thus consuming a greater proportion of healthcare resources. 
About 80 percent of older adults have at least one chronic 
condition; at least 50 percent of older adults have at least 
two chronic conditions.
    The impact and/or application of this research is that it 
will include applications of connected technologies that are 
possible, practical, and affordable. It has potential to 
improve the quality of healthcare that our aging populations 
needs and deserves, for example, having test results available 
when and where they are needed. It will also improve 
accessibility, for example, through telemedicine, allowing 
seniors to communicate with their healthcare providers remotely 
without costly and time-consuming (and potentially difficult) 
trips to the clinicians' offices. In addition, it can reduce 
costs through, for example, minimizing duplicative tests, or 
providing collaborative systems including personalized sensors 
and software converging through wireless Internet capability to 
permit seniors to stay in their own homes longer. Not only can 
results of this research improve healthcare, but it can improve 
the quality of life and preserve independence for our aging 
population.
    The research is exciting and newsworthy, because NIST has 
already been able to use its core competencies as articulated 
in our mission. Some of NIST's recent achievements in this area 
include:
     Developed software to advance the national goal of 
providing doctors secure and appropriate access to all 
patients' electronic health records, thereby enabling accurate 
diagnosis and treatment of disease. This software is used by 
U.S. regional healthcare systems (MA, NY, NC, Philadelphia) 
with over 40 vendors (IBM, GE Healthcare, Siemens, etc.) and is 
part of several national healthcare infrastructures (France, 
Demark, Italy, Austria, Spain, China, and Japan). It is the 
basis of the Healthcare Information Technology Standards 
Panel's Manage Sharing of Document specification that was 
recognized by the Secretary of HHS (Dec. 2007).
     Developed test tools to validate healthcare 
messages sent between healthcare systems. These tools have been 
incorporated into testing for DICOM (radiology images), used by 
the Certification Commission for Health Information Technology 
(CCHIT) in testing interoperability of Electronic Health Record 
systems, and used by the Veterans Administration, Kaiser 
Permanente, Siemens, and IBM Healthcare & Life Science, among 
others.
     Authored the conformance strategy and model to 
specify electronic health record (EHR) functions critical to 
care settings and for certification of EHR systems.
     Collaborated with the American Telemedicine 
Association on practice guidelines. For example, the Practice 
Guidelines for Ocular Telehealth have been adopted by several 
major ocular health centers, including the Joslin Diabetes 
Center, Inoveon, and the Walter Reed Medical Center.
     With the Center for Aging Services Technologies, 
hosted a major national summit that brought together a diverse 
group of stakeholders to address the challenges and enabling 
technologies needed to reach the vision of a connected home 
environment for the aging population in which healthcare 
devices are interoperable with home and consumer appliances, 
providing the infrastructure for patient-centric healthcare and 
wellness.
     Leading the development of an integrated virtual 
system to test interoperability of standards-based health 
systems. This is expected to be used by the Healthcare 
Information Technology Standards Panel (HITSP), the 
Certification Commission for Healthcare Information Technology, 
and implementers of the HITSP specifications. This test bed 
offers developers of health information technology (health IT) 
systems the interactions necessary to develop conformant 
standards-based implementations, leading to optimal health IT 
systems.
     Working with the private sector to harmonize 
healthcare standards and to develop specifications to enable 
transmission of health information securely using standard 
cryptographic technologies.
     Working on tools and tests to assure medical 
device interoperability.
    Cross Document sharing (XDS) Reference Implementation and 
Test Suite: http://ihewiki.wustl.edu/wiki/index.php/XDS Main 
Page IEEE Medical Device Test Tools: http://xw2k.nist.gov/
medicaldevices/index.html.
    Information on the NIST/CAST National Summit on Moving 
Towards Interoperability: Affordable, Accessible Healthcare: 
http://www.nist.gov/public_affairs/techbeat/tb2006_0831.htm; 
http://www.itl.nist.gov/Healthcare%20Summit/index.htm.
    NIST's role in this research area is recognized in reports 
such as the following: The ONC-Coordinated Federal Health IT 
Strategic Plan 2008-2012, released June 2008. Achieving 
Electronic Connectivity in Healthcare, Connecting for Health 
Collaborative, July 2004. Revolutionizing Health Care through 
Information Technology, President's Information Technology 
Advisory Committee, June 2004.

    United States Department of Commerce: NIST Computational Biology

    The Computational Biology Project aims to analyze and 
characterize image-processing techniques used by cellular 
biology researchers; provide guidance to researchers in 
selecting the appropriate techniques for their research; and 
bring computational and measurement science expertise to the 
cellular biology community to help them to effectively deal 
with the large amounts of images generated by their research.
    Lead agency: National Institute of Standards and Technology 
(NIST).
    Agency Mission: To promote U.S. innovation and industrial 
competitiveness by advancing measurement science, standards, 
and technology in ways that enhance economic security and 
improve our quality of life.
    Principal Investigator: Alden Dima, Computer Scientist, 
Information Technology Laboratory, National Institute of 
Standards and Technology, 100 Bureau Drive, Stop 8970, 
Gaithersburg, MD 20899-8970.
    Partner Agency: Karen Kafadar, University of Colorado.
    General Description: Research on aging, like all biological 
research today, is being facilitated by automation that 
provides instrumentation control and data acquisition. At the 
same time, there have been advances in imaging and other 
sensor-based technologies. Researchers are now able to quickly 
collect large amounts of multimodal image-based data that 
serves as the primary output of their experiments and as the 
source of their measurements. These measurements ultimately 
provide the information required to decipher complex cellular 
processes including those related to aging.
    Unfortunately, biological researchers are left with huge 
amounts of image data to process and analyze using techniques 
that are usually outside of their field of expertise. In 
addition, the large amounts of images require large amounts of 
secondary information (metadata) for their correct 
interpretation, handling and storage; gone are the days when a 
few sentence fragments in a lab notebook could jog memory and 
guarantee understandable and repeatable results.
    Scientific literature has many references to and 
descriptions of image processing techniques, but experience 
shows that many techniques have limited applicability; a method 
that works well for optical character recognition may well fail 
miserably in cell biology. Indeed, even within a well-defined 
field, certain techniques work well only on certain types of 
images; two images from different data channels of a microscope 
may require fundamentally different techniques. As image-based 
measurement becomes increasingly vital to biological research, 
the measurement uncertainty associated with image processing is 
increasingly becoming an issue.
    Today, the biological researcher is expected to be an 
expert in his/her field of research as well as a savvy user of 
image processing software and techniques. There is a deluge of 
available options, and typically the researcher chooses tools 
and techniques that they have been exposed to and feel 
comfortable with. There is little guidance available, and much 
of the biological literature seems to give little information 
about the methods used for analyzing experimental data and 
their associated parameters. This situation essentially 
distracts biological researchers from fulfilling the central 
goals of their research, such as understanding the biology of 
aging and developing new treatments for aging-related diseases. 
Given that the U.S. population is aging and that scientific 
resources are not unlimited, research that aims to improve the 
ability of biological researchers to handle their critical 
image-based data will ultimately facilitate the development of 
new treatments for aging-related diseases.
    A basic tenet of the Computational Biology project is that 
image processing and analysis techniques, despite their 
implementation in software, are fundamentally measurements and 
not simply calculations. As such, they can be characterized and 
understood in a manner similar to other measurement techniques. 
This suggests that the measurement uncertainty associated with 
the use of software-based image processing and analysis methods 
can and should be determined. It also suggests that clear 
guidance can be given to researchers to aid them in choosing 
the correct image processing techniques and will facilitate the 
interpretation of their research data.
    The Computational Biology Project aims to analyze and 
characterize image-processing techniques used by cellular 
biology researchers; provide guidance to researchers in 
selecting the appropriate techniques for their research; and 
bring computational and measurement science expertise to the 
cellular biology community to help them to effectively deal 
with the large amounts of images generated by their research.
    Excellence: What makes this project exceptional?
    Though this project is very new, it is exceptional in its 
approach to addressing some of the key issues hindering cell 
biology research that depends on large quantities of multimodal 
image data, including research on the biology of aging. 
Typically, a cell biology research project will focus on an 
area of interest, perhaps one or more particular cell processes 
related to aging. The research staff will consist mostly of 
biological researchers who will run experiments and collect 
data including images from microscopes.
    Given the complexity of cellular processes, at some point, 
the researchers will run into bottlenecks that slow down the 
pace of the research; perhaps they've collected huge amounts of 
complex images that need to be analyzed using techniques with 
which they are uncomfortable. They may bring in expertise from 
outside of the project's central area of interest to provide 
additional support. Over time, the project's success will 
become increasingly dependent on measurement and analysis 
techniques that are outside the scope of the biological 
researchers' specialized domain. The project will tend to start 
spending more time focusing on these ancillary issues instead 
of making progress on its primary research goal. Given the 
amount of biomedical research occurring, many projects will be 
in effect competing for the same outside support to solve a 
similar set of issues.
    If outside expertise is not available, the biological 
researchers may find themselves in the difficult position of 
becoming competent in technical fields outside of their primary 
area of expertise. They may make technical decisions that 
ultimately hinder their ability to progress with their primary 
research goals such as understanding the biology of aging and 
developing new treatments for aging-related diseases.
    The Computational Biology Project strategy is to 
effectively invert the problem to directly tackle the 
standards, measurements, and informatics issues that can slow 
down biological research. For example, one key issue with 
biological image data is the selection of the technique used to 
extract key features from the rest of the image (segmentation 
algorithms). Using cellular microscopy images generated by NIST 
biological researchers, our computational scientists, 
mathematicians, and statisticians intend to analyze and 
characterize common segmentation algorithms so that we can 
publish guidance for the biological research community as a 
whole. This will effectively mitigate the need for each project 
to address this issue and brings NIST measurement expertise to 
bear on the problem.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    As the population ages, an increasing emphasis will be 
placed on research related to the treatment of aging-related 
diseases--much of which will share infrastructure, resources, 
and expertise with other cell biology research.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    A key component in the treatment of aging-related diseases 
is the understanding of the complex cellular processes related 
to aging. This understanding, in turn, depends on sophisticated 
laboratory and data analysis techniques. By addressing some of 
the key issues related to the analysis of image data generated 
by cell biology research, the Computational Biology Project 
will improve the efficacy of cell biology research in general 
and as a result, research into the biology of aging will also 
benefit. This should, in turn, aid in the development of new 
treatments for aging-related diseases.
    Innovativeness: Why is this research exciting or 
newsworthy?
    From our perspective, this research is exciting because it 
brings NIST's traditional measurement expertise to bear in a 
new domain (cellular biology) and has the potential to make 
significant impact in terms of scientific and medical 
advancements. As our work progresses, we hope that it will 
become newsworthy in terms of the other advancements that were 
enabled by it.

                     65+ in the United States: 2005

    The report 65+ in the United States: 2005 provides a 
comprehensive description of the older population in the United 
States to foster a better understanding of their experiences 
and challenges.
    Lead Agency: Staff of the Population Division within the 
U.S. Census Bureau, Department of Commerce, conducted the 
research for the 65+ in the United States: 2005.
    Agency Mission: The mission of the Census Bureau is to 
serve as the leading source of quality data about the Nation's 
people and economy. We honor privacy, protect confidentiality, 
share our expertise globally, and conduct our work openly. We 
are guided on this mission by our strong and capable workforce, 
our readiness to innovate, and our abiding commitment to our 
customers.
    In addition, the specific mission of the Population 
Division is to provide regularly updated information on the 
population of the United States and countries around the world, 
and their demographic, geographic, and other characteristics. 
We share our expertise globally.
    Principal Investigator: Victoria A. Velkoff, Assistant 
Division Chief, Population Estimates and Projections, U.S. 
Census Bureau, POP HQ-5H185, 4600 Silver Hill Road, Washington, 
DC 20233, [email protected], 301-763-7070.
    Partner Agency: The National Institute on Aging.
    General description: The report 65+ in the United States: 
2005 provides a comprehensive description of the older 
population in the United States to foster a better 
understanding of their experiences and challenges.
    The dynamics of aging are affected by many interrelated 
factors, including demographic, social, economic, and medical 
influences. The growth of the older population has been 
dramatic. In the 20th century, this group increased from 3.1 
million to over 35 million, and its size is projected to double 
between 2000 and 2030. This substantial growth will challenge 
society on a range of issues, many of which are highlighted in 
this report.
    Diversity is a distinguishing feature of the older 
population in the United States and is highly likely to 
increase in the future on at least some dimensions. This report 
discusses diversity of age, sex, race, Hispanic origin, health, 
economic status, geographic distribution, marital status, 
living arrangements, and educational attainment among those 
aged 65 and older.
    The older population of tomorrow will differ from the older 
population of today in many ways. They will most likely be 
better educated and more racially and ethnically diverse than 
today's older population. While the older population will grow 
over the first half of the 21st century, the size of this 
growth is not certain. For example, if mortality decreases 
faster than projected, the older population of the future could 
be much larger than currently projected.
    How people experience aging depends on a variety of 
factors, including social and economic characteristics and 
health status, which are discussed in the chapters in this 
report. The second chapter of this report looks at the growth 
of the older population over the 20th century and into the 21st 
century, and includes data on race and Hispanic origin. The 
last section of this chapter provides a global context on 
population aging. The third chapter focuses on the health 
status of the older population. Trends in mortality are 
examined, and chronic diseases and disability are discussed. 
The fourth chapter covers economic characteristics of the older 
population, including trends in labor force participation and 
retirement. Data on wealth, income, and poverty are also 
presented. In the fifth chapter, geographic distribution and 
mobility of the older population are discussed. The sixth 
chapter examines social characteristics of the older 
population, such as marital status, living arrangements, and 
educational attainment.
    This report used data from a variety of sources. Data used 
in this report are primarily from Census 2000 and previous 
censuses; nationally-representative surveys such as the Current 
Population Survey , the Survey of Income and Program 
Participation, the National Health Interview Survey, the 
Longitudinal Study on Aging, and the American Housing Survey; 
recent population projections; and data compiled by other 
federal agencies, including the National Center for Health 
Statistics. This report also draws on information on the older 
population in numerous reports prepared by the Census Bureau, 
other federal agencies, and private researchers.
    The report 65+ in the United States: 2005 is exceptional 
because it provides a comprehensive portrait of the older 
population in the United States using multiple data sources. It 
presents demographic, social, and economic data on the older 
population in a manner that is accessible to a wide range of 
audiences.
    Population aging is one of the most important demographic 
dynamics affecting families and societies throughout the world. 
People are living longer and healthier lives. According to 
Census Bureau projections, a massive increase in the number of 
older people will occur when the Baby-Boom generation (people 
born between 1946 and 1964) begin to turn 65 in 2011. The older 
population is projected to double from 36 million in 2003 to 72 
million in 2030, and to increase from 12 percent to 20 percent 
of the population.
    The growth of the population aged 65 and over is 
challenging policymakers, families, businesses, and health care 
providers, among others, to meet the needs of aging 
individuals. Policymakers need to understand the 
characteristics of older populations, their strengths, and 
their requirements. Understanding the dynamics of aging 
requires accurate descriptions of older populations from 
interrelated perspectives, including demographic, social, and 
economic. This report is an effort to contribute to an accurate 
description of the older population in the United States.
    How people experience aging depends on a variety of 
factors, including social and economic characteristics and 
health status, which are discussed in this report. The growth 
of the older population over the 20th century and into the 21st 
century is presented, and data on race and Hispanic origin are 
included. The report also provides a global context on 
population aging. The health status of the older population is 
examined in the report, and trends in mortality, chronic 
diseases and disability are discussed. Information on the 
economic characteristics of the older population, including 
trends in labor force participation and retirement are 
presented, as well as data on wealth, income, and poverty. The 
geographic distribution and mobility of the older population 
are discussed. Finally, social characteristics of the older 
population, such as marital status, living arrangements, and 
educational attainment that impact how people experience aging 
are presented and discussed.

 Department of Labor: Retirement Adequacy With an Emphasis on the Baby 
                            Boom Generation

    RAND has taken an integrated approach to studying 
retirement adequacy with an emphasis on the Baby Boom 
generation. They have incorporated trends in health care costs, 
health, pension offerings and retirement behavior to provide a 
multi-dimensional look at retirement decisions.
    Lead Agency: Employee Benefits Security Administration 
(Department of Labor).
    Agency Mission: The Employee Benefits Security 
Administration (EBSA) of the Department of Labor (DOL) 
administers and enforces Title I and certain other provisions 
of the Employee Retirement Income and Security Act of 1974 
(ERISA). ERISA section 513(a) authorizes the Secretary to 
``undertake research * * * and in connection therewith to 
collect, compile, analyze, and publish data, information, and 
statistics relating to employee benefit plans, including 
retirement, deferred compensation, and welfare plans, and 
[other] * * * plans not subject to this Act.''
    Principal Investigator: Dr. Jeff Dominitz (Senior 
Economist, RAND), 1200 South Hayes Street, Arlington, VA 22202.
    Partner Agencies or Organizations: None.
    General Description: The rise in health care costs, shift 
from traditional defined benefit pension plans and erosion of 
retiree health plans has made it increasingly important for 
individuals to incorporate expected medical costs into their 
retirement planning. However, detailed health information, 
including expected health outcomes given medical expenditures 
as well as disease and mortality prevalence, has been absent 
from household financial data, hindering the ability of 
researchers to forecast the economic well being of future 
retirees. Absent this information, measures of retirement 
adequacy are incomplete and may lead to a false sense of 
security.
    RAND, with support from the Employee Benefits Security 
Administration (EBSA), has attempted to rectify this by taking 
a more integrated approach in their research, including 
projected health care costs into retirement planning, and by 
considering the many factors which go into the decision to 
retire. As a result, RAND has produced research for EBSA on 
such diverse topics as: alternative measures of replacement 
rates; offers of retiree health insurance; international 
comparisons of individual's responses to government policies; 
timing of retirement; and labor force transitions of older 
workers.
    In addition to their current research, RAND is expanding 
the Future Elderly Model (FEM), a dynamic health model, to 
include economic measures such as financial wealth, pension 
claiming and labor force participation. RAND intends to use the 
expanded model to perform various policy experiments, including 
projecting the solvency of the Social Security Trust Fund and 
the economic well-being of future cohorts, while controlling 
for expected health costs.
    Excellence: What makes this project exceptional?
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Innovativeness: Why is this research exciting or 
newsworthy?
    The RAND research project sponsored by EBSA employs several 
researchers with diverse backgrounds to examine issues facing 
an aging society. Typically, researchers focus on a single 
research topic and hold all other factors constant. RAND, 
however, takes a more unified approach, acknowledging that 
there are many issues which influence the choices made by aging 
individuals. For example, in modeling retirement decisions, 
RAND incorporates how health care coverage of a younger spouse 
may affect timing of retirement. In developing both income and 
consumption based replacement rates for retirement income, RAND 
includes potential health care costs in their calculations and 
presents the replacement rates in terms of the likelihood of 
having sufficient retirement income. To investigate 
institutional determinants of labor-force participation (with a 
focus on older workers), RAND looks at data from 12 other 
countries and develops standardized measures in order to 
compare how individuals respond to changes in retirement and 
health insurance policies. In its research, RAND take a 
complete look at the issues facing an aging workforce and it is 
this holistic approach that makes its research exceptional.
    The EBSA-sponsored research by RAND has focused on the 
effects of health insurance and pensions on labor-force 
transitions for older workers. Health and financial security 
are two of the most important issues facing older persons and 
RAND's research sheds light on how older persons make decisions 
that impact these issues.
    By looking at what influences how and when older workers 
retire as well as responses to various government policies, 
RAND's research provides policy-makers with insights into these 
difficult decisions. These new insights may in turn shape 
future legislation and regulations which target older persons.
    RAND's research is exciting because it combines different 
data sources as well as researchers of different disciplines to 
achieve a fuller picture of the issues facing older workers. 
RAND's research considers the many components of retirement and 
sheds light on how they interact with each other.

   Department of Labor: Pension Simulations (PENSIM) From Government 
                                Policies

    PENSIM is a dynamic micro-simulation model used to estimate 
the retirement income implications of government policies which 
affect employer-sponsored pensions, employer offerings of 
pensions, and employee behavior with respect to pensions.
    PENSIM is a dynamic simulation model that produces life 
histories for a sample of individuals born in a particular 
year.
    Lead Agency: Employee Benefits Security Administration 
(Department of Labor).
    Agency Mission: The Employee Benefits Security 
Administration (EBSA) of the Department of Labor (DOL) 
administers and enforces Title I and certain other provisions 
of the Employee Retirement Income and Security Act of 1974 
(ERISA). ERISA section 513(a) authorizes the Secretary to 
``undertake research * * * and in connection therewith to 
collect, compile, analyze, and publish data, information, and 
statistics relating to employee benefit plans, including 
retirement, deferred compensation, and welfare plans, and 
[other] * * * plans not subject to this Act.''
    Principal Investigator: Dr. Martin Holmer, President of the 
Policy Simulation Group, 1314 Kearney Street, NE., Rm N5718, 
Washington, DC 20210.
    Partner Agencies or Organizations: The Office of Retirement 
and Disability Policy (Social Security Administration) has 
sponsored substantial development of SSASIM and GEMINI since 
2001 in order to expand the range of Social Security reforms 
that can be simulated and enable simulated life histories from 
PENSIM to be used in producing aggregate Social Security 
solvency estimates.
    General Description: The U.S. Department of Labor's 
Employee Benefits Security Administration (EBSA) began 
supporting the development of PENSIM a dynamic micro-simulation 
model produced by the Policy Simulation Group (PSG), in 
September 1997. The model analyzes lifetime coverage and 
adequacy issues related to employer-sponsored pension plans in 
the United States using stimulated life histories of sample 
cohorts and detailed pension characteristics imputed based on 
National Compensation Survey establishment data.
    The life history for a sample individual includes a variety 
of life events and their timing: birth, schooling, marriage, 
divorce, childbirth, immigration, emigration, disability onset 
and recovery and death. In addition, a simulated life history 
contains a complete record of jobs held by the individual, 
including each job's starting and ending date, job 
characteristics, pension coverage and plan characteristics. The 
richness of the life history allows the estimation of, for each 
year of an individual's life, their Social Security taxes and 
benefits as well as employer-sponsored pension benefits.
    The design of PENSIM has been strongly influenced by the 
policy analysis needs of the EBSA. It has been used to study a 
number of employer-sponsored issues, particularly the 
sensitivity of future benefits to government policy, employer 
offerings, and employee behavior and plan design. Findings from 
PENSIM have been published in several GAO reports as well as 
regulations published by the Department of Labor.
    PSG began distributing PENSIM free to the public via its 
website in spring 2007, enabling individual users to conduct 
analysis of the simulated pension environment and produce 
research papers. The model is currently being compared to 
another pension model (Poterba, Rauh, Venti and Wise) to test 
its validity. Beginning in fall 2008, PSG intends to add 
defined contribution participant loans and hardship-
withdrawals, as well as federal income taxation of pension 
income to the model, to better reflect current pension issues.
    Excellence: What makes this project exceptional?
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Innovativeness: Why is this research exciting or 
newsworthy?
    Employer-sponsored pensions make up the third leg of the 
``three-legged stool'' used to describe the major sources of 
retirement income, along with Social Security and personal 
savings. However, because not all employees are covered by 
pensions throughout their working years, EBSA has become 
increasingly concerned as to the adequacy of retirement income 
provided by employer-sponsored pensions for some segments of 
the population. In order to study this issue and how it is 
impacted by government policy, EBSA commissioned work on the 
PENSIM beginning in September 1997.
    PENSIM is a smaller-scale model which represents the 
interaction between employees and employers that determines 
lifetime pension coverage and adequacy. PENSIM simulates life 
histories which are rich enough to allow estimation for each 
year in an individual's life of pension benefits as well as 
Social Security taxes and benefits. It is uniquely able to 
model pension accumulations of American workers across 
populations and over time, and as a result, had been used by 
EBSA as well as the Social Security Administration (SSA) and 
the Government Accountability Office (GAO) on such policy 
questions as Social Security and pension reform. PENSIM is 
exceptional precisely because it was designed as a leading 
rather than a lagging policy research activity that has been 
able to contribute significantly to high priority, behavioral 
analysis projects.
    PENSIM regularly revises its assumptions with regard to 
demographics and life events so that the simulated cohorts' 
life histories closely mimic the actual populations. As such 
PENSIM captures the ``graying'' of the workforce, the decline 
of defined benefit (DB) pensions in favor of defined 
contribution (DC) plans, changes in the Social Security rules, 
the delaying of childbearing, increases in divorce as well as 
other societal and generational shifts. This makes the model 
and the research it generates relevant not only to current 
retirees, but also to future retirees.
    Because PENSIM is focused on retirement savings over a 
lifetime, it is able to project the endowment an individual 
will have at the time of death. Moreover, it is able to measure 
the impact various policy proposals will have on this 
endowment. This provides insights into the well-being of older 
Americans under different economic and political assumptions 
which can in turn influence which policies are ultimately 
adopted and enforced by the government.
    PENSIM is exciting and newsworthy because it is currently 
being used to help shape pension legislation which will have 
far-reaching effects on the retirement adequacy of this and 
future generations. PENSIM is able to adjust to changes in the 
pension landscape quickly so that it can project impacts of 
proposals rather than analyze their effects after the fact. 
This is essential to insure that those policies ultimately 
adopted will best serve current and future retirees.

         Department of Labor, U.S. Consumer Expenditure Survey

    Research using the U.S. Consumer Expenditure Survey data 
documents the rising share in out-of-pocket expenditures over 
the past two decades of households at the retirement age. The 
findings also show the higher costs for retired households.
    Lead Agency: U.S. Bureau of Labor Statistics (BLS), 
Division of Consumer Expenditure Surveys.
    Agency Mission: Providing impartial, timely, and accurate 
data relevant to the social and economic conditions of our 
Nation, its workers, and their families.
    Principal Investigator: Meaghan Duetsch, Phase 2 Section 
Chief, Division of Consumer Expenditure Surveys, U.S. Bureau of 
Labor Statistics, 2 Massachusetts Ave., NE., Room 3985 Postal 
Square Building, Washington, DC 20212.
    Partner Agencies: The U.S. Bureau of the Census collects 
the Consumer Expenditure Survey data under contract with BLS. 
All research was done within BLS.
    General Description: This research project, Out-of-Pocket 
Care Spending Patterns of Older Americans, as Measured by the 
Consumer Expenditure Survey, used data from Consumer 
Expenditure Surveys, 1985, 1995, and 2005 and examined the out-
of-pocket healthcare expenditures of older families in the age-
ranges just before and just after the Medicare eligibility age 
of 65, and analyzed how health care expenditures for these two 
groups have changed.
    Components included in the study were health insurance 
premiums paid for by the household members, as well as spending 
for medical services, drugs, and medical supplies.
    The research showed that over this 20-year period, there 
was a greater percent increase in expenditures on health care 
than in total expenditures. As a share of average total annual 
expenditures, health care expenditures rose for both age groups 
over the two decades. The share of expenditures allocated to 
health care by the 65-74 year-old group is slightly more than 
1.5 times the share allocated by 55-64 year-old group in all 
three time periods.
    Future Plans: As this research covered up to 2005, the 
recent change to the new Medicare prescription drug benefit 
will warrant further analysis.
    Excellence: What makes this project exceptional?
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Innovativeness: Why is this research exciting or 
newsworthy?
    The United States has experienced many changes over the 
past two decades in the way health care is managed and the way 
households allocate their spending. Families approaching 
retirement need to understand these trends to prepare for the 
future, and retired persons need to be aware of how their 
spending patterns change. This research measures and documents 
these changes using the only Federal source of expenditure data 
linked to detailed household characteristics and demographics. 
Expenditures on health care have risen faster than overall 
spending, and retired households spend 50 percent more than do 
households approaching retirement age.

    Department of Labor: Gradual Retirement Through ``Bridge'' Jobs

    This research project examines why so many retirees are 
exiting the workforce gradually, in stages, and the economic 
consequences of these decisions. It focuses on the types of 
jobs that people take, the reasons behind their choices, and 
their socioeconomic outcomes.
    Lead Agency: U.S. Bureau of Labor Statistics.
    Agency Mission: Providing impartial, timely, and accurate 
data relevant to the social and economic conditions of our 
Nation, its workers, and their families.
    Principal Investigators: Michael D. Giandrea, PhD., U.S. 
Bureau of Labor Statistics, Office of Productivity and 
Technology, Postal Square Building, Room 2180, 2 Massachusetts 
Ave., NE., Washington, DC 20212; Kevin E. Cahill, PhD., 
Analysis Group, Inc., 111 Huntington Avenue, 10th Floor, 
Boston, MA 02199; Joseph F. Quinn, PhD., Department of 
Economics, Boston College, Chestnut Hill, MA 02467.
    Partner Agencies or Organizations: Dr. Cahill and Dr. Quinn 
received funding from the Sloan Center on Aging and Work/
Workplace Flexibility at Boston College and also from the 
Centre for Retirement Research at Boston College.
    General Description: More often than not, older Americans 
with full-time, long-tenure jobs move to a ``bridge'' job 
before finally leaving the labor force. These bridge jobs are 
voluntary for some, a way to try something new, remain socially 
active, or benefit in some other nonpecuniary way. For others, 
work later in life is a financial necessity to avoid hardship 
in retirement. Measuring the extent of these experiences and 
their consequences are of interest to policymakers. Policies 
that encourage work later in life have been proposed as a way 
to alleviate the expected economic strain on aging society. 
This research project examines bridge jobs and retirement 
transitions, including the extent to which bridge jobs are 
utilized by older and younger workers, the role of self 
employment in retirement transitions, and the relationship 
between bridge jobs and retiree well-being.
    One study in this project asked if today's younger retirees 
are following in the footsteps of their older peers with 
respect to gradual retirement. An earlier study by these 
researchers, based on the Health and Retirement Study (HRS), an 
ongoing nationally-representative survey of older Americans 
that began in 1992, found that the majority of older Americans 
with full-time career jobs later in life moved to another job 
prior to complete labor force withdrawal. In this follow-up 
study, the authors compared a cohort of older workers born 
between 1942 and 1947 with those born between 1931 and 1941, 
and found that younger retirees followed patterns of gradual-
retirement similar to those of their predecessors. This 
conforms the view that traditional one-time, permanent 
retirements remain the exception rather than the rule.
    In another paper, the authors examined transitions into and 
out of self employment among older workers who had career jobs. 
They utilized the HRS to investigate the prevalence of self 
employment transitions later in life and explored the factors 
that determine the choice of wage-and-salary employment or self 
employment. They found that post-career transitions into and 
out of self employment were common, that self employment 
increases in importance as workers age, and the health status, 
career occupation, and financial variables were important 
determinants of these transitions. As older Americans and the 
country confront financial strains in retirement income in the 
years ahead, self employment may be a vital part of the pro-
work solution.
    Finally, another aspect of this research examined the 
outcomes of older Americans who transitioned to bridge jobs 
following career employment. The authors examined the extent to 
which transitions onto bridge jobs were involuntary and how 
workers' bridge jobs compared to the career jobs they had left 
behind. They found that about 20 percent of those with full-
time career jobs later in life left these jobs involuntarily, 
and that these individuals were less likely than others to move 
to a bridge job. The large majority of older workers with full-
time career jobs, however, left these jobs voluntarily and 
moved to bridge jobs before complete retirement, suggesting 
that for most of these individuals work beyond career 
employment may be an effective way to maintain an adequate 
level of financial security and/or quality of life.
    Excellence: What makes this project exceptional?
    This research is timely and based on a nationally-
representative sample of older Americans born between 1931 and 
1941. Today's retirees are changing the way older workers exit 
the labor force. Traditional one-time, permanent retirements 
are now the exception rather than the rule, as older workers 
increasingly change jobs later in life or reenter the labor 
force after ``retiring.'' The conclusions are based on analyses 
of data from the Health and Retirement Study, a nationally-
representative sample of more than 12,000 older Americans 
surveyed every other year from 1992 to 2006.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    This research on work later in life is relevant because 
today's retirees are experiencing more financial risk than 
prior cohorts, and therefore may have to work later in life in 
order to supplement income from Social Security, private 
pensions, and savings.
    The pro-work mindset of many of today's older Americans is 
likely a reflection of many factors. People are healthier, are 
living longer and have higher levels of education compared to 
earlier generations. Jobs are also less physically demanding 
now than in the past. Over the past two decades, a generally 
strong labor market has provided older workers with job 
opportunities. These changes have enabled older workers to 
remain productive well beyond traditional retirement ages.
    Many of the financial incentives surrounding retirement 
have changed as well. Defined-benefit pension plans that offer 
a guaranteed annuity payment upon retirement are less common in 
today's private sector and many existing defined-benefit plans 
are being converted to cash balance plans or replaced with 
defined-contribution plans managed by the worker. Social 
Security, the bedrock of financial security late in life, is 
facing financial strain and will likely provide lower 
replacement rates than in the past. Finally, private saving, 
the third pillar of retirement income, is currently near record 
low rates.
    As a result, today's retirees are now in charge of their 
retirement finances and face more financial risk than at any 
time in the post-war era.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    The shift towards ``do-it-yourself'' retirement has both 
positive and negative consequences for older people. On the one 
hand, workers have more control of their retirement assets and 
they respond to many of the financial incentives associated 
with retirement by working longer and by taking on bridge jobs 
after career employment. The implication is that if retirement 
assets are less than expected upon retirement many older 
workers may remain active members of the labor force well into 
their late 60's and 70's. Conversely, if work later in life is 
not an option, because of factors such as health or inflexible 
work options, some retirees' well-being will be vulnerable to 
fluctuations in market conditions.
    What is clear is that retirement incentives have changed 
and these changes will likely influence the retirement 
decisions of older workers for years to come.
    Innovativeness: Why is this research exciting or 
newsworthy?
    This research is exciting because the topic of work later 
in life is important to a large number of Americans who are on 
the cusp of retirement. The leading edge of the Baby Boomers, 
in particular, reached traditional retirement age in 2008.
    Today's older workers are searching for increased levels of 
financial security for the remainder of their increasingly long 
lives. This research on bridge jobs illustrates how current 
retirees have utilized transitional employment to smooth 
financial shocks that may have occurred following full-time 
career employment. These bridge jobs also help older workers 
maintain social networks that are often available only among 
fellow workers.
    While other authors have investigated partial retirement 
and employment among older workers, they have developed a 
series of papers that relate and build upon each other. They 
first described the prevalence of bridge jobs in a 2006 
Gerontologist paper and then compared bridge job activity 
between an older and a younger cohort of workers above the age 
of 50 (forthcoming in Research on Aging). Building on this 
framework, they investigated the economic outcomes of older 
workers comparing those who retired directly from career jobs 
to those who transitioned to bridge jobs. They found that most 
transitions, particularly bridge jobs, were voluntary and that 
most workers were happy with their jobs. They then examined one 
of the most interesting transitions, from wage-and-salary 
career employment to self-employment (Center on Aging & Work 
Issue Brief).
    The work decisions of older Americans are diverse and rich. 
Policymakers should be interested in our findings, in light of 
the fact that Americans may be asked to work later in life in 
order to supplement traditional sources of retirement income.

  Department of Labor: Details of Plan Generosity Among 401(k) Plans 
                   Having Employer Matches 2002-2003

    This project provides new measures of the generosity of the 
401(k) plans provided by private employers in the United States 
in the calendar years 2002 and 2003, using the microdata 
collected as part of the Bureau of Labor Statistics' National 
Compensation Survey (NCS).
    Lead Agency: United States Bureau of Labor Statistics.
    Agency Mission: Providing impartial, timely, and accurate 
data relevant to the social and economic conditions of our 
Nation, its workers, and their families.
    Principal Investigator: Keenan Dworak-Fisher, Office of 
Compensation and Working Conditions, U.S. Bureau of Labor 
Statistics, Room 4130, 2 Massachusetts Ave., NE., Washington, 
DC 20212.
    General Description: This project provides new measures of 
the generosity of the 401(k) plans provided by private 
employers in the United States in the calendar years 2002 and 
2003, using the microdata collected as part of the Bureau of 
Labor Statistics' National Compensation Survey (NCS). With the 
ongoing transformation of employer-provided retirement benefits 
from a predominance of traditional Defined Benefit pensions to 
a concentration on optional, Defined Contribution plans now 
almost three decades old, understanding the generosity of these 
types of employer benefits is more and more important. Yet, 
much of what is known about these plans originates from small, 
non-representative surveys and household surveys whose 
potential for inaccuracy is oft cited. Regular BLS publications 
use NCS to provide useful descriptive information about Defined 
Contribution plans, but the complexity and variability of the 
plans prevents such publications from going into comprehensive 
detail on the generosity of 401(k) plans. This project provides 
many of these needed details.
    The generosity of the predominant type of 401(k) plans is 
reflected in the form and extent of matching contributions that 
the employer pledges to make when the employee contributes. 
While the value of the benefits ultimately received by the 
workers from their employers depends on the employees' own 
actions (participation and contribution rates), the structures 
of the employer matches themselves demonstrate the potential 
for employer contributions to add to employees' retirement 
savings. The paper draws on the coded microdata underlying NCS 
publications, as well as additional data gleaned from 
employers' plan brochure to describe the distribution of plan 
generosity observed in the NCS sample, which is representative 
of the nation as a whole.
    The project portrays many dimensions of the wide variation 
between the 401(k) plans offered by employers. Match rates are 
seen throughout the 0-100 percent range, and even higher. These 
matches are provided on 1 to 6 percent of employees' salaries, 
and even higher. Some matching schemes provide ``flat'' 
matches, while other employers vary the match rate over the 
distribution of employee contribution amounts, or between 
employees with different amounts of tenure. The project shows 
that some of these features of plan generosity are offsetting--
e.g., a low match rate is often compensated for by a high 
amount of employee salary eligible to be matched. Nonetheless, 
plans with variable match rates tend to be somewhat more 
generous than those providing flat rates. The project also 
documents how the generosities of plans differ by job and 
employer characteristics--for example, workers in the Western 
region tend have access to significantly more generous plans 
than workers in the South.
    This project has been published in the BLS's Monthly Labor 
Review and circulated to interested retirement researchers at 
other private and public organizations. It has also affected 
plans for future BLS publications using NCS data. And it forms 
a needed background and basis for the author's own continuing 
work using the underlying data to examine how the 
characteristics of 401(k) plans affect the participation rates 
of employees having access to them.
    Excellence: What makes this project exceptional?
    The project uses accurate data representative of all 
private employers in the United States to document 401(k) plan 
characteristics. This provides a more comprehensive view of the 
plans in existence than other studies, which have used samples 
of large employers or other subsets of the population.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    The amount of retirement saving is a key component of the 
resources available to older populations. 401(k) plans provided 
by employers are an increasingly large fraction of these 
savings, reflecting the evolution of employers' retirement 
benefits over the last three decades.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    This research will help establish a backdrop to further 
studies of 401(k) benefits, including simulations of retirement 
savings accumulations as well as studies of how plan details 
affect savings behavior. It may also be used in policy 
simulations that ask how changes to tax, Social Security, and 
savings policy might be accommodated by the population.
    Innovativeness: Why is this research exciting or 
newsworthy?
    The research demonstrates a wide variability between the 
401(k) plans provided by different employers and uncovers some 
of the correlates of plan generosity. Given the passive 
behavior of employees with regard to plan participation that 
has been documented in the literature, it seems likely that 
much of this variation (and subsequent sufficiency of 
retirement saving) is distributed arbitrarily across the 
population. If so, it poses some interesting questions about 
the operation of the labor market and may prompt interest in 
public policies aimed at leveling out the variation in 
generosity received.

Department of Labor: Survey of Occupational Injuries and Illnesses and 
               the Census of Fatal Occupational Injuries

    Americans are living longer than ever before, and many are 
staying in the workforce past age 55; although older workers 
experience similar events leading to injury, they sustain more 
severe injuries than their younger counterparts and require 
more days away from work to recover.
    Lead Agency: Bureau of Labor Statistics.
    Providing impartial, timely, and accurate data relevant to 
the social and economic conditions of our Nation, its workers, 
and their families.
    Principal Investigators: William J. Wiatrowski, Associate 
Commissioner, Office of Compensation and Working Conditions, 
Occupational Safety and Health Statistics, Postal Square 
Building, Room 3180, 2 Massachusetts Ave., NE., Washington, DC 
20212-0001; Elizabeth L. Rogers, Economist, Office of 
Compensation and Working Conditions, Occupational Safety and 
Health Statistics, Postal Square Building, Room 3180, 2 
Massachusetts Ave., NE., Washington, DC 20212-0001.
    General Description: Older workers face many of the same 
workplace hazards as do other workers; the most prevalent 
events leading to job-related injuries or fatalities are falls, 
assault, harmful exposures, or transportation incidents. But in 
many cases, the nature of the injury suffered by an older 
worker is more severe than that suffered by younger workers. 
Older workers who suffer a workplace injury may experience 
longer recovery periods than their younger counterparts. And 
older workers die from workplace injuries at a higher rate than 
do younger workers. This analysis focuses on occupational 
injuries, illnesses, and fatalities among older workers, and 
identifies differences in the severity of the events as a 
result of age.
    Americans are living longer than ever before, and 
increasing numbers of older Americans are working. These facts 
have led to expanded interest in the activities of older 
Americans and their work life. Americans born at the beginning 
of the 21st century can expect to live an average of 77 years, 
an increase of 9 years, compared with persons born a half 
century ago. Those aged 65 in 2000 can expect to live 18 years. 
Considering age 65 to be a typical retirement age, individuals 
can expect to live nearly 2 additional decades. Both the need 
to feel productive and the need for income may lead these older 
Americans to work during what are typically considered 
retirement years.
    But the need to work does not come without potential 
hazards. This article explores recent data on workplace 
injuries, illnesses, and fatalities among older workers. Data 
from the Bureau of Labor Statistics Survey of Occupational 
Injuries and Illnesses and Census of Fatal Occupational 
Injuries provide a wide range of information about the events 
that led to an injury, illness, or fatality, the demographics 
of the workers involved, and the types of occupations and 
industries where these incidents occur.
    Excellence: What makes this project exceptional?
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Innovativeness: Why is this research exciting or 
newsworthy?
    The percentage of older Americans in the labor force has 
been increasing. As it has, the need to understand the 
particular experience of older workers has expanded with it. 
Presenting the demographic data available from the Survey of 
Occupational Injuries and Illnesses and the Census of Fatal 
Occupational Injuries, this article demonstrates that older 
workers need more time to recover from non-fatal work-related 
injuries and illnesses, experience more traumatic injuries like 
fractures and multiple injuries, and sustain a higher fatality 
rate than do younger workers. Two case studies are included 
that demonstrate that older workers are likely to have more 
severe injuries even when the event leading to the injury was 
not particularly serious.
    These findings are important to policy makers, regulators, 
employers, and safety and health researchers. They are used in 
the development of safer workplaces for older workers, which is 
important as the American workforce ages.
    This article is innovative in that it presents demographic 
data available from the Survey of Occupational Injuries and 
Illnesses and the Census of Fatal Occupational Injuries, the 
premier source of information on the safety and health of 
American workers. Using these data, consistent comparisons 
between older and younger workers across many different case 
characteristics can be drawn. The data presented in this 
article highlight the experiences of older workers, experiences 
both anticipated and surprising.

    U.S. Department of Transportation: Dementia and Driving Ability

    This project explores the driving behaviors of people with 
early-stage memory impairments by collecting objective driving 
data from these people through custom in-vehicle technology.
    Lead Agency: U.S. Department of Transportation, National 
Highway Traffic Safety Administration (NHTSA).
    Agency Mission: Save lives, prevent injuries and reduce 
economic costs due to road traffic crashes through education, 
research, safety standards and enforcement activity.
    Principal Investigators: David W. Eby, Ph.D., Research 
Associate Professor, Principal Investigator, Social and 
Behavioral Analysis Division, University of Michigan 
Transportation Research Institute, Director, Michigan Center 
for Advancing Safe Transportation throughout the Lifespan, 2901 
Baxter Rd., Ann Arbor, MI 48109-2150.
    David J. LeBlanc, Ph.D., Associate Research Scientist, 
Engineering Research Division, University of Michigan 
Transportation Research Institute, 2901 Baxter Rd., Ann Arbor, 
MI 48109-2150.
    Lisa J. Molnar, M.H.S.A., Lead Research Associate, Social 
and Behavioral Analysis Division, University of Michigan 
Transportation Research Institute, Assistant Director, M-CASTL, 
2901 Baxter Rd., Ann Arbor, MI 48109-2150.
    Nina M. Silverstein, Ph.D. Professor and Program Director, 
Gerontology, College of Public and Community Service, 
University of Massachusetts Boston, 100 Morrissey Boulevard, 
Boston, MA 02125-3383.
    Geri Adler, Ph.D., Assistant Professor, Graduate College of 
Social Work, University of Houston, 4800 Calhoun Rd., Houston, 
TX 77004.
    Partner Agencies: University of Michigan Transportation 
Research Institute, University of Massachusetts, Boston, 
University of Houston.
    General Description: It is not unusual for a person who has 
been diagnosed with early-stage Alzheimer's or other dementia 
to continue to drive. While some studies indicate that those in 
the earliest stages of dementia may retain their driving 
skills, others document older drivers with dementia who 
continue to drive even after being involved in crashes and 
near-crashes. Thus, while many persons with early stage 
dementia drive, their ability to drive safely, particularly as 
the disease progresses, remains unclear.
    Those who want to know whether a family member who has been 
diagnosed with a form of dementia should continue to drive 
often turn to professionals including physicians, eye care 
specialists and retirement community personnel for guidance. 
These professionals may base their opinions on the driver's 
self assessment, the opinion of family members, or on the basis 
of a formal assessment. However, professionals, family members, 
and the drivers themselves may be unaware of the extent of 
declines in driving skills.
    Recent advances in technology make it possible to 
automatically collect detailed information about driving 
performance. This technology can be used to monitor the driving 
behavior of individuals diagnosed with early stage dementia to 
provide practitioners with a better sense of how to monitor 
these drivers' changing skills. Moreover, the validity of 
drivers' self-assessments and those of family members could be 
investigated using in-vehicle data.
    The primary objective of this project is to evaluate the 
feasibility of using existing in-vehicle technology to monitor 
a set of potentially hazardous driving behaviors common in 
persons with early stage dementia.
    Excellence: What makes this project exceptional?
    Research has plainly shown that individuals with dementia 
drive more poorly than drivers without dementia. Studies have 
identified several driving problems associated with dementia, 
including getting lost while driving, even in familiar areas, 
vehicle speed control difficulties, particularly driving 
consistently below posted speed limits, failure to signal lane 
changes, failure to check blind spots before lane changes, 
failure to maintain lateral lane position, running stop signs, 
and failure to recognize and obey traffic signs and signals. 
None of this research, however, examined driving behaviors 
objectively under natural driving conditions. Some studies rely 
on the self-report of family members, while others rely on the 
observations of an evaluator who rides with the person in their 
vehicle. Family member reports can be unreliable, the family 
member is not always with the driver with dementia, and people 
with dementia can improve their driving somewhat, if they know 
they are being evaluated. This study will be the first to 
collect objective driving measures in this population during a 
everyday driving.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    According to the Alzheimer's Association, there is a new 
case of Alzheimer's Disease diagnosed every 72 seconds. 
Alzheimer's and related dementias are quite common in the older 
adult population. With the first baby boomer reaching age 65 in 
2011 and all baby boomers being age 65 or older by 2029, there 
will be many older adults with dementia who will have mobility 
needs that need to be met. This project is a critical first 
step in studying the driving behaviors of this group of people, 
so that more effective driving evaluators, family members, 
health professionals, and others will have objective 
information on the driving skills that are declining for people 
with early-stage dementia.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    This project is designed to help all people who work with 
older adults become more aware of the how driving skills 
decline in people with dementia. By understanding how skills 
decline, more effective countermeasures can be developed to 
help maintain safe mobility for people with dementia. 
Ultimately, this research should help to identify those drivers 
who are no longer safe to drive while also allowing those who 
are safe drivers to continue driving even though they are 
experiencing memory impairments.
    Innovativeness: Why is this research exciting or 
newsworthy?
    This is the first project to use in-vehicle technology to 
objectively record the driving behaviors of people diagnosed 
with early-stage memory impairment (dementia). The project has 
other innovative features. First, the project developed a 
sensor-suite and computer system (collectively called a data-
acquisition system, DAS) that can be installed in the person's 
own vehicle. This meant that the DAS needed to be versatile 
enough to handle the huge variation in vehicle designs. Second, 
the project needed to develop algorithms to convert the raw 
sensor data into measures of nearly 20 driving behaviors. While 
some of these algorithms had been developed in previous 
studies, this project required that new ones be developed. For 
example, one behavior that the researchers expected to find 
with the memory-impairment subjects was that subjects will get 
lost. Because this behavior is rare in non-memory-impaired 
people, the project had to develop a way to analyze global 
positioning system (GPS) data to yield trips where people got 
lost. Finally, the project had to develop a sophisticated 
subject recruitment system. The project needed to find people 
with a diagnosis of early-stage memory impairment, who have 
recently had their driving professionally evaluated and been 
cleared to drive; and who were willing to have the technology 
installed in their vehicle.

      U.S. Department of Transportation: Aging Licensing Policies

    This study will examine how the various types of special 
screening and testing that State driver licensing agencies 
apply to older drivers affect older driver crash rate, 
licensing administration and older person quality of life.
    Lead Agency: U.S. Department of Transportation, National 
Highway Traffic Safety Administration (NHTSA).
    Agency Mission: Save lives, prevent injuries and reduce 
economic costs due to road traffic crashes through education, 
research, safety standards and enforcement activity.
    Principal Investigator: Richard D. Blomberg, President, 
Dunlap and Associates, Inc., 110 Lenox Avenue, Stamford, CT 
06906-2300.
    General Description: Some States attempt to screen out high 
risk older drivers (65+) using various administrative 
procedures and specific testing. This ongoing study focuses on 
assessing the effects of these licensing procedures on the 
crash rates of older drivers. The specific objectives of the 
study are to:
     Identify safety benefits and unintended 
consequences of licensing policies that are specific to older 
drivers.
     Conduct a process evaluation of driver license 
renewal policies and procedures that apply to the general 
public and those that apply specifically to older drivers 
across the United States.
     Collect information about licensing processes and 
procedures from each of the States as well as the District of 
Columbia.
     Select Special Emphasis States for a more 
comprehensive examination of general and older driver licensing 
procedures.
     Gather information from DMV officials, older 
drivers who have recently renewed their licenses and older 
adults who no longer drive in each of the Special Emphasis 
States.
    Excellence: What makes this project exceptional?
    This project is exceptional because it combines a 
scientific examination of the effect on crashes of various 
licensing policies for older drivers with a rigorous process 
examination of the way these policies are applied. A 
coordinated examination of outcome and process measures can 
facilitate identifying the mechanisms through which various 
State approaches work or whether ineffective implementation may 
be the reason for the absence of a safety benefit. The 
combination of a practical examination of the implementation of 
interventions with a fully coordinated crash-based assessment 
of safety benefit is unusual and should provide decision-makers 
with the best possible information.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    The literature on prior research well establishes that the 
aging process can affect safe driving. Older drivers who are 
still safe, however, do not want to be denied the driving 
privilege simply because they reach a chronological milestone. 
The challenge is to develop and successfully apply performance-
based criteria determining older driver fitness. This study 
will identify whether the current specialized licensing 
practices for the older driver as presently applied are 
effective as safety interventions, are accepted by older 
drivers and licensing officials and can reasonably be 
implemented. As such, the results of this study will influence 
licensing policies with respect to older drivers for the 
foreseeable future.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Older drivers want fair treatment. The literature indicates 
that they want to continue driving as long as they are safe and 
that they are willing to forego driving when their abilities 
are no longer capable of coping with the modern traffic 
environment. This research will quantify the effectiveness and 
consistency of application of some of the most widely used 
licensing interventions. The quantitative results this study 
will produce should allow all concerned to make data-driven and 
unemotional decisions with respect to licensing approaches for 
the older driver.
    Innovativeness: Why is this research exciting or 
newsworthy?
    The older population is growing and covets its mobility and 
independence. Crash studies show an increased rate of 
involvement as a function of age, but the effects are far from 
uniform. Licensing authorities and the older driver each need 
well-founded information upon which to base decisions 
concerning who should be prohibited from driving and how those 
prohibitions will be implemented.
    Current licensing policies for older drivers have evolved 
based on general studies of the capabilities of older persons 
and the professional judgments of State officials. This study 
will not only examine multiple implementations of popular 
approaches, but will also assess the extent to which approaches 
are actually implemented and the reactions of older drivers and 
license administration personnel to them. This appears to be 
the first time that a crash-based assessment has been coupled 
with an in-depth process examination of older driver licensing 
policies. As such, the study will provide government decision-
makers, advocates for the older person and older drivers 
themselves with better information to make informed decisions 
on older driver fitness.

   U.S. Department of Transportation: Medical Conditions and Driving 
                               Abilities

    This literature review summarizes forty years of research 
related to older driver safety. It focuses on how medical 
conditions affect driving skills and abilities. The report is a 
valuable compendium that can help driver licensing authorities, 
physicians, and policy-makers make appropriate decisions 
related to older driver safety. This is the first report to 
thoroughly address these issues.
    Lead Agency: U.S. Department of Transportation, National 
Highway Traffic Safety Administration (NHTSA).
    Agency Mission: Save lives, prevent injuries and reduce 
economic costs due to road traffic crashes through education, 
research, safety standards and enforcement activity.
    Principal Investigator: Bonnie Dobbs, Associate Professor, 
University of Alberta.
    Partner Agencies: Association for the Advancement of 
Automotive Medicine.
    General Description: This report reviews the contribution 
of medical conditions and functional limitations (e.g., 
sensory, motor, or cognitive functioning) to motor vehicle 
crashes. It provides a comprehensive and up-to-date review of 
the international research literature on the effects of medical 
and functional conditions on driving performance. The report is 
divided into 15 sections (Introduction, Vision, Hearing, 
Cardiovascular Diseases, Cerebrovascular Diseases, Peripheral 
Vascular Diseases, Diseases of the Nervous System, Respiratory 
Diseases, Metabolic Diseases, Renal Diseases, Musculoskeletal 
Disabilities, Psychiatric Diseases, Drugs, The Aging Driver, 
and the Effects of Anesthesia and Surgery). Each section 
contains a brief overview of the condition/illness; prevalence 
information; a review of the medical, gerontological, and 
epidemiological literature relevant to the condition/illness, 
followed by current fitness to drive guidelines for the 
condition/illness from Canada and Australia. The Appendix 
presents preliminary guidelines for physicians to assess 
medical fitness-to-drive. The report is a scholarly but 
practical compendium that can serve as a valuable resource for 
physicians, rehabilitation practitioners, other allied health 
care professionals and educators, Department of Motor Vehicle 
personnel, road and traffic safety personnel, transportation 
planners, highway safety researchers, and public policymakers. 
Its value is particularly relevant as the driving population 
increases in size and age.
    Excellence: What makes this project exceptional?
    Because there will be an increase in the numbers of older 
drivers in the coming decades, it is important to understand 
the types of safety challenges facing this population and those 
with whom they share the road. A special concern is age-related 
illness and its potential to influence driving safety.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    This report represents the first time that a compendium of 
medical conditions and driving has been compiled. The report 
presents findings that delineate the correlations between age-
related illnesses and safe driving ability that can be useful 
for physicians dealing with older patients.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    This project promotes safety and older citizen mobility by 
providing crucial support for functional ability screening. It 
has been used as a starting point for an evidence-based review 
that was sponsored by the American Occupational Therapy 
Association, and for research in Canada and the U.S.
    Innovativeness: Why is this research exciting or 
newsworthy?
    The compendium fills significant knowledge gaps in our 
understanding of the relationships between medical conditions, 
functional abilities, and crash risks.

          Federal Highway Administration: Safety and Mobility

    The NHTS is a national survey of the American public that 
provides detailed travel volume and behavior information on 
older people that supports a wide range of safety, mobility, 
and travel demand applications.
    Lead Agency: Federal Highway Administration, Office of 
Policy, Highway Policy Information.
    Agency Mission: Enhancing mobility on our Nation's highways 
through national leadership, innovation, and program delivery.
    Principal Investigator: Heather Contrino, Travel Surveys 
Team Leader, 1200 New Jersey Avenue, SE., Room E83-426, 
Washington, DC 20590.
    Partner Agency: FHWA Office of Policy, FHWA Office of 
Safety, FHWA Research and Development, Federal Transit Agency, 
American Association of Retired Persons (AARP).
    General Description: The National Household Travel Survey 
(NHTS) collects National, regional, and State level data on the 
characteristics of travel by the American public. The gathering 
and subsequent data analyses for older drivers are key 
components of the NHTS program. The NHTS provides detailed 
information aid in understanding and assessing mobility, 
accessibility, and safety for older Americans. The NHTS is used 
in research, policy, planning and engineering extensively 
throughout the transportation community including Federal, 
State and Local agencies, Non-profit organizations, and 
University researchers.
    Specifically, the NHTS surveys the public on travel 
behavior, choices, and preferences, providing 40 years of trend 
data on the past, current, and forecasted travel demand and 
travel characteristics of older people. The study provides 
estimates of vehicle miles of travel (VMT) person miles of 
travel (PMT) on all modes of transportation, detailed trip 
characteristics including time of day, speed, distance, trip 
purpose, and vehicle occupancy, and vehicle information 
including mileage, make, model, year, and primary driver.
    As the only source of data on travel behavior by people, 
NHTS data has been used extensively to support several older 
people safety and mobility programs and policies within and 
outside the Department of Transportation. In the 2001 NHTS our 
oldest driver was 102 years old. Most recently, the NHTS data 
was the core source of information for the 50-year forecast of 
travel demand by the aging population for the Policy and 
Revenue Commission.
    Excellence: What makes this project exceptional?
    The NHTS is an exceptional project because it provides a 
comprehensive measure of travel by older people on all modes of 
transportation and in all regions of the United States.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    The NHTS Program is highly relevant to older persons now 
and in the context of an aging population due to the direct 
support of several planning and policy applications that are 
core to the Department's mission in providing safety and 
mobility for all Americans. These include:
           Exposure rates, both VMT and PMT, for safety 
        measures,
           40 Years of trend data on the travel volume 
        and behavior of older people,
           Detailed vehicle/fleet data in the context 
        of travel volumes and demographics for safety and 
        mobility performance measurement and program 
        development,
           Trip characteristics by age and gender which 
        support short and long range forecasts of demand by 
        older people as our society ages,
           Information on the non-traveling public 
        provides measure of mobility for older people,
           Disability data and impacts on travel 
        behavior provide information on barriers to travel, 
        difficulties in driving, special transportation needs, 
        and accessibility.
    Effectiveness: What is the impact and/or application of 
this research to older person?
    The NHTS program connects older people with travel behavior 
in the context of mode choice and vehicle characteristics so 
that effective programs and policies can be put into place to 
ensure mobility and safety of this large and important 
population group. In addition, the NHTS supports performance 
measurement of the system and for specific policies and 
programs. With the NHTS, DOT understands the travel needs of 
older people, can identify safety risk groups, and evaluate and 
institute effective programs that improve safety and enhance 
mobility.
    Innovativeness: Why is this research exciting or 
newsworthy?
    Baby boomer population is aging and the sheer size of the 
older person population over the next 10-20 years allows for a 
potentially great impact on travel demand and travel behavior, 
as they are a more mobile group that previous generations of 
older people. This research gives DOT the information and tools 
to be proactive in planning for the transportation needs and 
safety of older people as this population grows.

    Federal Aviation Administration: Air Traffic Control Performance

    Researchers analyzed operational error data among Air 
Traffic Control Specialists by age, found no difference in 
error rates, suggested that the current age limitations may not 
be necessary, and called for further research.
    Lead Agency: Department of Transportation (DOT)--Federal 
Aviation Administration (FAA), Office of Aerospace Safety 
(AVS)-- Office of Aerospace Medicine (AAM)--Civil Aerospace 
Medical Institute (CAMI)--Aerospace Human Factors Research 
Division (AAM-500).
    Agency Mission: FAA: Federal Aviation Administrations 
mission is to provide the safest, most efficient aerospace 
system in the world.
    Aviation Safety and the Office of Aerospace Medicine's 
mission is to enhance aerospace safety through surveillance, 
research, education, medical standards, and the prevention of 
illness and injury.
    Principal Investigator: Dana Broach, Ph.D., Personnel 
Research Psychologist, FAA Civil Aerospace Medical Institute, 
P.O. Box 25082, Oklahoma City, OK 73125.
    Partner Agency: FAA Human Factors Research and Engineering 
Group (AJP-61).
    General Description: This study analyzed operational error 
data among Air Traffic Control Specialists above and below the 
age of 55. The results in indicated no difference in error 
rates, suggesting that the current age limitation may not be 
necessary. U.S. federal law requires that air traffic control 
specialists (ATCSs) hired after May 16, 1972 retire at age 56 
on the premise that the risk of adverse events such as 
operational errors (OEs) increases with age (U.S. House of 
Representatives, 1971). OE count was modeled as a function of 
en route ATCS age and exposure to test that premise using 
Poisson regression. The odds of OE involvement for older (age 
56 and older) and younger (age 55 or less) ATCSs were equal. 
These results suggest that the rationale for mandatory 
retirement of controllers might need to be reexamined through 
continued research. While recognizing that the results called 
into question the safety benefits of the law, they acknowledge 
that policy change would require replication of their findings 
and extension of analyses to other sources of data. They also 
discussed the competition of changes in cognitive function with 
age to accrual of experience with change. As such, the research 
represents a good start towards balancing our desire to avoid 
unwarranted discrimination with our desire to prevent errors 
and safety concerns that may be associated with cognitive 
changes.
    Excellence: What makes this project exceptional?
    This project was exceptional in its authors' recognition of 
Operation Error data potential to address aging effects and the 
careful conceptual approach taken to interpreting the data. The 
opportunity to examine the impact of aging on error frequency 
was presented by the age limitation decision by Congress in 
1971. The authors made use of operational error data collected 
by the Air Traffic Organization to examine possible age 
effects. Their interpretation of findings was appropriately 
limited to the dataset, but asked some fundamental questions 
about aging and suggested possible policy reassessment.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    The work is relevant to an aging society because it 
questions the impact of known trends in cognitive performance 
with age upon job performance. It suggests that while 
tactically-oriented cognitive speed and flexibility decreases 
with age may be accompanied by some degree of strategic 
compensation--experience may lead controllers to prevent 
situations that would require novel or speedy tactical 
interventions. Were this finding further validated, it would 
cause us to reassess most policies providing for firm age 
limits for a job category in favor of more individual-
assessments of cognitive function, leading to a potentially 
more fair set of decisions.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    The impact of the research has been limited, however, in 
that follow up activities were not sponsored or funded within 
the agency.
    Innovativeness: Why is this research exciting or 
newsworthy?
    The research is worthy of recognition because it challenges 
how we think about age limitations in air traffic control. The 
error data, at least, does not support our current policy. This 
calls for further reassessment. The authors' thoughtful 
interpretations call for more fundamental research about how 
controllers perform their jobs as they age.

    U.S. Department of Transportation: Clearview Highway Improvement

    The Clearview font allows agencies to meet the needs of 
older drivers, with regard to the legibility of guide signs, 
without an increase in the size and cost of the signs. In 
August 2004, the FHWA issued interim approval for the use of 
the Clearview font for positive contrast legends on guide 
signs.
    Lead Agency: U.S. Department of Transportation/Federal 
Highway Administration (FHWA).
    Agency Mission: Improve mobility on our Nation's highways 
through national leadership, innovation, and program delivery.
    Principal Investigator: Carl K. Andersen, Roadway Team 
Leader, Office of Safety Research & Development, Federal 
Highway Administration, HRDS-05, 6300 Georgetown Pike, McLean, 
VA 22101.
    Partner Agency: Texas Department of Transportation, 
Pennsylvania Department of Transportation.
    General Description: The Clearview highway sign font was 
developed through a decade of research starting in the early 
1990s. Clearview font letters were developed to address four 
issues with the legibility of standard highway sign alphabets:
          (1) upgrade highway signing word messages to 
        accommodate the needs of older drivers without 
        increasing the overall size of the signs;
          (2) improve word pattern recognition;
          (3) improve the speed and accuracy of destination 
        recognition and the distance at which a sign can be 
        read; and
          (4) control halation (glow that makes letters become 
        unrecognizable blobs) that may occur on high brightness 
        retroreflective materials for drivers with reduced 
        contrast sensitivity.
    The concept for an improved highway sign font was developed 
by Meeker & Associates, Inc., in response to the determination 
by the FHWA that guide signs using the standard highway sign 
alphabets would have to be increased in size to meet the needs 
of older drivers. The initial research on Clearview was 
conducted at the Pennsylvania Transportation Institute (PTI). 
In two PTI studies, the use of an early version of Clearview 
Bold improved nighttime sign reading distances by up to 16 
percent when compared to the E-modified road sign typeface. An 
initial study at the Texas Transportation Institute (TTI) found 
that there were significant differences in the legibility of 
full-size signs as compared to the smaller signs tested at PTI. 
Meeker & Associates, Inc. made refinements to the Clearview 
font that were used in additional joint FHWA/TxDOT studies 
conducted by TTI.
    A TTI study on nighttime sign legibility as a function of 
retroreflective material and sign font found that the refined 
Clearview font provided an 11 to 12 percent increase in 
legibility distances for guide signs using Clearview. Both the 
Pennsylvania and Texas Departments of Transportation reviewed 
the research on the use of Clearview font for guide signs and 
requested that Clearview font be allowed for use on positive 
contrast guide signs.
    Excellence: What makes this project exceptional?
    This project is exceptional because the results allow 
agencies to meet the nighttime guide sign legibility needs of 
older drivers without a need to increase the physical size of 
the signs. Increasing the sign size would potentially have 
resulted in a need to redesign and replace sign support 
structures. In many cases, larger signs are not feasible, as 
the existing signs are already 12 feet in width.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Development and evaluation of Clearview font demonstrated 
that the nighttime legibility requirements of older drivers 
could be met without the need to increase the size and cost of 
overhead guide signs. Without these results, it would have been 
difficult, if not impossible, for agencies to meet this need. 
The results are a significant improvement in the ability of the 
national highway signage system to meet the needs of older 
drivers, thereby improving their mobility and potentially 
improving safety by permitting all drivers to acquire 
information in a timely manner.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    The FHWA has issued interim approval for the use of 
Clearview font on positive contrast guide signs, which permits 
agencies to install signs that meet the nighttime visual 
requirements of older drivers.
    Innovativeness: Why is this research exciting or 
newsworthy?
    The development and evaluation of the Clearview font was a 
cooperative venture by a private company, two transportation 
institutes, two State Departments of Transportation, and the 
FHWA. Meeker & Associates, Inc. saw a national need that the 
company felt uniquely capable of fulfilling, and initiated work 
with the Pennsylvania DOT and PTI. The results of the initial 
evaluations prompted the FHWA and Texas DOT to fund research at 
TTI to complete the evaluation of the first alternative highway 
sign font developed in the U.S. in the last 50 years.

          U.S. Department of Transportation: Pedestrian Safety

    Lead Agency: U.S. Department of Transportation, Federal 
Highway Administration.
    Agency Mission: FHWA is charged with the broad 
responsibility of ensuring that America's roads and highways 
continue to be the safest and most technologically up-to-date.
    One of our Six Life Saving Strategies is to Reduce Roadway-
Related Pedestrian Deaths, which account for 12% of all roadway 
fatalities and a disproportionate number of the deaths of 
youthful and elderly crash victims: We encourage a systematic 
approach to community safety, including comprehensive programs 
to increase awareness of pedestrian safety issues; to provide 
pedestrian safety training; to improve roadway designs to more 
safely accommodate pedestrian needs; and to emphasize the need 
for pedestrian safety planning by MPOs and other planning 
organizations.
    Principal Investigators: David Harkey, Director, University 
of North Carolina, Highway Research Center, 730 Martin Luther 
King, Jr. Blvd., CB# 3430, Chapel Hill, NC 27599-3430.
    Tom Granda, PhD., Research Psychologist, Turner-Fairbank 
Highway, Research Center, 6300 Georgetown Pike, McLean, VA 
22101.
    Beth Alicandri, Director, FHWA Office of Safety Programs, 
1200 New Jersey Ave., SE., Washington, DC 20590.
    Gabe Rousseau, PhD., FHWA Office of Environment, 1200 New 
Jersey Ave., SE., Washington, DC 20590.
    F. E. (Gene) Amparano, P.E., Safety Engineer, FHWA Resource 
Center, Safety & Design Technical Services Team, 901 Locust 
Street, Suite 466, Kansas City, MO 64106.
    Gail Holley, Safe Mobility for Life Program and Research 
Mgr., Florida Department of Transportation, State Traffic 
Engineering and Operations Office, 605 Suwannee Street, M.S. 
36.
    Tom Welch, PE, State Transportation Safety Engineer, Iowa 
Dept. of Transportation, 800 Lincoln Way.
    Partner Agency: National Highway Traffic Safety 
Administration.
    General Description: In 1998 the Federal Highway 
Administration published the first edition of the Older Driver 
Highway Design Handbook. The original guide provided practical 
information to transportation professionals about designing 
roadways and traffic signals to improve safety for older 
drivers. In 2001, FHWA released a revised edition and broadened 
the scope to include other road users, namely pedestrians. It 
is now called the Highway Design Handbook for Older Drivers and 
Pedestrians. The 2001 Handbook provided detailed design 
recommendations and provided literature reviews to show the 
research basis for these recommendations. For example, the 
Handbook provides recommendations for roadway signs to ensure 
that older drivers can see them from an appropriate distance. 
Although the Handbook itself is not a set of standards, many of 
the recommendations in it have subsequently been incorporated 
in roadway and traffic signal design standards. A third version 
of the Handbook is currently being developed. The Handbook has 
been and continues to be a popular and important resource for 
transportation professionals who are trying to ensure that our 
growing population of older adults will have safe 
transportation options. The Handbook helps us address important 
societal issues including roadway safety and independent 
living.
    The FHWA also offers a 1-day training workshop to 
thoroughly review the recommendations and guidelines contained 
in the Highway Design Handbook for Older Drivers and 
Pedestrians. Interactive methods are used to help participants 
fully understand the changes that occur with aging. It provides 
information and demonstrations of the effects of aging on 
vision, range of motion and cognition; goes over the 
information in the handbook; and provides hands-on exercises 
with real world case studies to allow participants to apply 
what they have learned.
    Modifications to the roadway system are identified that can 
make it easier for older drivers and all drivers. Case studies 
are used during the workshop. The workshop is designed 
primarily for practicing highway and traffic engineers 
responsible for highway design and operations, and over 3,000 
transportation professionals have attended the workshop since 
it began.
    Demographic trends indicate that Americans are living 
longer. This is certainly good news, but the trends require 
that we examine how to ensure that Americans can maintain 
independence and quality of life in their senior years. Perhaps 
the key aspect of independence in our country pertains to 
transportation. In many communities independence is synonymous 
with being able to drive. As we grow older we experience age-
related changes in our vision, hearing, and cognition and these 
changes can make it harder to safely walk or drive on our 
roadways. In 2006, older adults comprised about 14 percent of 
all traffic fatalities even though they represent only 12 
percent of the population. Transportation researchers and 
practitioners are trying to ensure that older Americans can 
travel safely by using their knowledge of age-related ability 
changes to revise standards for roadways and traffic signs and 
signals. In 1998, the Federal Highway Administration published 
the first version of what is now called the Highway Design 
Handbook for Older Drivers and Pedestrians. The original 
Handbook and the more recent 2001 version have been a key 
resource for roadway designers and other transportation 
professionals. Because of the popularity of the previous 
Handbooks, it is currently being revised once again to 
incorporate new research findings. The Handbook has been the 
premier source of information for recommending design practices 
to accommodate older drivers and pedestrians. In addition, many 
of these recommendations have been incorporated into Federal 
transportation standards such as the Manual on Uniform Traffic 
Control Devices.
    The Handbook is a synthesis of research pertaining to older 
road users. What is unique about it is how it takes a wide 
range of research findings and incorporates them into a single 
document in order to develop recommendations for roadway 
situations that pose increased risk for older adults. Some of 
these situations include intersections, work zones, and roadway 
curvature and passing zones. Based on the analysis of the 
research, the Handbook presents recommendations on roadway 
design features (e.g., the recommended font size on roadway 
signs). One of the unique aspects of the Handbook is that for 
each recommendation, the authors examined how these 
recommendations compare or contrast for different standards 
that transportation professionals rely on for designing roads 
and traffic control devices (such as roadway signs). The intent 
is to unify these sometimes disparate standards.
    The aim of the guide is to improve safety for older adults 
but it is likely that road users of all ages and abilities will 
benefit from recommendations in the Handbook. Because the 
Handbook will continue to be revised in the future, it can be 
updated as new research emerges. New recommendations can be 
developed and we will be able to examine roadway safety 
statistics to determine what challenges older adults still 
experience.

          U.S. Department of Transportation: Visual Field Loss

    This project compared drivers with visual field loss to 
those with normal vision on driving scenarios at the National 
Advanced Driving Simulator. Participants with visual field loss 
showed more variance in maintaining the driving lane on curves, 
when leaving the simulated freeway, and when responding to 
peripheral information.
    Lead Agency: U.S. Department of Transportation, National 
Highway Traffic Safety Administration (NHTSA).
    Agency Mission: Save lives, prevent injuries and reduce 
economic costs due to road traffic crashes through education, 
research, safety standards and enforcement activity.
    Principal Investigators: Linda Boyle, Ph.D., Principal 
Investigator, Department of Mechanical and Industrial 
Engineering, University of Iowa, Iowa City, Iowa 52242-1320; 
Matthew Rizzo, Department of Neurology, College of Medicine, 
University of Iowa, Iowa City, Iowa 52242-1320; Mark Wilkinson, 
Department of Ophthalmology and Visual Sciences, College of 
Medicine, University of Iowa, Iowa City, Iowa 52242-1320.
    General Description: Vision is clearly essential for safe 
driving. Deterioration in vision through normal aging, as well 
as from eye diseases such as cataracts and macular degeneration 
has been shown to be a major contributing factor in changes in 
driving strategies and performance. Drivers, however, may not 
always compensate for their deterioration appropriately, 
resulting in higher crash risks.
    The goal of this study was to use the National Advanced 
Driving Simulator (NADS) to compare driving performance in 
participants with peripheral visual field loss (VFL) and those 
with normal vision. NADS is a high fidelity simulator that 
simulates the visual, auditory and haptic feedback one would 
experience during real world driving. The driving task was 
designed to capture compensatory behaviors in drivers with VFL 
such as increased head movements, eye scanning patterns, and 
mirror use in addition to driving performance measures in the 
simulator.
    The results from this study indicate that, while VFL and 
Control participants' performance was similar in most tasks, 
there were a few significant differences in driving performance 
measures between the groups. Participants with VFL exhibited 
some difficulties with lane maintenance on curves and when 
departing the freeway as well as a delay in responding to the 
vehicle incursion, an unanticipated hazard that originated in 
the periphery during the simulator driving task.
    Excellence: What makes this project exceptional?
    This project suggests a safety risk for driving for people 
with a reduced field of vision. The study identifies several 
driving conditions (curves, exit ramps) where drivers with VFL 
may be at increased risk.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Deterioration in vision through normal aging is a major 
contributing factor in changes in driving strategies and 
performance. Drivers may not always compensate for their 
deterioration appropriately resulting in higher crash risks. 
Understanding the degree to which visual field loss impairs 
driving will be helpful to older drivers.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    This research provides preliminary information about how 
visual field loss may impact the safe driving of older people.
    Innovativeness: Why is this research exciting or 
newsworthy?
    This research uses advanced simulator technology to examine 
how older drivers who have certain visual impairments that 
reduce the useable visual field perform on simulated driving 
tasks. Findings from this study will be used to build a 
taxonomy of driving scenarios that may increase crash risk, and 
suggest countermeasures to compensate for visual loss.

  U.S. Department of Transportation: Functional Ability and Crash Risk

    This project identified screening tools that can be used in 
an office-based setting to determine whether a driver might be 
at risk for crashing. Results revealed that a focus on 
functional ability rather than age was an effective way to 
examine crash risk. Recommendations for driver licensing policy 
reflect the importance of functional ability in assessing 
fitness to drive.
    Lead Agency: U.S. Department of Transportation, National 
Highway Traffic Safety Administration (NHTSA).
    Agency Mission: Save lives, prevent injuries and reduce 
economic costs due to road traffic crashes through education, 
research, safety standards and enforcement activity.
    Principal Investigator: Loren Staplin, Principal, 
TransAnalytics, 1722 Sumneytown Pike, Kulpsville, PA 19443, 
215-855-5830, [email protected].
    Partner Agencies: Maryland Motor Vehicle Administration.
    General Description: This research project studied the 
feasibility as well as the scientific validity and utility of 
performing functional capacity screening with older drivers. A 
Model Program was described encompassing procedures to detect 
functionally impaired drivers who pose an elevated risk to 
themselves and others; to support remediation of functional 
limitations if possible; to provide mobility counseling to 
inform and connect individuals with local alternative 
transportation options; and to educate the public and 
professionals about the link between functional decline and 
driving safety-all within a larger context of helping to 
preserve and extend the mobility of older persons.
    Early in this project, a questionnaire was developed and 
distributed to Driver License Administrators in the U.S. and 
Canada to broadly determine cost and time parameters, while 
identifying legal, ethical, or policy implications that could 
influence implementation of Model Program activities. 
Subsequently, a battery of functional tests was developed and 
pilot tested in Motor Vehicle Administration sites, and in the 
community. A database of scores on functional ability measures, 
driving habits information, and crash and violation history was 
created for over 2,500 drivers in three samples drawn from 
license renewal, medical referral, and residential community 
populations. Cost estimates for functional capacity screening 
and related Model Program activities were developed for 
research and production settings. A set of guidelines for motor 
vehicle administrators was also produced to update the 1992 
publication by NHTSA and AAMVA of the same title.
    Excellence: What makes this project exceptional?
    This research project is exceptional because it changed the 
dialogue within the Department from age-based testing to 
functional-ability based testing. The pivotal nature of this 
shift is reflected in all subsequent NHTSA research projects 
and in research conducted by outside organizations.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    The change in perspective to functional abilities 
influences the 29 million currently licensed drivers not only 
in their dealings with their state's driver licensing 
authorities, but with their medical providers, social services 
providers, and law enforcement officers.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    The findings from this investigation have been incorporated 
into educational materials for all of the people who help 
determine if an older driver is safe.
    Innovativeness: Why is this research exciting or 
newsworthy?
    By shifting the thinking about safety from age to ability, 
we have the opportunity to help older drivers stay behind the 
wheel as long as they are safe to do so.

        U.S. Department of Transportation: Infrastructure Safety

    In March 2008, a team of nine transportation safety, 
traffic engineering, and human factors experts from the U.S. 
visited Australia and Japan to evaluate infrastructure 
improvements designed to aid older road users. The scan tour 
members sought policy options and initiatives regarding 
transportation system planning, operations, and design as they 
relate to older road users. The information obtained during the 
trip identified several planning, design, and operational 
changes which could be implemented in the U.S. to improve the 
mobility and safety of older road users.
    Lead Agency: U.S. (U.S.) Department of Transportation 
(DOT), Federal Highway Administration (FHWA).
    Agency Mission: FHWA is charged with the broad 
responsibility of ensuring that America's roads and highways 
continue to be the safest and most technologically up-to-date.
    Principal Investigators: Elizabeth Alicandri (Co-Chair), 
Director, Office of Safety Programs, FHWA, HSSP, E-71, Room 
310, 1200 New Jersey Avenue, SE., Washington, DC 20590-9898; 
Pamela Hutton (Co-Chair), Chief Engineer, Colorado Department 
of Transportation, 4201 East Arkansas Avenue, Room 262, Denver, 
CO 80222.
    Partner Agencies: Federal Highway Administration, Florida 
Metropolitan Planning Organization Advisory Council, Missouri 
Department of Transportation, Texas Transportation Institute, 
University of North Carolina Highway Safety Research Center, 
and West Virginia Department of Transportation.
    General Description: In March 2008, a team of nine 
transportation safety, traffic engineering, and human factors 
experts from the U.S. visited Australia and Japan to evaluate 
infrastructure improvements designed to aid older road users. 
The scan tour members sought policy options and initiatives 
regarding transportation system planning, operations, and 
design as they relate to older road users. The group met with 
state and federal government transportation officials, 
University research centers, and staff from motorists' clubs 
and other non-governmental organizations interested in the 
mobility of older people. Although the primary focus of the 
scan was on infrastructure improvements, the team also learned 
about policies for older road user training, assessment, and 
licensing. In addition, general road safety programs were 
discussed with all agencies visited. The majority of these 
programs provided a benefit to older road users although they 
may not have been designed specifically with this user-group in 
mind. The converse of this is true as well; programs and 
policies developed for older road user safety and mobility will 
improve transportation for all users. The information obtained 
during the trip identified several planning, design, and 
operational changes which could be implemented in the U.S. to 
improve the mobility and safety of older road users.
    Major issues of interest included the following:
     Infrastructure-based international best practices 
that improve safety and mobility for older road users that 
could be applied in the near term on U.S. roadways.
     Policy approaches to improving infrastructure to 
better meet the needs and capabilities of older road users.
     Transportation planning policy initiatives to 
address mobility of older citizens in terms of land-use, 
transit, and other alternatives to driving. Policy approaches 
to improving older driver assessment, licensing, and training.
     Safety research collaboration opportunities 
between international and U.S. transportation research centers.
     Ways to improve U.S. and international practices 
for long-term transportation planning for older road users.
    Excellence: What makes this project exceptional?
    This effort is part of a national program that allows 
transportation experts in the U.S. the opportunity to meet with 
and discuss the major roadway infrastructure design and 
operational issues that are particularly related to the older 
road user. It further provides a sound basis for evaluating the 
potential effectiveness of the foreign best practices and 
lessons learned in regard to the application of those findings 
to older road users in the U.S.
    Significance: How is this research relevant to older 
persons, populations, and/or aging society?
    FHWA has a multitude of programs that are devoted to the 
integration of older road user needs involving the full 
spectrum of transportation systems. However, the focus of this 
project was primarily on the implementation of infrastructure 
improvements for older road users. Many countries, including 
the U.S. and Australia, have published documents detailing how 
the physical, perceptual, and cognitive changes associated with 
aging affect a person's ability to use the existing 
transportation system. These documents include recommendations 
for improvements to infrastructure and operations to address 
the needs of older road users, but few have reported on the 
successful implementation of these recommendations. This 
project also investigated policy initiatives regarding 
transportation system planning, operations, and design as they 
relate to older road users. The role of older road users in 
road safety programming, funding, prioritization and evaluation 
were also discussed with all of the governmental agencies.
    As a recent GAO report notes, knowledge sharing between the 
U.S. and other countries can help the U.S. prepare for the 
coming increase in the proportion of older road users as the 
baby boom population moves toward retirement in the coming 
years.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    The success of this international scan can be measured by 
the number of ideas brought back to the U.S. and translated 
into strategies that will improve safety and mobility for older 
road users. The following is a tentative list of items that 
will be further studied for implementation in the U.S.
    Enhancement of U.S. Roadway Design and Operations Practice:
    Integrate the knowledge of infrastructure improvements from 
Australia and Japan into relevant U.S. documents and training 
programs.
    Outreach to Non-Government Organizations:
    Further the development of partnerships between government 
agencies, such as departments of transportation and health, and 
between government and non-government organizations to address 
the needs of older road users.
    Targeted Research Program:
    Develop a research program on policies and interventions 
targeted at older road users. The scope of program should cover 
evaluation of specific interventions aimed at improving safety 
and mobility for older road users, development of new 
procedures and tools to aid practitioners in making decisions, 
and sharing of information on best practices through synthesis 
documents and professional conferences.
    Establish Development Guidelines:
    Develop planning and land development guidelines for 
congregate housing and related transportation facilities and 
services that are intended to meet the growing needs older 
populations and older road users. The guidelines would be 
developed to assist local governments and the development 
community in the planning and retrofitting of existing 
facilities, as well as to assist local governments in their 
evaluation of land development proposals as it relates to older 
populations and older road users. The proposal could become a 
joint venture research project to be cooperatively developed by 
national transportation and land development organizations.
    Innovativeness: Why is this research exciting or 
newsworthy?
    Application of innovative and successful ideas used in 
Australia and Japan.
    Establish a dialogue between older road user experts in the 
U.S. and Australia and Japan.
    Sharing of findings with transportation experts and 
practitioners in state DOTs, academia, industry, and 
transportation associations.

     U.S. Department of Transportation: Medications and Crash Risk

    This study examined medical insurance databases to show the 
relative frequency of various combinations of medications used 
by drivers who had a motor vehicle crash, analyzing the 
impairing effects of multiple medications, drug interactions, 
and drug-disease interactions on motor vehicle crashes for 
persons 50 years and older.
    Lead Agency: U.S. Department of Transportation, National 
Highway Traffic Safety Administration (NHTSA).
    Agency Mission: Save lives, prevent injuries and reduce 
economic costs due to road traffic crashes through education, 
research, safety standards and enforcement activity.
    Principal Investigator: Aida A. LeRoy, Iatrogen, LLC, World 
Gate IV, Suite 500, 12801 World Gate Drive, Herndon, VA 20170.
    General Description: The main objectives of this study were 
to determine the relative frequency of various combinations of 
medications used by those who have experienced a motor vehicle 
crash and those who have not by analyzing proprietary and non-
proprietary databases; and to conduct a case-control study of 
possible associations between the use of medications (and 
combinations thereof) and motor vehicle crashes among older 
drivers.
    The results of the study revealed an association between 
the kinds and number of medications used by older adults and 
the risk of involvement in a motor vehicle crash. Drugs known 
to have an impairing effect on the driving ability of older 
drivers were the most commonly used by older adults who had 
been involved in crash. The case control analysis suggested an 
association between crashes and many potentially driver 
impairing (PDI) medications, diseases, and various combinations 
of drugs and diseases.
    Study subjects taking any medication were found to be 1.43 
times more likely to be involved in a crash than older adults 
taking no medications. Compared to patients taking no PDI 
medications, those taking one or two PDI medications were 1.29 
times more likely to be involved in a crash and that risk 
increased to 1.87 more likely in patients taking three or more 
PDI medications. The risk for patients with one or two PDI 
diseases was 1.49 times greater than that for older adults 
without any PDI diseases. Three or more PDI diseases further 
increased the risk for crash involvement to 2.20 times that of 
older adults with no PDI diseases. Drug interactions were also 
associated with a statistically significant increased risk of 
crash involvement (odds ratio of 1.47 for 1-2 drug interactions 
and 1.92 for patients with 3 or more drug interactions).
    The results of this analysis suggest that both the kinds 
and number of medication exposures, and the characteristics of 
diseases/disorders present among study subjects may predict an 
increase in risk for crashes among older adults. By 
demonstrating a potential link between multiple drug therapies 
and crash involvement, this study highlights the need for a 
more thorough examination of the relationships between drugs, 
diseases, and the older driver, and the factors affecting aging 
adults and driving ability.
    Excellence: What makes this project exceptional?
    This is the only available report that provides current 
data on prescription medication use and its relationship to 
vehicle crashes.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    This report provides valuable information to drivers about 
the potentially impairing effects that combinations of certain 
medications and illnesses have on the ability to drive safely. 
Older adults are more likely to take multiple prescription 
medications past the age of 50.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    The results of this research point to the need to develop 
educational programs to increase awareness among health care 
providers and older drivers about the potential driver 
impairing effects of pharmaceutical use.
    Innovativeness: Why is this research exciting or 
newsworthy?
    This research names drug classes and illnesses that are 
common to older drivers that are potentially dangerous when 
combined with the driving task. Data come from large medical 
databases.

      U.S. Department of Transportation: Airline Passenger Health

    To address the concerns of age and health-compromised 
airline passenger population, the FAA, Harvard university, and 
the Boeing Company collaborated to evaluate the physiological 
effects of normal cabin pressure on a passenger population that 
included both healthy and less than healthy older subjects.
    Lead Agency: Department of Transportation (DOT)--Federal 
Aviation Administration (FAA), Office of Aerospace Safety 
(AVS)--office of Aerospace Medicine (AAM).
    Agency Mission: Federal Aviation Administration's mission 
is to provide the safest, most efficient aerospace system in 
the world.
    Aviation Safety and the Office of Aerospace Medicine's 
mission is to enhance aerospace safety through surveillance, 
research, education, medical standards, and the prevention of 
illness and injury.
    Principal Investigators: John D. Spengler, Ph.D, Harvard 
University, School of Public Health, 677 Huntington Avenue, 
Boston, MA 02115; Dennis Burian, Ph.D, AAM-600, FAA Civil 
Aeromedical Institute, P.O. Box 25082, Oklahoma City, OK 73125.
    Partner Agencies: Air Transportation Airliner Cabin 
Environment Research (ACER) Center of Excellence program, The 
Boeing Company, Harvard University School of Public Health, FAA 
Civil Aeromedical Research Institute, AAM-600.
    General Description: The demographics of the US flying 
population show that airline passengers are rapidly getting 
older and increasingly have significant health problems. To 
address the concerns of age and health in the passenger 
population, the FAA (CAMI), Harvard University and the Boeing 
Company collaborated under the FAA Center of Excellence (COE) 
for Airliner Cabin Environment Research (ACER) program to 
evaluate the physiological effect of normal cabin pressure 
(7,000 ft altitude) on a passenger population that included 
both healthy and less than healthy older subjects. This project 
evaluated subjects older than 55 years of age and included 
three test groups: a normal group, a group that had implantable 
cardiac defibrillators (ICD group) and a group of heavy 
smokers. The medical condition of the subjects and the 
extensive physiological evaluation of the subjects made this 
program one of the most complex ever conducted at the Civil 
Aerospace Medical Institute.
    Excellence: What makes this project exceptional?
    The study group represents a flying population for which 
little data regarding the risk of flight in commercial aircraft 
has been gathered. It is the first altitude study that 
addressed the health effects of cabin pressure on older 
passengers with cardiac and respiratory disease.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    The demographics of the US flying population show that 
airline passengers are rapidly getting older and increasingly 
have significant health problems. Flight in commercial aircraft 
typically exposes passengers to oxygen levels commensurate with 
6,000 to 8,000 ft altitudes. Previous studies of altitude 
exposure have been performed at higher altitudes and/or used 
subjects of a relatively young age. This study is investigating 
the effects of cabin altitude exposure on 55- to 80-year-old 
groups of subjects, healthy subjects with little overall health 
impairment, cardiac patients with implanted defibrillators, and 
smokers without other overt clinical symptoms.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Data gathered during the study includes changes in physical 
measurements from prolonged periods of being seated, 
physiological changes reflected in oxygen saturation, pulse and 
respiration rates, plasma and serum markers for organ function, 
cytokine markers of inflammation, and intracellular changes 
measured by gene expression analysis. Cognitive test data and 
mood/sleepiness surveys are also being collected to assess 
neuropsychological effects of mild altitude exposure. The 
results of the research will provide guidance to passengers 
relative to commercial air travel.
    Innovativeness: Why is this research exciting or 
newsworthy?
    The research complexity has not been accomplished in past-
related research and has never addressed the physiological 
aspects of older and health-compromised passengers.
    The functional genomics scientific field defines the future 
of aerospace medicine.

        U.S. Department of Transportation: The Physician's Guide

    The Physician's Guide is a tool for medical professionals 
to use to help their patients understand whether they are safe 
drivers. It provides office-based screening tools, information 
on the linkages between medical conditions, functional ability, 
and crash risk, and information on referring drivers to each 
state's driver licensing authority. The goal is to help drivers 
maintain their ability to drive safely, and to transition 
appropriately when they can no longer drive.
    Lead Agency: U.S. Department of Transportation, National 
Highway Traffic Safety Administration (NHTSA).
    Agency Mission: Save lives, prevent injuries and reduce 
economic costs due to road traffic crashes through education, 
research, safety standards and enforcement activity.
    Principal Investigator: Joanne Schwartzberg, American 
Medical Association, 515 N State Street, Chicago, IL 60610.
    Partner Agency: American Medical Association.
    General Description: The Physician's Guide to Assessing and 
Counseling Older Drivers was created by the American Medical 
Association (AMA) with support from the National Highway 
Traffic Safety Administration (NHTSA) to help physicians 
address preventable injuries--in particular, those injuries 
incurred in motor vehicle crashes. Currently, motor vehicle 
crashes are the number one cause of injury-related deaths in 
the 65-74 age group. While traffic safety programs have been 
successful in reducing the fatality rate for drivers under the 
age of 65, the fatality rate for older drivers has consistently 
remained high. Physicians are in a position to address and 
correct this problem. By providing effective health care, 
physicians can help their patients maintain a high level of 
fitness, enabling them to preserve safe driving skills later in 
life and protecting them against serious injuries in the event 
of a crash. By adopting preventive practices--including the 
assessment and counseling strategies outlined in this guide--
physicians can better identify drivers at increased risk for 
crashes, help them enhance their driving safety, and ease the 
transition to driving retirement if and when it becomes 
necessary. Through the practice of medicine, physicians have 
the opportunity to promote the safety of their patients and of 
the public. The goal of the Physician's Guide to Assessing and 
Counseling Older Drivers is to forge a link between public 
health and medicine, and to provide doctors with the tools and 
information they need to advise their patients about safe 
driving.
    Older drivers and their families consistently identify 
physicians as the most credible source for information related 
to a person's ability to drive. Unfortunately, physicians have 
not historically had the tools to comfortably assist older 
patients in making a determination about driving. This Guide 
provides physicians with advice on how to screen a driver, how 
to counsel a driver on maintaining their driving abilities and 
to document conversations about driving. Developed with the 
American Medical Association, the Guide brings their medical 
expertise and methods regarding functional abilities and 
screening to an educational tool that promotes to physicians 
having conversations with their patients about safe driving. 
Thousands of physicians from around the world have been trained 
on the use of the guide. Teams from multiple states have 
brought driver licensing and state medical societies together 
to promote the use of the guide. In FY 2008, AMA and NHTSA have 
renewed their support for the Guide and are issuing a revision. 
The partners are also developing a computer-based course 
designed to train medical residents on the use of the Guide. By 
using the Guide, physicians can help countless older drivers 
stay safer, longer.

         U.S. Department of Transportation: Pilot Health Study

    The FAA Aeromedical Research Program has included the study 
of diseases such as atrial fibrillation and diabetes that 
increase with age and their significance in aviation safety. 
The research provides the basis for ensuring the opportunity 
for aging pilots to continue to fly safely.
    Lead Agency: Department of Transportation (DOT)--Federal 
Aviation Administration (FAA)--Office of Aviation Safety 
(AVS)--Office of Aerospace Medicine (AAM)--Civil Aerospace 
Medical Institute (CAMI)--Aerospace Medical Research Division 
(AAM-600).
    Agency Mission: FAA: Federal Aviation Administrations 
mission is to provide the safest, most efficient aerospace 
system in the world.
    Aviation Safety and the Office of Aerospace Medicine's 
mission is to enhance aerospace safety through surveillance, 
research, education, medical standards, and the prevention of 
illness and injury.
    Principal Investigator: Estrella M. Forster, Ph.D., 
Aerospace Research Scientist, FAA CAMI, P.O. Box 25082, 
Oklahoma City, OK 73125.
    Partner Agency: FAA CAMI Aerospace Medical Education 
Division (AAM-400), National University of Colombia School of 
Medicine.
    General Description: Insulin is required to move glucose 
into cells where it can be metabolized. Diabetes is a disease 
in which the body is dysfunctional in the production or use of 
insulin. While still under investigation, both genetics and 
environmental factors appear to contribute to the development 
of the disease. The International Diabetes Federation projects 
the worldwide incidence of diabetes to climb from 5.1% in 2003 
to 6.3% in 2025. It also estimates that the world adult 
population (age 20-79 yr.) will be 5.3 billion by 2025. By 
then, 333 million people will have diabetes. This figure 
signifies an increase from 2003 of 1.2% in the prevalence of 
world diabetes. The highest prevalence of diabetes is in the 
North American Region, expected to reach 9.7% by 2025. In 2005, 
more than 9,000 diabetic pilots were certificated by the 
Federal Aviation Administration (FAA) medical certification 
process.
    Atrial fibrillation (AFIB) is an abnormal heart rhythm 
characterized as irregular, disorganized, electrical activity 
of the upper chambers (atria) of the heart. The atria quiver 
instead of regularly beating which causes them to move around 
300-600 times a minute (instead of 60-80 times a minute). 
Because the upper chambers are quivering so rapidly, the blood 
is not allowed to completely empty and causes pooling in the 
atria. Atrial fibrillation affects approximately 2.2 million 
adults in the United States and is the most common sustained 
heart rhythm disturbance observed in clinical practice. The 
rate of atrial fibrillation increases with age, from <1% among 
persons aged <60 years to approximately 10% among persons aged 
*80 years. Civil aviators with AFIB may, after the appropriate 
examination and follow-up, receive a special FAA medical 
issuance to enable flying status. By 2003, 2,446 diabetic 
pilots were certificated by the FAA medical certification 
process.
    Worldwide aeromedical specialists have made significant 
changes in the criteria for allowing individuals with diabetes 
and atrial fibrillation to pilot aircraft. The progress that 
continues in the treatment of these diseases (medications, 
insulin pumps, tissue/organ transplantation), the monitoring of 
diabetes (glycosylated hemoglobin, glucometers), and improved 
diagnostic classification of the same (types 1 and 2), promise 
to push the frontiers of safety concerns in the future. With 
the rapid worldwide increase in the prevalence of diabetes, 
especially type 2 diabetes, along with an increase in the 
population age, more individuals with diabetes will be entering 
the aviation system as pilots, flight crew, air traffic 
controllers, and passengers. Likewise, the incidence of atrial 
fibrillation will increase as the pilot population ages with 
time. Each group of individuals with these conditions can 
affect safety in aviation. Factors that are of interest to 
assess the potential risk to aviation implied by these diseases 
have included the progression of the condition, associated 
pathologies, medications, flight experience, and accident/
incident events if any experienced throughout the pilot's 
career. Thus, the aerospace medicine specialist will be relied 
upon to make wise, scientifically based decisions that ensure 
aerospace safety while simultaneously allowing individuals with 
diabetes or atrial fibrillation to have the maximum latitude to 
participate in aerospace activities.
    Excellence: What makes this project exceptional?
    The civilian pilot population is aging. Specific diseases 
such as atrial fibrillation and diabetes increase dramatically 
with age. Civilian pilots with these medical problems have been 
considered a risk for flying because of the potential for 
sudden in-flight incapacitation associated with the disease, 
associated co-morbidity, and treatment. This research project 
has allowed the FAA to develop an understanding of aging pilots 
with the diseases and verify the medical certification 
decisions that can allow them to fly longer and simultaneously 
ensure safely.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    More than half of the 16 million Americans estimated to 
have diabetes are over age 60. Of those over age 65, almost 1 
in 5 has diabetes, mostly type 2. According to the American 
Diabetes Association, approximately 18.3% (8.6 million) of 
Americans age 60 and older have diabetes. The prevalence of the 
disease increases with age; an estimated 50% of all diabetes 
happens in those aged 55 and older. The risk of developing type 
2 diabetes also increases with age. Atrial fibrillation affects 
approximately 2.2 million adults in the United States and is 
the most common sustained heart rhythm disturbance observed in 
clinical practice. The rate of atrial fibrillation increases 
with age, from <1% among persons aged <60 years to 
approximately 10% among persons aged *80 years. Over the last 
23 years there has been a continuous decline in the size of the 
population of civil aviation pilots as well as an increase in 
age of both male and female pilots. To maintain this pilot 
population and ensure their medical certification as well as 
their optimum flight performance, this research was conducted 
to increase our understanding of aging and its relationship to 
medical conditions that may render a pilot unable to safely 
continue his or her flying activities. As a pilot grows older 
medical problems that include atrial fibrillation and the 
current epidemic of type 2 diabetes become extremely important 
to understand so as to assess the potential risk to aviation 
implied by these diseases. The information gained from this 
line of research effort will expand the FAA's understanding 
these diseases and will assist in medical certification 
decision-making processes involving the U.S. aging pilot 
population.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    This research increases the opportunities for pilots in 
both private and commercial aviation to continue the safe 
participation in flying as they age, even when medical problems 
associated with aging are present. Diseases that have a greatly 
increased frequency with increasing age and were once totally 
disqualifying can now be carefully managed through proper fact-
based medical certification that ensures individual and public 
safety. The cardiac problem of atrial fibrillation is a growing 
public health problem especially in our aging population. The 
incidence of atrial fibrillation in the United States currently 
is estimated at 2.3 million with a projection to increase to 
5.6 million by 2050. Atrial fibrillation is associated with 
increased risk of stroke, heart failure, cognitive dysfunction, 
and premature death and has enormous socioeconomic 
implications. Glucose tolerance progressively declines with 
age, and there is a high prevalence of type 2 diabetes and the 
potential for sudden incapacitation associated with diabetes, 
its co-morbidity, and its treatment. Such problems are of 
specific concern for flight safety, especially with a pilot 
population that is increasing in age. Medical certification 
decision making in aging pilots with problems that increase 
with age is challenging but armed with fact-based research 
knowledge continued optimum flight performance of aging pilots 
can be accomplished while meeting the aviation safety goals of 
the agency.
    Innovativeness: Why is this research exciting or 
newsworthy?
    The FAA is making it possible for the pilots in our aging 
population to enjoy and earn a living flying for more years, 
even with disease processes (such as cardiac disease and 
diabetes that increase as humans age) and to do it safely. The 
development and utilization of the unique FAA Scientific 
Information System strengthens the National Aerospace System's 
medical research infrastructure and advances collaborative data 
collection efforts. The research represents the first aerospace 
medical research that integrates several fields of study 
relative to toxicology, biochemistry, medicine, accident 
investigation, functional genomics, and sophisticated 
bioinformatics' data analysis methods. The SIS unique database 
and analysis system enables the comprehensive review of almost 
20 million electronic medical records from 2.5 million pilots 
who were issued medical certificates between 1983 and 2005 and 
demonstrates a successful application of Safety Management 
Systems concepts. The research results provide the required 
fact-based knowledge to make aging pilot medical certification 
decisions that ensure safety while expanding the aging and 
disease related envelope.

    U.S. Department of Transportation: Medications and Driver Safety

    This project examined the driving safety of older adults 
who take multiple medications, comparing Occupational 
Therapists' driving assessments with in-vehicle video 
recordings of daily driving by older adults to assess safety 
risk.
    Lead Agency: U.S. Department of Transportation, National 
Highway Traffic Safety Administration (NHTSA).
    Agency Mission: Save lives, prevent injuries and reduce 
economic costs due to road traffic crashes through education, 
research, safety standards and enforcement activity.
    Principal Investigator: Loren Staplin, TransAnalytics, LLC, 
1722 Sumneytown Pike, Box 328, Kulpsville, PA 19443.
    Partner Agency: University of North Carolina Highway Safety 
Research Center.
    General Description: The use of medications and multiple 
medications becomes more prevalent with increasing age. This 
pilot study explored the relationship between polypharmacy and 
driving functioning through separate but related research 
activities. A patient-level administrative claims database 
containing prescription information as well as E-codes 
identifying the incidence of motor vehicle injuries was mined, 
yielding combinations of drugs that became inclusion criteria 
in a field study of driver performance among 44 older adults 
(range: 57 to 89; mean: 79). Measures included driving 
performance evaluations by an Occupational Therapist/Certified 
Driving Rehabilitation Specialist, a brake response time 
measure, and functional screening measures for the study 
sample, whose drug profiles were documented through a ``brown 
bag'' review by a licensed pharmacist. Descriptive data 
summaries and regression analyses examined the relationship 
between medication usage and each of these outcome measures.
    Additional project activities included a current (to 
October 2007) review of the literature on the prevalence of 
prescription medications and effects on driving of specific 
drugs and drug classes. The feasibility of conducting future 
studies using large, administrative claims databases was 
critically examined, with an overview of candidates and 
evaluation of their suitability for NHTSA research.
    Excellence: What makes this project exceptional?
    This project developed a methodology to examine the effects 
that talking multiple medications has on the ability of older 
adults to drive safely. Combinations of medications were 
selected using a patient-level administrative claims database 
linked to crash codes.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    This study provides a potential alternative methodology for 
assessing driver functionality by using in-vehicle video 
cameras that collects objective driving behavior information to 
examine how these drivers perform under daily driving 
conditions.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    This research provides important information to older 
drivers on the risks associated with taking certain medications 
and driving and for older driver specialists such as 
Occupational Therapists or Certified Driver Rehabilitation 
Specialists who may be conducting remedial driver training.
    Innovativeness: Why is this research exciting or 
newsworthy?
    This research uses in-vehicle technology to examine how 
older drivers taking multiple medications drive under their 
normal daily conditions and compares it to how they drive 
during a driving assessment administered by an occupational 
therapist. There are differences in how they drive under these 
circumstances.

        U.S. Department of Transportation: Driver Self Screening

    This project developed and tested a self-screening 
instrument for older drivers focused on health concerns that 
affect driving. It found the instrument useful as a first-tier 
screening tool for drivers 75 and older.
    Lead Agency: U.S. Department of Transportation, National 
Highway Traffic Safety Administration (NHTSA).
    Agency Mission: Save lives, prevent injuries and reduce 
economic costs due to road traffic crashes through education, 
research, safety standards and enforcement activity.
    Principal Investigator: David W. Eby, Research Associate 
Professor and Head, Social and Behavioral Analysis Division, 
University of Michigan Transportation Research Institute, 2901 
Baxter Road, Ann Arbor, MI 48109-2150.
    Partner Agency: University of Michigan.
    General Description: The purpose of this project was to 
improve upon existing self-screening instruments for older 
drivers by focusing entirely on ``health concerns'' that affect 
driving--that is, the symptoms that people experience due to 
medical conditions, the medications used to treat them, and the 
general aging process. The objective was to create an easy-to-
use self-screening instrument. The instrument identifies health 
symptoms experienced by the driver that relate to declines in 
driving abilities, and provides individualized feedback to the 
driver about those health conditions and what can be done to 
continue driving safely. The study included a literature 
review, deliberations by an expert panel, instrument 
development, and an evaluation/validation study.
    The literature review generated a list of health concerns 
that might influence driving and a list of critical driving 
skills. The expert panel finalized the lists of health concerns 
and critical driving skills to include in the instrument; 
discussed how severity levels of the health concerns influence 
critical driving skills; and considered the content of the 
self-screening instrument's feedback. Based on earlier project 
activities, 27 health concerns and 15 critical driving skills 
were included in the instrument.
    Results of the validation study showed that drivers who had 
a greater number of health concerns as identified by the self-
screening instrument also tended to have poorer observed 
driving performance. In addition, drivers who had a greater 
number of health concerns as identified by the instrument also 
tended to have greater deficits in driving-related abilities as 
identified by an occupational therapist. These relationships 
were true only for subjects 75 and older, not for those 65-74.
    Excellence: What makes this project exceptional?
    It is well-established that aging can lead to declines in 
perceptual, cognitive, and psychomotor functions. Accurately 
assessing declines in driving abilities and relating them to 
increased crash risk has been a goal of traffic safety 
professionals for many years. This project provides promising 
self-screening driving ability tools.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    There are several benefits of self screening: reluctant 
drivers may be more willing to assess their own driving 
abilities than to be professionally assessed; people may 
discover declines at an earlier stage; and self screening 
instruments can reach a wide variety of people because such 
instruments are easily distributed.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    This project provides five types of individualized feedback 
for drivers: general awareness of how certain health concerns 
can affect driving; self awareness about individual health 
concerns and driving skills that may be declining; 
individualized recommendations for behavioral changes to 
maintain safe driving; individualized recommendations for 
further evaluation; and individualized recommendations for 
vehicle modifications to maintain safe driving.
    Innovativeness: Why is this research exciting or 
newsworthy?
    The results of this project suggest that the instrument may 
be a useful and valid self-screening instrument for older adult 
drivers 75 and older.

       U.S. Department of Transportation: Improving Our Nation's 
                         Transportation System

    The FHWA has revised the national standards for traffic 
signs, signals, and markings to require these devices to be 
bigger, brighter, more conspicuously located, and more 
appropriately operated, in order to better meet the unique 
needs of older people.
    Lead Agency: U.S. Department of Transportation/Federal 
Highway Administration (FHWA).
    Agency Mission: Improve mobility on our Nation's highways 
through national leadership, innovation, and program delivery.
    Principal Investigator: Hari Kalla, MUTCD Team Leader, 
Federal Highway Administration, HOTO-1, 1200 New Jersey Avenue, 
SE., Washington, DC 20590.
    General Description: FHWA is helping to improve the 
nation's transportation system so that our increasingly older 
population can safely travel and maintain productive and 
independent lifestyles well into their senior years. With 
increasing age, older persons often find driving more hazardous 
and difficult as a result of vision problems, cognitive 
limitations, side effects of medications, slower reaction 
times, muscular difficulties, and other causes. Older citizens 
also tend to walk at a slower pace and will continue to face 
challenges in crossing busy streets and highways on foot.
    The FHWA is responsible for developing and regularly 
updating the Manual on Uniform Traffic Control Devices (MUTCD). 
Traffic control devices are the signs, signals, pavement 
markings, and other features that regulate, warn, and guide the 
traveling public as they traverse our Nation's most vital 
asset--its transportation system. Serving such a critical role 
requires a uniform set of cues to travelers so that those 
devices appear the same no matter where people travel 
throughout the United States. The MUTCD is, by law, the 
national standard governing all traffic control devices 
installed by State and local jurisdictions on all streets and 
highways open to public travel. With efforts that started in 
2001 and are continuing through the present, the FHWA has 
revised the MUTCD standards to better serve the needs of older 
drivers and pedestrians by increasing the visibility of traffic 
control devices, improving advance notification of traffic 
situations and roadway patterns, and simplifying decision 
making at intersection and interchange approaches.
    In 2003, the FHWA issued a new edition of the MUTCD to 
include a variety of new requirements designed to aid older 
drivers and pedestrians. These included larger lettering on 
street name signs to enhance readability, required use of 
advance street name signs that inform drivers of upcoming 
intersections, timing of pedestrian signals to provide longer 
times for pedestrians to cross, introduction of optional 
pedestrian countdown signal displays to inform pedestrians of 
the number of seconds left to complete crossing the roadway, 
and many other traffic control device enhancements.
    In 2008, the FHWA initiated rulemaking to make further 
changes to the MUTCD aimed at enhanced safety and mobility for 
older citizens. One such change is a proposed increase in the 
sizes of many signs to meet the legibility needs of drivers 
with 20/40 corrected vision, the minimum in most states to 
obtain or keep a driver's license. Based on research showing 
better understanding by older drivers, a new, clearer 
diagrammatic guide sign design featuring an upward arrow above 
each lane has been proposed for standard use in some complex 
highway situations. Also, a slower walking speed is proposed 
for timing pedestrian crossing signals, to better accommodate 
the increasing numbers of slower-walking individuals, including 
wheelchair users. The FHWA has also proposed to change the 
existing option of using pedestrian countdown displays to a 
requirement for use with all pedestrian signals.
    Excellence: What makes this project exceptional?
    This project is exceptional because of its far-reaching 
effects in upgrading the safety and convenience of older people 
as drivers and as pedestrians. No other single project can 
claim to have such direct, everyday positive impacts on the 
mobility of older persons.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    This project is relevant to all of the many millions of 
older persons who drive or walk as a part of their daily lives. 
The signs, signals, and markings older drivers and pedestrians 
rely on for their safe and convenient mobility have been and 
continue to be enhanced to better meet the needs of older 
persons and the physical effects of increasing age, such as 
declining vision, reaction times, and walking speeds.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    The FHWA has revised the standards to increase the 
visibility of traffic control devices, improve advance 
notification of traffic situations and roadway patterns, 
simplify decision making at intersection and interchange 
approaches, and provide more time and better information to 
pedestrians to aid their ability to cross streets. By upgrading 
the nation's standards for traffic control devices, our 
increasingly older population can safely travel and maintain 
productive and independent lifestyles well into their senior 
years.
    Innovativeness: Why is this research exciting or 
newsworthy?
    This project is newsworthy and exciting because of the far-
reaching, direct impacts on the vast majority of the increasing 
population of older people who wish to maintain their mobility 
as drivers and pedestrians.

   U.S. Department of Transportation: Taxonomy Project for Excellence

    A Taxonomy Table will be developed that cross-references 
driver performance errors to age-related functional deficits, 
providing new insights into risk factors for older drivers. 
This will be augmented with evaluations of behavioral 
countermeasures to reduce crash risk for this group.
    Lead Agency: U.S. Department of Transportation, National 
Highway Traffic Safety Administration (NHTSA)
    Agency Mission: Save lives, prevent injuries and reduce 
economic costs due to road traffic crashes through education, 
research, safety standards and enforcement activity.
    Principal Investigator: Loren Staplin, Ph.D., 
TransAnalytics, LLC, 1722 Sumneytown Pike, Box 328, Kulpsville, 
PA 19443.
    Partner Agency: University of North Carolina Highway Safety 
Research Center.
    General Description: The project's objectives are to 
identify risky behaviors, driving habits, and exposure patterns 
that have been shown to increase the likelihood of crash 
involvement among seniors, and to classify these crash 
contributing factors according to a set of underlying 
functional deficits specific to or more prevalent among older 
people. Deficits may result from normal aging, age-related 
medical conditions, or medication use. A further goal is to 
identify and critically examine behavioral countermeasures with 
the potential to mitigate functional loss and/or diminish the 
occurrence of risky behavior(s)--and thus ameliorate crash 
problems among older drivers.
    The centerpiece of this project will be the development of 
a Taxonomy Table that captures critical relationships between 
topics and subtopics highlighted in the project literature 
review and crash database analysis (FARS and GES). This table 
is expected to contain entries describing:
           Risky driving behaviors/driving errors 
        associated with older driver crash involvement;
           Operational factors and conditions under 
        which driving errors are most likely to occur;
           General and specific functional deficits 
        that have been identified as underlying causes of 
        driving errors and crash risk;
           Behavioral countermeasures that have been 
        developed to address specific functional deficits and/
        or associated risky behaviors;
           Countermeasure evaluations, where they 
        exist.
    Age-related functional losses in specific vision, 
cognition, and physical abilities that have a demonstrated 
relationship to increased crash risk for older drivers will be 
listed. These will be followed by the driving behaviors 
identified in the database analysis and literature review that 
are associated with increased crash risk in this population.
    Excellence: What makes this project exceptional?
    The continuing growth of the older driver population 
dictates a need to revisit and expand upon the base of 
knowledge documenting older drivers' functional declines in the 
abilities needed to drive safely. Contemporary investigations 
into factors contributing to older driver crashes, together 
with an update of research describing how age-related 
functional changes translate into specific driving errors, will 
provide valuable input to evaluations of the effectiveness of 
existing behavioral countermeasures and to the development of 
improved strategies to enhance older driver safety and mobility 
in the future.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society
    This project is exceptional because its main product, the 
Taxonomy Table, will be a resource that provides at-a-glance, 
state-of-the-knowledge practical and research-based information 
to assist researchers, health care practitioners, and others 
concerned about older drivers to identify particular risk 
factors, and what can be done to reduce the risk.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Equipping individuals with strategies and tactics to help 
them safely negotiate problem situations should enhance older 
driver safety and mobility.

   U.S. Department of Veterans Affairs: The Oregon Brain Aging Study

    The Oregon Brain Aging Study focuses on healthy brain aging 
to determine factors that may confer resistance to cognitive 
decline in aging. ``Average healthy'' oldest old were found 
more resistant to dementia at advanced age than those 
``exceptionally healthy.
    Lead Agency: U.S. Department of Veterans Affairs (VA), 
Veterans Health Administration (VHA).
    Agency Mission: ``To care for him who shall have borne the 
battle and for his widow and his orphan.''
    Principal Investigator: William Goldberg, PhD, 810 Vermont 
Ave NW., Washington DC 20420.
    Partner Agency: National Institutes of Health/National 
Institute of Aging (NIH/NIA)
    General Description:

                        OREGON BRAIN AGING STUDY

    The Oregon Brain Aging Study is a longitudinal study 
focused on factors associated with healthy brain aging. Current 
research questions are directed toward establishing biomarkers 
of brain aging protection associated with a recently 
identified, resistant to cognitive decline phenotype among the 
oldest old, and determining how these biomarkers map to rates 
or trajectories of functional decline prior to the emergence of 
dementia. Finally, the study ultimately focuses on establishing 
whether the resistive phenotype of cognitive decline and brain 
aging is associated with distinct neuropathology.
    Subjects enrolled in the longitudinal aging study are 
followed semiannually with standardized clinical, cognitive and 
volumetric Magnetic Resonance Imaging (MRI) to mark the 
trajectories of the healthy aging cohorts who are more or less 
resistant to developing mild cognitive decline. The accelerated 
atrophy associated with incipient cognitive impairment will be 
tracked with annually obtained biomarkers that have been shown 
to be associated with relevant age-related neuropathology in 
elderly subjects. Subjects will be followed to autopsy. Post 
mortem examination will be used to correlate common age-
associated pathologies (e.g., neuritic plaques, neurofibrillary 
tangles, micro infarcts) with rates of volume loss established 
with Magnetic Resonance Imaging, as well as the change in 
peripheral biomarkers.
    Standardized clinical examinations and psychometric tests 
are used to identify trajectories of cognitive and functional 
change over time. Volumetric Magnetic Resonance Imaging is used 
to measure the rates of atrophy characterizing subjects 
destined to develop cognitive impairment compared to those 
relatively resistant to decline. Biomarkers of plasma amyloid, 
antioxidant stress (F2- isoprostanes), vascular disease and 
brain damage (24S- hydroxycholesterol, plasma lipids, 
homocysteine) are measured annually and examined for their 
change relative to MRI established brain atrophy and cognitive 
decline. Post mortem brain examination will follow a 
standardized histopathological protocol and the coding system 
of the National Alzheimer's Consortium.
    Findings/Progress to Date: A cohort of average healthy 
oldest old have been discovered to paradoxically be more 
resistant to developing dementia at advanced age relative to an 
exceptionally healthy age-matched group. This suggests a human 
aging phenotype associated with the phenomenon of hormesis 
where chronic, non-lethal stressors may precondition the brain 
to be more capable of resisting insults than naively aging 
brains. Those relatively resistant to cognitive decline have a 
two phase acceleration of age-associated brain loss (on MRI) 
prior to developing cognitive decline such that there is a long 
premonitory period of accelerating loss followed by a more 
rapid phase of volume loss occurring approximately 2-3 years 
prior to apparent cognitive decline. This newly identified 
trajectory provides the opportunity to map plasma biomarkers as 
they emerge over time to detect signals of possible mechanisms 
associated with the earliest stages of neurodegeneration 
leading to cognitive decline. To date, plasma biomarkers have 
been collected on 96 individual subjects and are undergoing 
assay analysis.
    Excellence: What makes this project exceptional?
    Following a group of initially healthy aging subjects over 
time with semiannual standardized clinical examinations and 
psychometric tests that are used to identify trajectories of 
cognitive and functional change.
    Significance: How is this research relevant to older 
person, populations and/or an aging society?
    This study will establish the different characteristics of 
neuropathology in two groups of healthy oldest old patients, 
those that do and do not develop dementia.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    This study will establish biomarkers in blood that may 
predict early stages of neurodegeneration leading to cognitive 
decline. The identification of these biomarkers, in aged 
individuals with and without the development of dementia, may 
also provide insights to the mechanism(s) that contributes to 
the normal and abnormal brain aging.
    Innovativeness: Why is this research exciting or 
newsworthy?
    To date, there are no reliable blood biomarkers that can 
predict the development of dementia. With the identification of 
these biomarkers, it will be possible to identify individuals 
in the very early stages of the development of dementia. Early 
diagnosis is important for physicians to identify treatable 
causes of dementia, to effectively manage dementia and related 
illnesses, and to offer support services to the patient and 
family.

 U.S. Department of Veterans Affairs: Risk Factors for Cardiovascular 
                                Diseases

    A sedentary lifestyle, high calorie-fat diets and genetic 
susceptibility increase obesity, diabetes and cardiovascular 
disease risk with aging. These can be modified by disease-
specific exercise and dietary interventions to improve health 
and function in the elderly.
    Lead Agency: Department of Veterans Affairs.
    Agency Mission: ``To care for him who shall have borne the 
battle and for his widow and his orphan.''
    Principal Investigator: Andrew P. Goldberg, M.D., Director, 
Baltimore GRECC, Baltimore VA Medical Center, Geriatrics 
Service/GRECC (BT/18/GR), 10 N. Greene Street, Baltimore, MD 
21201-1524.
    Partner Agency: University of Maryland, Veterans Health 
Administration, Baltimore Geriatric Research, Education and 
Clinical Center.
    General Description: Aging research at the Baltimore VA 
GRECC examines the hypothesis that physiological declines in 
cardiovascular and metabolic function that accelerate 
cardiovascular disease (CVD) risk are predominately related to 
the influence of genetic susceptibility, a sedentary lifestyle 
and obesity-and that these can be effectively modified by 
exercise and dietary interventions. Research designed to modify 
CVD risk investigates (1) the effects of exercise and weight 
loss on CVD risk, (2) genetic predictors of disease, and (3) 
functional and health outcomes of structured exercise in 
chronic stroke. A multidisciplinary team leverages resources 
from six National Institutes of Health (NIH) and VA centers of 
excellence to conduct patient-oriented translational research 
and clinical trials in genetics, exercise and low-calorie 
feeding that translates basic science research into clinical 
practice to improve the health, function and quality of life in 
older Americans.
    Our research demonstrates that structured exercise and diet 
interventions modify fundamental biological processes that 
underlie diabetes and obesity in advancing age. GRECC 
researchers examine the molecular, cellular and genetic 
mechanisms by which fat produces inflammatory proteins and 
muscle accumulates fat in type 2 diabetes and obesity, and how 
these disease processes are reduced by exercise and weight 
loss. The clinical translation exercise and weight loss program 
in the VA--Managing Obesity for Veterans Everywhere (MOVE!) 
improves exercise capacity, functional performance and body 
composition to reduce diabetes and CVD risk. Research studies 
examining the molecular, genetic and physiologic basis of these 
improvements allow translation of basic mechanisms and novel 
rehabilitation techniques into effective treatment, prevention 
and rehabilitation modalities.
    Researchers examine the genetic and environmental causes of 
adult onset diabetes in the genetically homogeneous ``Founder 
Old Order'' Amish population, ideal for studies of CVD-related 
diseases. The Amish are as obese as the U.S. population, but 
have half the prevalence of type 2 diabetes due to high levels 
of physical activity. Amish subjects who are genetically 
susceptible to weight gain reduce risk of obesity through 
physical activity, suggesting genetic risk of obesity is 
modifiable through healthy lifestyle choices. We have been able 
to identify several common gene variations that are associated 
with diabetes and metabolic syndrome. Extensions of these 
genetic studies have identified new genes for hypertension, 
hyperlipidemia, uric acid, and glucose levels that are under 
exploration in other US populations at high risk for CVD.
    Stroke results in chronic impairments in walking and 
balance that limit functional independence and physical 
activity, even years after conventional rehabilitation care. 
This increases risk for diabetes and recurrent stroke. We 
developed a model of ``task-oriented'' treadmill training that 
facilitates recovery of walking by activating subcortical brain 
networks, while providing aerobic exercise to improve 
cardiovascular health and fitness in chronic stroke. This 
program improves glucose metabolism to reduce diabetes risk and 
reverse its prevalence in over half of exercising subjects. 
Hence, treadmill training offers a new approach for 
rehabilitation of older stroke victims that improves their 
health and function, and decreases the risk for diabetes and 
recurrent stroke.
    Excellence: What makes this project exceptional?
    This program is exceptional because it provides a unique 
interface between basic science and clinical medicine to 
advance knowledge into new approaches for the diagnosis and 
treatment of CVD risk factors and disability conditions 
prevalent in older people. There is an enriched environment of 
interdisciplinary collaboration in ``bench to bedside'' 
research among GRECC investigators that examines the cellular, 
molecular and genetic mechanisms by which lifestyle 
interventions reduce CVD risk and improve functionality. This 
in turn prevents obesity and diabetes-associated CVD and 
stroke-associated disability. The conceptual model posits that 
multiple physiological systems and genes interact to determine 
the long-term cardiovascular health and functional independence 
of older individuals. This multidisciplinary approach leverages 
resources across multiple NIH and VA centers of excellence to 
bring a basic science outlook to the design of novel structured 
physical activity and exercise rehabilitation interventions. 
Our goal is to prevent and treat diabetes, cardiovascular 
disease and disability conditions to promote recovery in older 
Americans living with chronic diseases and disability.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Aging and a sedentary lifestyle are associated with an 
increasing prevalence of overweight and obesity. These place 
older adults at greater risk for the development of diabetes, 
CVD, functional impairments and disability. Innovative research 
that translates interventions to the community will increase 
physical activity and promote weight loss. This has the 
potential to decrease morbidity and mortality and improve 
quality of life in older adults with chronic CVD. GRECC genetic 
research demonstrates the value of genetic screening to 
identify susceptibility to disease. It also identifies who are 
most likely to experience health benefits from exercise and 
diet interventions. This will advance the science of 
rehabilitation research in aging, leading to new discoveries to 
identify, prevent and treat disease to reduce risk for frailty 
and prolonged disability requiring long-term care. Our programs 
provide hope and empower older Americans living with diabetes, 
CVD and stroke to combat their chronic disability and improve 
their health and well-being through exercise and dietary 
lifestyle modification.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Our exercise training models are highly effective in 
improving cardiovascular fitness, strength and muscle mass, and 
glucose regulation to reduce CVD risk in older Americans living 
with diabetes, obesity and stroke. We thereby are enhancing the 
maintenance of functional independence even years after 
diagnosis. Routine clinical management of older adults with 
obesity, diabetes, CVD risk factors and disability associated 
with stroke do not provide resources for sustained or disease-
specific exercise or nutritional interventions that are needed 
to improve long-term health outcomes in the elderly. Our 
research shows a synergy between exercise and dietary 
interventions to optimize CVD risk modification for diabetes, 
obesity and aging-related disability conditions. This research 
provides data for evidence-based translation into the clinical 
setting to develop national guidelines for disease, disability 
and age-specific exercise and dietary recommendations for older 
Americans.
    Innovativeness: Why is this research exciting or 
newsworthy?
    GRECC researchers have presented novel findings at the 
Institute of Medicine that task-oriented treadmill training 
which combines ``motor learning'' with aerobic exercise 
mediates brain plasticity to enhance mobility function, while 
improving fitness and reversing diabetes in older chronic 
stroke patients, even decades after the stroke. In 2008, these 
findings will be incorporated in National Academies of Science, 
Evidence-Based Guidelines for Physical Activity for All 
Americans. These guidelines requested by the Secretary for 
Health and Human Services, include the evidence for 
effectiveness of physical activity in aging, chronic diseases 
including diabetes and obesity, and disability including 
stroke, will form the basis for new models of care.
    Genetic screening may allow us to target disease-specific 
interventions to subjects most likely to respond with 
improvements in functional performance and cardio metabolic 
health, even older people with multiple chronic medical 
comorbidities and stroke. GRECC scientists investigate basic 
science mechanisms at the cellular and molecular level for 
these physiologic adaptations. This will generate new knowledge 
and technologies to provide the scientific foundation and 
rationale for the incorporation of disease-specific exercise 
and dietary approaches for the prevention and treatment of CVD 
and related disabilities into clinical practice.

     U.S. Department of Veterans Affairs: Brain Monitoring Research

    This research is defining how to monitor and classify the 
brain dysfunction that occurs in 70 percent of critically ill 
patients, determining its epidemiology in the aging population 
at risk for ICU admission, and the role that sedatives and 
analgesics play in causing these debilitating deficits.
    Lead Agency: U.S. Department of Veterans Affairs.
    Agency Mission: ``To care for him who shall have borne the 
battle and for his widow and his orphan.''
    Principal Investigator: Kenneth Shay, DDS, MS, Director of 
Geriatric Programs, Office of Geriatrics and Extended Care 
(114), Department of Veterans Affairs, 810 Vermont St., NW., 
Washington, DC 20420.
    Partner Agency: Alliance for Aging Research (AFAR), John A. 
Hartford Foundation, National Institutes of Health; National 
Institute on Aging (NIH/NIA), Veterans Health Administration, 
Tennessee Valley VA Health Care System.
    General Description: This research is the outgrowth of an 
unmet need in critical care medicine regarding the exceedingly 
common occurrence of (a) delirium (acute brain dysfunction) 
among patients, predominantly of advanced age, treated in 
intensive care units (ICU) and (b) the associated long-term 
cognitive impairment that occurs in over half of ICU survivors. 
Every day, over 40,000 ICU patients in the United States alone 
are suffering from delirium. This problem is getting larger 
every year due to the aging of the population and the immense 
growth of critical care beds. Traditionally, ICU delirium was 
called ``ICU Psychosis,'' and professionals had erroneously not 
thought it to be clinically significant.
    Using clinical tools designed and validated through the VA 
Geriatric Clinical Research Education Clinical Center (GRECC) 
and at Vanderbilt University, the ICU Delirium and Cognitive 
Impairment Study Group (www.icudelirium.org) has now shown that 
delirium is associated with a tripling of the risk of death 
within 6 months of ICU admission. They have further shown that 
delirium occurs in about 50 to 80 percent of ICU patients. Even 
considering other factors such as age, severity of illness, 
duration of coma, and the use of psychoactive medications, 
every day spent in delirium by ICU patients was associated with 
a 10 percent higher risk of death and a 35 percent increased 
risk of long-term cognitive impairment among survivors. The 
occurrence of ICU delirium is also associated with dramatically 
higher hospital costs of over $25,000 U.S. dollars per patient 
when comparing those with mild vs. severe courses of delirium, 
and this doesn't include the added costs and family burden of 
having patients unable to return home due to the ongoing 
neuropsychological deficits that we are finding in the majority 
of younger and especially older survivors. We are only now 
learning about the relationships between the ICU delirium and 
the longer-term neuropsychological problems that plague ICU 
delirium survivors.
    Awareness of these issues is reaching a tipping point among 
the medical and lay community. Thousands of ICUs around the 
world are now implementing routine bedside monitoring of all 
ICU patients for arousal levels and delirium based on the above 
mentioned facts. In addition, there is growing interest in 
post-ICU specialty clinics to help patients and families deal 
with the unique constellation of acquired problems involved in 
returning to a functional and whole human being. The tools 
available from this research (e.g., a sedation scale called the 
Richmond Agitation-Sedation Scale (RASS) and a well-validated 
and easy to conduct delirium instrument called the Confusion 
Assessment Method-ICU (CAM-ICU), as well as a new ``wake up and 
breathe ABC sedation protocol'' that is proven to save 1 life 
for every 7 patients so treated) have been translated into over 
14 languages and international guidelines have recommended 
delirium monitoring as standard of care. Ongoing clinical 
trials are now exploring the safest and most effective ways to 
prevent and treat ICU delirium in hopes that treatment will not 
only reduce delirium but also the high morbidity and mortality 
associated with it.
    Excellence: What makes this project exceptional?
    Every day, 30,000 to 40,000 people in ICUs are suffering 
from delirium with potential devastating, long-lasting effects 
on how their brain will work and a higher chance of death. Once 
doctors and nurses in the ICU are aware of this problem, they 
can look out for it, perform simple bedside tests and take 
steps to reduce or maybe prevent it. The longer a person is 
delirious, the more likely they are to die.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Critical Care Medicine is a young field of Medicine, with 
early ICUs in this country appearing in the 1960s and not 
routinely being available in most hospitals until the 1970s. 
Survival rates for many critically ill conditions have shown 
striking increases, even without evidence of clinical trials of 
specific therapies showing objective benefits. Many more 
critically ill patients are now surviving and, in the last 
decade, it has become clear that these survivors of critical 
illness have a burden of illness that was previously 
unrecognized. This was first demonstrated by studies of the 
self-assessed quality of life in ICU survivors. Initially this 
finding was puzzling as the function of the failing organ 
resulting in critical illness often (usually) returned to 
normal or near-normal. This has been best studied in patients 
with acute lung injury (often only the most prominent and most 
severe clinical manifestation of multiple organ failure) where 
lung function returns to normal or near normal within 6 months 
whereas significant decrements in health-related quality of 
life persisted for years.
    Subsequent work has demonstrated that the most severe 
abnormalities in these critical illness survivors are in three 
related areas: neurocognitive deficits; psychological disorders 
(depression, post-traumatic stress disorder and other anxiety 
conditions); and neuromuscular abnormalities. We call this the 
post-ICU syndrome. Again, in the case of acute lung injury 
patients, a careful study showed that the majority of patients 
at one year following ICU discharge had neuropsychological 
abnormalities and 100 percent had significant neuromuscular 
complaints accompanied by objective findings. It would be 
difficult to over-exaggerate the magnitude of this problem; it 
is clearly one of public health importance. One of the major 
issues is that no medical discipline has owned this problem and 
taken responsible action on it. Although it came to light 
largely through the efforts of critical care investigators, 
critical care physicians rarely follow these patients once they 
leave the ICU. Primary care physicians, who will be following 
the great majority of these victims, are almost completely 
unaware of these abnormalities and they usually go 
unrecognized. Finally, rehabilitation specialists and 
psychiatrists have not been aware of these morbidities nor 
involved in their evaluation or management in any meaningful 
and organized way.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    This work will define the approach over the next 30 to 40 
years to preserving the minds of the millions of older patients 
who plan to live productive and functional lives well into 
their 80s and 90s but who, along the way, will have to sustain 
care in an ICU for some length of time as they overcome an 
unexpected critical illness.
    Innovativeness: Why is this research exciting or 
newsworthy?
    In summary, the problem of post-ICU syndrome is one of 
public health proportions, has enormous clinical, economic and 
societal consequences, and yet the problem is largely 
unrecognized or is being ignored by the medical community. This 
is a problem which is ripe for attention and intervention, and 
yet interventions are not going to be funded through the NIH 
RO1 mechanism. The science of each of the components of the 
morbidity is not mature, an intervention would by necessity be 
complex, and preliminary data regarding interventions are 
lacking; combined, these result in a kiss of death for 
conventional NIH funding mechanisms, ensuring that the problem 
will continue over decades. A fresh, innovative, necessarily 
``high-risk'' approach is required to jump start therapeutic 
solutions to this immense health problem.

   U.S. Department of Veterans Affairs: Reducing the Risk of Dementia

    This work explores the relationship between insulin 
resistance and the development of cognitive impairment and 
dementia in older adults. The team now is examining therapeutic 
strategies for reducing the risk of dementia and reducing 
cognitive impairment.
    Lead Agency: U.S. Department of Veterans Affairs (VA), 
Veterans Health Administration (VHA), Veterans Affairs Puget 
Sound Health Care System.
    Agency Mission: ``To care for him who shall have borne the 
battle and for his widow and his orphan.''
    Principal Investigator: Suzanne Craft, Ph.D., Associate 
Director, Geriatric Research, Education and Clinical Center, 
Veterans Affairs Puget Sound Health Care System, Professor of 
Psychiatry and Behavioral Sciences, University of Washington 
School of Medicine, GRECC S-182, VAPSHCS, 1660 South Columbian 
Way, Seattle, Washington 98108.
    Partner Agency: National Institute on Aging.
    General Description: Dr. Craft's research program examines 
the relationship between Alzheimer's disease and insulin 
resistance, a condition in which insulin does not work 
efficiently, leading to diabetes, obesity, and cardiovascular 
disease. In one set of projects her lab investigated the 
specific mechanisms through which insulin resistance affected 
pathology related to Alzheimer's disease. Older adults received 
infusions of insulin designed to mimic insulin resistance, and 
then underwent spinal taps to measure levels of proteins 
thought to cause Alzheimer's disease. High insulin levels 
caused temporary increases in levels of these toxic proteins 
and markers of inflammation that have been linked to 
Alzheimer's disease, illustrating an important relationship 
between insulin resistance and Alzheimer's disease. In an 
ongoing study, we are examining the effect of low fat and high 
fat diets on Alzheimer's disease markers in older adults and 
patients with Alzheimer's disease. This study will provide 
important data about environmental factors that can modulate 
the risk of developing Alzheimer's disease. In other studies, 
we have examined how treatments for insulin resistance have 
therapeutic benefit for patients with Alzheimer's disease. In a 
pilot study, medications used to treat patients with 
Alzheimer's disease were shown to benefit patients with 
Alzheimer's disease. In a second study, overcoming insulin 
resistance by providing insulin directly to the brain with a 
special nasal administration device resulted in improved memory 
and attention in patients with Alzheimer's disease. A larger 
clinical trial is now underway to determine whether long-term 
intranasal administration of insulin can benefit patients with 
Alzheimer's disease. Thus, her research projects have focused 
on important disease mechanisms that have yielded novel 
therapeutic approaches for this challenging disease.
    Excellence: What makes this project exceptional?
    These interrelated projects address important questions: 
How do insulin resistance and diabetes increase the risk of 
developing Alzheimer's disease and other dementias? Once 
potential mechanisms have been identified that appear to play a 
role in this risk, what therapies might be effective to improve 
the symptoms of Alzheimer's disease, or perhaps even delay or 
prevent its development?
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    The importance of these questions is underscored by the 
current pandemic of conditions associated with insulin 
resistance, such as obesity, diabetes, hypertension and 
cardiovascular disease. The proliferation of these conditions, 
in the context of a rapidly aging society, may significantly 
increase the prevalence of dementia.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    This area offers one of the few potential approaches to 
preventing or at least delaying the onset of dementia, by 
diagnosing and treating insulin resistance prior to its onset.
    Innovativeness: Why is this research exciting or 
newsworthy?
    The approach used to address these questions is innovative, 
working with safe yet informative experimental models of 
insulin resistance in human patients that are then translated 
into novel therapies. The innovativeness of this work has been 
recognized by the National Institute of Aging, who awarded a 
MERIT grant for excellence in aging research to Dr. Craft. The 
newsworthiness of this work has been acknowledged in a number 
of media reports, and as well as through its inclusion in an 
upcoming HBO series on Alzheimer's disease in March 2009.

             U.S. Department of Veterans Affairs: REACH VA

    REACH VA is an effective intervention to decrease dementia 
caregiver stress and improve the management of dementia patient 
behaviors that can be implemented throughout the VHA system and 
in community health care settings.
    Lead Agency: Department of Veterans Affairs.
    Agency Mission: ``To care for him who shall have borne the 
battle and for his widow and his orphan.''
    Principal Investigator: Pauline Sieverding, MPA, JD, PhD, 
Scientific Program Manager, Health Services Research and 
Development, 810 Vermont Ave., NW., Washington DC 20420.
    Partner Agency: National Institute on Aging (NIA), National 
Institute of Nursing Research (NINR).
    General Description:

    RESOURCES FOR ENHANCING ALZHEIMER'S CAREGIVERS HEALTH (REACH) VA

    In 2000, 4.5 million individuals in the United Stated had 
Alzheimer's disease. Currently, informal caregivers provide the 
majority of care for those with dementia, on average 16-20 
hours/day. As part of Congressional funding for caregiver 
assistance pilot programs to provide needed training and 
resources for caregivers who assist disabled and aging veterans 
in their homes, VHA funded REACH VA as a clinical translation 
of the successful Resources for Enhancing Alzheimer's 
Caregivers Health (REACH II) study. REACH II, funded by the NIA 
and the NINR, was the first national randomized clinical trial 
of a behavioral intervention to decrease stress and burden for 
racially and ethnically diverse dementia caregivers. The REACH 
VA program translates the REACH II intervention into clinical 
practice, which is the goal of research.
    The REACH VA intervention provides education, a focus on 
safety for the patient, support for the caregiver, and skills 
building to help caregivers manage difficult patient behaviors 
and decrease their own stress. It includes 12 individual 
sessions in the home and by telephone, and five telephone 
support groups over six months. Across the country, 24 Home 
Based Primary Care (HBPC) programs, which treat frail dementia 
patients and their caregivers in the home, are participating, 
providing the intervention as part of clinical care to families 
and patients. VA Medical Center at Memphis serves as the 
coordinating center for this program, providing training to the 
clinical sites, certification of staff to provide the 
intervention, and evaluation of the results.
    The goal of REACH VA is to implement an effective 
intervention to decrease caregiver stress and improve the 
management of patient behaviors throughout the VHA system. 
REACH VA is being discussed as an option to provide services to 
caregivers participating in VHA Adult Day Health Care. Specific 
objectives include: (1) improve emotional well-being and 
depression, burden, health, social support, and management of 
patient dementia-related behaviors for family caregivers of 
dementia patients; (2) decrease health care utilization, 
including unanticipated admissions, unscheduled outpatient 
visits, emergency room visits, and placement, for dementia 
patients; (3) decrease time spent ``on duty'' and time 
providing actual care for caregivers; (4) assess caregiver 
satisfaction with the services provided; (5) assess VHA 
clinical staff satisfaction with the intervention; and (6) 
determine the cost of the intervention for VHA.
    Excellence: What makes this project exceptional?
    The goal of research is to translate research findings into 
clinical practice and personal behavior. The VA system has made 
it possible to implement the REACH II research findings 
broadly, through funding of REACH VA as the first national 
clinical translation of a proven dementia caregiver behavioral 
intervention. Clinical staff from 24 HBPC programs in more than 
29 cities and 17 states have volunteered their time to train 
for and to deliver the intervention to stressed caregivers of 
dementia patients. Based on their dedication and their desire 
to provide the best possible care for their patients and their 
families, these staff are implementing the program as part of 
their clinical workload. Their goal is to raise the standard of 
care provided to dementia caregivers and patients using 
evidence based interventions. REACH VA materials are a 
practical resource for clinicians beyond the confines of the 
program, providing knowledge and materials to be used with 
other caregivers and patients.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Caregiving is a national and growing concern. Approximately 
54 million people provided care in the past year and 59% of 
adults are now or expect to be family caregivers in the future. 
Unpaid family caregivers are the largest source of long-term 
care services in the U.S. The value of ``free'' services 
provided by family members is $257 billion annually (in 2000 
dollars), more than nursing home and home health care combined. 
Factoring in all lost productivity and $36.5 billion in 
absenteeism, dementia costs American businesses $61 billion per 
year. REACH VA is designed to help caregivers cope with the 
stresses of caregiving.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Although most dementia caregivers express a desire to 
provide care in the home, the emotional and physical costs are 
enormous. The REACH II intervention has been shown to 
significantly improve caregiver quality of life--caregiver 
burden, depression/emotional well-being, self-care and healthy 
behaviors, social support, and management of care recipient 
problem behaviors. It also provides that most scarce commodity 
for caregivers--time--in an additional hour per day not 
providing direct care at an intervention cost of $5.00 per day. 
This intervention will now be available across the VHA system. 
In addition, the VA is a testing ground for the intervention to 
be used nationally with community agencies. The Roslynn Carter 
Institute for Caregiving has selected REACH VA as one of its 
National Caregiver Quality Programs.
    Innovativeness: Why is this research exciting or 
newsworthy?
    An editorial in the Annals of Internal Medicine on REACH II 
suggested that if the intervention was a drug, it would be on 
the fast track to approval. The VA system has provided a means 
to implement this first national clinical translation of a 
dementia caregiver behavioral intervention. REACH VA is also an 
example of the efforts of two federal agencies, the National 
Institutes of Health and the Department of Veterans Affairs, 
working together to translate research into clinical practice. 
REACH VA showcases the efforts of Congress, through the 
Department of Veterans Affairs, to provide support for family 
caregivers. Their funding for VHA Caregiver Pilot Assistance 
Programs was designed to identify programs that would enhance 
the quality of life of veterans and reduce the strain on 
veterans' caregivers and then be replicated beyond the 
demonstration site.

  U.S. Department of Veterans Affairs: Family Assessment of Treatment

    This unique project has created a way for the VA to improve 
the care that it provides to veterans near the end of life by 
asking veterans' families whether the veteran received the best 
possible care and, if not, how that care could be improved.
    Lead Agency: U.S. Department of Veterans Affairs (VA), 
Veterans Health Administration (VHA), Philadelphia VA Medical 
Center.
    Agency Mission: ``To care for him who shall have borne the 
battle and for his widow and his orphan.''
    Principal Investigator: David J. Casarett, MD, Chairperson, 
Ethics Advisory/Faculty Leader End of Life Care/Staff 
Physician, VAMC Philadelphia, Office of Geriatrics, University 
and Woodland Avenue, Philadelphia, PA 19104.
    General Description:

FAMILY ASSESSMENT OF TREATMENT AT END-OF-LIFE (FATE) SURVEY DEVELOPMENT

    Over the past 10 years, growing attention has focused on 
opportunities to improve the care that older adults receive 
near the end of their lives. For instance, previous studies 
have found that symptoms like pain, nausea, constipation, and 
shortness of breath are very common, but that clinicians are 
often unable to recognize these symptoms and manage them 
adequately. Other studies have found that clinicians do not 
communicate with patients about their health care preferences, 
and that treatment decisions are not always consistent with 
those preferences. In particular, patients often receive 
aggressive life-sustaining treatment that is not consistent 
with their preferences.
    The goal of this VA-funded project, the FATE study, was to 
develop and test a telephone survey that will allow the family 
members of veterans to evaluate the care that the veteran 
received near the end of his/her life. This survey allows 
family members to rate various aspects of the veteran's care 
including management of pain and other symptoms, and the 
availability of practical assistance (e.g. home care) and 
emotional and spiritual support. Families also are asked 
whether the veteran's preferences were respected, whether 
clinicians provided adequate information, and whether the 
veteran was treated with respect.
    This survey is currently being implemented in eight 
Veterans Integrated Service Networks (VISN) as a measure of the 
quality of care that they are providing to veterans near the 
end of life and their families. These surveys are then used to 
produce quarterly reports that are made available to VISN and 
hospital leaders. These reports highlight each hospital's 
strengths, as well as opportunities for improvement.
    Excellence: What makes this project exceptional?
    This is the first-ever successful project to measure and 
improve the quality of end of life care across an entire health 
care system. VA is the nation's largest integrated health care 
system, and offers unique opportunities both to identify 
opportunities for improving end-of-life care and, more 
importantly to identify those hospitals that provide excellent 
care. This project is the first of its kind to measure and 
improve the quality of end-of-life care on such a large scale.
    Significance: How is this research relevant to an older 
person, populations and/or an aging society?
    As the population ages, it will become increasingly 
important to ensure that we are providing the best possible 
care to older adults throughout their lives, and this includes 
the care that they receive near the end of their lives, when 
they are most vulnerable. Just as it is essential to preserve 
older adults' function and independence as long as possible, 
for instance, when they reach the last months of their lives, 
then attention turns toward maintaining comfort and preserving 
dignity. It is especially important to ensure that older adults 
receive high quality compassionate care during this period not 
only for the patient's sake, but also for the sake of family 
members.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    This survey, which is currently being rolled out with a 
plan for national implementation in the VA health care system, 
will provide unique insights into the care that the VA is able 
to provide to patients near the end of life and their families. 
For instance, the results of these surveys have already begun 
to identify areas of care (e.g., pain management) that need to 
be improved. In addition, these results have begun to identify 
hospitals and nursing homes that are providing excellent care, 
both with respect to pain management and in all aspects of 
care. By understanding what makes these hospitals so 
successful, we are able to take the lessons learned and apply 
them to improve care throughout the VA health care system. 
Finally, this survey has begun to provide the VA with important 
data to guide policy. For instance, the finding that veterans 
receive better care from dedicated hospice or ``palliative 
care'' teams supports the VA's commitment to ensure that all 
veterans have access to this specialized care.
    Innovativeness: Why is this research exciting or 
newsworthy?
    This is the first national effort to measure and improve 
the quality of care that older adults receive near the end of 
life across a health care system. This project offers important 
opportunities to identify opportunities for improvement and to 
identify hospitals and nursing homes whose successes can be 
shared.

U.S. Department of Veterans Affairs: Aging Veterans Health Policy Model

    HSR&D investigators, working with VHA policy and operations 
groups, and National Institute on Aging (NIA) investigators, 
combined VHA data on enrolled veteran demographics and health 
care use with similar data from the NLTCS and other federal 
survey to create a LTC projection model, validate the 
projections prospectively with data from CMS on nursing home 
use, and coordinate data collection with NIA in order to update 
the model for all veterans, both enrolled and non-enrolled.
    Lead Agency: U.S. Department of Veterans Affairs (VA).
    Agency Mission: ``To care for him who shall have borne the 
battle and for his widow and his orphan.''
    Principal Investigator: Bruce Kinosian, MD, Director of 
Community Options Program/Medical Director Hospital Home Care/
Staff Physician, VAMC Philadelphia, Office of Geriatrics, 
University and Woodland Avenue, Philadelphia, PA 19104.
    General Description:

                   AGING VETERANS HEALTH POLICY MODEL

    The VA Aging Policy Model has been a collaboration between 
VA's Health Services Research and Development Service (HSR&D), 
the Assistant Deputy Under Secretary for Health Policy and 
Planning, the VA's Office of the Actuary, and the Office of 
Geriatrics and Extended Care; and investigators from the 
University of Pennsylvania, Duke University, and the University 
of Michigan. The group undertook to revise VA's original long 
term care planning model in 2003, using data from the National 
Long Term Care Survey (NLTCS) and other federal surveys, 
including linking the NLTCS to the VA enrollment file. These 
investigators then used Center for Medicare and Medicaid 
Services (CMS) data on national nursing home (NH) use (the 
``Minimum Data Set'' or MDS), matched with VHA's enrollment 
file, to determine the actual number of veterans in NHs. 
Adjusting for methodologic differences, the LTC planning model 
accurately predicted total NH use among enrolled veterans. This 
was confirmed by using a subsequent round of the NLTCS (in 
2004) to validate the projections based on the prior round.
    These investigators combined all health care use by 
veterans in the NLTCS from CMS and VHA data files from 1994-
2004, in order to estimate an updated model based on combined 
health care and LTC use in 1994-2002, with validation of use 
for 2003-2004.
    Concurrently, these investigators used sophisticated 
regression techniques (CART) to map disability questions from 
the National Health Interview Survey to the U.S. Census 
detailed survey, in order to create county-level estimates of 
the prevalence of A disability among veterans.
    These investigators coordinated the 2004-2005 rounds of the 
VHA Survey Of Enrollees (SOE) and the NLTCS in order to (a) 
validate the SOE, (b) extend enrolled veteran disability 
estimates to the Veterans Integrated Service Network (VISN) and 
market levels, and (c) to comprehensively survey all veterans, 
to determine differences in disability between enrolled and 
non-enrolled veterans, and the role of enrollment in altering 
those differences. This coordination involved using same 
functional status question set in both surveys, and altering 
the NLTCS screening procedure so that every participant 
received the screen in 2004, and every participant was queried 
on veteran status. For the 3,727 veterans in the 2004 survey, 
it would have cost $5.6 M for VHA to have replicated the direct 
data collection, using per capita survey costs for the NLTCS. 
The modifications to the NLTCS provide the first comprehensive 
examination of functional and cognitive changes in an aging 
veteran population, how those changes segregate among enrollees 
and non-enrolled veterans, and the change over time in 
disability levels among the two groups. In contrast to the 
conventional finding of declining disability, which is true for 
all veterans, among enrolled veterans disability prevalence 
increased between 1999 and 2004, with relatively more disabled 
veterans continuing to enroll in VHA through 2004.
    Future work includes validating the county-level disability 
projections, finishing updating the LTC projection model using 
the combined 2004 data, extending the projection validation to 
2007 NH data, and re-surveying the NLTCS panel to determine 
continued enrollment and disability trends.
    This research is exceptional in its breadth of topic, data, 
and participants over time. Investigators from outside and 
within VA worked with VA research, operations, and policy staff 
to leverage a variety of Federal data resources from the 
Census, the National Center for Health Statistics, VHA, and NIA 
to create a long term care planning model for both 
institutional and home and community based care in 2003, using 
data from 1999 and 2000 surveys, and linking the NIA survey 
directly to VHA data. This same group then coordinated the 
2004/2005 rounds of VHA and NIA surveys in order to correct 
data gaps found in the first model, as well as to 
comprehensively characterize the entire veteran population, not 
just those who are enrolled in VHA. This process provided a 
test of the accuracy of the VHA survey of enrollees, finding 
that the VHA methodology resulted in a significant undercount 
of high-level impairments relative to the direct interviews of 
the NLTCS. By comprehensively surveying the entire veteran 
population, from a panel of male Medicare beneficiaries 
surveyed in 1999 and again in 2004, the study demonstrated a 
strong trend of increasing disability among enrolled veterans 
that continued to be driven by more disabled new enrollees in 
every age group >65 years of age. This coordinated survey found 
VHA with prevalences of functional disability and cognitive 
impairment from 1.5-2 times those found in the general veteran 
population, depending upon region, with significant regional 
variation in the concentration of disability and impairment. 
The investigators then used data from CMS to identify every 
veteran in a NH in 2003 and 2004, confirming the accuracy of 
the model's NH projections.
    The new data are being used to update the current long-term 
care model, and improve its precision in projecting specific 
home and community care services at a regional level. Future 
developments include embedding the VHA long-term care demand 
model within the general U.S. long-term care supply, in order 
to incorporate enrollment decisions of disabled, aged veterans 
in VHA.
    This work has demonstrated that VA is not experiencing the 
decline in functional disability found in the general 
population and the general veteran population, because of 
adverse enrollment: a significant exception to prior planning 
assumptions, and an exception to the major finding in aging 
demography of the past 30 years. The earlier model was used to 
determine the target for VHA's supply of home and community-
based services, resulting in a planned tripling of such 
services for aged veterans. The updated model will help target 
those investments to regions with greater demand, and 
distinguish the portion of total demand met by VHA and other 
payors for home and community based care. Characterization of 
cognitive and functional differences between the general 
elderly population that uses long-term care and those of 
enrolled veterans suggests that current VHA programs support 
veterans with greater levels of disability in the community 
than their non-veteran counterparts. Those comparisons also 
suggest the need for more creative programs to continue 
transitioning institutionalized veterans to supportive 
community settings.
    Excellence: What makes this project exceptional?
    Working across agencies and groups.
    Significance: How is this research relevant to older 
person, populations and/or an aging society?
    Demonstrated increased needs for home and community-based 
care (HCBC) services, and effectiveness of current services.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Resulted in tripling of HCBC services provided by VHA in 
setting to reliance targets.
    Innovativeness: Why is this research exciting or 
newsworthy?
    Overturns conventional assumptions about future needs, puts 
VA on a realistic planning path and highlights opportunities to 
leverage resources to areas of greatest need (both 
programmatically and geographically).

     U.S. Department of Veterans Affairs: Shingles Prevention Study

    Shingles causes substantial pain and suffering in older 
adults. This study showed that a vaccine reduced the incidence 
of shingles by 51 percent, the pain severity of the illness by 
61 percent and the incidence of postherpetic neuralgia by 66 
percent.
    Lead Agency: U.S. Department of Veterans Affairs (VA); 
Veterans Health Administration VA (VHA), Cooperative Trials and 
Durham VA Geriatric Research, Education and Clinical Center 
(GRECC).
    Agency Mission: ``To care for him who shall have borne the 
battle and for his widow and his orphan.''
    Principal Investigator: Michael Oxman, MD, Professor of 
Medicine, SPS 111F-1 San Diego VA Medical Center, 3350 La Jolla 
Village Drive, San Diego, CA 92161.
    Partner Agency: National Institute of Allergy and 
Infectious Diseases; Merck & Co.
    General Description: The Shingles Prevention Study is a VA 
Cooperative Study, carried out in collaboration with the NIAID 
and Merck & Co., to determine if the zoster vaccine would 
decrease the occurrence and/or severity of shingles (scientific 
name is herpes zoster) and postherpetic neuralgia, the painful 
condition that may persist afterwards. This disease mainly 
affects older adults. It is caused by the varicella-zoster 
virus (VZV) which also causes chickenpox. After a person has 
had the childhood infection, the virus persists in a dormant 
state in nerve cells. As resistance to VZV weakens with age, 
the virus can reactivate, causing a blistering rash. There is 
acute pain due to shingles but many older individuals 
experience pain for months or years, a condition called 
postherpetic neuralgia. The acute and chronic pain of shingles 
markedly interferes with quality of life and daily living. All 
older adults are at risk for shingles. Half of people who live 
to age 85 will get shingles, and it is estimated that more than 
a million new cases of shingles occur in the United States each 
year.
    The Shingles Prevention Study was a randomized, double-
blind, placebo-controlled study of the zoster vaccine in 38,546 
adults *60 years of age enrolled at 16 VA and 6 University 
sites across the U.S. Over the 5 years of the study, there were 
a total of 957 confirmed cases of herpes zoster (315 among 
vaccine recipients and 642 among placebo recipients) and 107 
cases of postherpetic neuralgia (27 among vaccine recipients 
and 80 among placebo recipients). The zoster vaccine reduced 
the incidence of herpes zoster by 51 percent, the pain severity 
of the illness by 61 percent and the incidence of postherpetic 
neuralgia by 66 percent. Of individuals who developed herpes 
zoster, the severity of illness was less in persons who 
received the vaccine. The vaccine was safe and well tolerated. 
This landmark study showed that the zoster vaccine markedly 
reduced the suffering from herpes zoster and postherpetic 
neuralgia among older adults. Studies are ongoing to determine 
the durability of the response to the vaccine.
    Excellence: What makes this project exceptional?
    The scientific basis, the methodology, and the results of 
the Shingles Prevention Study make it truly exceptional. 
Shingles (herpes zoster) is caused by the reactivation of 
varicella-zoster virus (VZV) from a dormant or latent infection 
of sensory nerve cells. This reactivation occurs when the 
immune system is too weak to contain the virus. Almost all 
adults in the U.S. are latently infected with VZV and therefore 
at risk for shingles. The Shingles Prevention Study is unique 
in that is was the first study to determine that a vaccine can 
successfully prevent a reactivated infection. All other 
vaccines (e.g., measles, mumps, rubella, influenza, 
pneumococcal, etc.) prevent primary infections. The Shingles 
Prevention Study was the largest vaccine study ever conducted 
in older adults with over 38,000 participants. The follow-up in 
the study was outstanding with only 0.7 percent of persons lost 
to follow-up and it used an innovative computerized telephone 
response system to stay in touch with participants. The 
diagnosis of shingles was done using state-of-the-art DNA 
detection methods whereas all prior shingles clinical drug 
trials relied on clinical diagnosis which may not be fully 
accurate.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    The occurrence of shingles increases dramatically with 
aging particularly after the age of 60 years. The increase in 
incidence with aging is due to a progressive decline in 
immunity to VZV with aging. The main problem with shingles is 
pain. The persistent pain that may follow shingles, known as 
postherpetic neuralgia, is much more common and severe in older 
adults. Shingles pain diminishes the quality of life and 
functional capacity of older adults, and markedly reduces their 
enjoyment of life. The zoster vaccine is relevant to older 
adults in that it can reduce the pain and suffering from 
shingles and improve quality of life.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    The zoster vaccine reduced the incidence of herpes zoster 
by 51 percent, the pain severity of the illness by 61 percent 
and the incidence of postherpetic neuralgia by 66 percent, 
demonstrating that the vaccine markedly reduced suffering from 
shingles and postherpetic neuralgia among older adults. Even 
among individuals who developed shingles, the severity of 
illness was less in persons who received the vaccine. If the 
zoster vaccine was used in all older adults in whom it was 
recommended, approximately 283,000 cases of shingles and 46,000 
cases of postherpetic neuralgia would be eliminated by 
vaccination each year in the United States.
    Innovativeness: Why is this research exciting or 
newsworthy?
    The zoster vaccine research adds a powerful new weapon in 
our armamentarium against shingles and the suffering that is 
causes in older adults. The science and methodology of the 
study as conducted by VA investigators was world-class. On the 
basis of the results of this one study, the U.S. Food and Drug 
Administration (FDA) approved the zoster vaccine for use in 
persons 60 years of age and older for the prevention of herpes 
zoster. The Advisory Committee on Immunization Practices (ACIP) 
of the Centers for Disease Control and Prevention (CDC) 
recommends that individuals *60 years of age receive the zoster 
vaccine to prevent herpes zoster and postherpetic neuralgia. In 
October 2007, the zoster vaccine was added to the CDC's 
Schedule of Recommended Adult Immunizations. Their final 
recommendations for the use of the zoster vaccine was published 
in the CDC's Morbidity and Mortality Weekly Report, June 6, 
2008 (MMWR Volume 57, No. RR-5 ``Prevention of Herpes 
Zoster'').

         U.S. Environmental Protection Agency: Aging Initiative

    EPA's ``Aging Initiative,'' a research program focused on 
the environmental health of older adults, has increased our 
understanding of exposure to--and health effects of--
environmental contaminants on older adults to enhance the 
Agency's efforts in health promotion and risk assessment.
    Lead Agency: U.S. Environmental Protection Agency.
    Agency Mission: The mission of the U.S. Environmental 
Protection Agency (EPA) is to protect public health and 
safeguard the natural environment.
    Principal Investigator: Andrew Geller, PhD, Assistant 
Laboratory Director for Human Health and Computational 
Toxicology, National Health and Environmental Effects 
Laboratory, Office of Research and Development, U.S. 
Environmental Protection Agency, MD B305-02, Research Triangle 
Park, NC 27711.
    Partner Agencies: Environmental and Occupational Health 
Science Institute, Research Triangle Institute, Hamner 
Institute, University of Mississippi, University of North 
Carolina at Chapel Hill.
    General Description: EPA's ``Aging Initiative,'' a research 
program focused on the environmental health of older adults, 
has increased our understanding of the environmental 
contaminants to which older adults are exposed and their 
resulting health effects. The program is identifying key aging-
related factors that contribute to variability in environmental 
exposures and responses to those exposures that could result in 
adverse health outcomes. By soliciting and incorporating input 
from individuals in the community, advocacy groups, and 
scientific experts to derive a creative and comprehensive 
action plan based on sound science, EPA is helping to enhance 
and protect the health of aging Americans.
    The rapid growth in the number of older Americans has many 
implications for public health, including the need to better 
understand the health risks posed by environmental exposures to 
older adults. Biological capacity declines with normal aging 
and with diseases of aging. This decline can result in 
compromised responses to environmental exposures encountered in 
daily activities, resulting in adverse health outcomes.
    In recognition of these factors, and consistent with EPA's 
mandate to protect the health of vulnerable Americans, EPA 
developed the ``Aging Initiative.'' This research program is 
designed to answer the following questions to insure that EPA's 
regulations and educational outreach programs promote the 
health of older Americans:
     Where do older adults live and what are the 
important pollution sources in those locations?
     What activities are older adults engaged in that 
bring them into contact with these pollutants?
     What happens to those pollutants inside the body?
     What are the critical adverse health effects and 
adverse outcomes?
     How do we link all of the above for effective risk 
assessment, management, and communication?
    EPA pioneered this research program so that the Agency and 
its stakeholders will be able to anticipate, accommodate, and 
manage the environmental risks associated with this inevitable 
shift in American demographics toward an aging society. The 
program is generating data, models, and guidance to incorporate 
the susceptibility of this heterogeneous population into health 
promotion and intervention strategies to ameliorate risk from 
environmental exposures.
    Excellence: What makes the project exceptional?
    EPA's Aging Initiative is exceptional because it solicits 
and incorporates input from individuals in the community, 
advocacy groups and scientific experts to derive a creative and 
comprehensive action plan, based on sound science, to enhance 
and protect the health of aging Americans.
    Significance: How is this research relevant to older 
persons, populations and/or aging society?
    EPA's program to protect the health of older Americans is a 
unique combination of intra- and extramural research and public 
outreach. The two efforts have a common goal of identifying the 
pollutants that are most hazardous to older adults and the 
reasons why some older adults are more susceptible than others. 
This information can lead to more informed decisions in setting 
exposure standards for the public that insures protection of 
the aging population. The information is also valuable to the 
community in their efforts to improve environmental quality and 
minimize the hazards they encounter.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    EPA's Aging Initiative has highlighted the importance of 
the aging population's vulnerability to pollutants through data 
generation and publications in peer-review scientific journals, 
communication with older adult stakeholder groups, and 
presentation of research findings in scientific conferences.
    Innovation: Why is this research exciting or newsworthy?
    EPA has mounted a program on susceptibility of the aging 
population that combines laboratory, clinical, and social 
research together with public outreach education. This 
multifaceted program insures that research findings can be 
quickly and accurately translated into regulatory decisions as 
well as public awareness and action.

  U.S. Environmental Protection Agency: Air Quality and Its Effect on 
                              Heart Rates

    Particulate matter and ozone levels are associated with 
alterations in heart rate variability, a measure of autonomic 
or involuntary nervous system control of cardiac function, 
among individuals living in eastern Massachusetts.
    Lead Agency: U.S. Environmental Protection Agency.
    Agency Mission: The mission of the U.S. Environmental 
Protection Agency (EPA) is to protect public health and 
safeguard the natural environment.
    Principal Investigator: Joel Schwartz, PhD, Harvard School 
of Public Health, 665 Huntington Avenue, Boston, MA 02115.
    Partner Agency: Harvard School of Public Health.
    General Description: The EPA-funded Harvard Particulate 
Matter Center conducted a series of studies that focused on how 
air particles or particulate matter (PM) affect the rhythm of 
the human heart. The Harvard researchers found that particulate 
matter and ozone levels were associated with alterations in 
heart rate variability, a measure of cardiac function that is 
under autonomic or involuntary control, among individuals 
living in eastern Massachusetts. Harvard PM Center researchers 
have begun to examine different biologic control pathways that 
may play a role in the effect of PM on the heart. In addition, 
they are investigating the specific sources of PM that may be 
most important in influencing health responses in this study 
population, participants in the Normative Aging Study (NAS), a 
large longitudinal study established in 1963 by the U.S. 
Veterans Administration, because different types of particles 
may affect different biological pathways.
    Heart rate variability reflects autonomic control of the 
rhythmic activity of the heart. The 2280 men enrolled in the 
Normative Aging Study were originally confirmed to be free of 
known chronic medical conditions, and active, continuing 
participants are examined every three years. This study 
analyzed information for 603 persons examined between 2000 and 
2003. Ambient fine air particles (PM2.5) and black 
carbon measurements were obtained from a monitoring site 
located 1 kilometer from the clinic and were evaluated in 
relation to the clinical measurements. Researchers found that 
ozone and ambient PM2.5 and black carbon 
concentrations, averaged over the previous 4 hours to 48 hours, 
were associated with reductions in heart rate variability. The 
greatest reductions were observed among hypertensive 
individuals and those with ischemic heart disease. Ambient 
black carbon concentrations were further found to be associated 
with increased C-reactive protein and fibrinogen levels in 
blood samples. These results suggest that the effects caused by 
PM could be brought about through pathways involving the 
autonomic nervous system and systemic inflammation.
    More recent studies in the Normative Aging Cohort found 
that the effects of traffic-related PM are modulated by 
biologic markers of specific pathways that may be involved in 
the disease process. Particle exposure could increase adverse 
responses including oxidative stress, inflammation, and 
thrombosis (blood clots), leading to alterations in cardiac 
autonomic function and cardiovascular problems such as heart 
attacks. Researchers examined these effects using white blood 
cell counts, C-reactive protein, sediment rate, and fibrinogen 
from blood samples collected from study participants. Traffic-
related PM components, black carbon, and particle number were 
related to increased levels of inflammatory and thrombotic 
markers, with associations most consistent for the blood 
clotting factor, fibrinogen. The association was strongest when 
exposures were averaged over the 4-weeks prior to the 
measurement.
    Excellence: What makes this project exceptional?
    This project has shown that markers of PM from traffic are 
associated with alterations in autonomic control of heart 
rhythms, which may increase the risk of cardiovascular disease 
and death from heart disease. The relation between particle 
pollution and cardiac effects was determined in the Normative 
Aging Study which provides very strong evidence for the 
observed link because new clinical data and information on risk 
factors is collected on the participants every 3 to 5 years. 
Subsequent studies in this cohort have confirmed the original 
observations and provided stronger evidence that traffic-
related particle pollution is associated with cardiac autonomic 
control and inflammation.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Reductions of heart rate variability over long periods has 
been associated with increased risk of mortality in middle-aged 
and elderly subjects, in patients with diabetes, and in 
survivors of heart attacks and other cardiovascular diseases. 
Researchers found that ozone and ambient PM2.5 and 
black carbon concentrations and particle number, averaged over 
the previous 4 hours to 48 hours, were associated with 
reductions in heart rate variability. The greatest reductions 
were observed among hypertensive individuals and those with 
ischemic heart disease. Individuals with these pre-existing 
conditions appear to be more susceptible to the adverse effects 
of PM exposure.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    This research indicates that older people, especially 
people with pre-existing health conditions, should be very 
cautious about their time spent outside on days when the air 
quality is poor. It reinforces the need for alerts on days with 
large amounts of fine particle pollution in the air. It also 
underscores the need to rigorously enforce and periodically re-
evaluate the National Ambient Air Quality Standards for 
particulate matter.
    Innovativeness: Why is this research exciting or 
newsworthy?
    This project has shown that markers of PM from traffic are 
associated with alterations in autonomic control of heart 
rhythms, which may increase the risk of cardiovascular disease 
and death from heart disease. The relation between particle 
pollution and cardiac effects was determined in the Normative 
Aging Study which provides very strong evidence for the 
observed link because new clinical data and information on risk 
factors is collected on the participants every 3 to 5 years. 
Subsequent studies in this cohort have confirmed the original 
observations and provided stronger evidence that traffic-
related particle pollution is associated with cardiac autonomic 
control and inflammation.

 U.S. Environmental Protection Agency: Air Quality and Cardiovascular 
                                Diseases

    Older women living in areas with high levels of fine 
particles or particulate matter (PM) pollution have a greater 
risk of developing cardiovascular disease and subsequently 
dying from cardiovascular causes.
    Lead Agency: U.S. Environmental Protection Agency.
    Agency Mission: The mission of the U.S. Environmental 
Protection Agency (EPA) is to protect public health and 
safeguard the natural environment.
    Principal Investigator: Joel Kaufman, M.D., Principal 
Investigator, Univ. of WA Dept. Env. & Occ. Health Sciences, 
P.O. Box 357234, Seattle, WA 98195.
    Partner Agency: University of Washington.
    General Description: EPA-funded research at the University 
of Washington found that older women living in areas with high 
levels of fine particles or particulate matter (PM) pollution 
have a greater risk of developing cardiovascular disease and 
subsequently dying from cardiovascular causes. Scientists 
studied more than 65,000 women, aged 50 to 79, with no history 
of cardiovascular disease. These postmenopausal women lived in 
36 U.S. metropolitan areas throughout the United States and 
were part of the Women's Health Initiative Observational Study, 
initiated by the National Institutes of Health. Researchers 
found that long-term exposure to fine particulate air pollution 
was strongly associated with cardiovascular disease and death 
among postmenopausal women. Each 10  g/m\3\ increase in the 
level of fine particulate matter in ambient air was linked to a 
76 percent increase in the risk of death from cardiovascular 
disease, after taking into account known risk factors such as 
blood pressure, cholesterol, and smoking. Increased average 
levels of fine particulate matter were associated with a 24 
percent increased risk of cardiovascular disease problems, 
including stroke and heart attack. Finally, the study found 
that obese individuals, defined as having a high body mass 
index or high waist-to-hip ratio, were more susceptible to the 
health effects linked to increased particulate matter levels. 
These are intriguing new findings that have spurred additional 
research studies to verify and understand the link with 
obesity.
    The people in this study were ideally suited for the 
investigation of the links between long-term air pollution 
exposure and cardiovascular disease and mortality. The very 
large cohort or population was established between 1994 and 
1998, and study participants were followed for up to nine years 
to see who had heart attacks, stroke, coronary bypass surgery, 
or died from cardiovascular causes. Participants resided in 36 
cities throughout the United States, allowing for comparisons 
of cities with a variety of air pollution levels and with 
different atmospheric composition. To estimate people's 
exposure to fine particles or PM2.5, the researchers 
used the average PM2.5 level recorded in the year 
2000 (the midpoint of follow-up in the study) recorded by a 
monitor located closest to a participant's residence. Most 
women lived within 6 miles of a monitor. In addition, the 
investigators were able to explore differences in risk 
associated with particulate matter concentrations in the cities 
where participants lived and compare them to between-city 
effects. For cardiovascular events, the within-city effect was 
larger than the between-city effect.
    Excellence: What makes this project exceptional?
    This is the first study to follow, over time, the 
development of new cases of cardiovascular disease in a healthy 
population. Previous studies have relied solely on reviews of 
death records. The scientists studied air pollution exposure 
among participants of a longitudinal study established by the 
National Heart Lung and Blood Institute of NIH which has 
produced other important research on heart disease, cancers, 
and osteoporosis. The study was designed to document specific, 
first, cardiovascular ``events'' such as heart attacks. Study 
scientists conducted annual questionnaires to ascertain 
cardiovascular diagnoses and then reviewed medical records to 
confirm and classify them. Deaths were identified through 
family members and the National Death Index.
    This is also one of the first studies to look at local air 
pollution levels within metropolitan areas. Local differences 
in particulate matter levels within a city, as well as exposure 
differences between cities, translate to a higher or lower risk 
of cardiovascular disease and related death. In previous 
studies of the long-term effects of air pollution, scientists 
averaged pollutant concentrations from monitors located in a 
city and then compared health effects between cities. The 
assignment of particulate matter concentrations measured at the 
monitor closest to the participants' homes probably resulted in 
more accurate estimates of PM exposure for each individual 
compared to previous studies.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    This study establishes a stronger association between long-
term exposure to fine particulate air pollution and death from 
coronary heart disease, one of the leading causes of illness 
and mortality among older adults, than was found in earlier 
studies. The finding that health risks associated with within-
city differences in pollutant concentrations are higher than 
risks associated with between-city pollution levels suggests 
that, as pollution exposure estimates assigned to study 
participants become more precise, studies may find that health 
risks associated with fine particulate air pollution are higher 
than previously estimated.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    This research indicates that older people, especially 
people with pre-existing health conditions, should be very 
cautious about their time spent outside on days when the air 
quality is poor. It reinforces the need for alerts on days with 
large amounts of fine particle pollution in the air. It also 
underscores the need to rigorously enforce and periodically re-
evaluate the National Ambient Air Quality Standards for 
particulate matter.
    Innovativeness: Why is this research exciting or 
newsworthy?
    This research is the first to look at fine air pollution 
levels in major metropolitan areas around the U.S. and connect 
exposure to pollution with the development of new cases of 
cardiovascular disease in a healthy population.

   U.S. Environmental Protection Agency: Air Quality and Respiratory 
                                Diseases

    Researchers at The Johns Hopkins Bloomberg School of Public 
Health found that hospital admission rates for cardiovascular 
and respiratory diseases were significantly associated with 
short-term, fine particle exposure in air in individuals over 
65 years of age.
    Lead Agency: U.S. Environmental Protection Agency.
    Agency Mission: The mission of the U.S. Environmental 
Protection Agency (EPA) is to protect public health and 
safeguard the natural environment.
    Principal Investigator: Francesca Dominici, PhD., Johns 
Hopkins University, Bloomberg School of Public Health, 615 N. 
Wolfe Street, Baltimore, MD 21205.
    Partner Agency: Johns Hopkins Bloomberg School of Public 
Health.
    General Description: A large study, funded by the EPA and 
published in the Journal of the American Medical Association in 
2006, looked at Medicare recipients across the country and 
found that short-term exposure to fine particles or particulate 
matter (PM) is related to a greater risk of hospitalizations. 
Researchers at The Johns Hopkins Bloomberg School of Public 
Health found that hospital admission rates for cardiovascular 
and respiratory diseases were significantly associated with 
short-term, fine PM exposure in individuals over 65 years of 
age. The study used Medicare data for 11.5 million people 
living in 204 urban counties in the United States. This is one 
of the first studies to use an expanded, nationwide, monitoring 
network for ambient particulate matter less than 2.5  m in 
diameter (PM2.5). Interestingly, the average ambient 
concentration of fine PM in the locations during the study 
period was lower than the PM levels that existed during many 
previous studies. Region-specific differences in PM-associated 
deaths between the eastern and western United States also were 
reported.
    Researchers compiled a data set of daily hospitalization 
admission rates for cardiovascular and respiratory disease and 
injuries between 1999 and 2002 from the billing claims of 
Medicare participants across the United States. The data were 
paired with ambient PM2.5 concentrations in the same 
county on the date of hospitalization and up to two days prior. 
The resulting data set encompassed 204 urban counties in the 
United States and 11.5 million Medicare participants living 
within an average of 5.9 miles of a PM2.5 monitor. 
Hospital admission rates increased in relation to increases in 
PM2.5 concentration on the same or immediately 
preceding days for all outcomes studied except injuries. The 
health outcomes found to be associated with PM2.5 
concentration were cerebrovascular disease including stroke, 
peripheral vascular disease, ischemic heart disease (where the 
blood supply to heart muscle is reduced), heart rhythm, heart 
failure, chronic obstructive pulmonary disease, and respiratory 
tract infection.
    The study investigators also compared the mortality risks 
associated with fine particulate air pollution across seven 
regions of the United States. The risk for air pollution-
related cardiovascular disease was highest in counties located 
in the eastern United States. In contrast, the risk of 
hospitalization for respiratory causes was consistent across 
all the counties. The regional differences seen by the 
researchers have focused their efforts to identify what factors 
are responsible. This is a complex question and may involve 
regional differences in the composition of PM in the atmosphere 
from specific sources of PM.
    The research was conducted as part of a four-year project 
funded through a grant from the EPA to the Johns Hopkins 
University Bloomberg School of Public Health. The project 
started in 2003 and examined the effect of annual average and 
daily PM2.5 concentration on illness and death among 
Medicare recipients. The study researchers are continuing to 
follow the Medicare study population as part of the Johns 
Hopkins Particulate Matter Center, one of five research centers 
established by the EPA to study particulate air pollution and 
health effects.
    Excellence: What makes this project exceptional?
    This was one of the first studies to show the effects of 
fine particles on Medicare recipients across the nation, 
comprising nearly all members of the U.S. population over the 
age of 65 years.
    The size of the Medicare population allowed the researchers 
to assess risks pertaining to specific cardiovascular 
diagnoses. The findings have led to more specific 
investigations concerning the biologic pathways that are 
affected by exposure to particulate matter.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    For the first time, nationwide Medicare data were analyzed 
to assess the health effects of fine particulate matter (PM). 
EPA-funded grantees from Johns Hopkins University found that 
increases in hospital admission rates for cardiovascular and 
respiratory diseases were significantly associated with short-
term changes in ambient levels of PM2.5. When the 
risk estimates were evaluated for individuals in different age 
categories, the oldest group, aged 75 years and older, was at 
highest risk for several outcomes including ischemic heart 
disease, heart rhythm disturbances, heart failure, and chronic 
obstructive pulmonary disease.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    This research indicates that older people, especially 
people with pre-existing health conditions, should be very 
cautious about their time spent outside on days when the air 
quality is poor. It reinforces the need for alerts on days with 
large amounts of fine particle pollution in the air. It also 
underscores the need to rigorously enforce and periodically re-
evaluate the National Ambient Air Quality Standards for 
particulate matter.
    Innovativeness: Why is this research exciting or 
newsworthy?
    For the first time, nationwide Medicare data were analyzed 
to assess the health effects of fine particulate matter (PM). 
EPA-funded grantees from Johns Hopkins University found that 
increases in hospital admission rates for cardiovascular and 
respiratory diseases were significantly associated with short-
term changes in ambient levels of PM2.5. When the 
risk estimates were evaluated for individuals in different age 
categories, the oldest group, aged 75 years and older, was at 
highest risk for several outcomes including ischemic heart 
disease, heart rhythm disturbances, heart failure, and chronic 
obstructive pulmonary disease.

    U.S. Environmental Protection Agency: Air Pollution and Chronic 
                                Diseases

    EPA scientists have developed tools that use air pollution 
levels and activities of older adults to estimate the exposure 
of older individuals to air pollution. These estimates, in 
turn, can be used to evaluate whether air pollution can 
exacerbate diseases of aging, such as heart attack, stroke, 
chronic obstructive pulmonary disease (COPD), and asthma in 
older adults.
    Lead Agency: U.S. Environmental Protection Agency.
    Agency Mission: The mission of the U.S. Environmental 
Protection Agency (EPA) is to protect public health and 
safeguard the natural environment.
    Principal Investigator: Andrew Geller, PhD, Assistant 
Laboratory Director for Human Health and Computational 
Toxicology, National Health and Environmental Effects 
Laboratory, Office of Research and Development, U.S. 
Environmental Protection Agency, MD B305-02, Research Triangle 
Park, NC 27711.
    Partner Agency: Research Triangle Institute, University of 
North Carolina at Chapel Hill, Environmental and Occupational 
Health Science Institute.
    General Description: Measuring air pollution levels at 
pollution sources, or even at monitoring sites around the 
nation, does not tell us what individuals are actually exposed 
to. This research helps EPA estimate the real, personal 
exposure of older individuals to environmental pollutants by 
taking into account their micro-environments and personal 
activities through the day.
    EPA scientists have developed tools and information to 
estimate air pollution exposure to older individuals. These 
tools use air pollution levels measured at ambient (or 
background) monitoring sites plus information about where older 
adults spend their time and what they do. These estimates, in 
turn, can be used to evaluate whether air pollution can 
exacerbate diseases of aging, such as heart attack, stroke, 
chronic obstructive pulmonary disease (COPD), and asthma in 
older adults. This research has given EPA the ability to 
incorporate information on pollution sources, ambient air 
pollution levels, and personal micro-environments to produce 
estimates of real-world exposure to potentially hazardous 
environmental compounds.
    Estimates of personal or population-group exposure tell EPA 
where to intervene with their risk mitigation efforts. These 
estimates are also used to evaluate whether or not air 
pollution can exacerbate diseases of aging. Importantly, EPA 
can thereby consider the health of older adults when setting 
National Ambient Air Quality Standards.
    Excellence: What makes this project exceptional?
    This research received EPA's highest level Science and 
Technical Achievement Award, an internal award given to 
excellent, scientific, peer-reviewed publications.
    Significance: How is this research relevant to older 
persons, populations and/or aging society?
    Measurement of air pollution levels at pollution sources, 
or even at monitoring sites distributed throughout the nation, 
does not tell us what individuals are exposed to. This research 
helps the Agency estimate the real, personal exposure of older 
individuals to environmental pollutants by taking into account 
their micro-environments and personal activities through the 
day.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Estimates of personal or population-group exposure derived 
from ambient monitoring data tells the EPA where to intervene 
with risk mitigation efforts. These estimates are also used to 
evaluate whether air pollution can exacerbate diseases of 
aging. EPA can thereby consider the health of older adults when 
setting National Ambient Air Quality Standards.
    Innovation: Why is this research exciting or newsworthy?
    This research helps EPA estimate the real, personal 
exposure of older individuals to environmental pollutants by 
taking into account their micro-environments and personal 
activities through the day.

 U.S. Environmental Protection Agency: Environmental Risk Factors for 
                              Older Adults

    EPA researchers have developed the first publically-
available database that can be used to model the physiology and 
metabolism of older adults to determine whether environmental 
pollutants put them at risk. This peer-reviewed database can be 
used to produce environmental health risk assessments that help 
protect older adults from environmental health hazards while 
still recognizing the need for the use of chemicals and 
pharmaceuticals in commerce.
    Lead Agency: U.S. Environmental Protection Agency.
    Agency Mission: The mission of the U.S. Environmental 
Protection Agency (EPA) is to protect public health and 
safeguard the natural environment.
    Principal Investigator: Bob Sonawane, PhD, Chief, Effects 
Identification and Characterization Group, National Center for 
Environmental Assessment, Office of Research and Development, 
U.S. Environmental Protection Agency.
    General Description: EPA researchers have developed the 
first publically-available database that can be used to model 
the physiology and metabolism of older adults to determine 
whether environmental pollutants put them at risk. This peer-
reviewed database can be used to produce environmental health 
risk assessments that help protect older adults from 
environmental health hazards while still recognizing the need 
for the use of chemicals and pharmaceuticals in commerce.
    EPA engaged the world's top experts to collect the factors 
to produce this resource. Before this database was developed 
and made available to the public, risk assessors had to rely on 
physiological data that were scattered throughout the 
scientific literature. In addition, mathematical models that 
incorporated older adult susceptibilities to environmental 
health hazards did not exist in the scientific or risk 
assessment literature. This database allows these critical 
models to be generated, enhancing the science-based evaluation 
of risk for older adults. This single, reviewed source 
standardizes risk assessment models while using the best 
available data. Importantly, it captures factors determined 
scientifically rather than using default factors which may 
underestimate or overestimate risk. This, in turn, ensures that 
these environmental health risk assessments provide better 
protection for older adults.
    Although this database was only recently unveiled to the 
public, it has already attracted attention from the 
environmental health, occupational health, and pharmaceutical 
communities because of its general applicability to the 
concerns of older adults. Combined with information from 
similar databases providing parameters for young children and 
adults, this database will be instrumental in enhancing risk 
assessment across the entire human lifespan.
    Excellence: Why is this project exceptional?
    EPA engaged the world's top experts to collate factors to 
produce this peer-reviewed publically-available resource, the 
first of its kind to address the physiology of older adults.
    Significance: How is this research relevant to older 
persons, populations and/or aging society?
    Physiological factors are scattered throughout the 
scientific literature. This single, reviewed source provides 
for standardization of models and the use of the best available 
data. Science-based factors replace default uncertainty factors 
to produce environmental health risk assessments that provide 
better protection for older adults from environmental health 
hazards while recognizing the need for the use of chemicals in 
commerce.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    This database, only recently unveiled to the public, has 
already attracted attention from the environmental health, 
occupational health and pharmaceutical communities because of 
its general applicability to concerns of older adults. Taken 
together with information from similar databases providing 
parameters for young children and adults, risk assessment is 
enhanced across the entire lifespan.
    Innovation: Why is this research exciting or newsworthy?
    Mathematical models that incorporate older adult 
susceptibility to environmental health hazards do not exist in 
the scientific or risk assessment literature. This database 
will allow these critical models to be generated, enhancing the 
science-based evaluation of risk for older adults from 
environmental contaminants.

U.S. Environmental Protection Agency: Environmental Pollution and Liver 
                                Function

    Lead Agency: U.S. Environmental Protection Agency.
    Agency Mission: The mission of the U.S. Environmental 
Protection Agency (EPA) is to protect public health and 
safeguard the natural environment.
    Principal Investigator: Andrew Geller, PhD, Assistant 
Laboratory Director for Human Health and Computational 
Toxicology, National Health and Environmental Effects 
Laboratory, Office of Research and Development (ORD), U.S. 
Environmental Protection Agency, MD B305-02, Research Triangle 
Park, NC 27711.
    General Description: EPA scientists are beginning to 
understand how the liver response changes with aging and 
exposure to environmental chemicals. The liver is both the most 
important part of the body for protecting individuals from 
toxic chemicals and the target organ for many environmental 
pollutants. Understanding how the liver responds to exposure to 
environmental chemicals is critical to characterizing risk to 
older adults.
    Experimental models demonstrate that aging is accompanied 
by mild decreases in the capacity to detoxify and eliminate 
environmental pollutants. These models help the Agency 
understand how much of the toxic response is attributable to 
changes in metabolism and how much is due to other changes in 
biological capacity with aging.
    This important research allows risk assessors to better 
understand how exposure to toxic chemicals can affect older 
adults' health. In addition, data generated by this study is 
helping the EPA include polypharmacy--the use of two or more 
drugs together, which is common in the older adult population--
in its consideration of risk and its design of risk mitigation 
efforts.
    This research complements EPA's efforts to address the 
scientific goals laid out by the National Academies of Science 
in their report on ``Toxicity Testing in the 21st Century.'' An 
important aspect of this work is that it is helping EPA produce 
more efficient models that predict how to better protect older 
adults while reducing the use of animal testing.
    Excellence: Why is this project exceptional?
    U.S. EPA scientists have been invited to present this 
research at invited symposia for Health Canada, California EPA, 
and Society of Toxicology.
    Significance: How is this research relevant to older 
persons, populations and/or aging society?
    The liver is both the most important part of the body for 
protecting individuals from toxic chemicals and the target 
organ for many environmental pollutants. Understanding how the 
liver response changes with aging is critical to characterizing 
risk to older adults. EPA research suggests that there are 
decreases in liver detoxification capacity in older adults. 
These changes, in combination with other changes in the aging 
body's capacity to respond to toxicity, are likely responsible 
for increased sensitivity to environmental chemicals in the 
older adults.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    This research allows risk assessors to better understand 
how toxic exposures affect older adults' health. It allows the 
Agency to consider factors such as polypharmacy, common in the 
older adult population, in its consideration of risk and its 
design of risk mitigation efforts.
    Innovation: Why is this research exciting or newsworthy?
    This research complements EPA's efforts to address 
scientific goals laid out by the National Academies of Science 
in their report on ``Toxicity Testing in the 21st Century.'' 
The work will allow EPA to produce predictive models to better 
protect older adults while increasing efficiency and reducing 
the use of animals in testing.

U.S. Environmental Protection Agency: Building Healthy Communities for 
                       Active Aging Award Program

    The principal goal of the Building Healthy Communities for 
Active Aging Award program is to raise awareness across the 
nation about healthy synergies that can be achieved by 
communities combining Smart Growth and Active Aging concepts. 
Awards are presented to communities that demonstrate the best 
and most inclusive overall approach to implementing smart 
growth and active aging at the neighborhood, tribe, 
municipality, county, and/or regional levels.
    Lead Agency: U.S. Environmental Protection Agency (EPA).
    Agency Mission: The mission of the U.S. Environmental 
Protection Agency is to protect public health and safeguard the 
natural environment.
    Principal Investigator: Kathy Sykes, MA, Senior Advisor, 
Aging Initiative, Office of Children's Health Protection and 
Environmental Education, Division of Child and Aging Health 
Protection, U.S. Environmental Protection Agency, Mail Code 
1107A, Room 2512N (Ariel Rios North), 1200 Pennsylvania Ave., 
NW., Washington, DC 20460.
    Partner Agencies: National Council on Aging, National 
Blueprint, Centers for Disease Control, Active for Life, 
President's Council for Fitness and Sports.
    General Description: Communities built for healthy aging 
are characterized by development patterns that emphasize ease 
of getting around, with convenient housing options, walking and 
biking paths, and abundant green space to create an attractive 
environment. Conversely, unbridled growth or haphazard 
development harms not just the environment, but healthy and 
quality of life. As our population 85 years and older grows, 
many may no longer be driving. Communities that plan ahead and 
provide a variety of transportation options or housing 
developments situated near public transit will be better 
prepared to meet the needs of those who choose not to or no 
longer can drive their own automobile. Smart growth is a term 
used to control the spread of auto dependent development away 
from cities and traditional suburbs by revitalizing urban areas 
to be more attractive and healthy places to live. Older adults 
can play a critical role in making smart growth possible by 
getting involved in local planning efforts.
    Chronic health conditions such as heart disease, stroke and 
diabetes result in adverse human costs and impacts. Lifestyle 
changes are a critical component of effective health promotion 
strategies. Obesity is reaching epidemic proportions and soon 
will pass smoking as a major cause of preventable disease and 
premature death. Daily physical activity is vital for keeping 
fit and controlling chronic conditions. Walkable communities, a 
principle of smart growth, encourage active aging and are 
essential to prevention and management of chronic diseases. 
Smart growth practices that promote walkable communities and 
shorter trips to work, to shop and to do other activities help 
protect the environment and the ability of people to maintain 
their independence and quality of life as they age. An added 
advantage is that walking through one's neighborhood increases 
awareness of neighbors, and expands social contacts and 
potential support networks.
    Impervious surfaces will cause storm water runoff to bypass 
soil filtration, potentially affecting drinking water sources. 
Traveling long distances can be not only a barrier for elders 
seeking care, but also contributes to air pollution. Many 
studies have found an association between air pollution and 
aggravation of heart and lung diseases, resulting in increased 
medication use, more visits to health care providers and 
admissions to emergency rooms. Involvement in local planning 
efforts at the community level is critical for the 
implementation of smart growth principles.
    In May 2007, EPA announced, with its partners, CDC, the 
President's Council for Fitness and Sports, the National 
Council on Aging, Active for Life, (funded by the Robert Wood 
Johnson Foundation) and the National Blueprint, a new awards 
program that encourages communities to adopt smart growth 
principles and encourage active aging, ``Building Healthy 
Communities for Active Aging.'' In 2008, seven communities were 
recognized for their excellence in smart growth and active 
aging. The awards program is a voluntary effort allowing 
communities to lead by example and showcase their successes in 
building a health community for active aging.

                              SMART GROWTH

    Older persons are a susceptible population with respect to 
air and water pollution, and research has demonstrated links 
between development and environmental degradation. Increases in 
impervious surfaces result in more storm water runoff that 
directly enters surface waters without being filtered through 
the soil, potentially contributing to contaminants in drinking 
water. Increasing distances between where people live, work, 
and play can contribute to longer trips, increasing motor 
vehicle emissions and air pollution. Smart growth practices 
combined with active aging provide choices that both protect 
the environment and help people maintain their independence as 
they age, resulting in environmental benefits and enhanced 
quality of life.

                          HEALTHY COMMUNITIES

    The EPA Aging Initiative and a coalition of federal and 
non-governmental partners recognized that community design 
directly affects our health. Considerable attention has been 
paid to risk factors predicting longevity and quality of life. 
This award focuses our attention on the built environment. For 
example, encouraging communities to design neighborhoods for 
walking and biking is also directly influencing the quality of 
one's life and the livability of the community.
    Cities will become healthier for Americans as they work to 
preserve their natural environment, reduce air pollution and 
improve water quality--key smart growth benefits. Those who 
move to the edge of towns expect amenities such as 
transportation, health care, shopping and recreation along with 
safe drinking water, waste water treatment and solid waste 
disposal, but they may not realize that those demands stress 
their environment. The location, configuration and scale of 
homes and communities within a watershed not only increase 
risks to wildlife, but also threaten environmental 
sustainability. Efforts to assure smart growth will produce 
huge dividends for communities that want to retain a reputation 
for being a good place to live.

             BUILDING HEALTHY COMMUNITIES FOR ACTIVE AGING

    In February 2008, the EPA announced the seven winners and 
two communities received the highest awards, the achievement 
awards: the Atlanta Regional Commission and Kirkland, WA.
    The Atlanta Regional Commission (ARC) launched Aging 
Atlanta, a partnership of 50 organizations focused on meeting 
the needs of the region's growing older adult population. Aging 
Atlanta's pilot projects laid the foundation for the Lifelong 
Communities Initiative. The Initiative works with local 
governments to create housing and transportation options that 
enable older adults to ``age in place.'' To improve housing 
developments located close to services and connected to 
existing neighborhoods. With more than 90% of Atlanta's older 
adults relying on automobiles for transportation, ARC has taken 
steps to decrease auto dependency by promoting ride sharing 
through its six voucher programs and working to improve bus 
stops and routes. These efforts increase quality of life and 
offer environmental benefits. ARC and its partners converted 
traditional senior centers to wellness centers, emphasizing 
physical activity and social interaction. Currently, 46 of 
these centers offer programs for the 400,000 older adults in 
the metro area, and approximately 1,000 individuals have joined 
walking clubs. Through community involvement, ARC has 
incorporated older adults' needs into parks, trails and 
pedestrian paths. Work with city and county staff, ARC is 
integrating age-appropriate features into local sidewalk audits 
and plans.
    The city of Kirkland, WA has succeeded in making its 
physical activities more accessible for its 19,000 older 
residents by organizing exercise opportunities and improving 
infrastructure. The city offers more than 50 physical activity 
programs specifically designed for older adults. The Kirkland 
Steppers Walk Program, which is free for adults over age 50, 
organizes group walks through downtown twice a week during the 
summer.
    Over the next six years, the city of Kirkland will invest 
$6 million to improve sidewalk connections between commercial 
and residential developments to make the city more walkable. In 
addition, Kirkland is the first city in the state of Washington 
to adopt a Complete Streets Ordinance to design streets for the 
needs of walkers, bicyclists and drivers. It has adopted two 
innovative programs: the ``PedFlag'' Program, which has placed 
flags at 63 crosswalks to remind drivers to yield to 
pedestrians, and the Flashing Crosswalk Program, which has 
incorporated flashing lights into the pavement of 30 
crosswalks. Both programs promote a safe pedestrian 
environment. By listening to the good counsel and 
recommendations from the Active Living Task Force and the 
Kirkland Senior Council, the city of Kirkland has and will 
continue to enhance the quality of life for its older 
residents.

  HHS/FDA/Center for Biologics Evaluation and Research (CBER): Joint 
   Studies for Potential Treatments of Joint Disorders for Americans

    Using human gene studies as well as mouse and amphibian 
embryos, we discovered several proteins involved in the growth 
and development of joints that appear to have great potential 
as treatments for joint disorders caused by structural damage.
    Lead Agency: HHS/FDA/Center for Biologics Evaluation and 
Research (CBER).
    Agency Mission: The FDA is responsible for protecting the 
public health by assuring the safety, efficacy, and security of 
human and veterinary drugs, biological products, medical 
devices, our nation's food supply, cosmetics, and products that 
emit radiation. The FDA is also responsible for advancing the 
public health by helping to speed innovations that make 
medicines and foods more effective, safer, and more affordable; 
and helping the public get the accurate, science-based 
information they need to use medicines and foods to improve 
their health.
    Principal Investigator: Malcolm Moos Jr., M.D., Ph.D., 1401 
Rockville Pike, Suite 200N, HFM-730, Rockville, MD 20852.
    Partner Agencies: National Institute of Dental and 
Craniofacial Research (NIDCR). NIDCR is one of the National 
Institutes of Health (NIH).
    General Description: Trauma (accident or injury), normal 
wear and tear, disease, and cancer surgery can all damage 
specific tissues and organs. The ideal treatment for repairing 
this damage would restore the tissue or organ to ``like new'' 
condition.
    But before researchers can design such treatments, they 
must first have a detailed understanding of the biochemical 
processes the body itself uses to make these specific 
structures.
    Among the most important elements that guides the growth of 
tissues and organs are biochemical signals called growth 
factors--proteins that trigger specific, immature cells to 
mature into a cell that is committed to a particular identity, 
such as a bone cell rather than a cartilage cell. The body uses 
dozens of different growth factors that cooperate under normal 
circumstances to direct proper formation of developing embryos 
as well as to repair tissues during the life of an individual.
    Our laboratory uses a combination of experimental 
approaches to understand the role of growth factors in 
triggering growth and repair of tissues in the joints. We use a 
variety of strategies to identify and study several previously 
unknown growth factors crucial to the development of joints in 
vertebrates (e.g., humans). Specifically, we use conventional 
rodent models for studying bone and cartilage formation and use 
the embryos of the South African clawed frog (Xenopus) to work 
out the detailed biology of the growth factors that control 
joint development and other processes. In addition, we analyzed 
DNA from families affected by genetic disorders that lead to 
short stature and deformed limbs to identify the specific DNA 
sequence changes that caused two different clinical syndromes, 
thus confirming the role of the factors identified in human 
disease.
    Our work has led to the discovery of several novel growth 
factors, the most important of which are Cartilage-Derived 
Morphogenetic Proteins (CDMP) 1, 2, and 3, and Frzb.
    CDMPs 1 and 2 are found only in joint cartilage, and appear 
to be required for normal joint formation. For example, 
individuals who lack a functioning gene for CDMP1 are very 
short and have deformed limbs. Therefore, CDMP growth factors 
are now being evaluated to determine if they offer potential as 
therapies for joint disorders.
    Unlike the CDMPs, the job of Frzb is to block the activity 
of other growth factors that belong to a group of molecules 
called Wnts. The family of Wnt growth factors is crucial to the 
formation and repair of many tissues, including joints; but 
when these growth factors are overexpressed (i.e., the genes 
that code for them are too active and make too much growth 
factor) the Wnt proteins sometimes trigger uncontrolled growth, 
that is, they cause cancer. Therefore, our work with Frzb and 
Wnts has the potential to lead to new strategies for repairing 
joints as well as for diagnosing and treating certain forms of 
cancer.
    While both CDMPs and Frzb growth factors might prove useful 
as stand-alone therapies, it is more likely that they will be 
most valuable when used in combination with other growth 
factors, living cells, and various natural or synthetic 
biomaterials to manufacture various tissue-engineered medical 
products.
    We are currently trying to identify at the molecular level 
other crucial biochemical steps that make up the signaling 
systems triggered by these growth factors. We hope this work 
will help us better understand these pathways that become 
active ``downstream,'' after the initial growth factor signal.
    The outcome of these studies would likely contribute to the 
design of improved products to repair joint disease. In 
addition, our finding could help improve techniques for testing 
products under clinical development in order to predict how 
well they will work in the clinic.
    We are currently preparing for submission to scientific 
publications several manuscripts that describe our work in 
these areas.
    Excellence: What makes this project exceptional?
    We suggested, years ahead of most investigators in the 
field, that the processes controlling many types of tissue 
repair-especially skeletal repair-was generally similar to the 
processes that control embryonic development.
    We tested the idea in two ways. First, we tested the 
activity of growth factors that we identified in newborn 
mammals to determine their effects in developing frog embryos; 
and then we searched both frog and fish embryos for growth 
factors that might be useful therapies for human joint 
diseases.
    Both approaches were successful and enabled FDA researchers 
and their colleagues at the National Institutes of Health to 
obtain patents for molecules now proposed for testing in human 
clinical trials for the repair of damaged joints.
    Also of interest is the fact we combined laboratory 
research techniques commonly used in embryology (in our case, 
frog embryos) with genetic studies of both mice and human 
families afflicted with certain short stature syndromes. This 
rather unconventional approach to the study enabled us to find 
key growth factors more efficiently and economically than would 
have been possible with conventional approaches.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Since virtually all older individuals develop joint damage, 
this work is relevant to a large and growing population of 
Americans.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    New therapies based on our growth factor discoveries could 
significantly improve the quality of life of the many older 
persons who develop joint damage (e.g., osteoarthritis), and 
help them retain their independent functioning.
    Innovativeness: Why is this research exciting and 
newsworthy?
    The findings hold promise for more effective treatments to 
repair, or perhaps even completely reconstruct, damaged joint 
tissues, eliminating the need for artificial joints.

      U.S. Department of Health and Human Services/Food and Drug 
               Administration: Neurodegenerative Diseases

    Using mouse models of neurodegeneration disease in the 
aging brain, we showed that loss of normal connections between 
neurons precedes nerve death; and we are studying the impact of 
accumulating abnormal protein deposits in neurodegenerative 
disease.
    Lead Agency: U.S. Department of Health and Human Services 
(HHS), Food and Drug Administration (FDA)
    Agency Mission: The FDA is responsible for protecting the 
public health by assuring the safety, efficacy, and security of 
human and veterinary drugs, biological products, medical 
devices, our nation's food supply, cosmetics, and products that 
emit radiation. The FDA is also responsible for advancing the 
public health by helping to speed innovations that make 
medicines and foods more effective, safer, and more affordable; 
and helping the public get the accurate, science-based 
information they need to use medicines and foods to improve 
their health.
    Principal Investigator: Pedro Piccardo, M.D., Biologist, 
Senior Investigator 5516 Nicholson Lane, NLRC B1, Room 126 
(HFM-313), Kensington, Maryland 20895.
    Partner Agencies: Center for Biologics Evaluation and 
Research (CBER), Office of Blood Research and Review (OBRR), 
Division of Emerging and Transfusion-Transmitted Diseases 
(DTTD), Laboratory of Bacterial, Parasitic and Unconventional 
Agents (LBPUA), National Institutes of Health (NIH), USA, 
Biotechnology and Biological Sciences Research Council (BBSRC), 
UK.
    General Description: Transmissible spongiform 
encephalopathies (TSEs or prion diseases) are neurodegenerative 
diseases that affect humans and animals. The most common human 
TSE is Creutzfeldt-Jakob disease (CJD), which the Centers for 
Disease Control and Prevention estimates strikes about one in 
9,000 persons. Patients with TSEs become progressively demented 
and develop movement disorders.
    Although TSEs are different from the more common 
Alzheimer's disease (AD), doctors sometimes find it difficult 
to tell the two diseases apart. Patients with AD tend to 
survive much longer; and unlike CJD, AD is not associated with 
a transmissible agent that could infect others. Therefore, it 
is critical to develop better criteria to diagnose the two 
dementing diseases of adults correctly.
    Investigators in LBPUA, DETTD, OBRR, CBER, FDA, developed a 
quantitative system that might assist in the laboratory 
diagnosis of TSE. Currently, under the auspices of the National 
Institute of Allergy and Infectious Diseases (NIAID) 
interagency agreement, we are leading a project entitled 
``Potential of Candidate Cell Substrates for Vaccine Production 
to Propagate the Agents of Transmissible Spongiform 
Encephalopathies.'' In both TSEs and AD, aggregates of 
abnormally folded proteins called ``amyloids'' (that in some 
instances form microscopically visible plaques) accumulate in 
the brain--prion protein (PrP) in CJD and A% protein in AD. It 
has long been thought that amyloid plaques are accumulations of 
toxic proteins that cause neurodegeneration. A collaborative 
research project between an FDA staff member with investigators 
from Indiana University, Washington University, and the 
University of Edinburgh (funded in part by NIAID-NIH-FDA 
Interagency Agreement [see above]), has developed lines of 
transgenic mice with various genetic mutations implicated in 
the pathogenesis of some TSEs. These mice have already yielded 
useful information for better understanding basic mechanisms of 
human neurodegenerative diseases. Recent results indicate that 
specific alterations in connections between nerve cells of the 
brain (synaptic damage) preceded cell death and might be a 
common feature in the pathogenesis of neurodegenerative 
diseases. Others have proposed that, because some degenerating 
nerve cells show evidence of the phenomenon termed programmed 
cell death (``cell suicide'') or apoptosis, treatments to 
inhibit apoptosis might be clinically useful. However, we found 
that such treatments failed to rescue mice with neurological 
disease. Thus, it seems unlikely that anti-apoptotic therapies 
alone will have a beneficial effect in human neurodenerative 
diseases unless combined with other treatments aimed at 
preventing synaptic damage and neuronal dysfunction. In a 
related project, we found that substantial amounts of amyloid 
proteins accumulated in brains of transgenic mice that 
developed no overt illness, no tissue changes of ``spongiform'' 
degeneration--the pathologic hallmark of TSEs--and contained no 
transmissible infectious agent. We propose that amyloid plaques 
may form as part of a ``protective'' mechanism that sequesters 
small toxic proteins; if that is true, then therapies designed 
to disrupt amyloid plaques might paradoxically enhance disease 
rather than reversing it. We are now investigating 
abnormalities in the brain that take place early in the course 
of neurodegeneration, seeking both a better understanding of 
the process and more promising targets for possible therapy.
    Excellence: What makes this project exceptional?
    This research program is based on our previous work 
(published in peer-reviewed, high-impact scientific journals) 
that showed that transgenic mice we developed have faithfully 
reproduced some of the same clinical and pathologic features 
found in patients with dementing diseases of aging. The ongoing 
research program takes advantage of a close collaboration 
between laboratories at FDA and academic institutions in the 
United States and the United Kingdom. The importance of our 
published studies was recently recognized by the editorial 
board of the Proceedings of the National Academy of Science, 
USA, which selected a publication for special editorial comment 
in the area of neuroscience.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Converging lines of evidence suggest that progressive 
accumulation of misfolded proteins in the brain plays a central 
role in causing neurodegenerative diseases of aging, such as 
Alzheimer's disease, as well as some forms of transmissible 
spongiform encephalopathies. Our work is shedding light on the 
causes of those diseases and suggesting new ways to treat them.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    A number of important questions about neurodegenerative 
diseases affecting older people cannot be answered by studies 
in cell culture systems and require animal models. We developed 
several lines of transgenic mice as models for human 
neurodegenerative diseases in which abnormal forms of prion 
protein accumulate in the brain. Those models have been useful 
for better understanding basic processes causing 
neurodegeneration and offer an opportunity for testing effects 
of new therapies.
    Innovativeness: Why is this research exciting and 
newsworthy?
    Our work challenges the long-held assumption that amyloid 
plaques are toxic and trigger the neurodegeneration that 
ultimately damages the aging brain. Instead, our findings 
suggest those conclusions might not be true.
    Future studies aim to better explain the basic mechanisms 
of amyloid formation and neuronal cell death and to seek new 
targets for therapeutic intervention in neurodegenerative 
diseases of the aging brain.

   U.S. Food and Drug Administration/Center for Drug Evaluation and 
   Research (CDER): Parkinson's Disease Research and Drug Development

    With increases in the aging population, the prevalence of 
neurodegenerative diseases such as Parkinson's disease will 
increase. Drugs that can slow the worsening of symptoms are 
clearly needed, but tools to guide the design of clinical 
trials which can measure the effect of a drug on disease 
progression are not available. Our research has used existing 
clinical trial data to develop publicly available quantitative 
models that may aid in the successful design of clinical trials 
that support evaluation of the disease modifying potential of 
newly developed therapies for Parkinson's disease.
    Lead Agency: U.S. Department of Health and Human Services, 
Food and Drug Administration, Center for Drug Evaluation and 
Research (CDER).
    Agency Mission: The FDA is responsible for protecting the 
public health by assuring the safety, efficacy, and security of 
human and veterinary drugs, biological products, medical 
devices, our nation's food supply, cosmetics, and products that 
emit radiation. The FDA is also responsible for advancing the 
public health by helping to speed innovations that make 
medicines and foods more effective, safer, and more affordable; 
and helping the public get the accurate, science-based 
information they need to use medicines and foods to improve 
their health.
    Principal Investigators: Dr. Venkatesh A. Bhattaram, 10903 
New Hampshire Ave., Bldg 51, Rm. 3160, Silver Spring, MD 20993-
0002; Dr. Ohidul Siddiqui, 10903 New Hampshire Ave., Bldg 21, 
Rm. 4606, Silver Spring, MD 20993-0002; Dr. Leonard Kapcala, 
10903 New Hampshire Ave., Bldg 22, Rm. 4368, Silver Spring, MD 
20993-0002.
    Partner Agencies: National Institute of Health, University 
of Rochester, NY, Parkinson's Study Group, Michael J. Fox 
Foundation for Parkinson's Disease, Parkinson's Action Network.
    General Description: With an increasing aging population, 
the number of Americans who suffer from neurodegenerative 
diseases such as Parkinson's disease will increase. Parkinson's 
disease is a debilitating movement disorder that severely 
curtails the quality of life for patients and may lead to other 
serious secondary complications. Available drugs to treat this 
disease primarily provide symptomatic relief, but do not slow 
the disease progression. Drugs which may provide symptomatic 
relief when Parkinson's disease is first diagnosed become less 
effective as the disease progresses. Pharmaceutical companies 
are now developing drugs intended to slow the disease 
progression. Success of these development programs will have a 
major impact on public health. The scientific challenges 
associated with drug development programs are paralleled by 
scientific challenges associated with the development of 
objective evaluation tools to gauge the effectiveness of 
disease modifying treatments. Clearly, the trial designs, 
endpoints and analyses currently used for evaluating the 
effectiveness of drugs for symptomatic benefit are not 
applicable for testing whether a drug slows the progression of 
a disease. Thorough scientific research on the appropriate 
endpoints for discerning symptomatic and disease modifying 
effects is imperative if new therapies are to be successfully 
developed and evaluated.
    A group of FDA scientists initiated the Parkinson's disease 
research project with the goal of developing objective models 
and tools to aid in the design and evaluation of clinical 
trials intended to demonstrate a disease-modifying effect. The 
approach focused on using previously collected clinical trial 
data to develop a quantitative description of multiple factors 
important to predicting disease progression in clinical trials. 
Patient level disease, demographic, trial design and other 
relevant data from several clinical trials within the FDA files 
and a NIH sponsored trial were collected and quantitative 
disease-drug-trial models for Parkinson's disease were 
developed. These models described the natural progression of 
the disease, patient disposition in terms of baseline disease 
severity, patient's age at disease onset, projected drug 
effects on disease progression, and reasons for patient 
discontinuation. Subsequently, the models were employed to 
explore competing endpoints and analyses that could demonstrate 
a disease-modifying effect. The results of the research were 
presented at the FDA Clinical Pharmacology Advisory Committee 
meeting (October 2006), and later at a public conference 
sponsored by FDA, Michael J. Fox Foundation, Parkinson's Study 
Group, and American Association of Pharmaceutical Scientists 
(April 2008).
    The generalized mathematical model is a useful tool which 
may support the effective design of clinical trials by clinical 
investigators/researchers in the pharmaceutical industry and 
academia, thus advancing the public health by helping to speed 
innovations in drug development.
    Excellence: What makes this project exceptional?
    1. High public health value: Parkinson's disease is 
debilitating and patients need new therapies that not only 
provide relief of symptoms, but that retard the rate of disease 
progression. However, FDA and industry have little experience 
with drug development programs for drugs with this indication. 
Clear guidelines on how to develop such drugs and demonstrate 
disease-modification (i.e., slowing disease worsening) are 
lacking. FDA took a proactive step in leading the scientific 
thinking and building knowledge on how to efficiently develop 
and evaluate such drugs.
    2. Objective use of prior knowledge: The first step in 
developing guidelines for future development is to accrue prior 
knowledge. FDA scientists evaluated prior trials submitted as 
part of New Drug Applications and a NIH sponsored study to 
appreciate the key features of the underlying disease. 
Specifically, the research set out to answer questions such as: 
How fast does a patient's disease worsen? What patient 
characteristics, if any, control the pace of the disease's 
progression? Do patients discontinue treatments because of 
toxicity or due to lack of effectiveness? Answering these 
questions was crucial to explore strategies to test if a new 
drug indeed modifies the pace of the disease. FDA is in a 
unique position to address these questions with its access to 
vast archive of clinical trial data and expertise in 
pharmacometrics, clinical trial design and biostatistics. 
Leveraging that knowledge is in the best interest of public 
health.
    3. Effective collaboration across institutions/disciplines 
towards public health advancement: FDA scientists recognized 
the need for a collaborative approach to this research. The 
Offices of Clinical Pharmacology, Biostatistics and New Drugs 
within FDA collaborated actively in seeking answers to the 
above questions. At different stages of the research, different 
organizations/groups were engaged, which included: FDA, Michael 
J. Fox Foundation for Parkinson's Disease, University of 
Rochester, NY, Parkinson's Study Group, Parkinson's Action 
Network, several pharmaceutical industry representatives, and 
FDA advisors.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Parkinson's disease is a debilitating disease, which occurs 
mostly in the elderly. These aging patients need better drugs, 
which not only provide relief of symptoms, but retard disease 
progression.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Developing guidelines on testing for drugs developed to 
slow disease progression is important to promote the design of 
efficient clinical trials that will provide for a clear and 
objective evaluation of new therapies which seek a disease 
modifying claim.
    Innovativeness: Why is this research exciting and 
newsworthy?
    This is an example of FDA scientists recognizing the 
tremendous public health benefit that can be realized by 
proactively leveraging prior knowledge in a systematic manner 
to aid future drug development. The creativity and dedication 
of the scientists involved is illustrated by the fact that much 
of the work was accomplished outside of their regular work 
assignments. This project exemplifies the tremendous potential 
of FDA's Critical Path Initiative to improve the public health 
by providing tools that can reduce the uncertainties 
surrounding development of urgently needed new therapies.

 U.S. Food and Drug Administration, National Center for Toxicological 
   Research: Safety and Bioactivity of Estrogenic Dietary Supplements

    Americans of all ages can be exposed to potent estrogenic 
compounds in dietary supplements, foods, and drugs, but many of 
the products are specifically marketed to older individuals, 
such as menopausal or postmenopausal women for their perceived 
health benefits and potential to relieve menopausal symptoms. 
This research project has critically investigated the role of 
dose, target tissue, and life stage timing of exposure in 
producing physiological effects, because both beneficial and 
detrimental effects are possible in mammary, adipose tissue, 
and the central nervous system.
    Lead Agency: U.S. Department of Health and Human Services, 
U.S. Food and Drug Administration, National Center for 
Toxicological Research (NCTR).
    Agency Mission: The FDA is responsible for protecting the 
public health by assuring the safety, efficacy, and security of 
human and veterinary drugs, biological products, medical 
devices, our nation's food supply, cosmetics, and products that 
emit radiation. The FDA is also responsible for advancing the 
public health by helping to speed innovations that make 
medicines and foods more effective, safer, and more affordable; 
and helping the public get the accurate, science-based 
information they need to use medicines and foods to improve 
their health.
    Principal Investigator: Daniel R. Doerge, Ph.D., Research 
Chemist, 3900 NCTR Road, Jefferson, AR 72079.
    Partner Agencies: University of Illinois--CRADA 
(Cooperative Research and Development Agreement).
    General Description: The overall goal of this project has 
been to evaluate the safety and bioactivity of estrogenic 
dietary supplements. The component projects are aimed 
collectively at defining the activity of estrogenic dietary 
supplements in various target tissues (including mammary gland, 
adipose tissue, and central nervous system) in which estrogens 
are known to have diverse--sometimes beneficial and sometimes 
detrimental--effects. All of the investigations were also 
designed to critically evaluate the important issue of safety, 
which with hormonal agents such as estrogens is typically 
complex, because it depends on dosage and exposure, metabolism, 
and age, and often can vary from target tissue to target 
tissue. Americans of all ages are exposed to these potent 
estrogenic compounds, but many of the products are specifically 
marketed to older individuals, such as menopausal or 
postmenopausal women for their perceived health benefits and 
potential to relieve menopausal symptoms. Therefore, the 
research has focused in particular on the benefits and risks 
from the use of these products by older individuals.
    Excellence: What makes this project exceptional?
    The overall goal of this research project was to evaluate 
the safety and bioactivity of estrogenic dietary supplements 
through the combined effort of several experienced 
investigators, who have a long-standing track record of 
scientific excellence and well-developed collaboration among 
them. Together, these investigators have organized a series of 
interdependent research projects that collectively are aimed at 
defining the activity of estrogenic dietary supplements in 
mammary, adipose tissue, and the central nervous system, in 
which estrogens are known to have diverse effects.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    The FDA has severely limited regulatory authority over 
dietary supplements, and, as a result, the safety and efficacy 
of most of these products are unknown. A significant proportion 
of the estrogenic dietary supplements currently on the market 
contain soy isoflavones. Many of the beneficial effects of 
isoflavones are associated with their estrogenic action. This 
presents a paradox--because dietary estrogens, like endogenous 
and hormone-replacement therapy, have both potential risks and 
benefits. Many of these products are specifically marketed to 
older individuals, particularly menopausal or postmenopausal 
women for their perceived health benefits and potential to 
relieve menopausal symptoms. Based on research from this 
project in appropriate animal models, consumption of dietary 
estrogens could affect growth of estrogen-dependent breast 
cancer, the development of adipose tissue and obesity, and 
affect cognitive function in the elderly.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    These studies contain important direct estrogenic 
comparisons of effects from purified isoflavones, which occur 
in dietary supplements, with more complex soy ingredients that 
occur in whole-soy foods and other commercial products. In this 
way, critical guidance can be provided to older Americans about 
the healthiest practices regarding consumption of soy-based 
products.
    Innovativeness: Why is this research exciting and 
newsworthy?
    Breast cancer is the second leading cause of cancer death 
in U.S. women, most breast cancer cases (75%) occur in 
postmenopausal women, and most (70%) are estrogen-dependent. 
The stimulatory effect of estrogens on the growth of breast 
cancers can be blocked by two manipulations: competitive 
binding interactions at the estrogen receptor (ER) by anti-
estrogens like tamoxifen, and competitive inhibition of 
estrogen synthesis by aromatase inhibitors. These adjuvant 
endocrine therapies have proven to be highly effective and have 
led to significant improvements in survival for postmenopausal 
women with early-stage estrogen-dependent breast cancer. This 
research project has shown that dietary soy isoflavones can 
negate the inhibitory effects of tamoxifen and aromatase 
inhibitors on the growth of human breast tumors in a mouse 
xenograft model. These studies suggest that such diet-drug 
interactions have the potential to reduce the effectiveness of 
frontline endocrine therapy for breast cancer in postmenopausal 
women.

  U.S. Food and Drug Administration/National Center for Toxicological 
  Research (NCTR): Effects of Dietary Supplements in Aging Individuals

    This research project is designed to investigate the 
possible toxic effects of the consumption of large doses of the 
over-the-counter dietary supplements glucosamine and 
chondroitin sulfate on the metabolism of sugar by aging 
individuals who may have Type II diabetes. The project will 
also evaluate the effects that glucosamine or glucosamine and 
chondroitin sulfate in combination have on blood glucose, 
insulin, cholesterol, and triglycerides. Organ systems that 
will be investigated include liver, kidney, and eyes.
    Lead Agency: U.S. Department of Health and Humans Services, 
U.S. Food and Drug Administration, National Center for 
Toxicological Research (NCTR).
    Agency Mission: The FDA is responsible for protecting the 
public health by assuring the safety, efficacy, and security of 
human and veterinary drugs, biological products, medical 
devices, our nation's food supply, cosmetics, and products that 
emit radiation. The FDA is also responsible for advancing the 
public health by helping to speed innovations that make 
medicines and foods more effective, safer, and more affordable; 
and helping the public get the accurate, science-based 
information they need to use medicines and foods to improve 
their health.
    Principal Investigator: Julian Leakey, Ph.D., Research 
Biologist, 50 RM647 HFT-030, 3900 NCTR Road, Jefferson, AR 
72079.
    Partner Agencies: National Toxicology Program (NIEHS).
    General Description: This research project is designed to 
investigate the chronic effects of the long-term use of 
glucosamine and chondroitin sulfate, over-the-counter dietary 
supplements commonly used for inflammation and chronic joint 
pain relief, and the possible interference of sugar metabolism 
in individuals who may have Type II diabetes. Approximately 40 
million Americans have been reported to suffer from 
osteoarthritis; annual retail sales of these dietary 
supplements approached $750,000,000 in 2004. Use of these 
dietary supplements continues to increase among an aging U.S. 
population that seeks to maintain hip, knee, and spinal health 
and, therefore, preserve mobility and productive activity.
    Data indicate that the subpopulation of consumers using 
these compounds for chronic joint or arthritic pain management 
is in its 50s or beyond, are usually overweight, and may 
consume doses in excess of manufacturer's recommended levels. 
It is thought that the compounds in question could accelerate 
the development of vascular degeneration and other 
physiological and clinical effects associated with Type II 
diabetes. The potential for kidney degeneration may also prove 
to be an increased risk for Type II diabetes when these drugs 
are used for extended periods of time. The primary concern is 
for the individuals in this sub-group who are not aware they 
are Type II diabetics. The lack of dietary control has been 
shown to be a contributing factor in the development of this 
disease. Joint pain is increased as the level of obesity rises, 
which tends to cause these self-medicated individuals to 
routinely increase the dose of dietary supplements to offset 
the discomfort. When one considers that most of this treatment 
is without the knowledge or advice of a medical professional, 
these individuals could be endangering their future health to 
the point of loss of limbs, blindness, vascular disease, or 
even death. The data from this project will provide much needed 
information for the education of this aging population.
    Excellence: What makes this project exceptional?
    While use of the dietary supplements, glucosamine and 
chondroitin sulfate, continues to increase in the aging U.S. 
population, there is currently no long-term toxicology data on 
these compounds. The depth and breadth of this study will 
provide insight as to whether glucosamine or glucosamine and 
chondroitin sulfate in combination, dosed at various 
concentrations, will have a lasting effect on organ systems 
that are also affected by diabetes. Of particular interest is 
investigating whether these dietary supplements can cause 
kidney damage in normal or diabetic animal models. The use of 
lean (normal) and diabetic (obese) rat models in this study act 
as surrogates of two human populations of individuals. The 
models will allow a comparison of the effects of these drugs 
under both physiological conditions and whether these 
supplements will cause kidney damage in either or both rat 
strains. The obese, diabetic rat begins to develop kidney 
sclerosis at 20 weeks of age; osteoarthritis also begins to 
develop at an early age in the obese rat. We therefore have a 
model that develops signs of disease at an early age, and a 
normal animal to which we can compare that disease development.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Data indicate that the likely consumers of these readily 
available, over-the-counter dietary supplements, who use these 
compounds for chronic joint or arthritic pain management, 
comprise a large segment of the aging U.S. population. 
Frequently these individuals are overweight and likely 
candidates for development of Type II diabetes. It is further 
thought that these supplements have the potential to accelerate 
the development of vascular degeneration, kidney degeneration, 
and other physiological and clinical effects known to be 
associated with Type II diabetes.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Glucosamine or glucosamine and chondroitin sulfate in 
combination are dietary supplements promoted and purchased to 
relieve the symptoms of chronic inflammation and joint pain. 
Consumers are predominately the middle-aged or older segment of 
our population; many are obese and at risk for the development 
of Type II diabetes. Significant numbers of these individuals 
self-medicate independent of medical supervision, to routinely 
increase the dosage to offset increased discomfort. There are 
currently no data to guide individuals on short- or long-term 
use of these dietary supplements. The data from this project 
will provide much needed information for the education of this 
aging population.
    Innovativeness: Why is this research exciting and 
newsworthy?
    As our population ages and becomes limited in mobility and 
productive activity, dietary supplements that are promoted to 
alleviate the pain and discomfort of inflammation, joint pain, 
and arthritis are used with greater frequency and at higher 
doses. Sound guidelines for use and appropriate dosages do not 
exist. As life expectancy of aging populations in the U.S. 
increases, the potential for long-term use of glucosamine or 
glucosamine and chondroitin sulfate in combination also 
increases. Currently, there is no toxicology data on the 
effects of these drugs on multiple organ systems or on the 
potential for associated diabetes risk among aging, obese 
populations. This study promises to provide sound scientific 
data for such risk assessment.

 U.S. Food and Drug Administration/Office of Women's Health: Impact of 
Gender Analysis and Pharmacogenomics on Clinical Efficacy, Safety, and 
Pharmocokinetics of Drugs Used for the Treatment of Alzheimer's Disease

    The objectives of this project were to examine the 
representation of women in Alzheimer's disease trials and to 
identify whether gender and ApoE genotype are predictive 
factors of the response to Alzheimer's disease drugs.
    Lead Agency: U.S. Department of Health and Human Services 
(HHS), U.S. Food and Drug Administration (FDA), Office of 
Women's Health (OWH).
    Agency Mission: The FDA is responsible for protecting the 
public health by assuring the safety, efficacy, and security of 
human and veterinary drugs, biological products, medical 
devices, our nation's food supply, cosmetics, and products that 
emit radiation. The FDA is also responsible for advancing the 
public health by helping to speed innovations that make 
medicines and foods more effective, safer, and more affordable; 
and helping the public get the accurate, science-based 
information they need to use medicines and foods to improve 
their health.
    Principal Investigator: Angela Men, Ph.D., Staff Fellow, 
Division of Clinical Pharmacology V, OCP, OTS/OCP/DCP5 Center 
for Drug Evaluation and Research, 10903 New Hampshire Avenue, 
Silver Spring, MD.
    Partner Agencies: Center for Drug Evaluation and Research 
(CDER), Office of Clinical Pharmacology (OCP), Division of 
Neurology Products (DNP), Office of Drug Evaluation I (ODEI), 
Office of New Drugs (OND), Office of Pharmacoepidemiology and 
Statistical Science (OPASS), Office of Biostatistics (OB), 
Divison of Biometrics I (DBI).
    General Description: Impact of Gender Analysis and 
Pharmacogenomics on Clinical Efficacy, Safety, and 
Pharmacokinetics of Drugs Used for the Treatment of Alzheimer's 
Disease. Alzheimer's disease (AD) is the most common cause of 
dementia in the elderly. Risk factors for AD include one form 
of the apolipoprotein E (ApoE) genotype and gender: females and 
ApoE4 carriers are at higher risk for AD. Several literature 
reports showed that certain patients respond better to the 
treatment than others. Thus, it will be very helpful to 
identify whether gender and ApoE genotype are predictive 
factors of the response to AD.
    The medications approved at the time of the study are 
cholinesterase inhibitors and drugs regulating glutamate.
    This project examined the clinical trials associated with 
AD for gender-based analysis. Historically females have been 
underrepresented in clinical research and thus have examined 
these clinical trials determine if the number of women enrolled 
is adequate. Further, since AD affects 1.5 to 3 times as many 
women as men and because there are studies that suggest gender 
is likely to be a more powerful determinant of outcome of 
cholinesterase inhibitor treatment than ApoE status in the 
short term, it was of increased importance that we track the 
inclusion of women and investigate the roles that gender may 
play.
    Large strides have been made to ensure that women were not 
underrepresented in these clinical trials. Issues of 
insufficient enrollment are no longer significant in AD 
clinical trials. Available genomic data show that AD patients 
with homozygous ApoE4 responded more positively to treatment of 
these two drugs on the cognitive function than ApoE4 negative 
and heterozygous ApoE4 patients. This work shows that 
pharmacogenomic information in FDA submissions is useful for 
examining efficacy in important AD disease subgroups. To better 
understand the impact of ApoE on clinical efficacy, collection 
of pharmacogenomic information in the IND and NDA submission is 
recommended.
    Excellence: What makes this project exceptional?
    Alzheimer's disease (AD) is characterized by progressive 
impairment in memory, language, visual-spatial perceptions, and 
judgment. Risk factors for AD include one form of the 
apolipoprotein E (APOE) genotype and gender. Females are at 
higher risk for AD. Although AD affects both men and women, 
studies show that 1.5 to 3 times as many women suffer from AD 
as do their male counterparts. The results from the study 
showed that the ratios of women to men ranged from as low as 
1.3 to 2.1. This study also explored the relationship between 
ApoE biomarker and clinical outcome of AD patients when treated 
with approved drugs. Since there is no cure for AD, any 
progress that can be made in understanding the disease is a 
tremendous step forward.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Alzheimer's Disease (AD), an age-related neurodegenerative 
disorder, is the most common cause of dementia in elderly 
people. There are two types of AD, early onset and late onset. 
In early onset AD, symptoms first appear before age 65. Early 
onset AD is much less common, accounting for only 5-10% of 
cases. Late-onset AD, the more common form, develops after age 
65. Although AD affects both men and women, studies show that 
1.5 to 3 times as many women suffer from AD as do their male 
counterparts. In 1992, researchers found that certain forms of 
the apolipoprotein E (ApoE) gene can influence AD risk. The 
ApoE4 is the main known genetic risk factor for AD. The ApoE4 
alleles decrease and the ApoE2 alleles increase age at onset of 
AD. It is estimated that the number of AD patients will reach 9 
million by the year 2040 if there are no curative treatments 
developed.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    One of the objectives of this project was to determine 
whether enrollment of women in AD clinical trials is sufficient 
and fairly representative of the disease demographic. Based on 
the obtained results, it can be said that large strides have 
been made to ensure that women were not underrepresented in 
these clinical trials. The results of the study demonstrate the 
importance of collecting pharmacogenomic data in AD trials.
    Innovativeness: Why is this research exciting and 
newsworthy?
    Tracking inclusion of women in these clinical trials and 
identifying the gender and the genomic effects on the 
pharmacokinetic/pharmacodynamic of drugs used to treat AD will 
help achieve the goal of personalized medicine.

U.S. Food and Drug Administration/Office of Women's Health: Evaluating 
   the Effectiveness of Vertebroplasty for Improving the Mechanical 
         Properties of the Spine in Patients With Osteoporosis

    The objective of this project was to help surgeons identify 
osteoporosis patients for vertebroplasty surgery, optimize the 
quantity of cement being injected and provide information to 
FDA to facilitate regulatory decision making process on the use 
of cements for vertebroplasty surgery.
    Lead Agency: U.S. Department of Health and Human Services 
(HHS), U.S. Food and Drug Administration (FDA), Office of 
Women's Health (OWH).
    Agency Mission: The FDA is responsible for protecting the 
public health by assuring the safety, efficacy, and security of 
human and veterinary drugs, biological products, medical 
devices, our nation's food supply, cosmetics, and products that 
emit radiation. The FDA is also responsible for advancing the 
public health by helping to speed innovations that make 
medicines and foods more effective, safer, and more affordable; 
and helping the public get the accurate, science-based 
information they need to use medicines and foods to improve 
their health.
    Principal Investigator: Jove Graham, Ph.D., Mechanical 
Engineer, Materials Engineering Branch (MEB), Office of Science 
and Technology (OST), Center for Devices and Radiological 
Health, Mail Code: HFZ-150.
    Partner Agencies: University of California, Berkeley 
(Department of Bioengineering, Department of Mechanical 
Engineering, Department of Orthopaedic Surgery, Medical 
Polymers and Biomaterials Laboratory), and University of 
California, San Francisco (Engineering Systems).
    General Description: Vertebral compression fractures are 
estimated to affect 33% of women over age 65, causing pain, 
disability, and increased mortality risk. An emerging surgical 
treatment is vertebroplasty, or injection of acrylic bone 
cement into the vertebral body. Previous work has suggested 
that bone porosity can have a significant effect on the 
integrity of cement fixation in joint replacement, so the 
potential benefit of vertebroplasty may depend on a patient's 
degree of osteoporosis. The hypothesis was to test whether bone 
mineral density (BMD) can be used to predict mechanical 
strength and stiffness of the vertebral body after cement 
injection. A corollary hypothesis was to test whether the 
relationship between mechanical properties and BMD varies with 
amount of cement injected. Vertebral columns from thirteen 
adult Caucasian female cadavers were obtained and bone mineral 
density was measured with DEXA. Vertebrae were randomly 
assigned to five groups: intact, untreated, 4%, 12% and 24% 
cement fill treatment. Specimens were first compressed to 
simulate a vertebral wedge fracture and then treated with 
cement. Strength and stiffness of all specimens were measured. 
The results suggest that there may be significant differences 
between patients with high and low bone density in terms of the 
relative improvement in strength that vertebroplasty can offer 
them. In the study, only the highest cement dose used (24% 
fill) had any effect on mechanical strength or stiffness. More 
importantly, samples with very low bone density (i.e., highly 
osteoporotic) did not how as great an improvement in stiffness 
as high-density samples even when cement volume was increased 
to 24% fill. This study suggests that clinicians may be able to 
use DEXA to select a cement volume and to predict the 
mechanical integrity after vertebroplasty for a specific 
patient based on bone mineral density.
    Excellence: What makes this project exceptional?
    Among persons over 65, fracture rates are three times 
higher in women than in men, and women with osteoporosis are 
more likely to suffer vertebral compression fractures. 
Vertebral compression fractures are the most common injury 
resulting from osteoporosis, with an estimated incidence of 
700,000 per year in the U.S. These fractures, if untreated, 
have been shown to cause acute and chronic back pain, 
disability, and increased mortality risk. In a 2000 study of 
6,459 women with osteoporosis followed for 3.8 years, those 
women who sustained a spine fracture were 8.7 times more likely 
to die than those women who did not experience a fracture. One 
treatment for these fractures is vertebroplasty, or injection 
of acrylic bone cement into the vertebral body to restore its 
strength. This minimally-invasive approach is expected to 
result in earlier recovery times than other more conservative 
options, and it is used for severe, intractable cases where 
non-surgical treatments are not sufficient to relieve the pain 
and deformity caused by the fracture. Acrylic bone cement, 
normally reserved for joint replacement surgery, has not been 
FDA-approved for this procedure, but the cement is used ``off-
label'' for vertebroplasty at the surgeon's discretion. The 
objective of this project was to test two important hypotheses 
related to the safety and effectiveness of vertebroplasty 
surgery. The first hypothesis is that, by diagnosing a 
patient's degree of osteoporosis with non-invasive clinical 
techniques, we will be able to predict the success of 
vertebroplasty as measured by improvement in mechanical 
strength of the vertebral body. The second hypothesis was that 
the volume of cement injected can be optimized to restore 
strength without causing an excessive stiffness of the 
vertebral body that might lead to secondary fractures.
    This study suggests that clinicians may be able to use DEXA 
to select a cement volume and to predict the mechanical 
integrity after vertebroplasty for a specific patient based on 
bone mineral density.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Vertebral compression fractures are estimated to affect 33% 
of women over age 65, causing pain, disability, and increased 
mortality risk. An emerging surgical treatment is 
vertebroplasty, or injection of reinforcing acrylic bone cement 
into the vertebral body. Cements have not been FDA-approved for 
this procedure, but they are used ``off-label'' at surgeons' 
discretion.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Recent studies performed by FDA investigators have 
established that bone porosity can have a significant effect on 
the quality of cement fixation in joint replacement, so it was 
hypothesized that there might also be limitations to the 
benefits of vertebroplasty surgery depending on a patient's 
degree of osteoporosis. A secondary long term complication of 
the surgery is that adjacent vertebrae may fracture due to a 
redistribution of loads following the repair of the original 
fracture. It may be important to optimize the quantity of 
cement being injected in order to avoid excessive stiffening of 
the repaired segment relative to the adjacent bone. Such an 
optimization technique has not yet been studied or reported in 
the literature until this study was conducted.
    As the off-label use of existing bone cements for 
vertebroplasty becomes more popular, the FDA anticipates a 
surge in submissions for new cement devices specific to this 
application. It is a very recent, emerging area with a lack of 
published data from the industry and very limited clinical 
follow-up data from surgeons. The results of this project could 
help FDA/ODE to develop a model for preclinical testing that 
could evaluate safety and effectiveness without the need for 
human studies. This project could provide important information 
to ODE reviewers about the proper clinical indications for 
these devices, thus reducing uncertainty in the review process 
and leading to faster review times. The results of this study 
should be beneficial to OSB by helping them to make informed 
decisions about actions that the FDA should or should not take 
in regulating these devices.
    Innovativeness: Why is this research exciting and 
newsworthy?
    Public health will be enhanced by helping surgeons use 
existing diagnostic tools to make better-informed decisions 
about benefits and limitations of vertebroplasty surgery for a 
specific patient.

Health Resources and Services Administration: Access to Health Care in 
                             Rural America

    This research addresses issues of access to formal home 
health care in rural areas.
    Lead Agency: U.S. Department of Health and Human Services 
(HHS), Health Resources and Services Administration (HRSA).
    Agency Mission: HHS Mission: The HHS mission is to enhance 
the health and well-being of Americans by providing for 
effective health and human services and by fostering sound, 
sustained advances in the sciences underlying medicine, public 
health, and social services.
    HRSA Mission: HRSA provides national leadership, program 
resources and services needed to improve access to culturally 
competent, quality health care. As the Nation's Access Agency, 
HRSA focuses on uninsured, underserved, and special needs 
populations in its goals and program activities.
    Principal Investigator: William J. McAuley, Ph.D., 
Communication Department, George Mason University, Center for 
Social Science Research, 9201 Chain Bridge Road, Suite B100-MSN 
1H5, Fairfax, VA 22030.
    General Description:

            ACCESS TO FORMAL HOME HEALTH CARE IN RURAL AREAS

    This research addresses issues of access to formal home 
health care in rural areas, and examines the use of formal home 
health care in such areas. It also examines the impact of the 
Balanced Budget Act (BBA) of 1997 and other recent policies on 
the staffing characteristics of Medicare-certified home health 
agencies (HHAs) across rural and urban counties from 1996 to 
2002, a period encompassing changes of the BBA and related 
policies.
    Excellence: What makes this project exceptional?
    This research highlighted the policy impact on use of 
formal home health care in both small rural counties and remote 
counties. The risk of any formal home care use is significantly 
higher for Medicaid enrollees residing in small rural counties 
(i.e., with no town larger than 10,000). Use of Medicare home 
health care is significantly greater for residents of the most 
remote counties. There were substantial population-adjusted 
decreases in home health aides based in HHAs in all counties, 
including remote counties.
    Significance: How is this research relevant to older 
persons, populations and or an aging society?
    Results suggest that for the elderly in rural counties, 
Medicaid coverage, especially of case-management services, may 
facilitate access to acute and chronic care services, 
especially Medicare home health care. The limitedpresence of 
stable HHA staff in certain rural counties, especially in 
remote counties, has been exacerbated since implementation of 
the BBA.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    This research provides information for decision-makers 
about the impact of Medicaid in rural places as an important 
mechanism for linking the elderly to formal home care, 
especially to Medicare formal home health care. The loss of 
home health aides in more rural counties may limit the 
availability of home-based long term care in these locations. 
Formal home health care may substitute for less available forms 
of care in the most rural counties.
    Innovativeness: Why is this research exciting or 
newsworthy?
    This research is newsworthy because it suggests that 
policies that limit access to formal home care could lead to 
increased service-related vulnerabilities among the elderly in 
rural areas.

 U.S. Department of Health and Human Services: Medicare Advantage Plans

    This research focuses on the analysis of Medicare Advantage 
plan choices for rural beneficiaries.
    Lead Agency: U.S. Department of Health and Human Services 
(HHS), Health Resources and Services Administration (HRSA).
    Agency Mission: HHS Mission: The HHS mission is to enhance 
the health and well-being of Americans by providing for 
effective health and human services and by fostering sound, 
sustained advances in the sciences underlying medicine, public 
health, and social services.
    HRSA Mission: HRSA provides national leadership, program 
resources and services needed to improve access to culturally 
competent, quality health care. As the Nation's Access Agency, 
HRSA focuses on uninsured, underserved, and special needs 
populations in its goals and program activities.
    Principal Investigator: Keith Mueller, Ph.D, Director, 
RUPRI Center for Rural Health Policy Analysis, University of 
Nebraska Medical Center, Department of Health Services Research 
and Administration, 987835 Nebraska Medical Center, Omaha, NE 
68198.
    General Description:

    IMPACT OF MEDICARE ADVANTAGE PLAN CONCENTRATION ON CHOICES AND 
                       COMPETITION IN RURAL AREAS

    This research focuses on the analysis of Medicare Advantage 
(MA) plan choices for rural beneficiaries and what the 
concentration of plan choices in rural areas may mean in the 
context of how rural beneficiaries are making their choices. 
Using measures of concentration from the economics literature, 
this project explores the relationship between market 
concentration in MA plans and the generosity of MA plans, and 
how it varies by the location of residence of Medicare 
beneficiaries.
    Excellence: What makes this project exceptional?
    This research is exceptional because of its emphasis on 
assisting the elderly in rural America to obtain the benefits 
of the Medicare Advantage program.
    Significance: How is this research relevant to older 
persons, populations and or an aging society?
    This research is relevant because it examines the need for 
outreach and education of the rural elderly about the 
usefulness of the Medicare Advantage program.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    The research provides information for decision-makers 
concerned with the slow start in enrollment in rural areas to 
review policies concerning Medicare Advantage in rural areas.
    Innovativeness: Why is this research exciting or 
newsworthy?
    This research is exciting because it shows that enrollment 
in Medicare Advantage in rural areas, which was off to a slow 
start, is now growing rapidly so rural elderly can take 
advantage of the extra benefits provided by Medicare Advantage.

   Congressional Research Service: Affordable Housing for the Elderly

    This report gives a detailed history of how the Department 
of Housing and Urban Development (HUD) has funded, and 
continues to fund, housing for older households. The report 
describes how HUD supportive services programs can assist 
elderly residents to stay in their residential units as they 
age.
    Lead Agency: Congressional Research Service.
    Agency Mission: The Congressional Research Service 
provides, exclusively to the United States Congress, objective, 
non-partisan assessments of legislative options for addressing 
the public policy problems facing the nation.
    Principal Investigator: Libby Perl, Analyst in Housing.
    General Description: The Department of Housing and Urban 
Development (HUD) operates a number of programs that provide 
assisted housing specifically for low-income ``elderly'' 
households (defined by HUD as those with a head of household or 
spouse age 62 or older). Together with housing assistance, HUD 
also funds several programs that provide supportive services 
for residents to allow them to remain in their apartments as 
they age. This report describes those programs, along with 
current developments in the area of housing for elderly 
households.
    This report also describes current issues involving HUD-
assisted housing for elderly residents. Among the issues 
described is the preservation of affordable housing for low-
income elderly households. At the time affordable housing 
projects were developed, building owners entered into contracts 
with HUD in which they agreed to maintain affordability for a 
certain number of years. The duration of these contracts were 
generally between 20 and 50 years. In recent years, these 
contracts have begun to expire or, in some cases, property 
owners have chosen to pay off their mortgages early and end the 
use restrictions. When this occurs, owners may charge market-
rate rents for the units, and the affordable units are lost. In 
coming years, more and more property owners will be in a 
position to opt out of affordability restrictions and thousands 
of units could be lost.
    This report will be updated in the future to provide more 
information about HUD developments, in particular Section 202 
developments, with updated data from HUD. The report will also 
discuss the new Intergenerational Housing Demonstration Project 
through HUD that has just begun to accept grant applications.
    Excellence: What makes this project exceptional?
    The report explains complicated concepts in a way that 
policymakers unfamiliar with the programs discussed as well as 
the complexities of housing finance can understand. The report 
chronicles Congressional efforts over nearly fifty years to 
develop housing for elderly households. These efforts began in 
1959, when Congress created the Section 202 Supportive Housing 
for the Elderly program, which at the time was targeted to 
underserved, moderate income households (low-income households 
at the time were served through the Public Housing program). 
The report focuses on the Section 202 program because it is the 
only program devoted exclusively to serving elderly households 
and because its history is complex. The program has had many 
incarnations; the system of providing financing for 
developments has changed from loans to grants, the tenant 
population targeted has moved from moderate-income elderly 
households to very low-income elderly households, and the 
program has gone from serving only elderly households to 
serving elderly and disabled households, and then back to 
serving elderly households exclusively. This history of Section 
202 is important to policymakers because many projects 
developed in the early years of the program continue to operate 
under the rules in place at the time they were built, and 
changes to the law must take account of those rules.
    The report also discusses four programs that provide 
housing devoted to elderly households, but that do not receive 
as much attention as Section 202. Two of these programs, 
Section 221(d)(3) and Section 236, were created in 1961 and 
1968 respectively, however they have not been used to build new 
housing since the 1970s. As a result, there is not much 
information available about the way in which these programs 
developed and currently operate. These sections of the report 
are therefore a good source of information that is otherwise 
difficult to find. The report also details how buildings 
developed through the Section 8 project based rental assistance 
program and Public Housing program may be dedicated to elderly 
residents exclusively and the rules involved in dedicating 
these facilities. Finally, the report brings in a discussion of 
HUD supportive services programs and how they work together 
with HUD-assisted housing. These programs are the Service 
Coordinator program, Congregate Housing program, Assisted 
Living Conversion program, and the Resident Opportunity and 
Self Sufficiency program.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    This report unifies the discussion of how the federal 
government supports affordable housing for Older Americans. 
Numerous funding streams for both housing and supportive 
services exist, and the way in which they interact to serve 
``elderly'' households, defined by the Department of Housing 
and Urban Development (HUD) as those with a head of household 
or spouse age 62 or older, is not always clear. Over the years, 
HUD has developed assisted housing through multiple programs, 
and the structure of those programs, the financing 
arrangements, and the populations that they serve all differ to 
some degree. For example, some of these programs have not 
funded new housing developments since the 1970s, and others 
have changed their financing schemes as well as the 
characteristics of households eligible to live there.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    The report's purpose is to inform Congressional staff and 
Members of Congress about how existing programs operate as they 
consider future policy approaches to this issue. Knowing the 
evolution of the Section 202 program is important background 
for understanding pending legislation, since its provisions 
would affect Section 202 developments differently depending on 
which version of the program financed their construction.
    Innovativeness: Why is this research exciting or 
newsworthy?
    This report takes a comprehensive and detailed approach to 
chronicling these varied and complex housing programs. Although 
other existing reports may present information about the 
history of the Section 202 program, for example (both HUD and 
AARP have done this), this report differs in that it also 
discusses four other HUD programs that provide housing for 
elderly households in an attempt to cover the spectrum of 
assisted housing. Unlike the Section 202 program, these 
programs--Section 236, Section 221(d)(3), Section 8 project-
based housing, and Public Housing--also provide housing for 
non-elderly households, but building owners may choose to 
dedicate their facilities to elderly residents. Nor do other 
existing reports include discussions of how HUD supportive 
services programs interact with HUD housing programs so that 
residents may remain in their units as they age.

      Congressional Research Service: Long-Term Family Caregiving

    This report describes the role of family caregivers in 
providing long-term care to older individuals; federal programs 
and initiative that directly and indirectly assist family 
caregivers; and, selected policy issues that would provide 
direct assistance to family caregivers.
    Lead Agency: Congressional Research Service.
    Agency Mission: The Congressional Research Service 
provides, exclusively to the United States Congress, objective, 
non-partisan assessments of legislative options for addressing 
the public policy problems facing the nation.
    Principal Investigator: Kirsten J. Colello, Analyst in 
Gerontology.
    General Description:

    FAMILY CAREGIVING TO THE OLDER POPULATION: BACKGROUND, FEDERAL 
                   PROGRAMS, AND ISSUES FOR CONGRESS

    This report describes the role of family caregivers in 
providing long-term care to older individuals; federal programs 
and initiatives that directly and indirectly assist family 
caregivers; and, selected policy issues that would provide 
direct assistance to family caregivers. These policy issues, 
which have been the subject of discussion among federal 
policymakers and other interested stakeholders, include the 
following: caregiver services and supports, flexible workplace 
accommodations and income security, and additional tax credits.
    Family caregiving to older individuals in need of long-term 
care encompasses a wide range of activities, services, and 
supports. Caregiving can include assistance with personal care 
needs, such as bathing, dressing, and eating, as well as other 
activities necessary for independent living, such as shopping, 
medication management, and meal preparation. In addition, 
family caregivers may arrange, supervise, or pay for formal or 
paid care to be provided to the care recipient.
    Family caregivers fulfill the majority of the need for 
long-term care among older persons with chronic disabilities in 
the United States. As a result of increases in life expectancy, 
as well as the aging of the baby-boom generation, demand for 
family caregiving to the older population is likely to 
increase. However, demographic trends such as reduced 
fertility, increased divorce rates, and greater labor force 
participation among women may limit the number of available 
caregivers to older individuals, as well as the capacity for 
caregivers to provide needed care.
    Excellence: What makes this project exceptional?
    This report assists Congress in identifying and describing 
the various federal programs and initiatives that provide both 
direct and indirect assistance to family caregivers. 
Recognizing family caregivers as an important part of the 
nation's long-term care delivery system, the federal government 
has established programs and initiatives that provide direct 
supports to caregivers, such as respite care, education and 
training, tax relief, and cash assistance. This report 
summarizes federal programs and initiatives that provide both 
direct and indirect support to family caregivers. Benefits that 
are targeted directly at family caregivers help to reduce 
stress and financial hardship, and to improve caregiving 
skills, among other things. Other federal programs and 
initiatives provide home-and community-based long-term care 
services and supports to the care recipient. These programs can 
indirectly benefit caregivers in relieving caregiver burden by 
either supplementing the informal care they are providing or 
substituting with paid support. This report assists federal 
policymakers by describing these federal programs and 
initiatives. The report also summarizes key policy issues for 
family caregivers to the older population that have been the 
subject of discussion among federal policymakers and other 
interested stakeholders.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    The need for long-term care increases with advancing age. 
Family caregivers fulfill the majority of the need for long-
term care among older persons with chronic disabilities in the 
United States. As a result of increases in life expectancy, as 
well as the aging of the baby-boom generation, demand for 
family caregiving to the older population is likely to 
increase. However, demographic trends such as reduced 
fertility, increased divorce rates, and greater labor force 
participation among women may limit the number of available 
caregivers as well as the capacity for caregivers to provide 
needed care to older individuals. Given these competing 
factors, it is likely that family caregiving to the older 
population will remain an important topic for consideration 
among policymakers.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    About 5.5 million adults aged 65 and older--about 16% of 
the U.S. population aged 65 and older--receive long-term care 
services and supports. Of those receiving services, the 
majority (70%, or 3.8 million) live in the community; the 
remaining 30% (1.7 million) live in institutional settings. It 
is estimated that between 7 and 54 million Americans provide 
assistance with personal care and other activities necessary 
for individuals to function independently in their own homes 
and communities. The majority of these individuals providing 
care to older relatives are family members, such as a spouse or 
adult child. Many do so willingly out of a sense of 
responsibility or personal obligation to their family member. 
As a result, some do not identify themselves as caregivers. 
However, researchers have increasingly paid more attention to 
the issue of family members providing unpaid care to older 
relatives, many of whom provide assistance with long-term care 
needs for extended periods of time. It is estimated that family 
caregivers provide on average, 46 hours of care per week for 
over 4 years. Family caregivers seeking information on 
available public and private long-term care services and 
supports for their older relative may be overwhelmed with what 
is often described as a fragmented and confusing system.
    Innovativeness: Why is this research exciting or 
newsworthy?
    Family caregivers will continue to play an important role 
in the delivery of long-term care services and support to the 
older population. Researchers are continuing to examine ways in 
which education, training, and other services and supports can 
best assist family caregivers. Policymakers will continue to 
debate ways in which the federal government can further assist 
family caregivers providing long-term care to older 
individuals.

   Social Security Reform: Possible Effects on the Elderly Poor and 
                           Mitigation Options

    This report analyzes the projected effects of four possible 
options to mitigate the effects of Social Security (SS) benefit 
reductions on elderly poverty. The four options examined are 
(1) a poverty-line SS minimum benefit; (2) a sliding-scale SS 
minimum benefit; (3) a poverty-line Supplemental Security 
Income (SSI) benefit; and (4) a poverty-line SSI benefit with 
liberalized eligibility.
    Lead Agency: Congressional Research Service
    Agency Mission: The Congressional Research Service 
provides, exclusively to the United States Congress, objective, 
non-partisan assessments of legislative options for addressing 
the public policy problems facing the nation.
    Principal Investigator: Kathleen Romig, Analyst in Income 
Security.
    General Description:

   SOCIAL SECURITY REFORM: POSSIBLE EFFECTS ON THE ELDERLY POOR AND 
                           MITIGATION OPTIONS

    This report analyzes the projected effects of four possible 
approaches to mitigating the effects of Social Security benefit 
reductions on elderly poverty in 2042, the first full year of 
projected trust fund insolvency. The options are compared to a 
payable baseline, which assumes current-law benefits would need 
to be cut across the board to balance Social Security's annual 
income and spending at the point of insolvency. The four 
options examined are (1) a poverty-line Social Security minimum 
benefit; (2) a sliding-scale Social Security minimum benefit; 
(3) a poverty-line SSI benefit; and (4) a poverty-line SSI 
benefit with liberalized eligibility.
    Major findings include the following:
     Each of the four options would reduce elderly 
poverty compared to the payable baseline--ranging from a 
negligible reduction in the elderly poverty rate for the option 
to create a sliding-scale Social Security minimum benefit to a 
reduction of three percentage points for the poverty-line SSI 
benefit with liberalized eligibility.
     The elderly poverty rate under all of the options 
would be higher than under the current law scheduled baseline, 
which assumes the current benefit formula can be maintained 
with no reductions.
     The SSI options examined would target the 
additional spending more efficiently toward the poor elderly 
than would the Social Security options.
     The Social Security options examined would reduce 
the incomes of some elderly because of interaction effects; the 
SSI options would not create such interactions.
    Excellence: What makes this project exceptional?
    This program uses a microsimulation model to simulate the 
impact of alternative Social Security reform proposals on the 
elderly poor. This research can be distinguished from other 
research as it focuses on the poor elderly specifically and is 
able to simulate the interaction of Social Security and 
Supplemental Security Income (SSI). Most other research has 
focused on only the effects of Social Security on the low, 
median and high-wage earner. This information should help 
policymakers identify any potential unintended consequences 
through the interaction of these effects.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    The Social Security system faces a long-term financing 
problem. The Social Security Trustees project cash-flow 
deficits beginning in 2017 and trust fund insolvency in 2041. 
Many recent proposals to improve system solvency would reduce 
Social Security benefits in the future. Benefit reductions 
could affect the low-income elderly, many of whom rely on 
Social Security benefits for almost all of their income. Such 
potential benefit reductions could lead to higher rates of 
poverty among the elderly compared to those projected under the 
current benefit formula. Because the low-income elderly are 
especially vulnerable to benefit reductions, many recent Social 
Security reform proposals have included minimum benefits or 
other provisions that would mitigate the effect of benefit cuts 
on the elderly poor. This report is significant in that it 
quantifies the effect of four possible options for mitigating 
the effect of Social Security reform on the elderly poor.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Congress will be faced with the addressing Social Security 
reform in the next few years and will be looking at many 
options. Since Social Security has played a unique role in 
reducing elderly poverty over time, the findings from this 
research can inform policymakers as they consider reforming the 
program.
    Innovativeness: Why is this research exciting or 
newsworthy?
    When discussing changes to public policy, it is important 
to keep in mind the possible unintended consequences of 
potential changes. This research uses a microsimulation model 
and provides an advantage in that it can identify unexpected 
interactions between policy options and existing program rules. 
Social Security is a complex program, and changes to its 
structure could lead to unexpected results--both within Social 
Security and in the relationship of Social Security to 
Supplemental Security Income (SSI). In the most extreme case, 
an increase in Social Security benefits could actually make 
some low-income beneficiaries worse off because they would lose 
eligibility for other programs as a result.

   Congressional Research Service: Retirement Savings: How Much Will 
                     Workers Have When They Retire?

    This report shows how varying the age at which households 
begin to save for retirement, the percentage of their earnings 
that they save, and the rate of return on investment can affect 
the amount of retirement savings the household will have 
accumulated by age 65.
    Lead Agency: Congressional Research Service.
    Agency Mission: The Congressional Research Service 
provides, exclusively to the United States Congress, objective, 
non-partisan assessments of legislative options for addressing 
the public policy problems facing the nation.
    Principal Investigator: Patrick Purcell, Specialist in 
Income Security.
    General Description:

    RETIREMENT SAVINGS: HOW MUCH WILL WORKERS HAVE WHEN THEY RETIRE?

    This report presents the results of an analysis of the 
amount of retirement savings that households might be able to 
accumulate by age 65 under a number of different scenarios. The 
analysis shows how varying the age at which households begin to 
save for retirement, the percentage of their earnings that they 
save, and the rate of return on investment can affect the 
amount of retirement savings the household will accumulate. 
Based on Monte Carlo simulations of the variability of 
investment rates of return, a married-couple household that 
contributes 8% of pay annually for 30 years beginning at age 35 
to a retirement plan invested in a mix of stocks and bonds 
could expect to accumulate $468,000 (in 2004 dollars) by age 65 
if rates of return were at the median over the 30-year period. 
Nevertheless, given the variability of rates of return, there 
is a 5% chance that the couple would have $961,000 or more and 
a 5% chance that the couple would have $214,000 or less. Higher 
contribution rates and longer investment periods lead to higher 
account balances, but also increase the impact of the 
variability of investment rates of return. At a 10% 
contribution rate over 30 years, the household could expect to 
accumulate $594,000, with a 90% probability that account would 
total between $301,000 and $1.2 million. Saving 8% of pay over 
40 years, the household could expect to accumulate $844,000, 
with a 90% probability that the account would total between 
$370,000 and $2 million.
    Excellence: What makes this project exceptional?
    Rather than estimating future retirement account balances 
based on average historical rates of return on stocks and 
bonds, the estimates presented in this report are based on 
Monte Carlo analysis, which simulates thousands of possible 
outcomes. The results of the analysis provide estimates of 
retirement account balances under favorable and unfavorable 
market conditions as well as the average outcome.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Over the past 25 years, although the percentage of the 
workforce who participate in employer-sponsored retirement 
plans has remained relatively stable at approximately half of 
all workers, the type of plan by which most workers are covered 
has changed from defined benefit (DB) pensions to defined 
contribution (DC) plans. The responsibilities of managing a DB 
plan--making contributions, investing the assets, and paying 
the benefits to retired workers and their survivors--lie mainly 
with the employer. In a typical DC plan, the worker must decide 
whether to participate in the plan, how much to contribute, how 
to invest the contributions, and what to do with the money in 
the plan when he or she changes jobs or retires. As a result of 
the shift from DB plans to DC plans, workers today bear more 
responsibility for preparing for their financial security in 
retirement. This report illustrated the impact of those 
decisions on retirement savings.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    The impact of this report on older persons would be 
indirect, as a result of informing the Congress on this issue. 
The oldest members of the ``baby boom''--the 78 million 
Americans who were born between 1946 and 1964--are 62 years old 
in 2008. The youngest members of the baby boom, however, are 
just 44 years old. The report illustrates how those who have 
postponed saving for retirement until after age 40 can still 
accumulate substantial retirement savings, but that it requires 
a substantially higher savings rate than would have been needed 
if they had begun to save for retirement at an earlier age.
    Innovativeness: Why is this research exciting or 
newsworthy?
    The research is innovative in the application of Monte 
Carlo simulation techniques that clearly illustrate the effects 
of the variability in rates of return on retirement savings.

   The Human Research Program: Astronaut Health and Elderly Treatment

    Because some of the effects of space flight on astronauts 
have similarities to the effects of human aging, NASA's 
research can illuminate the mechanisms behind the effects 
common to both.
    Lead Agency: The Human Research Program, Advanced 
Capabilities Division, Exploration Systems Mission Directorate, 
of the National Aeronautics and Space Administration.
    Agency Mission: The Human Research Program (HRP) is 
instrumental in carrying out the Vision for Space Exploration 
(VSE), by developing and delivering research findings, health 
countermeasures, and human systems technologies for spacecraft 
that will support crews on missions to the moon, Mars, and 
beyond.
    Principal Investigator: Jacob Bloomberg, Ph.D., Brian 
Crucian, Ph.D., Judith Hayes, M.S., Lauren Leveton, Ph.D., 
William Paloski, Ph.D., Steven Platts, Ph.D., Scott Smith, 
Ph.D., Human Research Program, NASA Johnson Space Center, 
Houston, TX 77058.
    Partner Agencies: NASA's HRP funds research with a large 
number of academic institutions and collaborates with many 
national and international government agencies and commercial 
entities.
    General Description: NASA's Human Research Program 
undertakes biomedical research and develops technologies to 
assure human health, safety, and performance during space 
exploration missions to the moon and Mars. Because some of the 
effects of space flight on astronauts have similarities to the 
effects of human aging, NASA's research on astronaut health may 
offer significant utility for treatment of the elderly. The 
following research areas demonstrate this linkage:
    Balance and Gait Control: Falls in astronauts and the 
elderly can be caused by problems with the sense of balance. 
Astronaut's nervous systems adapt to weightlessness in ways 
that disturb balance and gait when they return to Earth or land 
on another planet. The human nervous system has evolved 
components that optimize body movements and posture control 
under Earth's gravity. Both space flight and aging affect the 
performance of the components. NASA is investigating ways to 
help astronauts ``learn how to learn'' to adapt to new 
gravitational environments. This involves techniques that 
systematically test and challenge the balance and gait control 
systems. (References: BG-1 to BG-12)
    Orthostatic Hypotension: The decrease of blood pressure 
while standing upright may lead to fainting, falls and thus 
injuries in astronauts and the elderly. Astronauts' orthostatic 
hypotension has been shown to be related to dehydration and 
blunted functioning of the cardiovascular control system, and 
there is evidence of similar mechanisms in elderly hypotensive 
patients. NASA's work in understanding this problem in 
astronauts has suggested treatments ranging from mechanical 
support, to oral rehydration, to a medication named Midodrine 
that augments the nervous system's control of the circulation. 
(References: OH-1 to OH-4)
    Osteoporosis and Bone Fracture Risk: The injuries from 
falls in the elderly are often manifested in bone fractures, 
which are also a significant risk to astronauts if they occur 
during stressful missions on another planet, at a great 
distance from definitive medical care on Earth. Osteoporosis is 
perceived as a disease of the elderly because the inevitable 
loss of bone mass with aging occurs by a slow, chronic process 
that does not display symptoms until a low-trauma fracture 
occurs. But loss of bone strength happens in young, fit 
astronauts at a much faster rate than in the elderly, in a 
process that NASA calls premature osteoporosis. This is a long-
term health risk to astronauts after a space flight, as well as 
a risk during the mission. (References: B-1 to B-4)
    Impaired Nutrition and Vitamin D Metabolism: Many of NASA's 
nutritional biochemistry efforts have important applications to 
the elderly, foremost among them NASA's vitamin D research. 
This involves astronauts in spaceflight, scientists in the 
Antarctic, and the self-neglecting elderly. NASA collaborated 
with the Surgeon General's Office in 2004 and 2005 in 
conferences titled ``Vitamin D and Bone Health Conference: An 
Update from Earth and Outer Space.'' (References: N-1 to N-2, 
VD-1 to VD-3)
    Reduced Immunological Response: Innate immunity, the first 
line response to bacterial infections, is diminished in up to 
20% of adults over age 65 who do not develop fevers in response 
to infections. Immunity has been found to be altered during and 
following space flight. In particular, the reversible nature of 
the space flight effects offers hope for slowing or even 
reversing the effects of aging. Specifically, astronauts have 
exhibited altered number and function of immune cells and 
reactivation of latent herpesviruses. (References: I-1 to I-7)
    Noninvasive Behavioral Health Techniques: There are 
neurobehavioral and psychosocial factors that influence both 
the elderly and astronauts including risk of depression, sleep 
disorders, and cognitive function changes that can benefit from 
noninvasive techniques. These noninvasive behavioral health 
techniques can aid physicians to provide treatments for 
individuals at risk, to enable them to continue leading 
productive and healthy lives, whether in space or on Earth.
    Excellence: What makes this project exceptional?
    Unique perspective and contributions to aging research are 
resulting from NASA's space biomedical research program.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Balance and Gait Control importance to Aging: Falls in the 
elderly are a significant (and growing) public health problem 
because they lead to death, injury, and activity restrictions. 
Approximately one-third of community-dwelling persons over age 
65 falls at least once per year. As a result, 40% of all 
nursing home admissions are due to fall-related injuries. The 
risk is greater in women.
    Orthostatic Hypotension Importance to Aging: This risk 
increases rapidly with age and resulted in 164,000 
hospitalizations in 1994 alone.
    Osteoporosis and Bone Fracture Risk importance to Aging 
Research: The injuries from falls in the elderly are often 
manifested in bone fractures, which can lead to hospitalization 
and subsequent decline.
    Nutrition and Vitamin D Research Importance to Aging: 
Insufficient exposure to the ultraviolet light in sunshine, 
through immobility or confinement whether on Earth or in a 
spacecraft, leads to decreased production of Vitamin D. This 
can increase the risk of diseases such as Alzheimer's and 
diabetes in the elderly, as well as depression, cancer, 
impaired physical performance, weakened immune function and 
decreased bone health which the elderly on Earth may have in 
common with astronauts on long, hazardous space missions.
    Reduced Immunological Response importance to Aging: Immune 
system dysregulation is observed in both the elderly and 
astronauts during space flight. Innate immunity, the first line 
response to bacterial infections, is diminished in up to 20% of 
adults over age 65 who do not develop fevers in response to 
infections.
    Noninvasive Behavioral Health Techniques importance to 
Aging: There are neurobehavioral and psychosocial factors that 
influence both the elderly and astronauts including risk of 
depression, sleep disorders, and cognitive function changes 
that can benefit from noninvasive techniques.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Balance and Gait Control Results/Application of Research: 
Some of these techniques were applied to community-dwelling 
participants in a study associated with John Glenn's second 
space flight in 1998. The techniques applied in spaceflight 
could also be used in rehabilitation of patients with balance 
disorders, and for fall prevention training in the elderly.
    Orthostatic Hypotension Practical Applications of Research: 
The most beneficial discovery in this area for astronauts and 
the elderly in the form of a warning. It came from a study that 
determined that Midodrine may interact badly with Promethazine 
(Phenergan%), a medication used to control severe motion 
sickness whether due to space flight, radiation treatment, 
chemotherapy or surgical anesthesia. The effects may include 
twitching, anxiety and even violent behavior.
    Osteoporosis and Bone Fracture Risk Results/Application of 
Research: NASA has just started funding a collaborative study 
with the Mayo Clinic to evaluate factors such as ethnicity, 
gender, genetics, age, nutritional status and fitness level and 
their importance on bone health in astronauts. This will have 
obvious implications for the elderly.
    Nutrition and Vitamin D Results/Application of Research: 
NASA-funded research evaluated the ability of diet modification 
to mitigate bone loss, based on extensive ground research (N1-
N2). Vitamin D is a dietary factor related to diseases such as 
cancers and diabetes, as well as bone health, in people on 
Earth and in space. The 2005 USDA Dietary Guidelines for 
Americans specifically called out the need for supplementation 
of vitamin D in at risk populations, including the elderly, and 
those with insufficient exposure to the ultraviolet light in 
sunshine, due to limited mobility and confinement in the 
elderly (ref. VD-3), or to being in a small spacecraft without 
many windows that protects astronauts from the unfiltered sun 
(refs. VD-1 to VD-2). On-going NASA research will determine 
safe and effective vitamin D dosing regimens in individuals 
with insufficient ultraviolet light exposure.
    Reduced Immunological Response Results/Application of 
Research: A recent study has demonstrated that the elderly 
suffer higher levels of latent herpesvirus reactivation, which 
is usually associated with reduced immune function. NASA 
studies of astronaut immunity during space flight have revealed 
similar observations (ref. I-7). The flight of John Glenn (age 
77) in 1998 specifically revealed differences in white blood 
cells and in stress hormone levels between him and his younger 
crewmates.
    Noninvasive Behavioral Health Techniques Results/
Application of Research: NASA is funding research at the 
National Space Biomedical Research Institute designed to 
address behavioral health risks including: (1) use of 
noninvasive near-infrared neuro-imaging technology to identify 
biomarkers indicating a tendency to depression, (2) development 
of speech monitoring technologies that can indicate damage to 
portions of the central nervous system that can result from 
radiation exposure or hypoxia (in astronauts) or the early 
stages of Alzheimer's disease (in the elderly), (3) use of blue 
light to maintain circadian rhythms and alertness, and (4) 
developing systems that can provide feedback to astronauts on 
long, stressful missions to warn them if their cognitive 
function is changing, so they can seek appropriate treatments 
and counseling, which could also be made available to the 
elderly on Earth.
    Innovativeness: Why is this research exciting or 
newsworthy?
    In many forms and areas, NASA's research into the causes of 
maladaptation to weightlessness, and the development of 
treatments and preventions for them, may offer significant 
utility and importance for the elderly. The opportunity to 
provide tangible benefits to the segment of the population who 
initiated and supported the development of America's 
exploration of space is a demonstration of the potential of 
space exploration to improve the lives of all Americans while 
extending our reach further into the universe.

 National Space Biomedical Research Institute Ultrasound Technology in 
                       Assisted Living Facilities

    This project trains non-medical personnel to use ultrasound 
to assess health situations for a space mission. These 
techniques can be applied on earth, e.g. staff at assisted 
living facilities, ambulance crews, rural medical caregivers 
and military medics.
    Lead Agency: National Space Biomedical Research Institute 
(funded through a cooperative agreement with NASA).
    Agency Mission: The National Space Biomedical Research 
Institute leads a national effort for accomplishing the 
integrated, critical path, biomedical research necessary to 
support long-term human presence, development and exploration 
of space and to enhance life on Earth by applying the resultant 
advances in human knowledge and technology acquired through 
living and working in space.
    Principal Investigator: Scott A. Dulchavsky, M.D., Ph.D., 
Henry Ford Health System, 2799 W. Grand Boulevard, CFP 110, 
Detroit, MI 48202.
    Partner Agency: Henry Ford Health System.
    General Description: In spaceflight, a number of crew 
health situations, such as severe abdominal pain, tooth 
abscess, sinus infection, muscle and bone loss, broken or 
fractured bones, and eye, knee or shoulder trauma, could 
severely impact the success of long-duration missions. These 
same injuries are common in the elderly. Diagnosing and 
managing acute health problems in remote locations or non-
hospital environments, including space, is challenging due to 
availability of equipment and trained personnel. Dr. Scott 
Dulchavsky's project, funded by National Space Biomedical 
Research Institute, assessed the ability to use ultrasound in 
health situations which would have a high impact on mission 
success.
    This project uses training regimens and CD-ROM refresher 
modules to teach non-medical personnel to easily perform 
ultrasound imaging. Trainees learn to use miniaturized 
ultrasound to assess health situations that could impact all 
aspects of a space mission. These same training techniques are 
transferable to Earth-based medicine, including staff at 
assisted living facilities, ambulance crews, rural medical 
caregivers and military medics.
    The program gave trainees the tools to assess injuries 
using real-time remote assistance from medical experts, 
enabling persons working in a remote environment to assess and 
manage an emergency medical condition. His team developed 
training regimens and refresher modules that allowed non-
physicians to operate ultrasound as if they were technicians. 
It normally takes 200 hours plus yearly updates to learn to 
operate ultrasound, but Dr. Dulchavsky and his team developed 
training methods that cut the time to two-three hours a year. 
The training program consists of a computer-based instructional 
presentation on the basics of ultrasound examination and 
examples of remote guidance. Trainees then participate in a 
hands-on session where they perform abdominal and 
musculoskeletal ultrasound scans.
    With remote guidance, a modestly trained operator is 
coupled with an experienced medical expert, essentially making 
the non-physician the hands of the expert. The diagnostic, 
treatment, and training protocols developed in this study will 
also provide information which can be used in rural care, 
assisted living care, military conflicts, and third world 
medicine on Earth. The methods have been used with professional 
sports teams, in research projects studying athletes at the 
Olympics in Italy, and during a recent Mount Everest 
expedition.
    Excellence: What makes this project exceptional?
    This portable technology facilitates training of lay 
individuals in a complex medical task that results in improved 
disease detection and the potential to save lives.
    Significance: How is this research relevant to older 
persons, populations, and/or an aging society?
    Because many elderly individuals are immobile or living in 
confined conditions, this technique allows the technology to 
come to the patient, without the patient having to come to the 
clinic or hospital.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    This technology provides improved capabilities for 
diagnosis of medical problems by a portable means that can be 
used by non-medical personnel.
    Innovation: Why is this research exciting or newsworthy?
    This ultrasound training concept is global in nature, in 
that it has no boundaries.

  National Aeronautics and Space Agency: Surgical Implant Technology 
                                Research

    Orthopedic implant decontamination is an application 
developed from NASA research on combating the corrosive effects 
of atomic oxygen in space. Understanding this corrosive gas has 
resulted in new methods to decontaminate surgical implants.
    Lead Agency: National Aeronautics and Space Agency (NASA).
    Agency Mission: NASA's mission is to pioneer the future in 
space exploration, scientific discovery and aeronautics 
research.
    Principal Investigator: Bruce Banks, Senior Physicist, 
Consultant to Alphaport supporting NASA Glenn Research Center, 
21000 Brookpark Road, M/S 309-2, Cleveland, OH 44135.
    Partner Agency: Case Western Reserve University Department 
of Orthopedics and DePuy Orthopedics, Inc.
    General Description: Orthopedic implant decontamination is 
a spinoff application that has been developed as a direct 
result of NASA's research on low Earth orbital atomic oxygen 
interactions with spacecraft materials. The contribution 
consists of a process for removal of biologically active 
contaminants from the surfaces of orthopedic implants. 
Currently most orthopedic implants have endotoxins on their 
surfaces, which cause inflammation and pain. Such responses can 
lead to joint loosening and implant failure. Sterilization does 
not remove endotoxins because they are non-living chemicals 
consisting of mostly bacterial cell wall fragments. Implant 
surface exposure to atomic oxygen has been demonstrated to 
fully remove all endotoxins thus minimizing the chances of 
inflammation in the patient after surgery.
    The technology that inspired the spinoff applications was 
NASA's investigation of low Earth orbital atomic interaction 
with materials. All hydrocarbon materials and hydrocarbon 
polymers have been found to erode though oxidation when exposed 
to the low Earth orbital environment. As a result of this 
reactive environment polymers used for solar array blankets and 
thermal control materials can be eroded away unless protective 
coatings could be used to prevent chemical reactions from 
occurring. Protective coatings were developed to protect such 
polymers. Validation of protective coating solutions to atomic 
oxygen erosion needed to be performed in ground laboratory 
facilities. To address NASA's mission needs, ground based 
atomic oxygen facilities were developed and used to validate 
full mission durability for International Space Station (ISS) 
solar array blanket materials. Protective coatings developed 
for ISS solar array blankets are now used on all the USA 
supplied ISS solar arrays. The resulting knowledge of atomic 
oxygen interaction with materials and being made aware of 
specific biomedical needs provided the inspiration for the 
innovation of this biomedical application.
    Excellence: What makes this project exceptional?
    Exposure to atomic oxygen is the only known method that 
fully removes all endotoxins on surgical implants, thus 
minimizing the chances of inflammation in the patient after 
surgery.
    Significance: How is this research relevant to older 
persons, populations, and/or an aging society?
    Osteoarthritis affects between 20% and 30% of the people in 
the USA over 70 years old and 32 million people of all ages. 
There are 350,000 hip fractures in the USA each year that 
require orthopedic implants for repair. It is estimated that by 
the year 2050 there will be 1,800 hip fractures per day that 
will require surgery. Almost all such surgeries will require 
implantation of orthopedic devices that are currently 
contaminated with biologically active chemicals which can cause 
inflammation. The quality of life and financial cost associated 
with inflammation resulting from implant contamination is 
enormous. As the average life expectancy increases along with 
weight of Americans the incidence of restorative orthopedic 
surgery will obviously increase. Surveys indicate that the 
worldwide orthopedic implant market was $4.5 billion in 2002 
and is expected to be $7 billion in 2007. The quality of life 
improvements and reduction in corrective orthopedic operations 
enabled by reduction in inflammation through use of atomic 
oxygen removal of biologically active contaminants would be 
significant.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    The value of this technology will increase as the life 
expectancy increases and average weight of adults increases. 
Although this nomination deals with orthopedic implants many 
other surgical implant surfaces may cause adverse biological 
responses which lead to functional compromises due to presence 
of biologically active contaminants. One example is titanium 
vascular stents which may occlude if there is a presence of 
organic contaminants which are used in the machining process 
during fabrication.
    Innovation: Why is this research exciting or newsworthy?
    Recent tests of commercially produced, sterilized and 
packaged bone screws from four different orthopedic supplier 
companies indicated that three quarters of the screws showed 
presence of endotoxins on their surface.

    National Aeronautics and Space Administration: BioWatch Monitors

    Originally designed to monitor astronaut health, BioWATCH 
monitors multiple vital signs and transmits data to doctors. It 
can monitor various diseases across levels of acuity, which 
makes it ideal for patients at home. BioWATCH can dramatically 
increase a patient's quality of life.
    Lead Agency: National Aeronautics and Space Administration 
(NASA).
    Agency Mission: NASA's mission is to pioneer the future in 
space exploration, scientific discovery, and aeronautics 
research.
    Principal Investigator: Alan Chmiel, Vice President, ZIN 
Technologies, 6745 Engle Road, Cleveland, Ohio 44130.
    General Description: Biomedical Wireless and Ambulatory 
Telemetry for Crew Health (BioWATCH) is a wireless biometric 
monitoring system originally designed to monitor astronaut 
health in space. It can measure heart rate, blood pressure, 
glucose, temperature, joint angle, ECG, and blood oxygenation, 
and then send the information to doctors on Earth in real time. 
BioWATCH was developed by ZIN Technologies and The Cleveland 
Clinic Foundation under NASA Glenn's Small Business Innovation 
Research Program.
    The commercial version of BioWATCH transmits data to 
doctors wirelessly via cell phone, wireless internet or 
Bluetooth. It can be configured to monitor various conditions, 
which makes it ideal for post-surgery patients, participants in 
clinical drug trials, and home healthcare patients.
    Based on the success of the initial prototypes, ZIN and the 
Cleveland Clinic teamed to deploy BioWATCH in an application 
monitoring heart rhythm in patients following a procedure 
designed to eliminate a heart rhythm irregularity known as 
atrial fibrillation. BioWATCH can be used in applications to 
monitor patients with histories of heart disease, arterial 
disease, hypertension, diabetes, pulmonary disease, stroke, 
myocardial infarction, or sleep apnea.
    The technology of BioWATCH allows for transmission of 
patient data from the patient to a health professional in real 
time. Since BioWATCH is a small wearable monitor, it can travel 
with the patient. All of these features allow for a substantial 
improvement in quality of life.
    Ten percent of Americans over age 70 have a heart condition 
known as atrial fibrillation (AF), which is treated with 
anticoagulation drugs that require regular screenings. 
Typically, patients on these drugs are tested twice monthly for 
potentially fatal side effects. With BioWATCH patients can be 
tested daily, and results are available to the doctor 
instantaneously, reducing the risks. Also, patients facing long 
rehabilitation from orthopedic surgery can use BioWATCH to 
track their progress, thereby reducing rehabilitation time and 
readmission rates.
    BioWATCH is a single solution that can affect the quality 
of life of millions of Americans.
    Excellence: What makes this project exceptional?
    BioWATCH is the only technology platform that can be used 
across various diseases and acuteness of symptoms. The real-
time data transmission expedites diagnosis and treatment by 
keeping medical professionals accurately informed about a 
patient's specific symptoms and conditions. BioWATCH can 
measure a patient's pulse, blood pressure, glucose, 
temperature, joint angles and more, and then send the 
information to a doctor in another location in real time. Its 
batteries have an operating life more than four times longer 
than current monitoring systems. It is also much lighter than 
other systems. Its battery life, small size, and wireless 
transmission are a few of many factors that make the BioWATCH 
exceptional.
    Significance: How is this research relevant to older 
persons, populations, and/or an aging society?
    Existing monitors allow for only one parameter to be 
monitored at a time. However, 40 percent of patients who need 
monitoring have multiple symptoms or complications, which is 
why BioWATCH's adaptability is so valuable.
    The wearable monitor can be used in the car, at home, or 
outside to monitor cardiac, orthopedic, diabetic, or 
neurological disease. Remote monitoring technology will allow 
for increased efficiency of the over-tasked nursing population.
    Because many older adults take an active role in monitoring 
their health, the BioWATCH is a significant product that allows 
comfortable at-home wellness and peace of mind for any adult 
concerned about their medical history. Rather than reacting to 
severe medical emergencies after a patient is already in 
distress, a patient and his or her doctor may be alerted to 
potentially dangerous conditions far earlier, enabling the 
patient to feel empowered while taking a pro-active approach to 
health and longevity.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    BioWATCH can be prescribed without the need for outside 
laboratories or technicians. It can reduce the cost or need for 
hospitalization, improve patient compliance with treatment, 
improve quality of life, and improve life expectancy.
    Innovation: Why is this research exciting or newsworthy?
    BioWATCH is the application of a flexible technology to the 
aging population. Unlike other monitoring products, BioWATCH's 
innovative technology allows a single monitor to be used in a 
variety of settings and disease severity. Results can be 
transmitted easily and wirelessly, without the patient needing 
to visit a lab or clinic; it allows for a better quality of 
life by increasing patient freedom, allowing patients to visit 
family or travel without missing routine medical testing.

National Aeronautics and Space Administration: Blood Glucose Monitoring

    NASA technology for Earth orbital atomic oxygen 
interactions is being applied to advanced concepts for blood 
glucose monitoring which would use blood analyte-responsive 
detection method in which blood only contacts the end of an 
optical fiber.
    Lead Agency: National Aeronautics and Space Administration 
(NASA).
    Agency Mission: NASA's mission is to pioneer the future in 
space exploration, scientific discovery and Aeronautics 
research.
    Principal Investigator: Bruce Banks, Senior Physicist, 
Consultant to Alphaport, NASA Glenn Research Center, 21000 
Brookpark Road, M/S 309-2, Cleveland, OH 44135.
    Partner Agency: QuestStar Medical Inc.
    General Description: This is a spinoff application that has 
been developed as a direct result of NASA's research on low 
Earth orbital atomic oxygen interactions with spacecraft 
materials. The contribution consists of a practical and 
effective method of constructing microscopic cones on the 
surface of optical fibers that are necessary for a fiber optic 
blood glucose monitoring device to function. Blood glucose 
monitoring for diabetics is typically performed by piercing the 
skin of a finger with a lance and applying a droplet of blood 
on a reagent pad or test strip. The quantity of blood that is 
required to perform the test determines size and depth of the 
cut required. The amount of blood required for blood glucose 
monitoring could be significantly reduced using this new 
technology. Advanced concepts for blood glucose monitoring are 
being considered which would use blood analyte-responsive 
detection method in which blood only contacts the end of an 
optical fiber. The process makes use of knowledge space 
environmental interactions and the atomic oxygen test 
facilities that exist at NASA's Glenn Research Center.
    Excellence: What makes this project exceptional?
    The technology developed by NASA Glenn Research Center to 
produce inexpensive glucose monitoring devices that require 
much smaller quantities of blood than conventional lance and 
absorbent strip devices will invite more frequent monitoring 
and thus better potential for control of blood glucose levels 
because of affordability and the fact that samples can be taken 
from almost anywhere on the body with reduced pain associated 
with blood sampling.
    Significance: How is this research relevant to older 
persons, populations, and/or an aging society?
    The National Institutes of Health reports that 7% of the 
U.S.A. population has diabetes (14.6 million diagnosed and 6.2 
million undiagnosed) in 2005. For the same year 20.9% of the 
population aged 60 years or older is reported to have diabetes. 
Diabetes was the 6th leading cause of death in 2002. The total 
cost of diabetes in the U.S.A. in 2002 was a staggering $132 
billion for direct medical costs and indirect costs 
(disability, work loss, and premature mortality).
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    The surface modification technique used for the blood 
glucose optical fibers cannot be accomplished by conventional 
chemical or mechanical means because of the small scale and 
high aspect ratio (cone height-to-width ratio) shape of the 
morphology required. However, NASA technology developed for 
space simulation is both applicable and potentially cost 
effective to produce a glucose monitor that can function on an 
order of magnitude less blood than conventional monitors. It is 
for this reason that the development of the blood glucose 
monitor by QuestStar Medical has had numerous Reimbursable 
Space Act Agreements with NASA Glenn Research Center to assist 
in the development of the monitor.
    Innovation: Why is this research exciting or newsworthy?
    The U.S. population developing diabetes is growing.

 National Council on Disability: Promoting Self Sufficiency of People 
                        Living With Disabilities

    Federal indicator systems should include people with 
disabilities to ensure effective enforcement, program 
monitoring, evaluation, and performance reporting. Indicators 
and data need to inform decision makers about quality of life 
status across all citizens.
    Lead Agency: National Council on Disability.
    Agency Mission: The mission of the National Council on 
Disability is to promote the full inclusion, independent 
living, and economic self-sufficiency of people with 
disabilities of all ages and backgrounds by providing advice, 
analysis, and recommendations on disability policy to the 
President, Congress, and other federal agencies.
    Principal Investigator: Martin Gould, Ed. D., Director of 
Research, National Council on Disability, 1331 F Street, NW., 
Suite 850, Washington, DC 20004-1138.
    General Description: Through this research, NCD sought to: 
(a) ensure appropriate Federal Government monitoring, program 
evaluation, and supports for people with disabilities, without 
duplicating ongoing efforts, and (b) determine how the Federal 
Government can contribute effectively to improve performance 
reporting across major social programs for Americans with 
disabilities and their families.
    Nationally, a major reporting mechanism has been the use of 
indicator systems; yet, few adequately address (or even 
include) outcome data related to people with disabilities. Most 
indicator systems also are domain-specific (e.g., addressing 
health while omitting other areas of people's lives). On one 
hand, better information that presents a full picture can 
benefit people with disabilities, business, and government. On 
the other hand, some of the proposed changes might require 
regulatory and legislative action.
    NCD's research identifies valid federal indicators and data 
focused on people with disabilities. It also describes the 
status of the U.S. population of Americans with disabilities 
and points to knowledge gaps. NCD's report makes 
recommendations for transforming the existing indicator system 
and contributing to the knowledge base. This includes the 
prospect of gaining useful information about the extent that 
federal programs are beneficial to people with disabilities.
    Excellence: What makes this project exceptional?
    No other federal research report exists which has examined 
the issues of improving federal statistics, outcome data and 
indicator systems, and proposed a set of quality-of-life 
indicators for the United States based on extant, reliable and 
valid statistical data.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    The research conducted for this report included a review of 
federal aging data collection, indicator projects, and 
statistical reports. The proposed set of quality-of-life 
indictors offered by this report are applicable to people up to 
64 years of age.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    One impact is that this report has demonstrated the ability 
to use existing federal statistical data to depict the quality 
of life of people with disabilities who are aging. Extant 
federal indicator systems for older persons could adopt and/or 
adapt specific items from NCD's set of 18 for the purpose of 
enhancing the extant systems.
    Innovativeness: Why is this research exciting or 
newsworthy?
    There has been an almost immediate demonstration of public 
excitement and newsworthiness about this research. On June 4, 
2008, less than two months after the report's public release, 
the U.S. House Committee on Oversight and Government Reform, 
Subcommittee on Information Policy, the Census, and National 
Archives conducted a hearing on the topic.

    National Council on Disability: Consumer Directed Health Reports

    Non-government and government-wide reform should expand 
consumer-directed health care options/choices available for 
people with disabilities and/or who are aging. Consumers need 
cross-disability involvement from the planning to evaluation 
phases.
    Lead Agency: National Council on Disability.
    Agency Mission: The mission of the National Council on 
Disability is to promote the full inclusion, independent 
living, and economic self-sufficiency of people with 
disabilities of all ages and backgrounds by providing advice, 
analysis, and recommendations on disability policy to the 
President, Congress, and other federal agencies.
    Principal Investigator: Martin Gould, Ed.D, Director of 
Research, National Council on Disability, 1331 F Street, NW., 
Suite 850, Washington, DC 20004-1138, Telephone (Voice): (202) 
272-2004; (TTY): (202) 272-2074.
    Partner Agency: Health and Disability Working Group, School 
of Public Health, Boston University.
    General Description: NCD reviewed the literature on 
consumer-directed care, obtained guidance from a key informants 
and a Consumer Advisory Board, evaluated relevant policies, 
identified practices in consumer-directed health care for 
people with disabilities. The agency also made recommendations 
for improving how health care planning, services and outcomes 
are established, implemented, and/or evaluated.
    In the health and supportive services arena, people's 
desire for independence and control is more likely to be 
satisfied when health care systems have several factors in 
place. First, such systems are consumer directed and provide 
care coordination. Second, they seek to eliminate barriers to 
care and give consumers choice about the location and type of 
services provided. Third, the favored health care systems 
provide high-quality, seamless, consumer-centered, and 
continuous care across settings and providers. Fourth, these 
systems provide support services linked to housing to increase 
the availability and efficiency of service provision. A fifth 
factor is that people with disabilities and their caregivers 
need and want access to timely, understandable, and culturally 
appropriate information. Combined, the factors help people 
navigate the maze of services and make informed choices.
    The report informs policy discussions among policymakers, 
practitioners, researchers, consumers, and advocates for health 
reform. The report also examines current laws; program and 
policy trends in financing; outcomes; implementation of models; 
barriers to and facilitators of consumer-direction; the role of 
federal agencies; and includes recommendations for 
improvements.
    Key NCD recommendations imply that shifts are needed in 
government and non-government strategies for organizing, 
locating, and managing health care for people with 
disabilities. The recommendations include replacing a narrow 
diagnosis-focused approach and limited service options with a 
cross-disability, lifespan approach that: (a) considers 
consumer input and (b) includes funding to meet individual 
needs. The role of government should change from the oversight 
of tightly defined program options. Broader responsibility of 
government should include ongoing assessments of consumer needs 
and a continuum of choices, provision of resources directed to 
fill gaps in the service continuum, and incorporation of 
programs and practices that meet rigorous evaluation standards 
for clear consumer-defined outcomes.
    Excellence: What makes this project exceptional?
    This report is based on a one-of-a-kind systematic analysis 
of federal policy, program, and research initiatives regarding 
the interaction of consumer-directed health care and the needs 
of individuals with disabilities including people who are 
elderly. Taken as a whole, the methodology, findings and 
recommendations in this report imply a major shift in the way 
government, private agencies, and even to some extent consumer 
organizations think about organizing and locating, and managing 
health care for people with disabilities and people who are 
elderly.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    The systematic analysis relied on in this report included 
evidenced-based federal and state level research available 
regarding people who are elderly and people with disabilities. 
The evidence-based research captured for analysis involved 
seminal demonstration projects (e.g., Cash and Counseling), 
traditional federal initiatives (e.g., Medicaid Waivers), and 
programs that provide a continuum of community-based care 
(e.g., Programs of All-Inclusive Care for the Elderly (PACE).
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Federal agencies play an important role in promoting 
research on consumer-directed and consumer-oriented health 
care. The Centers for Medicare and Medicaid Services, the 
Office of the Assistant Secretary for Planning and Evaluation, 
and the National Institute on Disability and Rehabilitation 
Research play leading roles in this area. This report's 
findings support federal initiatives needed to expand the 
implementation of consumer-directed and -oriented care, as 
demonstrated through:
    Streamlining of the Waiver process and improved 
communication with states through Independence Plus;
    Real Choice Systems Change and Medicaid Infrastructure 
Grants; and
    The proposed Money Follows the Person Rebalancing 
Initiative.
    CMS has implemented the Real Systems Change Grant 
Initiative to help states implement community-based care 
systems through partnership with community organizations. These 
grants support the development of programs that enable 
individuals to move out of institutions into the most 
integrated community setting appropriate to their individual 
needs and preferences. Real Systems Change programs also offer 
consumers choice in regard to living environments, care 
providers, the types of services they use, and the way these 
services are delivered (CMS Web site, 2004). This was the first 
major federal initiative to support consumer-oriented and 
directed care across the spectrum of disability and across the 
lifespan, and as such has facilitated the implementation of 
community-based care systems.
    The joint support of CMS and the Administration on Aging of 
Aging and Disability Resource Centers in 40 states is intended 
to help those states develop ``one-stop shopping'' programs. 
These programs, which work at the community level to help 
people make informed decisions about their service and support 
options, serve as the entry point to the long-term care system. 
Eligible populations for these programs include people over 65 
and at least one additional population (such as people with 
serious mental illness, developmental disabilities, or physical 
disabilities). Funds are used to coordinate or redesign 
information systems, to provide consumer education, or to 
facilitate access to care across multiple federal, state, and 
local programs (CMS Web site, 2004). This program has the 
potential to address some of the consumer education barriers to 
community-based care, and it also begins to break down some of 
the age-related barriers to care.
    Innovativeness: Why is this research exciting or 
newsworthy?
    The report, Consumer-Directed Health Care: How Well Does It 
Work?, offers a clear picture of the strengths and limitations 
of our Federal Government's current research agenda related to 
consumer-directed health care for Americans with disabilities. 
It sheds light on the relationship between consumer-directed 
health care and practice. It also provides a basis for 
policymakers who use health research evidence to make informed 
policy decisions in keeping with the intent of the New Freedom 
Initiative.

          National Council on Disability: Livable Communities

    Livable communities promote adult well-being, independence, 
and inclusion of people with disabilities and seniors in daily 
living. Coordinated government planning and funding can be 
useful to break barriers, establish, and sustain positive 
changes.
    Lead Agency: National Council on Disability.
    Agency Mission: The mission of the National Council on 
Disability is to promote the full inclusion, independent 
living, and economic self-sufficiency of people with 
disabilities of all ages and backgrounds by providing advice, 
analysis, and recommendations on disability policy to the 
President, Congress, and other federal agencies.
    Principal Investigator: Penny Feldman, Mia Oberlink, Michal 
Gursen & Colleagues, Visiting Nurse Service of New York, Center 
for Home Care Policy and Research, 107 East 70th Street, New 
York, NY 10021, http://www.vnsny.org/research.
    Partner Agency: The Center for Home Care Policy and 
Research.
    General Description: NCD began this project with the 
premise that full community integration recognizes the needs of 
people with disabilities. Among those needs are safe and 
affordable housing; access to transportation; access to the 
political process; and the right to enjoy services, programs, 
and activities that public and private entities offer to all 
members of the community.
    Livable communities enable citizens who choose to reside in 
their homes and communities to do so, regardless of age or 
disability. However, across America, many communities face 
difficult choices and decisions about how to grow, plan for 
change, and improve the quality of life for all citizens. 
Researchers for this NCD project adapted characteristics of a 
model or framework originally established to help communities 
measure and improve their livability by people who are aging. 
The resulting ``livable communities'' framework identifies 
elements that a number of communities around the country have 
incorporated in their approaches to inclusion.
    NCD's project shines the spotlight on inclusive community 
practices that are working. Attention to common needs among 
people who are growing older and other adults with disabilities 
were not surprising. The project identifies and provides 
examples of the strategies used to transfer policy into 
actions. Broadly, the strategies address identifiable elements 
focused on environmental inclusion, safety and affordability. 
The project also makes recommendations for consideration by 
other entities.
    Excellence: What makes this project exceptional?
    This unique report clearly describes how communities can 
improve the quality of life for adults with disabilities, as 
well as for the growing population of seniors who may develop 
disabilities later in life. The report is organized around six 
key goals: (1) providing affordable, appropriate, accessible 
housing; (2) ensuring accessible, affordable, reliable, safe 
transportation; (3) adjusting the physical environment for 
inclusiveness and accessibility; (4) providing work, volunteer, 
and education opportunities; (5) ensuring access to key health 
and support services; and (6) encouraging participation in 
civic, cultural, social, and recreational activities. A number 
of model programs from around the United States are 
highlighted. Individual's stories of livability are described. 
And one community's regional approach to incorporating 
livability principles for long-term planning and growth is 
presented.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    This report is based on the research and the community 
model of livability as constructed by the American Association 
for Retired Persons (AARP). This research is organized around 
six key goals necessary for community living for people with 
disabilities and people who are elderly. The key goals involve: 
(1) providing affordable, appropriate, accessible housing; (2) 
ensuring accessible, affordable, reliable, safe transportation; 
(3) adjusting the physical environment for inclusiveness and 
accessibility; (4) providing work, volunteer, and education 
opportunities; (5) ensuring access to key health and support 
services; and (6) encouraging participation in civic, cultural, 
social, and recreational activities.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Communities across the country are aging. By the year 2030, 
one out of five people in America will be over 65. Those 85 and 
older are the fastest-growing segment of the population. As 
they grow older, the overwhelming majority of Americans will 
remain in their homes and communities. In fact, contrary to 
popular perception of older adults relocating to retirement 
communities, people aged 65 to 85 are the least likely of any 
age group to move. The active involvement of vital, independent 
older citizens--those ``aging in place''--can enhance the 
social and civic life of communities. At the same time, 
communities will need to provide services to a growing number 
of their frail and disabled elders. To prepare for this so-
called ``Age Boom,'' many communities need help in creating an 
environment that will support older people's health and well-
being as they age.
    Comprehensive regional planning approaches such as the one 
described in Livable Communities for Adults with Disabilities 
address at a macro level what community planners, policy 
makers, funders, home builders and remodelers, and citizens 
know at the local level--i.e., that lifespan planning may not 
have been a priority for Boomers in their financing of 
retirement but it has certainly begun to catch on. In many 
respects, these planning approaches call for new and achievable 
configurations of services for older adults that imitate what 
Centers for Independent Living for people with disabilities 
have refined over decades--i.e., that the goal of living 
independently is possible and of the highest priority.
    Innovativeness: Why is this research exciting or 
newsworthy?
    The discussion of livable community components in this 
research report includes many examples of communities across 
the United States that have successfully implemented measures 
to improve the quality of life for people of all ages and 
abilities. Communities large and small are increasingly looking 
toward the livable community concept to help them address some 
of the most challenging issues that they face today, such as a 
growing population of older residents, an increasing number of 
persons with disabilities from diverse cultures, rising housing 
costs, limited transportation alternatives, lack of 
coordination among agencies, and limited and ``silo'' funding. 
The examples demonstrate what is possible when stakeholders 
work together and make livability a priority in their 
community.

       National Council on Disability: Long Term Support Service

    Seniors and people with disabilities need a coherent and 
comprehensive framework of long-term services and supports 
across states. Congress should authorize federal interagency 
coordination of essential public policies, programs, and 
funding.
    Lead Agency: National Council on Disability.
    Agency Mission: The mission of the National Council on 
Disability is to promote the full inclusion, independent 
living, and economic self-sufficiency of people with 
disabilities of all ages and backgrounds by providing advice, 
analysis, and recommendations on disability policy to the 
President, Congress, and other federal agencies.
    Principal Investigator: Michael Morris, Director National 
Disability Institute, Johnette Hartnett, Ed.D., NCD Capitol 
Impact, National Cooperative Bank Development Corporation, 
National Disability Institute, 1667 K Street, NW., Suite 640, 
Washington, DC 20006.
    Partner Agency: National Disability Institute.
    General Description: The NCD report called attention to 
America's changing demographics--growing numbers of people age 
65 and people with disabilities. More than 20 federal agencies 
and nearly 200 programs with varying policy objectives provide 
assistance and services. Elders (people who are seniors) and 
people with disabilities need choices when seeking assistance 
with daily living that maintains their self-determination and 
maximum dignity and independence. Significant reform should 
explore possibilities of a universal approach to the design and 
financing before existing financing mechanisms become 
unsustainable. NCD (1) analyzed the state of long-term services 
and supports, future market demand and system reform needs; (2) 
surveyed promising state practices and local innovations; (3) 
solicited suggestions and comments from an expert panel of 
public and private stakeholders; and offered the following 
recommendations to Congress:
     Decouple eligibility for Home- and Community-Based 
Services (HCBS) under an HCBS waiver from a determination of 
nursing home eligibility. Remove the institutional bias in the 
Medicaid program to give Medicaid beneficiaries greater choice 
in how financial assistance is provided to cover a range of 
LTSS.
     Increase support for families and significant 
others in their role as informal and unpaid caregivers. 
Eligibility for LTSS and the scope and intensity of covered 
services varies significantly from state to state. Despite 
state variability in criteria for Medicaid eligibility and 
scope of benefits, in all states, individuals with disabilities 
are dependent on informal caregivers, including parents, family 
members, and significant others. The estimated benefit of 
informal caregiving exceeds $200 billion annually. Services 
should be designed to support, not supplant, the role of the 
family and actions of informal caregivers.
     Improve the supply, retention, and performance of 
direct support workers to meet increasing demand. Authorize 
funding for collaborative demonstration projects between the 
U.S. Departments of Labor and Health and Human Services that 
promote collaboration between community colleges and 
disability-related organizations to develop a high-quality set 
of competencies to be taught in a new support worker 
certificate program that expands supplies of quality workers to 
meet market demand in home- and community-based settings.
     Mandate coordination and collaboration among 
federal agencies to align public policy and transform 
infrastructure to be responsive to consumer needs and 
preferences for a comprehensive system of LTSS. Congress should 
consider holding hearings to evaluate possible options for 
improvement of multiple department collaboration to provide 
access to information and supports and services to meet the 
long-term needs of people with disabilities. Congress should 
also consider establishing an Interagency Council on Meeting 
the Housing and Service Needs of Seniors and Persons with 
Disabilities.
    Excellence: What makes this project exceptional?
    This is the most comprehensive policy analysis of LTSS that 
evaluates federal LTSS laws, regulations, policies, and 
programs for people over 65 years of age (with and without 
disabilities) and people with disabilities under 65 years of 
age who use LTSS.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    NCD undertook research for this report because it had grown 
increasingly concerned about the (a) lack of a coherent 
national long-term services and supports (LTSS) public policy 
for all people with disabilities; (b) fragmented nature of 
service and support delivery systems, with uneven access and 
services provisions; and (c) LTSS costs of 22 percent or more 
of state budgets, which are fast becoming unsustainable. 
Additionally, NCD noted in undertaking research for this report 
that no single federal program, federal agency, or 
congressional committee was charged with the responsibility for 
the management, funding, and oversight of LTSS; however, 23 
federal agencies were actively involved in LTSS using the NCD 
definition.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    As demonstrated in the findings of this NCD report, the 
United States needs a coherent and comprehensive framework for 
its LTSS policies, programs, and funding based on five inter-
related realities. First, that people who are elderly and 
people with disabilities both desire and deserve choices when 
seeking assistance with daily living that maintains their self-
determination and maximum dignity and independence. Second, the 
current financing mechanisms (public and private) will become 
unsustainable in the near future without significant reform. 
The system must be affordable to all Americans regardless of 
income levels and must consider opportunities to leverage 
public and private support in new ways without impoverishing 
beneficiaries. Third, there is an opportunity with the changing 
demographic picture of the United States to explore the 
possibilities of a universal approach to the design and 
financing of supports that is responsive to individuals under 
the age of 65, as well as Americans over 65 who may or may not 
have disabilities, without sacrificing individual choice and 
flexibility. Fourth, formal and informal care giving must be 
sustained, including examination of family needs and workforce 
recruitment and retention challenges. Fifth, the approach to 
quality must include consumer direction and control of 
resources in addition to traditional external quality assurance 
mechanisms.
    Innovativeness: Why is this research exciting or 
newsworthy?
    This is the first federal analysis of the issue of long-
term services and supports (LTSS) which is based on an 
operational definition of LTSS identical to the one used by the 
American Association for Retired Persons. It is the first 
federal analysis that looks at LTSS for people over 65 years of 
age (with and without disabilities) and people with 
disabilities under 65 years of age who use LTSS. It is the 
first to review federal government LTSS policies, laws, and 
programs for both population groups. And it is the first to 
codify Executive Branch and Congressional operations involving 
LTSS initiatives.

          National Council on Disability: Livable Communities

    Livable communities promote adult well-being, independence, 
and inclusion of people with disabilities and seniors in daily 
living. Coordinated government planning and funding can be 
useful to break barriers, establish, and sustain positive 
changes.
    Lead Agency: National Council on Disability.
    Agency Mission: The mission of the National Council on 
Disability is to promote the full inclusion, independent 
living, and economic self-sufficiency of people with 
disabilities of all ages and backgrounds by providing advice, 
analysis, and recommendations on disability policy to the 
President, Congress, and other federal agencies.
    Principal Investigator: Penny Feldman, Mia Oberlink, Michal 
Gursen & Colleagues, Visiting Nurse Service of New York, Center 
for Home Care Policy and Research, 107 East 70th Street, New 
York, NY 10021, http://www.vnsny.org/research.
    Partner Agency: The Center for Home Care Policy and 
Research.
    General Description: NCD began this project with the 
premise that full community integration recognizes the needs of 
people with disabilities. Among those needs are safe and 
affordable housing; access to transportation; access to the 
political process; and the right to enjoy services, programs, 
and activities that public and private entities offer to all 
members of the community
    Livable communities enable citizens who choose to reside 
their homes and communities to do so, regardless of age or 
disability. However, across America, many communities face 
difficult choices and decisions about how to grow, plan for 
change, and improve the quality of life for all citizens. 
Researchers for this NCD project adapted characteristics of a 
model or framework originally established to help communities 
measure and improve their livability by people who are aging. 
The resulting ``livable communities'' framework identifies 
elements that a number of communities around the country have 
incorporated in their approaches to inclusion.
    NCD's project shines the spotlight on inclusive community 
practices that are working. Attention to common needs among 
people who are growing older and other adults with disabilities 
were not surprising. The project identifies and provides 
examples of the strategies used to transfer policy into 
actions. Broadly, the strategies address identifiable elements 
focused on environmental inclusion, safety and affordability. 
The project also makes recommendations for consideration by 
other entities.
    Excellence: What makes this project exceptional?
    This unique report clearly describes how communities can 
improve the quality of life for adults with disabilities, as 
well as for the growing population of seniors who may develop 
disabilities later in life. The report is organized around six 
key goals: 1) providing affordable, appropriate, accessible 
housing; 2) ensuring accessible, affordable, reliable, safe 
transportation; 3) adjusting the physical environment for 
inclusiveness and accessibility; 4) providing work, volunteer, 
and education opportunities; 5) ensuring access to key health 
and support services; and 6) encouraging participation in 
civic, cultural, social, and recreational activities. A number 
of model programs from around the United States are 
highlighted. Individual's stories of livability are described. 
And one community's regional approach to incorporating 
livability principles for long-term planning and growth is 
presented.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    This report is based on the research and the community 
model of livability as constructed by the American Association 
for Retired Persons (AARP). This research is organized around 
six key goals necessary for community living for people with 
disabilities and people who are elderly. The key goals involve: 
(1) providing affordable, appropriate, accessible housing; (2) 
ensuring accessible, affordable, reliable, safe transportation; 
(3) adjusting the physical environment for inclusiveness and 
accessibility; (4) providing work, volunteer, and education 
opportunities; (5) ensuring access to key health and support 
services; and (6) encouraging participation in civic, cultural, 
social, and recreational activities.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Communities across the country are aging. By the year 2030, 
one out of five people in America will be over 65. Those 85 and 
older are the fastest-growing segment of the population. As 
they grow older, the overwhelming majority of Americans will 
remain in their homes and communities. In fact, contrary to 
popular perception of older adults relocating to retirement 
communities, people aged 65 to 85 are the least likely of any 
age group to move. The active involvement of vital, independent 
older citizens--those ``aging in place''--can enhance the 
social and civic life of communities. At the same time, 
communities will need to provide services to a growing number 
of their frail and disabled elders. To prepare for this so-
called ``Age Boom,'' many communities need help in creating an 
environment that will support older people's health and well-
being as they age.
    Comprehensive regional planning approaches such as the one 
described in Livable Communities for Adults with Disabilities 
address at a macro level what community planners, policy 
makers, funders, home builders and remodelers, and citizens 
know at the local level--i.e., that lifespan planning may not 
have been a priority for Boomers in their financing of 
retirement but it has certainly begun to catch on. In many 
respects, these planning approaches call for new and achievable 
configurations of services for older adults that imitate what 
Centers for Independent Living for people with disabilities 
have refined over decades--i.e., that the goal of living 
independently is possible and of the highest priority.
    Innovativeness: Why is this research exciting or 
newsworthy?
    The discussion of livable community components in this 
research report includes many examples of communities across 
the United States that have successfully implemented measures 
to improve the quality of life for people of all ages and 
abilities. Communities large and small are increasingly looking 
toward the livable community concept to help them address some 
of the most challenging issues that they face today, such as a 
growing population of older residents, an increasing number of 
persons with disabilities from diverse cultures, rising housing 
costs, limited transportation alternatives, lack of 
coordination among agencies, and limited and ``silo'' funding. 
The examples demonstrate what is possible when stakeholders 
work together and make livability a priority in their 
community.

National Endowment for the Arts: Involvement in Arts & Health Promotion

    The Creativity and Aging in America study evaluated the 
effects of active involvement in the arts on the physical 
health, mental health, and social functioning of adults ages 
65-103, as compared to a Control Group. Results showed striking 
positive results relevant to health promotion and cost savings.
    Lead Agency: National Endowment for the Arts.
    Agency Mission: The National Endowment for the Arts is a 
federal agency dedicated to supporting excellence in the arts, 
both new and established; bringing the arts to all Americans; 
and providing leadership in arts education.
    Principal Investigators: Gene D. Cohen, M.D., Ph.D, George 
Washington University, Center on Aging, Health & Humanities.
    Partner Agencies: National Endowment for the Arts (Lead 
Sponsor), U.S. Department of Health and Human Services (DHHS), 
Substance Abuse and Mental Health Services Administration 
(SAMHSA), Center for Mental Health Services, National Institute 
of Health (NIH), National Institute of Mental Health (NIMH), 
AARP, National Retired Teachers Association, Stella and Charles 
Guttman Foundation, International Foundation for Music 
Research.
    General Description: In 2001, the National Endowment for 
the Arts engaged George Washington University to conduct a 
multi-site, national study with the aim of measuring the impact 
of professionally conducted community-based cultural programs 
on the general health, mental health, and social activities of 
older persons, age 65 and older. The study measured 
participants engaged in on-going, weekly programs in creative 
writing, visual arts, music, and theater. Referred to as the 
Creativity and Aging Study, the project's formal title is ``The 
Impact of Professionally Conducted Cultural Programs on Older 
Adults.'' No previous study of this nature using an 
experimental or related scientific design and a control group 
had been carried out.
    The study took place in three different sites across the 
country:
           The Levine School of Music, Washington, DC;
           Elders Share the Arts, Brooklyn, New York; 
        and
           Center for Elders and Youth in the Arts, 
        Institute on Aging, San Francisco, California.
    Each site involved two groups--(1) the Intervention Group, 
comprised of older individuals who were involved in a weekly 
participatory art program, and (2) a Control Group, comprised 
of individuals involved in their ongoing activities as usual. 
Each site recruited at least 100 older persons--50 participants 
in the Intervention Group and Control Group alike. The overall 
study had 300 participants--150 in the Intervention Groups, 150 
in the Control Groups. The average age in all three sites and 
all Intervention and Control Groups, was approximately 80 years 
old, which is older than the average American's life 
expectancy. Approximately 30 percent of the groups reflected 
racial and ethnic minorities.
    The groups were very well matched in level of functioning 
at the start of the Study, with very similar physical health, 
mental health, and level of activity profiles. Participants 
were each interviewed three times by George Washington 
University research assistants:
          (1) at the start of the Study to establish a 
        baseline;
          (2) a year later; and finally;
          (3) two years after the baseline assessment.
    Results reveal strikingly positive differences in the 
Intervention Group (those involved in intensive, weekly 
participatory art programs) as compared to the Control Group. 
The Intervention Group at the one-and two-year follow-up 
assessments, reported:
          (1) better health, fewer doctor visits, and less 
        medication usage;
          (2) more positive responses on mental health 
        measures; and
          (3) more involvement in overall activities.
    Since the study collected so much rich data, analyses of 
existing data are expected to continue through 2010.
    In conclusion, the results suggest sharply positive 
intervention effects of these community-based art programs run 
by professional artists. The Study points to true health 
promotion and disease prevention effects. It also shows 
significant cost savings through fewer doctor visits and 
reduced medication usage. In that they also show stabilization 
and actual increase in community-based activities in general 
among those in the cultural programs, the Study reveals a 
positive impact on maintaining independence and reducing 
dependency. This latter point demonstrates that these 
community-based cultural programs for older adults appear to be 
reducing risk factors that drive the need for long-term care.
    Excellence: What makes this project exceptional?
    The Creativity and Aging study is the first theory-driven, 
multi-site, national study with an experimental or related 
scientific design and a control group that sought to assess the 
impact of active involvement in community-based art programs on 
the physical health, mental health, and social functioning of 
older adults. Moreover, for a study cohort with an average age 
of 80, most scientists would expect that any positive effects 
would take the form of merely a slower decline in health. 
Instead, what makes this Study truly noteworthy are evidence-
based, statistically significant findings that show actual 
improvement in overall health among those participating in the 
art programs, versus declines in the Control Group.
    The partnership that supported the study is unique in 
itself. The study was conducted and supported by a diverse 
group of government agencies and private sector organizations 
in the scientific and arts fields with individual and common 
goals for older Americans--brought together by the National 
Endowment for the Arts through a series of interagency 
agreements and contracts.
    For example, one of goals of the National Endowment for the 
Arts is to make the best art available to all Americans. Over 
the years, the Endowment and many of its grantees have observed 
how involvement in quality arts programming, including dance, 
creative writing, theater, painting, and music, appear to make 
a remarkable difference in participants' lives. However, there 
was no substantive data to validate the observation. The 
National Institutes of Health have long been concerned with 
improving the mental and physical health of older adults. And 
the AARP is dedicated to positive social change and enhancing 
the quality of life for people as they age. The International 
Foundation on Music Research works to advance active 
participation in music making across the lifespan. This effort 
addresses all of these important missions.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    This research is highly relevant because it has shown, 
among older adults, clear health promotion and prevention 
effects. The Study results reflect a reduction in risk factors 
that drive the need for long-term care. It has also 
demonstrated important cost-saving outcomes highly relevant to 
an aging society. The arts programs in the Study can be 
replicated in urban, suburban, and rural settings across the 
country.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    The positive impact of this research on the physical 
health, mental health, independent social functioning, and 
health care cost-savings for older persons is of high relevance 
to older adults, their families, their communities, and 
society. In the two years following start-up Federal funding 
for the Levine School's Senior Chorale, the program doubled in 
size because of public demand and recognition of its 
effectiveness.
    Innovativeness: Why is this research exciting and 
newsworthy?
    The Creativity and Aging research is exciting and 
newsworthy because it illustrates surprising health 
improvements in a population group with an average age greater 
than normal life expectancy, when one would typically 
anticipate noticeable declines in health. It also reveals 
dramatic cost-saving ramifications without causing an added 
burden to Medicare or Medicaid programs. This study and 
participation by the Levine School's Senior Chorale were 
featured with in-depth coverage on the CBS Evening News with 
Dan Rather.
    One year after the study began, Medicare D went into 
effect. The study had been measuring medication usage. In the 
Medicare D-eligible population, a savings of a mere 8 cents a 
day--extrapolated to the 36.5 million persons in this age 
group--comes to $1 billion per year in savings.* On 
the other hand, a dollar a day in savings nets $13 billion a 
year in total savings. In fact, the results from the just-
completed cost analysis of the Senior Chorale reflect a savings 
close to a dollar a day. At the same time, doctor visits, 
though essentially the same in number among those in the Senior 
Chorale and the control group at the start of the study, had 
grown to an average of 3.56 visits per year for the control 
group two years later. Extrapolating this finding to all 
Medicare-eligible Americans would mean a yearly savings of $6.3 
billion a year by being in a chorale similar to the one in the 
Intervention Group. The Study reveals the profound role on 
healthcare cost savings that is played by creative engagement 
through involvement in community-based arts.
         *Medicare data found under ``Statistics'' 
        at:\1\ www.cms.hhs.gov.

  Factors That Impact the Determination by Medical Examiners of Elder 
            Mistreatment as a Cause of Death in Older People

    The professionals best equipped to determine that elder 
abuse caused an individual's death are medical examiners and 
coroners. However, medical examiners rarely deem elder 
mistreatment as a cause of death; this is likely due to a lack 
of research and evidence to support this determination. In 
response, this project was undertaken to begin to develop 
primary data and a literature base on the topic of death due to 
elder mistreatment.
    Lead Agency: National Institute of Justice, Office of 
Justice Programs.
    Agency Mission: NIJ is the research, development, and 
evaluation agency of the U.S. Department of Justice and is 
dedicated to researching crime control and justice issues. NIJ 
provides objective, independent, evidence-based knowledge and 
tools to meet the challenges of crime and justice, particularly 
at the State and local levels.
    Principal Investigator: Dr. Carmel B. Dyer, Professor and 
Director of the Division of Geriatric and Palliative Medicine, 
University of Texas Health Center, Health Science Center at 
Houston, P.O. Box 20708, Houston, TX 77225.
    Partner Agencies: U.S. Department of Justice's Elder 
Justice and Nursing Home Initiative.
    General Description: The professionals best equipped to 
determine that elder abuse caused an individual's death are 
medical examiners and coroners. However, medical examiners 
rarely deem elder mistreatment as a cause of death; this is 
likely due to a lack of research and evidence to support this 
determination. In response, this project was undertaken to 
begin to develop primary data and a literature base on the 
topic of death due to elder mistreatment. The research team 
conducted four distinct projects to evaluate these three 
aspects of death determination by medical examiners:
     Phase I was a survey exploring the views of 
medical examiners, which showed that medical examiners 
infrequently determine elder mistreatment as a cause of death 
in older decedents even when the signs are there to do so.
     Phase II evaluated scene investigation and medical 
records and toxicology by studying the medical examiners' case 
conferences and case records. This study showed that while the 
medical examiners are expert at performing autopsies, 
interpreting toxicology and determining the cause and manner of 
death, they are not versed (nor should they be expected to be) 
in the standard of care of older persons.
     Phase III was a study of the scene investigation, 
which showed that the scene investigation is not necessarily 
geared to the detection of forensic markers and risk factors 
for elder mistreatment and that the training of investigators 
in the specifics of elder mistreatment may be helpful.
     Phase IV explored autopsy and physical examination 
findings, which found that in cases where dementia was 
documented or pressure ulcers were present, the decedents were 
more likely to have been contacted by Adult Protective Services 
prior to their death.
    Excellence: What makes this project exceptional?
    This project was the first to examine the ability of 
medical examiners to determine whether someone died of elder 
mistreatment rather than the natural health complications and 
degeneration associated with old age. The results of each of 
these studies offers pilot data that inform readers of the 
factors that account for the low rate of determination of elder 
mistreatment as a cause of death in older persons. These 
studies not only increase understanding of elder mistreatment 
death determinations but also lay the groundwork for future 
research by a wide variety of disciplines including 
prosecutors, police officers, protective service workers and 
medical examiners.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    As the American elderly population expands exponentially 
over the coming decades, law enforcement will need new tools 
and knowledge to detect signs of abuse of these members of this 
vulnerable population. These two projects lay the groundwork 
for the production and communication of such guidance.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    This research expands our knowledge of the signs of elder 
abuse and the ability (or inability) of medical and criminal 
justice personnel to detect such abuse in this population. 
These findings will lead to an increased ability of caretakers 
and law enforcement to detect and respond to these crimes, 
which are currently under-reported and go largely unaddressed.
    Innovativeness: Why is this research exciting or 
newsworthy?
    This project demonstrated the need for training for medical 
examiners in the area of elder mistreatment, as many are 
currently unable to distinguish between signs of elder abuse 
and other natural byproducts of aging. Such training would 
greatly increase detection of homicides of elderly individuals.

         Bruising as a Forensic Marker of Physical Elder Abuse

    Very little is known regarding the ``red flags'' that law 
enforcement and caretakers can use to look for signs of 
physical abuse of elderly people. This project will provide 
practical information to medical, forensic and law enforcement 
personnel on how bruises that are caused by abuse appear in the 
elderly population. In addition, it will greatly advance the 
science on physical signs and injuries that result from elder 
abuse.
    Lead Agency: National Institute of Justice, Office of 
Justice Programs.
    Agency Mission: NIJ is the research, development, and 
evaluation agency of the U.S. Department of Justice and is 
dedicated to researching crime control and justice issues. NIJ 
provides objective, independent, evidence-based knowledge and 
tools to meet the challenges of crime and justice, particularly 
at the State and local levels.
    Principal Investigator: Dr. Laura Mosqueda, Professor of 
Clinical Family Medicine and Director of Geriatrics, UCI 
Medical Center, Pavilion III, ZC1150, 101 The City Drive, 
Orange County, CA 92868.
    Partner Agencies: U.S. Department of Justice's Elder 
Justice and Nursing Home Initiative.
    General Description: In 2001, NIJ took a significant step 
in building the medical forensic literature on elder 
mistreatment by funding a project entitled Bruising in the 
Geriatric Population. This project systematically documented 
the occurrence, location, color, progression, and resolution of 
accidental bruising in a sample of adults aged 65 and older. 
Using the results of this first study, the research team is now 
systematically documenting bruising known to have occurred in 
elders who have been physically abused. This project will 
provide practical information to medical, forensic and law 
enforcement personnel on how bruises that are caused by abuse 
appear in the elderly population; and will advance the science 
on forensic markers of physical elder abuse.
    Excellence: What makes this project exceptional?
    This project is the first to attempt to delineate how 
injuries (bruises, in this case) that result from abuse differ 
from those that occur accidentally. The findings will greatly 
aid first responders in determining whether signs of bruising 
are cause for concern and additional investigation.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    As the American elderly population expands exponentially 
over the coming decades, law enforcement will need new tools 
and knowledge to detect signs of abuse of these members of this 
vulnerable population. These two projects lay the groundwork 
for the production and communication of such guidance.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    This research expands our knowledge of the signs of elder 
abuse and the ability (or inability) of medical and criminal 
justice personnel to detect such abuse in this population. 
These findings will lead to an increased ability of caretakers 
and law enforcement to detect and respond to these crimes, 
which are currently under-reported and go largely unaddressed.
    Innovativeness: Why is this research exciting or 
newsworthy?
    This project will give the field its first solid piece of 
evidence that bruises that result from abuse differ from those 
that result from accidental injury. This information has 
already changed investigative practices in Orange County, CA, 
and will hopefully influence the law enforcement practices 
across the country once results are reviewed and disseminated.

National Institute on Aging (NIA)/National Institutes of Health (NIH): 
 Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE)

    The ACTIVE study showed that certain mental exercises can 
offset some of the expected decline in older adults' thinking 
skills and show promise for maintaining cognitive abilities 
needed to do everyday tasks such as shopping, making meals and 
handling finances.
    Lead Agency: National Institute on Aging (NIA), National 
Institutes of Health (NIH).
    Agency Mission:
     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.
    Principal Investigators: Sharon L. Tennstedt, Ph.D., New 
England Research Institute, Inc., Institute for Studies on 
Aging, 9 Galen Street, Watertown, MA 02472.
    Partner Agency: National Institute of Nursing Research 
(NINR).
    General Description: Results from the NIH-supported 
Advanced Cognitive Training for Independent and Vital Elderly 
(ACTIVE) study demonstrated, for the first time in a 
randomized, controlled trial, that certain mental exercises can 
offset some of the expected decline in older adults' thinking 
skills and show promise for maintaining cognitive abilities 
needed to do everyday tasks such as shopping, making meals and 
handling finances. Some of the benefits of the short-term 
training tested in this study lasted for as long as five years.
    Excellence: What makes this project exceptional?
    The ACTIVE study is the first randomized, controlled trial 
to demonstrate long-lasting, positive effects of brief 
cognitive training in older adults, and the only trial to date 
in which the effects of mental exercises were assessed after 
five years for both cognitive and functional status.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Some studies suggest that as many as 22.2 percent of 
Americans age 71 and older--some 5.4 million people--display 
some level of cognitive impairment that does not reach the 
threshold for a diagnosis of dementia. This study offers hope 
that cognitive training may be useful, demonstrating that 
relatively brief targeted exercises can produce durable 
changes.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Although these findings are promising, further research is 
needed to determine how these and similar interventions can 
best be employed in real-world settings.
    Innovativeness: Why is this exciting or newsworthy?
    This is the first randomized, controlled trial to 
demonstrate long-lasting, positive effects of cognitive 
training in older adults. Cognitive exercises are potentially 
less expensive than pharmacological interventions, with fewer 
side effects.

National Institute on Aging (NIA)/National Institutes of Health (NIH): 
          The Dynamics of Health, Aging, and Body Composition

    The Health ABC study will identify how increases in body 
fat and declines in lean mass and bone mineral yield a body 
susceptible to multiple diseases contributing to disability in 
old age. 3,075 men and women between the ages of 70-79 who are 
free of disability were selected for this study. Body weight, 
lean body mass, and body fat are quantified from computed 
tomography images using software developed by CIT's Biomedical 
Imaging Research Services Section (BIRSS), Division of 
Computational Bioscience (DCB).
    Lead Agency: National Institute on Aging (NIA), National 
Institutes of Health (NIH).
    Agency Mission:
     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.
    Principal Investigators: Tamara B. Harris, M.D., M.S., 
Senior Investigator, Intramural Research Program, National 
Institute on Aging, Laboratory of Epidemiology, Demography, and 
Biometry, Gateway Building, 3C309, 7201 Wisconsin Avenue, 
Bethesda, MD 20892.
    Partner Agency: NIH Center for Information Technology 
(CIT), National Institute of Diabetes and Digestive and Kidney 
Diseases (NIDDK), National Institute of Arthritis and 
Musculoskeletal and Skin Diseases (NIAMS), National Research 
Council of Italy, American Heart Association, American Diabetes 
Association, and Hologic Inc.
    General Description: The Center for Information Technology 
is collaborating with the National Institute of Aging to assist 
in image segmentation and quantification in a clinical research 
study, the Dynamics of Health, Aging and Body Composition 
(Health ABC). The Health ABC study will identify how increases 
in body fat and declines in lean mass and bone mineral yield a 
body susceptible to multiple diseases contributing to 
disability in old age. 3,075 men and women between the ages of 
70-79 who are free of disability were selected for this study. 
CIT is augmenting the analysis from computerized tomography 
scans. Lean body mass, and body fat are quantified from 
computed tomography images using software developed by CIT's 
Biomedical Imaging Research Services Section (BIRSS), Division 
of Computational Bioscience (DCB). Manual image segmentation is 
laborious and subject to inter and intra-observer variability 
when performing volumetric analysis. An extension of BIRSS' 
MIPAV software provides researchers with a multistage 
semiautomatic process for image segmentation, quantification, 
and visualization.
    Excellence: What makes this project exceptional?
    The Health ABC study will identify how increases in body 
fat and declines in lean mass and bone mineral yield a body 
susceptible to multiple diseases contributing to disability in 
old age. This should help to address questions of morbidity 
related to body weight and weight related health conditions in 
old age.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Older people incur multiple health conditions as they age 
that affect multiple organ systems. Most studies of aging that 
had been performed prior to 1998 tended to emphasize the 
function of one organ system: heart, brain, bone rather than a 
comprehensive assessment. Health ABC used the principle of 
weight-related health conditions to organize a multi-
dimensional study.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    This research has shown that the same risk factors that 
cause early declines in function contribute to later, major 
losses in function and the onset of frailty. This is a powerful 
prevention message for aging.
    Innovativeness: Why is this exciting or newsworthy?
    Early interventions on weight, heart disease, diabetes, 
inflammation, and depression may prevent later declines to 
frailty in old age.

National Center for Complementary and Alternative Medicine Acupuncture 
       Relieves Pain and Improves Function in Knee Osteoarthritis

    Acupuncture provides pain relief and improves function for 
people with osteoarthritis of the knee and serves as an 
effective complement to standard medical care.
    Lead Agency: National Center for Complementary and 
Alternative Medicine (NCCAM)/National Institutes of Health 
(NIH).
    Agency Mission:
     Explore complementary and alternative healing 
practices in the context of rigorous science.
     Train complementary and alternative medicine 
researchers.
     Disseminate authoritative information to the 
public and professionals.
    Principal Investigator: Brian M. Berman, M.D., Family 
Medicine, University of Maryland School of Medicine, 419 W. 
Redwood Street, Suite 470B, Baltimore, MD 21201-1734.
    General Description:

 ACUPUNCTURE RELIEVES PAIN AND IMPROVES FUNCTION IN KNEE OSTEOARTHRITIS

    The multi-site study team, including rheumatologists and 
licensed acupuncturists, enrolled 570 patients, aged 50 or 
older with osteoarthritis of the knee. Participants were 
randomly assigned to receive one of three treatments: 
acupuncture; sham acupuncture; or participation in a control 
group that followed the Arthritis Foundation's self-help course 
for managing osteoarthritis. Patients continued to receive 
standard medical care from their primary physicians, including 
anti-inflammatory medications, such as COX-2 selective 
inhibitors, non-steroidal anti-inflammatory drugs, and opioid 
pain relievers.
    After enrolling in the study, patients' pain and knee 
function were assessed using standard arthritis research survey 
instruments and measurement tools, such as the Western Ontario 
and McMaster Universities Osteoarthritis Index (WOMAC). 
Patients' progress was assessed at 4, 8, 14, and 26 weeks. By 
week 8, participants receiving acupuncture were showing a 
significant increase in function and, by week 14, a significant 
decrease in pain, compared with the sham and control groups. 
These results, shown by declining scores on the WOMAC index, 
sustained through week 26. Overall, those who received 
acupuncture had a 40 percent decrease in pain and a nearly 40 
percent improvement in function compared to baseline 
assessments.
    Excellence: What makes this project exceptional?
    This study is a well-designed phase 3 clinical trial that 
demonstrated the safety and efficacy of Traditional Chinese 
Acupuncture as a complementary treatment for osteoarthritis of 
the knee.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    More than 20 million Americans have osteoarthritis, which 
is one of the most frequent causes of physical disability among 
adults. Acupuncture provides a non-pharmacologic, complementary 
treatment for osteoarthritis of the knee.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    These results demonstrate that acupuncture is an effective 
non-pharmacologic complementary treatment for osteoarthritis of 
the knee, potentially resulting in a higher-quality of life and 
functioning for individuals with osteoarthritis.
    Innovativeness: Why is this research exciting or 
newsworthy?
    A survey conducted by the Centers for Disease Control and 
Prevention showed that, in 2002, acupuncture was used by an 
estimated 2.1 million U.S. adults. This trial provides evidence 
that acupuncture is an effective non-pharmacologic complement 
to conventional treatment for osteoarthritis, and can be 
utilized successfully as a part of an integrated approach to 
treating the symptoms of osteoarthritis.

   The National Institute of Environmental Health Sciences: Powerful 
       Techniques for Studying DNA Damage Recognition and Repair

    This research project uses very powerful electron 
microscopic techniques to study DNA repair and DNA damage 
recognition. The researchers also study telomeres, which are 
structures of repetitive DNA sequences at the ends of 
chromosomes.
    Lead Agency: The National Institute of Environmental Health 
Sciences (NIEHS)/National Institutes of Health (NIH).
    Agency Mission: The mission of the NIEHS is to reduce the 
burden of human illness and disability by understanding how the 
environment influences the development and progression of human 
disease.
    Principal Investigator: Jack D. Griffith, Professor, 
Department of Microbiology/Immunology, CB# 7295, RM 11-119, 
Lineberger Comprehensive Cancer Center, University of North 
Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-
7295.
    General Description:

   POWERFUL TECHNIQUES FOR STUDYING DNA DAMAGE RECOGNITION AND REPAIR

    Single molecule electron microscopy provides a powerful 
approach for studying the way in which damaged DNA is remodeled 
by proteins. The focus of this application is to understand how 
a number of central human DNA repair and telomere binding 
proteins interact at large, complex DNA structures containing 
damage, and how they carry out repair or signal the presence of 
lesions. This is a highly interactive program which represents 
longstanding fruitful collaborations with Dr. Paul Modrich 
working on human mismatch factors, Dr. Aziz Sancar working on 
human repair signaling factors, and with Dr. Titia deLange 
working on telomere binding proteins. Together from our own 
work on this topic and through these collaborations we have 
published over 20 papers in the past 5 years. This is a highly 
propitious time to carry out these studies since we have 
developed two powerful new EM methods: nano-scale biopointers 
that provide a means of identifying the location of proteins 
within multi-protein complexes and glycerol spray/low voltage 
EM that provide a more gentle means of preparing samples for 
EM. Further, as substrates for these studies, we have produced 
large natural DNAs containing replication forks or Holliday 
junctions with nearby mismatched bases and a model telomere 
DNA. Work on the mismatch repair proteins will take advantage 
of the recent in vitro reconstitution of nick directed excision 
repair by the Modrich laboratory. Work on Claspin and the Rad 
9- Husl-Radl complex will focus on learning how these proteins 
interact with replication forks containing damage. Studies of 
the remodeling of telomeres will take advantage of the recent 
discovery of discrete multi protein complexes at telomeres. 
Finally continuing work from our laboratory will focus on p53 
as a facilitator of DNA damage recognition. Each system offers 
a unique window into basic questions of DNA protein remodeling 
at sites of damage and telomeres and information garnered from 
one study is immediately applied to the others.
    Excellence: What makes this project exceptional?
    The research team has discovered a fundamental difference 
between the telomeres of the roundworm C. elegans and those of 
mammals. Telomeres act like buffers preventing chromosomes from 
fusing together or rearranging. Those types of abnormalities 
can lead to cancer. The team found that roundworm telomeres are 
rich in the compound cytosine as opposed to mammalian telomeres 
which are rich in guanine.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    As humans and all higher organisms age, the telomeres at 
the ends of their chromosomes shorten. Very short telomeres, 
reached after several cell divisions, signal the cell to go 
through programmed cell death, thus preventing the chromosomes 
from rearranging in ways that have been associated with the 
development of cancer. However, in some forms of cancer, the 
death signal is not sent and the tumor cells continue to divide 
allowing the cancer to grow and spread.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    For the most part, cancer is a disease associated with 
aging. In fact, most people, if they live long enough, will 
develop some form of cancer in their lives. By identifying 
methods to prevent or treat cancer, we can extend the healthy 
years of life for all people.
    Innovativeness: Why is this research exciting or 
newsworthy?
    This research team will now search for cytosine-rich 
telomeres in mammalian cells. If they are found, they could 
play a role in extending telomere maintenance and in cancer 
prevention. The research team hopes to exploit these findings 
in stopping cells from becoming cancerous or killing early 
stages of cancer by blocking an enzyme critical in telomere 
synthesis.

        Office of Portfolio Analysis and Strategic Initiatives: 
          Interdisciplinary Research Consortium in Geroscience

    The Roadmap Interdisciplinary Research Program is intended 
to address significant research and health challenges by 
bringing together researchers from different fields to develop 
new approaches to solve problems. The Interdisciplinary 
Research Consortium in Geroscience will foster 
interdisciplinary collaborations that will help unravel the 
reasons why we age so that we can better understand what goes 
wrong in age-related diseases and disorders. Many avenues will 
be explored including how dietary restriction affects aging and 
why the aging brain recovers less easily from traumatic brain 
injury.
    Lead Agency: Office of Portfolio Analysis and Strategic 
Initiatives (OPASI)/Common Fund, NIH Office of the Director.
    Agency Mission: Strategic planning and implementation of 
trans-NIH initiatives that seek to transform the way health 
research is conducted.
    Development and distribution of tools and methodologies to 
NIH Institutes and Centers for analysis and evaluation of NIH 
programs.
    Principal Investigator: Dr. Gordon J. Lithgow, Associate 
Professor, Buck Institute for Age Research, 8001 Redwood Blvd., 
Novato, CA 94945.
    Partner Agencies: All NIH Institutes and Centers 
participate in the planning and implementation of NIH Common 
Fund/Roadmap Programs. The NIDCR plays a lead role in 
implementing the Interdisciplinary Research Program. The 
Geroscience research program at the Buck Institute for Age 
Research is one of nine interdisciplinary research consortia 
funded by the NIH Director's Roadmap program.
    General Description: The Roadmap Interdisciplinary Research 
Program brings together scientists from numerous fields to 
develop new approaches that will address significant research 
and health challenges. The Interdisciplinary Research 
Consortium in Geroscience will foster interdisciplinary 
collaborations between cell and molecular biologists, 
biochemists, geneticists, endocrinologists, physiologists, 
bioinformaticians, and chemists that will elucidate the 
fundamental mechanisms of aging in order to better understand 
what goes awry in age-related diseases and disorders. The 
research will be carried out at the Buck Institute for Age 
Research, which is an NIH-designed Center of Excellence, and 
the only independent research institute in the United States 
focused solely on aging research. The Geroscience Consortium 
will synergize research on the basic mechanisms of aging with 
research on age-associated diseases and with designing and 
optimizing new technologies that may be of great value to the 
geroscience community.
    The research will include determining how cellular 
signaling pathways (e.g., TOR) increase longevity in response 
to environmental cues (e.g., dietary restriction) and how the 
same genes that control cell division and thereby suppress 
cancer (e.g., HUR) also promote neurodegeneration. Chemical 
compounds will be searched for that increase lifespan and also 
protect mammalian neurons from stressors. How proteins interact 
and how they change shape in an aging cell vs. a diseased cell 
will be explored since these processes are fundamental to the 
development of several neurodegenerative diseases. The role of 
histone deacetylase in aging and neurodegeneration will be 
investigated since this enzyme plays a critical role in 
modifying the epigenome of many cell types and may play a role 
in the development of Huntington's Disease and Parkinson's 
Disease. In addition, the research will explore why it is 
harder for the aged brain to recover from injury.
    Excellence: What makes this project exceptional?
    The nine interdisciplinary research consortia including the 
Geroscience Consortium were chosen through an incredibly 
competitive process. Each proposed consortium had to have a 
team of exceptionally accomplished scientists drawn from many 
disciplines who could address significant research challenges 
not amenable to existing uni- or multidisciplinary approaches. 
The Geroscience Consortium is located at a premier aging 
research institute--The Buck Institute for Age Research in 
Novato, CA--which has no academic departments and is therefore 
ideal for fostering interdisciplinary research at the interface 
of different fields. The Geroscience Consortium will integrate 
research on the molecular mechanisms of aging with age-
associated disease research and with designing and optimizing 
new technologies of great potential value to the geroscience 
community.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    This research directly targets older persons. By 
determining what constitutes the ``normal'' aging process, one 
can better understand what biological processes go awry in age-
related diseases and disorders, and find therapeutic agents to 
target these processes.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Finding out how aging occurs at the molecular and cellular 
level will result in a better understanding of pathological 
processes associated with disease. The Geroscience Consortium 
has taken a multi-pronged approach to understanding aging and 
addressing age-related diseases from examining changes in the 
DNA (regulated epigenetic changes and stochastic oxidative 
damage), to looking at changing protein dynamics (including the 
formation of protein aggregates in Huntington's Disease and 
Parkinson's Disease), to why aging brains do not recover well 
from trauma (may be a paucity of stem cells). Knowing the 
molecular players in the aging process and the factors that 
modulate their functions normally and during disease 
progression will allow for the development of therapeutic 
agents or adoption of lifestyle changes to increase longevity 
and combat disease.
    Innovativeness: Why is this research exciting or 
newsworthy?
    Much has yet to be elucidated with respect to the molecular 
pathways underlying aging in order to begin to get at what goes 
awry in these pathways during the development of age-related 
disease and to identify which molecules can be targeted by 
therapeutic agents or can be modulated by lifestyle choices--
e.g., in diet.

     National Institute on Aging: Health and Retirement Study (HRS)

    The Health and Retirement Study (HRS) surveys more than 
22,000 Americans over the age of 50 every two years. Survey 
results and analyses paint an emerging portrait of an aging 
America's physical and mental health, insurance coverage, 
financial status, family support systems, labor market status, 
and retirement planning. The data contain unique and innovative 
features and are designed for cross-national comparisons with 
international counterparts that allow analysts to consider 
important research questions relating to aging societies.
    Lead Agency: National Institute on Aging (NIA)/National 
Institutes of Health (NIH).
    Agency Mission: 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.
    Principal Investigator: David Weir, PhD, Institute for 
Social Research, University of Michigan, 426 Thompson Street, 
Ann Arbor, Michigan 48106-1248.
    Partner Agency: Social Security Administration.
    General Description:

                   HEALTH AND RETIREMENT STUDY (HRS)

    Since 1992, the NIH-supported Health and Retirement Study 
(HRS) has painted a detailed portrait of America's older 
adults, helping us learn about this growing population's 
physical and mental health, insurance coverage, financial 
situations, family support systems, work status, and retirement 
planning. Through its unique and in-depth interviews with a 
nationally representative sample of adults over the age of 50, 
the HRS provides an invaluable, growing body of 
multidisciplinary data to help address the challenges and 
opportunities of aging. During each 2-year cycle of interviews, 
the HRS team surveys more than 20,000 people who represent the 
Nation's diversity of economic conditions, racial and ethnic 
backgrounds, health, marital histories and family compositions, 
occupations and employment histories, living arrangements, and 
other aspects of life. Since the inception of the HRS, more 
than 27,000 people have given 200,000 hours of interviews. The 
design and content of the HRS provides opportunities to analyze 
individual aging and population trends and subgroup 
differences, develop and test causal models, and simulate 
policy. The data have proven to be a valuable scientific and 
policy resource to both academic and federal researchers--there 
are over 7,000 registered users of the data and nearly 1,000 
researchers have employed the data to publish more than 1,300 
reports, including more than 600 peer-reviewed journal articles 
and book chapters, and 70 doctoral dissertations. The HRS is 
managed jointly through a cooperative agreement between the 
National Institute on Aging (NIA) and the Institute for Social 
Research (ISR) at the University of Michigan. The study is 
designed, administered, and conducted by the ISR, and decisions 
about the study content are made by the investigators. The 
principal investigators at the University of Michigan are 
joined by a cadre of co-investigators and working group members 
who are leading academic researchers from across the United 
States in a variety of disciplines, including economics, 
medicine, demography, psychology, public health, and survey 
methodology. In addition, a Data Monitoring Committee is 
charged with maintaining HRS quality, keeping the survey 
relevant and attuned to the technical needs of researchers who 
use the data and ensuring that it addresses the information 
needs of policymakers and the public. The development of 
international longitudinal aging studies using the HRS as a 
model is leading to the production of a network of cross-
nationally comparable data sources to conduct timely research 
on population aging.
    Excellence: What makes this project exceptional?
    The Health and Retirement Study (HRS) has provided an 
invaluable, long-term look at the complex interplay of health, 
work, and economic status of Americans age 51 and older. Over 
the years, the study has been recognized for its high level of 
innovation and unique approaches within the social science 
research arena and has become the premier source of retirement 
data. The data is widely used by both academic and federal 
researchers. In terms of budget, sample size, number of 
interview hours, and number of researchers involved, the HRS 
ranks among the largest and most ambitious social and 
behavioral studies ever undertaken. Rather than being a 
narrowly controlled investigation of the hypotheses of a small 
group of scientists, it provides a laboratory for many 
researchers to explore their theories. The HRS has served as a 
model for other countries to develop harmonized cross-
nationally comparable surveys.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    The HRS is widely recognized as the leading data source for 
research on the health and retirement behavior of older 
populations. The data are being used by federal and academic 
researchers to address critical questions facing aging 
populations. Broad national representation in the study allows 
it to look at the older population in general as well as the 
great diversity and variability of aging. The structure of the 
data allows researchers to investigate both current issues and 
changes over time. The HRS tracks the health of respondents 
over time allowing researchers to probe the impacts of 
unexpected health events on other aspects of individuals' 
lives. The HRS, along with harmonized international companion 
studies, allows for comparisons of trends in aging and 
retirement worldwide.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    The HRS has enabled a significant amount of research 
supported by the federal government and private institutions of 
aging. Data and analyses from HRS have been used to publish 
more than 1,300 reports, including more than 600 peer-reviewed 
journal articles and book chapters and 70 doctoral 
dissertations on health and retirement.
    Innovativeness: Why is this research exciting or 
newsworthy?
    The HRS contains many survey innovations, including:
     Providing improved measurement of key concepts 
like assets using random entry bracketing, which reduces the 
number of non-responses by eliciting ranges of values from 
respondents who would otherwise give no information at all.
     Innovative concepts like participants' future 
expectations such as how long people expect to work in the 
future, their estimates of how long they will live, the 
likelihood of giving major financial assistance to family 
members in the future, whether or not they expect to leave a 
bequest and the amount of that bequest, and whether they think 
they will enter a nursing home or move to a new home or other 
living arrangement in the future.
     Short experimental modules administered to 
randomly selected subgroups of participants to test new 
concepts and explore narrowly focused topics such as 
physiological capacity, early childhood experiences, 
personality, quality of life, and employment opportunities.
     The largest national study of the prevalence of 
dementia in the United States using in-home assessments (the 
Aging, Demographics, and Memory Study--ADAMS).
     Collection of biomarker data including grip 
strength, lung capacity, walking ability, blood pressure, blood 
spot samples to assay for some common disease markers and 
salivary DNA samples.
     Consumption and time-use data.
     Linkages to administrative records on benefits and 
earnings from federal programs like Social Security and 
Medicare as well as employers to better understand pension 
plans.
     International data collections modeled after the 
HRS provide opportunities for comparable data for cross-
national analyses.

 National Eye Institute (NEI)/National Institutes of Health (NIH): Age-
     Related Eye Disease Study: Women Interagency HIV Study (WIHS)

    AREDS investigators reported on clinical trial findings 
that a daily, high-dose combination of antioxidant vitamins C, 
E, and beta-carotene, and the trace element zinc reduced the 
risk of developing advanced AMD by 25% over a five-year period.
    Lead Agency: National Eye Institute (NEI), National 
Institutes of Health (NIH).
    Agency Mission: The National Eye Institute (NEI) was 
established by Congress in 1968 to protect and prolong the 
vision of the American people. As one of the Federal 
government's National Institutes of Health (NIH), the NEI 
conducts and supports research that helps prevent and treat eye 
diseases and other disorders of vision. This research leads to 
sight-saving treatments, reduces visual impairment and 
blindness, and improves the quality of life for people of all 
ages. NEI-supported research has advanced our knowledge of how 
the visual system functions in health and disease.
    Principal Investigators: Dr. Frederick Ferris, Address: 10-
CRC--Hatfield Clinical Research Center, 3-2531, 10 Center 
Drive, Bethesda, MD 20892.
    General Description:

                 AGE-RELATED EYE DISEASE STUDY (AREDS)

    The two most common eye diseases associated with aging are 
lens opacities (cataract), a leading cause of worldwide 
blindness, and age-related macular degeneration (AMD), the 
leading cause of irreversible vision loss in the United States 
among persons over 65 years of age. Cataract surgery replaces 
the opaque, natural lens with a clear, synthetic lens and is 
highly successful in the United States. However, in developing 
countries, the procedure is costly and not readily available. 
There are no cures for AMD, which causes the loss of light 
sensing photoreceptor cells in the central portion of the 
retina (macula) that provides us with sharp visual acuity and 
color vision. In the initial phases of the disease, patients 
experience trouble reading fine print and seeing in dim light. 
During the advanced stages, the disease destroys the macula, 
resulting in severe vision loss and legal blindness. Patients 
with advanced AMD can no longer read, recognize faces, drive a 
car, or perform simple daily tasks that require hand-eye 
coordination. AMD greatly diminishes mobility, independence and 
the quality of life. A delay in the progression of AMD would 
provide improved visual function for afflicted individuals. As 
the U.S. population ages, the prevalence of AMD and cataracts 
is expected to rise sharply, placing ever greater burdens on 
healthcare and social services.
    The NEI initiated the Age-Related Eye Disease Study (AREDS) 
to evaluate, in part, the effects of antioxidants on the 
development and progression of AMD and cataracts. AREDS 
included a large, multi-center clinical trial involving 4,757 
participants, 55 to 80 years of age, in 11 clinical centers 
nationwide. Researchers found that people at high risk of 
developing advanced stages of AMD lowered their risk of 
progression by about 25 percent over a five-year period when 
treated with a daily, high-dose combination of antioxidant 
vitamins C, E, and beta-carotene, and the trace element zinc. 
No effect of these nutrients on cataract formation was 
observed. This nutritional therapy represents the first 
treatment to slow the progression of AMD and delay the onset of 
severe and debilitating vision loss. Based on published 
prevalence data, an estimated 8 million Americans at least 55 
years old are at high risk to develop advanced AMD. Based on 
results from the AREDS, 1.3 million of these people would 
develop advanced AMD over the next five years if no treatment 
were given to reduce their risk. If this at-risk population 
avails themselves of the AREDS nutritional formulation 
(vitamins C, E, beta-carotene, and zinc), greater than 300,000 
would avoid advanced AMD and its associated vision loss over 
the next five years.
    AREDS also added to our understanding of the epidemiology 
of AMD and cataract. Data from AREDS and other studies 
suggested that lutein/zeaxanthin and omega-3 long chain 
polyunsaturated fatty acids might also have benefit in AMD and 
cataract. Leveraging these findings, NEI began AREDS 2 in 2005, 
a multicenter study that will include up to 100 clinical sites 
to evaluate these supplements and other modifications of the 
original AREDS formulations on AMD and cataract.

                   WOMEN INTERAGENCY HIV STUDY (WIHS)

    The Women's Interagency HIV Study (WIHS) was established in 
August 1993 to investigate the impact of HIV infection on women 
in the United States. Approximately 3,700 women have been 
enrolled, of which 2,400 are still attending visits every six 
months (the remaining have either died or lost to follow-up). 
The core portion of this NIH-supported study includes a 
detailed and structured interview, physical and gynecologic 
examinations, and laboratory testing. The WIHS participants are 
also asked to enroll in various sub-studies, including 
cardiovascular, metabolic, and physical functioning.
    Excellence: What makes this project exceptional?
    AREDS offers the first treatment to slow the progression of 
AMD.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    AMD is the leading cause of blindness in older Americans in 
the United States.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    If the more than 8 million older Americans at high risk of 
developing advanced AMD took the AREDS formulation, more than 
300,000 would avoid severe vision loss over the next 5 years.
    Innovativeness: Why is this exciting or newsworthy?
    AREDS offers a valuable therapy to prevent severe vision 
loss simply by taking a relatively low-cost antioxidant 
supplement.

 National Center for Complementary and Alternative Medicine: Turmeric 
                   and Rheumatoid Arthritis Symptoms

    Using an experimental animal model of rheumatoid arthritis, 
NCCAM-supported investigators demonstrated that a curcuminoid-
containing turmeric extract, similar to that found in turmeric 
dietary supplements, significantly inhibited joint inflammation 
and joint destruction.
    Lead Agency: National Center for Complementary and 
Alternative Medicine (NCCAM)/National Institutes of Health 
(NIH).
    Agency Mission:
     Explore complementary and alternative healing 
practices in the context of rigorous science.
     Train complementary and alternative medicine 
researchers.
     Disseminate authoritative information to the 
public and professionals.
    Principal Investigator: Barbara Timmermann, Ph.D., 
Department of Medicinal Chemistry, University of Kansas, School 
of Pharmacy, 4070 Malott Hall, 1251 Wescoe Hall Dr., Lawrence, 
KS 66045-7582.
    Partner Agencies: Office of Dietary Supplements (ODS), 
Office of the Director/National Institutes of Health.
    General Description:

               TURMERIC AND RHEUMATOID ARTHRITIS SYMPTOMS

    Rheumatoid arthritis (RA) is an autoimmune disease that 
causes inflammation in the joints, resulting in pain, swelling, 
stiffness, and loss of function in the affected joints. 
Scientists estimate that about 2.1 million people in the United 
States have RA, which occurs in all races and ethnic groups. 
The financial and social impact of this disease is substantial: 
the medical and surgical treatment costs and the wages lost 
because of disability add up to billions of dollars annually.
    Using an experimental animal model of arthritis, NCCAM-
supported investigators demonstrated that a curcuminoid-
containing turmeric extract, similar to that found in turmeric 
dietary supplements, significantly inhibited joint inflammation 
and joint destruction. These findings suggest a mechanism for 
turmeric's protective, antiarthritic effect. The investigators 
documented the chemical composition of a curcumin-containing 
compound tested in an animal model for antiarthritic activity; 
provided evidence of antiarthritic efficacy of a turmeric 
extract similar to turmeric dietary supplements; and proposed a 
mechanism of action of curcumin-containing extracts in 
arthritis treatments.
    The centuries-old practice of Ayurvedic medicine supports 
the use of turmeric as an anti-inflammatory agent. Turmeric, a 
botanical supplement, has been widely promoted in the United 
States as a treatment for arthritis, despite the lack of 
standardization of over-the-counter products and paucity of 
scientific efficacy data. This scientific advance builds on and 
extends previous findings that turmeric can prevent joint 
inflammation in an animal model of RA. It also demonstrates the 
application of sophisticated research techniques to assess the 
potential therapeutic benefits of botanicals. Thus, these 
results lay the foundation for further clinical evaluation of 
turmeric dietary supplements in the treatment of RA.
    Excellence: What makes this project exceptional?
    More than 2 million Americans suffer from rheumatoid 
arthritis (RA), a condition in which the body's immune system 
attacks the joints, causing pain, swelling, stiffness, and loss 
of function. Using an animal model, this project provided 
evidence of antiarthritic activity of a turmeric extract, 
similar to that in turmeric dietary supplements.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Rheumatoid arthritis affects the middle-aged and occurs 
with increased frequency in older individuals. This study has 
demonstrated that a turmeric extract, similar to that found in 
turmeric dietary supplements, significantly inhibited joint 
inflammation and joint destruction. The successful translation 
of these results from an animal model to human use would 
provide another effective treatment for arthritis and, 
potentially, other inflammatory diseases.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    These investigators demonstrated in vivo efficacy and 
identified the mechanism of action for a well-characterized 
turmeric extract, which lays the groundwork for clinical 
evaluation of turmeric dietary supplements for the treatment of 
RA.
    Innovativeness: Why is this research exciting or 
newsworthy?
    A variety of medical and lifestyle approaches are used to 
treat RA-associated pain and inflammation, and slow down or 
halt the subsequent joint damage. This study lays the 
foundation for the clinical evaluation of a potentially new 
treatment for a painful and debilitating disease that affects 
older adults. In addition, the research results provide a 
proof-of-concept for the potential use of a botanical to treat 
other inflammatory diseases, such as inflammatory bowel 
disease, asthma, and multiple sclerosis.

  National Center for Complementary and Alternative Medicine: Tai Chi 
           Boosts Immunity to Shingles Virus in Older Adults

    This is the first rigorous clinical trial to suggest that a 
mind-body intervention, tai chi, alone or together with a 
vaccine, can help protect older adults from the varicella 
virus, which causes both chickenpox and shingles.
    Lead Agency: National Center for Complementary and 
Alternative Medicine (NCCAM)/National Institutes of Health 
(NIH).
    Agency Mission:
     Explore complementary and alternative healing 
practices in the context of rigorous science.
     Train complementary and alternative medicine 
researchers.
     Disseminate authoritative information to the 
public and professionals.
    Principal Investigator: Michael R Irwin, M.D., University 
of California, Los Angeles, Neuropsychiatric Institute, 300 
UCLA Medical Plaza, Suite 3109, Los Angeles, CA 90095-7076.
    General Description:

       TAI CHI BOOSTS IMMUNITY TO SHINGLES VIRUS IN OLDER ADULTS

    In a randomized, controlled clinical trial, NIH-supported 
researchers demonstrated that tai chi increases the immunity of 
older adults to the varicella zoster virus that causes both 
chickenpox and shingles and boosts their immune responses to 
the chickenpox vaccine. Tai chi, developed in China around the 
12th century as a martial art, is a low-impact form of exercise 
and moving meditation that can improve physical condition, 
muscle strength, coordination, and flexibility.
    One hundred twelve healthy adults, ages 59 to 86, took part 
in a 16-week program in which they received either a tai chi 
intervention or participated in a health education control 
group. After completing the program, both groups received a 
single injection of VARIVAX%, the chickenpox vaccine. Periodic 
blood tests determined levels of viral immunity during the 
program and nine weeks following vaccine administration. Prior 
to vaccination, tai chi was found to increase pre-existing 
immunity to varicella. Following vaccination, the level of 
immunity to varicella was significantly higher in the tai chi 
group, about a 40 percent increase, compared to the education 
group.
    The researchers further showed that the tai chi group's 
rate of increase in immunity over the course of the study was 
double that of the control group. The tai chi group also 
reported significant improvements in physical functioning, body 
pain, vitality, and mental health.
    Excellence: What makes this project exceptional?
    Tai chi, a traditional Chinese form of exercise, may help 
older adults avoid getting shingles by increasing immunity to 
varicella-zoster virus (VZV) and boosting the immune response 
to varicella vaccine in older adults. This study is the first 
rigorous clinical trial to suggest that a behavioral 
intervention, alone or in combination with a vaccine, can help 
protect older adults from VZV, which causes both chickenpox and 
shingles.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    One in five people who have had chickenpox will get 
shingles later in life, usually after age 50, and the risk 
increases as people get older. More research is needed, but 
this study suggests that the tai chi intervention tested, in 
combination with immunization, may enhance protection of older 
adults from this painful condition.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Tai chi, developed in China around the 12th century as a 
martial art, is a low-impact form of exercise and moving 
meditation that can improve physical condition, muscle 
strength, coordination, and flexibility. It is also said to 
improve balance, which may lower the risk of falls, especially 
in the elderly, and to ease pain and stiffness caused, for 
example, by arthritis. Tai chi is considered to be particularly 
suitable for older people because it is low-impact and can be 
modified easily to accommodate health limitations.
    Innovativeness: Why is this research exciting or 
newsworthy?
    This is the first rigorous clinical trial to suggest that a 
mind-body intervention, tai chi, alone or together with a 
vaccine, can help protect older adults from the varicella 
virus, which causes both chickenpox and shingles.

  National Cancer Institute: Elderly Medicaid Patients Less Likely To 
               Receive Chemotherapy for Colorectal Cancer

    A study using data from the Michigan Tumor Registry and the 
Centers for Medicare and Medicaid Services showed that elderly 
Medicaid-insured patients in the state are less likely to 
initiate or complete chemotherapy for colorectal cancer 
compared with Medicare-insured patients. Previous studies have 
shown that Medicaid-insured patients have worse survival rates 
for colorectal cancer, but it had not been known if they 
receive less treatment than patients with other forms of 
insurance.
    Lead Agency: National Cancer Institute (NCI)/National 
Institutes of Health (NIH).
    Agency Mission: The National Cancer Institute coordinates 
the National Cancer Program, which conducts and supports 
research, training, health information dissemination, and other 
programs with respect to the cause, diagnosis, prevention, and 
treatment of cancer, rehabilitation from cancer, and the 
continuing care of cancer patients and the families of cancer 
patients. Specifically, the Institute:
    Principal Investigator: Cathy J. Bradley, Virginia 
Commonwealth University, 1008 East Clay St., Richmond, VA.
    General Description: Elderly Medicaid Patients Less Likely 
to Receive Chemotherapy for Colorectal Cancer. While major 
improvements have been made in the collection of epidemiologic 
data, special populations such as minorities and the medically 
underserved have been excluded. No accurate epidemiologic 
information exists on the cancer incidence, diagnosis, and 
treatment of these populations. The investigators collected 
data from 4,765 patients aged 65 or older who were diagnosed 
with colorectal cancer between January 1997 and December 2000 
and insured through Medicaid, Medicare, or both. In addition to 
data on chemotherapy initiation and completion, the 
investigators compared whether patients were evaluated by an 
oncologist, subsequently hospitalized, and experienced 
comorbidities; demographic variables including age, race, sex, 
household income, and whether patients lived in a metropolitan, 
urban, or rural area were also studied.
    Patients insured through Medicaid were more likely to be 
African American or of another minority race, female, and to 
live in a low-income area. For all patients, those with 
Medicaid insurance were less likely to initiate or complete 
chemotherapy and less likely to be evaluated by a medical 
oncologist. Older patients were also less likely to initiate 
chemotherapy, even though studies have shown that these 
patients benefit from adjuvant treatment. Future projects using 
the data can include the prevention of disease or disability, 
the restoration or maintenance of health, and interventions for 
more effective health care.
    Excellence: What makes this project exceptional?
    This research provides evidence that elderly patients with 
Medicaid are less likely to initiate or complete chemotherapy 
for colorectal cancer. Previous studies have shown that 
Medicaid-insured patients have worse survival rates for 
colorectal cancer, but it had not been known if they receive 
less treatment than patients with other forms of insurance.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Between 2001 and 2005 the median age at diagnosis for 
colorectal cancer was 71, and approximately 66% of those 
diagnosed were over 65. This research shows that older patients 
with Medicaid are less likely to initiate chemotherapy, even 
though studies have shown that these patients benefit from 
adjuvant treatment.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Medicaid enrollment is associated with disparate colon 
cancer treatment, which likely compromises the survival of 
these patients. Recognizing the deficiencies in the quality of 
care Medicaid patients with colorectal cancer receive will 
hopefully encourage the changes in policies and practices 
needed to reduce this trend.
    Innovativeness: Why is this research exciting or 
newsworthy?
    This research demonstrates the substantially disparate 
treatment uptake and compliance received by Medicaid patients. 
Ensuring access to appropriate care for Medicaid recipients 
with colorectal cancer has the potential to greatly improve the 
quality of life, and life expectancy of these patients, 
especially if similar trends are seen in other states around 
the nation.

 National Cancer Institute: Survival With Treatment vs. Observation of 
                Localized Prostate Cancer in Elderly Men

    Prostate-specific antigen screening has led to an increase 
in the diagnosis and treatment of localized prostate cancer. 
However, the role of active treatment of low- and intermediate-
risk disease in elderly men is controversial. This study 
estimates the association between treatment (with radiation 
therapy or radical prostatectomy) compared with observation and 
overall survival in men with low- and intermediate-risk 
prostate cancer. This study suggests a survival advantage is 
associated with active treatment for low- and intermediate-risk 
prostate cancer in elderly men aged 65 to 80 years.
    Lead Agency: National Cancer Institute (NCI)/National 
Institutes of Health (NIH).
    Agency Mission: The National Cancer Institute coordinates 
the National Cancer Program, which conducts and supports 
research, training, health information dissemination, and other 
programs with respect to the cause, diagnosis, prevention, and 
treatment of cancer, rehabilitation from cancer, and the 
continuing care of cancer patients and the families of cancer 
patients.
    Principal Investigator: Dr. Timothy Rebbeck, Center for 
Clinical Epidemiology and Biostatistics, University of 
Pennsylvania School of Medicine, 904 Blockley Hall, 423 
Guardian Drive, Philadelphia, PA 19104-6021.
    General Description: Survival with Treatment vs. 
Observation of Localized Prostate Cancer in Elderly Men. 
Prostate-specific antigen screening has led to an increase in 
the diagnosis and treatment of localized prostate cancer. 
However, the role of active treatment of low- and intermediate-
risk disease in elderly men is controversial. This study 
estimates the association between treatment (with radiation 
therapy or radical prostatectomy) compared with observation and 
overall survival in men with low- and intermediate-risk 
prostate cancer using the US cohort from Surveillance, 
Epidemiology, and End Results Medicare data. A total of 44,630 
men aged 65 to 80 years who were diagnosed between 1991 and 
1999 with organ-confined, well- or moderately differentiated 
prostate cancer and who had survived more than a year past 
diagnosis. Patients were followed up until death or study end 
and were classified as having received treatment if they had 
claims for radical prostatectomy or radiation therapy during 
the first 6 months after diagnosis. They were classified as 
having received observation if they did not have claims for 
radical prostatectomy, radiation, or hormonal therapy. Patients 
who received only hormonal therapy were excluded. At the end of 
the 12-year study period, 37% of men in the observational group 
23.8% in the treatment group had died. The treatment group had 
longer 5- and 10-year survival than the observation group. 
After using propensity scores to adjust for potential 
confounders (tumor characteristics, demographics, and 
comorbidities), there was a statistically significant survival 
advantage associated with treatment. A benefit associated with 
treatment was seen in all subgroups examined, including older 
men (aged 75-80 years at diagnosis), black men, and men with 
low-risk disease. This study suggests a survival advantage is 
associated with active treatment for low- and intermediate-risk 
prostate cancer in elderly men aged 65 to 80 years. Because 
observational data cannot completely adjust for potential 
selection bias and confounding, these results must be validated 
in randomized controlled trials of alternative management 
strategies in elderly men with localized prostate cancer.
    Excellence: What makes this project exceptional?
    This observational study suggests a reduced risk of 
mortality associated with active treatment for low- and 
intermediate-risk prostate cancer in the elderly Medicare 
population examined. Although a randomized controlled trial 
design is needed to confirm these findings, they help begin to 
answer the long-standing questions regarding treatment 
decisions for older men.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    This study is relevant to older populations because 
prostate cancer primarily affects older men. In fact, from 
2001-2005, the median age at diagnosis for cancer of the 
prostate was 68 years of age, with over 62% of all persons 
diagnosed over 65. This study supports the use of treatment to 
prolong life for these older men.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    This research is especially applicable to older men because 
of the large percentage of prostate cancer cases in this 
population. Upon further study, confirmation of these results 
will lead to the more effective treatment of older men.
    Innovativeness: Why is this research exciting or 
newsworthy?
    This study suggests a survival advantage is associated with 
active treatment for low- and intermediate-risk prostate cancer 
in elderly men aged 65 to 80 years. By helping to answer long-
standing questions about appropriate types of treatment for 
prostate cancer, especially for older men, these findings 
propel researchers to begin to confirm these findings. Through 
future randomized studies the finding that treatment is 
effective for older men can be confirmed and put into practice 
holding the promise to affect countless older men diagnosed 
with this disease.

  National Cancer Institute: Integrating Aging and Cancer Research at 
                     NCI-Designated Cancer Centers

    The goal of this program is to expand the capacity of the 
NCI-designated Cancer Centers to carry out research that 
concentrates on aging and age-related aspects of human cancer 
through support of new investigators, pilot projects, and 
shared resources focused on aging and cancer. Grantees are 
expected to develop a formal research program that would become 
a stable component of the cancer center dedicated to 
collaborative research in aging and cancer and translation of 
findings into the clinical and population settings.
    Lead Agency: National Cancer Institute (NCI)/National 
Institutes of Health (NIH).
    Agency Mission: The National Cancer Institute coordinates 
the National Cancer Program, which conducts and supports 
research, training, health information dissemination, and other 
programs with respect to the cause, diagnosis, prevention, and 
treatment of cancer, rehabilitation from cancer, and the 
continuing care of cancer patients and the families of cancer 
patients.
    Principal Investigator: Richard H. Weindruch, Ph.D., 
University of Wisconsin, VA Hospital (GRECC-4D), 2500 Overlook 
Terrance, Madison, Wisconsin 53705-2286.
    Partner Agency: National Institute on Aging (NIA)/National 
Institutes of Health (NIH).
    General Description: Planning and Development Grants 
Integrating Aging and Cancer Research at NCI-Designated Cancer 
Centers. The goal of this program is to expand the capacity of 
Cancer Centers to engage in pioneering research that 
concentrates on aging- and age-related aspects of human cancer 
through support of new investigators, pilot projects, and 
shared resources focused on aging and cancer. Grantees are 
expected to design and coordinate a research effort in a five-
year project period that will result in a formal aging/cancer 
``Program'' or an equally effective integrated research 
activity that becomes a component of the NCI-funded Cancer 
Center. A solid, focused infrastructure for the conduct and 
continued development of an aging/cancer research program, 
allowing for incorporation of multiple disciplines and creative 
exploration of new approaches to cancer, is also expected.
    A broad range of cancer research falls under this 
scientific initiative, based on seven thematic areas defined in 
a 2001 NIA/NCI Workshop Report: Treatment Efficacy and 
Tolerance; Effects of Comorbidity; The Biology of Aging and 
Cancer; Patterns of Care; Prevention, Risk Assessment, and 
Screening; Psychosocial and Medical Effects; and Palliative 
Care, End-of-Life Care, and Pain Relief.
    Excellence: What makes this project exceptional?
    It was specifically designed to build research capability 
in aging-and age-related aspects of human cancer through the 
NCI-designated Cancer Centers, building upon their abilities to 
work across organizational boundaries, foster transdisciplinary 
research, create long-term stability for scientists and 
research programs, provide extensive core resources to 
investigators, and link to their communities.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    There is a clear need to encourage research which draws 
from expertise in many disciplines to focus on the problems of 
cancer in older persons. This initiative is an effort to 
mobilize expertise through a planning and implementation effort 
that accelerates research at the aging/cancer interface. The 
research initiative provides the initial resources to develop 
and create an integrated, interactive research capability with 
a significant base of externally funded, peer reviewed research 
projects in NCI-designated Cancer Centers that focuses on 
problems of cancer in the elderly. The unique cancer center 
infrastructure and its critical mass of multidisciplinary 
expertise provide an ideal research setting for meeting the 
challenges inherent in integrating aging and cancer research. 
Cancer Centers have well-established interactive research 
environments, and they have the leadership, space, equipment, 
structure and resources available to take advantage of new 
research directions as opportunities arise.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Persons 65 and older are at highest risk for cancer and 
have a higher mortality rate than younger persons. This 
initiative is still underway and it will be some time before 
the true and long-term impact can be assessed. However, it 
should accelerate research specifically focused on in cancer 
and aging research.
    Innovativeness: Why is this research exciting or 
newsworthy?
    This program is the culmination of several years of effort 
by NIA and NCI and extramural scientists with expertise in many 
areas relevant to cancer and aging. It should stimulate 
research capability in this area in the funded institutions and 
visibility for aging/cancer issues, build a cadre of future 
investigators at the cancer/aging research interface, and 
identify important focal areas for further research and 
infrastructure support, thus serving as a platform for 
additional efforts in the future.

 National Human Genome Research Institute: Hutchinson-Gilford Progeria 
                                Syndrome

    The gene responsible for the rare and deadly accelerated 
aging syndrome known as progeria is called LMNA, which is 
translated into a mutant form of a protein called progerin. The 
research aims to understand the specific dysfunctions of 
mutated progerin in the cell by observing cell division, 
creating a mouse model, testing inhibitors, and starting the 
first ever human clinical trial. Understanding the variations 
in the gene and protein product can potentially help treat 
children with progeria, as well as shed light on the normal 
aging process.
    Lead Agency: National Human Genome Research Institute 
(NHGRI)/National Institutes of Health (NIH).
    Agency Mission: The National Human Genome Research 
Institute (NHGRI) led the National Institutes of Health's (NIH) 
contribution to the International Human Genome Project, which 
had as its primary goal the sequencing of the human genome. 
This project was successfully completed in April 2003. Now, the 
NHGRI's mission has expanded to encompass a broad range of 
studies aimed at understanding the structure and function of 
the human genome and its role in health and disease.
    To that end, NHGRI supports the development of resources 
and technology that will accelerate genome research and its 
application to human health. A critical part of the NHGRI 
mission continues to be the study of the ethical, legal, and 
social implications (ELSI) of genome research. NHGRI also 
supports the training of investigators and the dissemination of 
genome information to the public and to health professionals.
    Principal Investigator: Francis S. Collins, MD, PhD, 
Director, NHGRI, Building 31, Room 4B09, 31 Center Dr, MSC 
2152, Bethesda, MD 20892-2152.
    General Description: Hutchinson-Gilford progeria syndrome 
(HGPS) is the most dramatic human syndrome of premature aging. 
Children with this rare condition are normal at birth, but by 
age 2 they have stopped growing, lost their hair, and shown 
skin changes and loss of subcutaneous tissue that resemble the 
ravages of old age. They rarely live past adolescence, dying 
almost always of advanced cardiovascular disease (heart attack 
and stroke). The classic syndrome has never been observed to 
recur in families. The laboratory conducting this research 
discovered that nearly all cases of HGPS harbor a de novo point 
mutation in codon 608 of the LMNA gene. This mutation causes 
disease by creating an abnormal splice donor, generating a mRNA 
with an internal deletion of 150 nt. This is translated into a 
mutant form of the lamin A protein (referred to now as 
progerin) that lacks 50 amino acids near the C-terminus. This 
research has shown that progerin acts as a dominant negative to 
disrupt the structure of the nuclear membrane scaffold. Recent 
data has also demonstrated that progerin interferes with proper 
chromosome segregation during mitosis. A mouse model for HGPS 
has been developed. Animals carrying a human BAC transgene 
bearing the codon 608 mutation show progressive loss of smooth 
muscle cells in the media of large vessels, with replacement by 
proteoglycan. Thus, the mouse model nicely replicates the 
cardiovascular phenotype of HGPS.
    This project has also explored the possibility that 
farnesyl transferase inhibitors (FTIs) might be beneficial in 
HGPS, since lamin A is a farnesylated protein. Treatment of 
progeria fibroblasts growing in cell culture demonstrates that 
FTIs are capable of reversing the dramatic nuclear blebbing 
that is the hallmark of the disease. Based on this data, the 
research team is conducting a trial of FTIs in the progeria 
mouse model. A clinical trial of FTIs in children with the 
disease is planned to be initiated shortly.
    Finally, it is hypothesized that other structural or 
regulatory variants in the LMNA gene might actually be 
protective against the normal aging process. Accordingly, the 
lab is also comparing haplotypes in well-matched cohorts of 
controls and individuals who have achieved exceptional 
longevity.
    Excellence: What makes this project exceptional?
    The research team has uncovered remarkable findings about 
the syndrome as well as its basic biological malfunctions. In 
addition to discovering the gene responsible and its regulatory 
pathway inside the cell, the team has discovered that drugs 
known as farnesyltransferase inhibitors (FTIs), which are 
currently being tested in people with myeloid leukemia, 
neurofibromatosis and other conditions, might also provide a 
potential therapy for children suffering from Hutchinson-
Gilford Progeria Syndrome.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Progeria studies are crucial to understand the normal aging 
process. Understanding the biology of progeria and the mutated 
form of the LMNA protein also helps researchers understand the 
normal process that happens in the rest of us.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    If the mutated progerin proteins are able to be slowed down 
by drugs, the research may provide potential ways to extend 
longevity and health in the normal population as well.
    Innovativeness: Why is this research exciting or 
newsworthy?
    Not only does this research hold promise for children and 
families affected by progeria by initiating the first ever 
clinical trial, it also sheds light on the biology of aging and 
common elderly conditions such as atherosclerotic disease.

    National Human Genome Research Institute: Understanding of the 
            Molecular Mechanisms of Cardiovascular Diseases

    This innovative laboratory team seeks to identify the 
molecular, cellular, and genetic mechanisms that cause vascular 
disorders. In particular, their research focuses on defining 
the pathways that regulate cell growth in the vasculature, 
remodel the vasculature after injury, and lead to genetic 
susceptibility to vascular diseases. Taken together, these 
studies focus on the molecular genetics of vascular diseases, 
with an emphasis on cell cycle regulation of proliferation, 
inflammation, and apoptosis.
    Lead Agency: National Human Genome Research Institute 
(NHGRI)/National Institutes of Health
    Agency Mission: The National Human Genome Research 
Institute (NHGRI) led the National Institutes of Health's (NIH) 
contribution to the International Human Genome Project, which 
had as its primary goal the sequencing of the human genome. 
This project was successfully completed in April 2003. Now, the 
NHGRI's mission has expanded to encompass a broad range of 
studies aimed at understanding the structure and function of 
the human genome and its role in health and disease.
    To that end NHGRI supports the development of resources and 
technology that will accelerate genome research and its 
application to human health. A critical part of the NHGRI 
mission continues to be the study of the ethical, legal and 
social implications (ELSI) of genome research. NHGRI also 
supports the training of investigators and the dissemination of 
genome information to the public and to health professionals.
    Principal Investigator: Elizabeth G. Nabel, M.D., Director, 
NHLBI, Building 50, Room 4525, 50 South Dr, MSC 8016, Bethesda, 
MD 20892-8016.
    General Description:

   UNDERSTANDING THE MOLECULAR MECHANISMS OF CARDIOVASCULAR DISEASES

    Cardiovascular diseases are the leading cause of morbidity 
and mortality in industrialized countries. Most cardiovascular 
diseases result from complications of atherosclerosis, which is 
a chronic and progressive inflammatory condition characterized 
by excessive cellular proliferation of vascular smooth muscle 
cells, endothelial cells, and inflammatory cells that leads to 
occlusive vascular disease, myocardial infarction, and stroke. 
Recent studies have revealed the important role of cyclins, 
cyclin-dependent kinases (CDKs), and cyclin-dependent kinase 
inhibitors (CKIs) in vascular and cardiac tissue injury, 
inflammation, and wound repair. This research seeks to 
understand the circuitry of the cyclin-CDK-CKI interactions in 
normal physiology and disease pathology, providing a better 
understanding of the molecular mechanisms of cardiovascular 
diseases. This approach will hopefully lead to the rational 
design of new classes of therapeutic agents.
    Given the role of cyclins in vascular health, a major focus 
of the study is CKIs, which are primarily involved in 
inhibiting the proliferation of a variety of normal cell types. 
Previous research identified a particular CKI, known as 
p27Kip1, as a major regulator of vascular cell 
proliferation during arterial remodeling. In one set of 
studies, her group found that p27Kip1 plays a major 
role in cardiovascular disease through its effects on the 
proliferation of bone marrow-derived immune cells that migrate 
into vascular lesions. To demonstrate whether 
p27Kip1 regulates arterial wound repair, NHGRI 
Investigators recently subjected p27-/- (homozygous 
knockout), p27+/- (heterozygous knockout), and 
p27+/+ (wild-type) mice to a wire injury in the 
femoral artery and examined subsequent cell proliferation and 
lesion formation. Cell proliferation was significantly 
increased in the innermost lining of the blood vessels of 
p27-/- mouse arteries compared with 
p27+/+ arteries. Arterial lesions also were markedly 
increased in the p27-/- mice compared with those of 
p27+/+ mice. The heterozygous knockout mice 
(p27-/+) had an intermediate phenotype. These 
findings suggest that vascular repair and regeneration are 
regulated by the proliferation of hematopoietically and 
nonhematopoietically derived cells through a 
p27Kip1-dependent mechanism, with immune cells 
largely mediating these effects.
    A related area of study focuses on the structural and 
functional analysis of a serine-threonine kinase called kinase 
interacting stathmin, or KIS. A nuclear protein that binds the 
C-terminal domain of p27Kip1, KIS phosphorylates a 
serine residue at position 10 (Ser 10) in the sequence and 
thereby promotes its export to the cytoplasm. KIS is activated 
by mitogens during G0/G1, and expression of KIS overcomes 
growth arrest induced by p27Kip1. Depletion of KIS 
with small interfering RNA (siRNA) inhibits Ser 10 
phosphorylation and enhances growth arrest. In addition, 
treating p27-/- cells with KIS siRNA causes them to 
grow and progress to S/G2, similar to control-treated cells, 
implicating p27Kip1 as the critical target for KIS. 
Previous research cloned and characterized the gene encoding 
this kinase and is studies are now examining its structure and 
function, including the transcriptional control of the KIS 
promoter, the phenotypic consequences of knockout out the KIS 
gene in mice, and the effect of knock-in mutations at different 
phosphorylation sites of p27.
    NHGRI investigators are also involved in a clinical study 
of the genetics of restenosis, which is the recurrence of a 
blockage in an artery after it has been manually reopened with 
an artificial stent. Restenosis is a major limitation of stent 
therapy for coronary artery disease. In this study, the 
investigators are following patients who have received bare 
metal stents for the treatment of a blocked coronary artery and 
then comparing the genetic profiles of patients with restenosis 
with those of patients with no restenosis. The genetic analyses 
include gene expression profiling, serum proteomics, and 
genotyping using candidate gene and genome-wide scanning 
approaches. The goal is to identify gene, RNA, and protein 
profiles of patients with recurrent restenosis, so as to 
advance our understanding of the pathogenesis of this problem 
and to target potential therapies.
    Excellence: What makes this project exceptional?
    This project utilizes both cardiovascular and genetic 
medicine to create innovative therapeutic targets for 
conditions that affect millions worldwide.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Cardiovascular disease remains the leading cause of death 
and disability in the elderly population, and cardiovascular 
risk increases steadily with age.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Understanding the molecular pathophysiology of vascular 
diseases, such as in-stent restenosis, is critical to the 
design and development of novel therapeutics.
    Innovativeness: Why is this research exciting or 
newsworthy?
    This research has the potential to identify key genetic 
variants responsible for cardiovascular inflammation, a wide-
spread condition, with the aim of eventually tailoring 
therapies specifically for each group.

     National Heart, Lung, and Blood Institute: Action To Control 
                Cardiovascular Risk in Diabetes (ACCORD)

    ACCORD (Action to Control Cardiovascular Risk in Diabetes) 
is evaluating approaches to decrease the occurrence of major 
CVD events--heart attack, stroke or death from CVD--among high-
risk patients with type 2 diabetes.
    Lead Agency: National Heart, Lung, and Blood Institute 
(NHLBI)/National Institutes of Health (NIH).
    Agency Mission:
     Provide leadership for a national program in 
diseases of the heart, blood vessels, lung, and blood; blood 
resources; and sleep disorders.
     Plan, conduct, foster, and support an integrated 
and coordinated program of basic research, clinical 
investigations and trials, observational studies, and 
demonstration and education projects related to the causes, 
prevention, diagnosis, and treatment of heart, blood vessel, 
lung, and blood diseases; and sleep disorders.
     Conduct educational activities for health 
professionals and the public with an emphasis on prevention.
     Support research training and career development 
of new and established researchers in fundamental sciences and 
clinical disciplines.
    Principal Investigator(s):
    Coordinating Center PI: Robert Byington, Ph.D, Email: 
[email protected], Phone: 336-716-2885.
    Steering Committee Chairman: William Friedewald, M.D., 
Email: [email protected], Phone: 212-305-3017.
    NHLBI Project Officer: Denise Simons-Morton, M.D., Ph.D, 
Email: [email protected], Phone: 301-435-0384.
    Partner Agencies: National Institute of Diabetes and 
Digestive and Kidney Diseases (NIDDK), National Center on 
Minority Health and Health Disparities (NCMHD), National 
Institute on Aging (NIA), National Eye Institute (NEI), Centers 
for Disease Control and Prevention (CDC), and Sanofi Aventis 
(Conditional gift fund).
    General Description:

       ACTION TO CONTROL CARDIOVASCULAR RISK IN DIABETES (ACCORD)

    ACCORD (www.accordtrial.org) is a large clinical trial of 
adults with established type 2 diabetes who are at especially 
high risk of cardiovascular disease (CVD). Type 2 diabetes is a 
complex metabolic disease characterized by high blood glucose 
(sugar) levels. People with this form of diabetes have insulin 
resistance and a progressive loss of the ability to produce 
insulin.
    Type 2 diabetes increases the risk of a number of 
complications, especially CVD. Adults with type 2 diabetes are 
two to four times more likely to die of heart disease and 
stroke than adults without diabetes; about 65 percent of people 
with diabetes succumb to these diseases. Many people with type 
2 diabetes are overweight and have high blood pressure and 
undesirable cholesterol levels--conditions that further add to 
CVD risk.
    ACCORD is testing approaches to decrease the high rate of 
major CVD events--heart attack, stroke, or death from CVD--
among high-risk patients with type 2 diabetes. Three treatment 
approaches are being evaluated: intensive lowering of blood 
sugar levels compared with lowering to the conventional target 
level, intensive lowering of blood pressure compared with 
lowering to the conventional target level, and modification of 
blood cholesterol levels using a fibrate plus a statin compared 
with a statin alone.
    The study began enrolling participants in 2001 at 77 
clinical sites across the United States and Canada. A total of 
10,251 adults with established type 2 diabetes are 
participating. At enrollment, they were 40-79 years of age 
(average age, 62), had diabetes for an average of 10 years, and 
either had diagnosed CVD or had at least two CVD risk factors 
(high LDL cholesterol, high blood pressure, smoking, obesity) 
in addition to type 2 diabetes.
    In addition to CVD, outcomes of interest include 
microvascular diseases, cognition, and quality of life.
    Treatment is scheduled to end in 2009, with final results 
reported in 2010.
    Excellence: What makes this project exceptional?
    ACCORD is testing aggressive strategies to reduce the 
burden of CVD among highly vulnerable patients with type 2 
diabetes.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Type 2 diabetes primarily affects older persons, and its 
prevalence is growing as the population ages and risk factors 
such as obesity affect increasing numbers of people.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Recently, ACCORD found that intensively lowering blood 
sugar to near-normal levels did not significantly reduce the 
risk of major CVD events, such as fatal or non-fatal heart 
attacks or strokes. In fact, when compared with standard 
treatment this approach appeared to increase the risk of death. 
This is important evidence to help guide treatment of adults 
with type 2 diabetes who already have CVD or are at high risk 
of developing it. For such individuals, intensively lowering 
blood sugar may be too risky.
    Innovativeness: Why is this research exciting or 
newsworthy?
    The research addresses an important clinical problem for 
which no effective preventive strategies have heretofore been 
identified.

 National Heart, Lung, and Blood Institute: Home Oxygen Therapy Trial 
               for Chronic Obstructive Pulmonary Disease?

    The LOTT will determine the effectiveness and safety of 
long-term, home-administered oxygen therapy in patients with 
moderate COPD. Findings will inform decision-making about 
extending coverage for home oxygen treatment to such patients.
    Lead Agency: National Heart, Lung, and Blood Institute 
(NHLBI)/National Institutes of Health (NIH).
    Agency Mission:
     Provide leadership for a national program in 
diseases of the heart, blood vessels, lung, and blood; blood 
resources; and sleep disorders.
     Plan, conduct, foster, and support an integrated 
and coordinated program of basic research, clinical 
investigations and trials, observational studies, and 
demonstration and education projects related to the causes, 
prevention, diagnosis, and treatment of heart, blood vessel, 
lung, and blood diseases; and sleep disorders.
     Conduct educational activities for health 
professionals and the public with an emphasis on prevention.
     Support research training and career development 
of new and established researchers in fundamental sciences and 
clinical disciplines.
    Principal Investigator:
    Steering Committee Chairman: William Bailey, M.D., UAB 
Hospital 1802 6th Avenue South, Birmingham, AL 35249.
    NHLBI Project Officer: Thomas Croxton, M.D., Ph.D.
    Partner Agencies: The Centers for Medicare and Medicaid 
Services (CMS).
    General Description:

  HOME OXYGEN THERAPY TRIAL FOR CHRONIC OBSTRUCTIVE PULMONARY DISEASE

    The NHLBI, in collaboration with the Center for Medicare 
and Medicaid Services (CMS), has launched a large randomized 
clinical trial of the effectiveness and safety of long-term, 
home oxygen therapy for COPD (chronic obstructive pulmonary 
disease). The six-year, $28 million project will study patients 
with moderate disease.
    COPD, a lung disease that severely impairs the ability to 
breathe, is the fourth most common cause of death in the United 
States. In the Long-Term Oxygen Treatment Trial (LOTT), 
researchers at 14 clinical centers across the United States 
will study approximately 3,500 COPD patients to determine 
whether supplemental oxygen will improve longevity, exercise 
capacity, and quality of life.
    The results will provide a scientific basis for decisions 
about whether to extend Medicare coverage for home oxygen 
treatment to patients with moderate disease. Currently, 
coverage of home oxygen therapy is limited to beneficiaries 
with severe COPD (very low blood oxygen levels while resting).
    Excellence: What makes this project exceptional?
    LOTT is the largest randomized clinical trial of the 
effectiveness and safety of long-term, home oxygen therapy for 
COPD.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Approximately 12 million adults in the United States have 
been diagnosed with COPD, and it is believed that another 12 
million have the disease but are unaware of it. COPD typically 
develops in older persons after years of cigarette smoking. It 
is a major cause of disability and death.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    If the LOTT determines that home oxygen treatment is 
beneficial for patients with moderate COPD, it is likely that 
Medicare coverage for this therapy will follow.
    Innovativeness: Why is this research exciting or 
newsworthy?
    Many individuals with COPD are desperate for approaches to 
alleviate symptoms and improve function, and they are largely 
dependent on Medicare coverage to pay for treatment.

 National Heart, Lung, and Blood Institute (NHLBI)/National Institutes 
 of Health (NIH): Women's Health Initiative (WHI): Hormone Replacement 
                                Therapy

    The WHI is a 15-year study of strategies for preventing 
heart disease, breast and colorectal cancers, and osteoporosis 
in postmenopausal women.
    Lead Agency: National Heart, Lung, and Blood Institute 
(NHLBI), National Institutes of Health (NIH).
    Agency Mission:
     Provide leadership for a national program in 
diseases of the heart, blood vessels, lung, and blood; blood 
resources; and sleep disorders.
     Plan, conduct, foster, and support an integrated 
and coordinated program of basic research, clinical 
investigations and trials, observational studies, and 
demonstration and education projects related to the causes, 
prevention, diagnosis, and treatment of heart, blood vessel, 
lung, and blood diseases; and sleep disorders.
     Conduct educational activities for health 
professionals and the public with an emphasis on prevention.
     Support research training and career development 
of new and established researchers in fundamental sciences and 
clinical disciplines.
    Principal Investigators: Dr. Marcia Stefanick, Steering 
Committee Chair, National Heart, Lung, and Blood Institute, 
NIH, Bethesda, MD 20892-2482.
    Partner Agency: National Institute of Arthritis and 
Musculoskeletal and Skin Diseases (NIAMS), Office of Research 
on Women's Health (ORWH), Health Resources and Services 
Administration (HRSA), and National Cancer Institute (NCI).
    General Description: The WHI is a 15-year study of 
strategies for preventing heart disease, breast and colorectal 
cancers, and osteoporosis in postmenopausal women. Launched by 
the NIH in 1991, it has been administered by the NHLBI since 
fiscal year 1998. More than 160,000 women from across the 
United States, who were between 50 and 79 years of age at the 
time of their recruitment, enrolled in the WHI clinical trials 
and observational study; almost 30,000 of them are minorities. 
The clinical trial component, now completed, consists of three 
prevention studies examining the effects of postmenopausal 
hormone therapy on risk of coronary heart disease (CHD), 
osteoporosis, and breast cancer; the effects of a low-fat diet 
on risk of breast and colorectal cancers and CHD; and the role 
of calcium and vitamin D supplementation in preventing 
fractures and colorectal cancer. The Observational Study 
component has focused on identifying predictors of disease. In 
addition, a Community Prevention Study was conducted in 
collaboration with the Centers for Disease Control and 
Prevention to examine strategies for enhancing adoption of 
healthful behaviors, particularly among minority and under-
served women.
    Excellence: What makes this project exceptional?
    The WHI is the largest disease prevention study ever 
undertaken in postmenopausal women.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Given the remarkable increases in life expectancy that have 
occurred in recent years, the average American woman can expect 
to live more than a third of her life after menopause and, 
thus, experience a high risk of developing CHD, breast and 
colorectal cancer, and osteoporosis. Effective strategies are 
needed to prevent these chronic diseases and thereby enhance 
longevity and quality of life.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    The WHI postmenopausal hormone trials produced startling 
results that had an immediate effect on prescribing practices. 
They included two placebo-controlled components--a study of 
estrogen plus progestin in women who had an intact uterus and a 
study of estrogen alone in women who had undergone a 
hysterectomy. Both studies were designed to test the hypothesis 
that long-term use of hormone therapy could reduce risk of CHD.
    The estrogen-plus-progestin trial was halted ahead of 
schedule in July 2002. Compared with women taking a placebo, 
study participants taking hormones experienced higher rates of 
heart attack, stroke, blood clots, and invasive breast cancer. 
Although the women taking hormones also had a lower incidence 
of colon cancer and fewer hip fractures, the overall balance of 
risks and benefits was unfavorable.
    In March 2004, the second hormone trial component also was 
halted ahead of schedule. With an average of nearly 7 years of 
follow-up completed, the trial revealed that estrogen-alone 
therapy had no effect on CHD risk, but it increased risk of 
stroke and of blood clots in the legs. No evidence of elevated 
breast cancer risk was found, and a favorable effect on bone 
health emerged. On balance, however, the trial indicated that 
postmenopausal hormone therapy should not be prescribed for 
chronic disease prevention, but only for short-term relief of 
menopausal symptoms.
    The WHI hormone trials also failed to find evidence of 
other putative benefits of hormone therapy--on cognitive 
function, urinary incontinence, or quality of life, for 
example.
    A follow-up study published in 2008 found that the 
unfavorable balance of risk versus benefit associated with 
long-term use of estrogen-plus-progestin therapy persisted even 
after the drugs were stopped. Although the increased risk of 
CHD diminished three years after halting treatment, overall 
risks including stroke, blood clots, and cancer, remained 
elevated.
    Innovativeness: Why is this exciting or newsworthy?
    For many years postmenopausal hormones were prescribed to 
women not only because they alleviate symptoms (e.g., hot 
flashes) but also because they were believed to be helpful in 
preventing CHD and other chronic conditions. The surprising 
findings of the WHI trials fundamentally changed perceptions of 
the role of hormone therapy in health promotion among 
postmenopausal women.

   National Institute on Aging: Alzheimer's Disease Research Centers

    Much of the progress in Alzheimer's disease research in the 
United States over the past 20 years has been made through the 
NIH-supported Alzheimer's Disease Centers, where ADC scientists 
have conducted exemplary research and provided rich resources 
to investigators across the community of Alzheimer's disease 
researchers.
    Lead Agency: National Institute on Aging (NIA)/National 
Institutes of Health (NIH).
    Agency Mission: 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.
    Principal Investigator: Creighton Phelps, Ph.D., National 
Institute on Aging, Division of Neuroscience, 7201 Wisconsin 
Avenue, Bethesda, MD 20892.
    General Description:

                  ALZHEIMER'S DISEASE RESEARCH CENTERS

    Much of the important progress made in Alzheimer's disease 
(AD) research in the United States over the past 20 years has 
come through studies conducted by the NIH-supported Alzheimer's 
Disease Centers (ADCs). For example, ADC scientists have 
conducted much of the research on protein processing related to 
plaque and tangle formation--the hallmark of AD. Other studies 
are examining changes in brain structure at different clinical 
stages of AD, developing brain imaging technologies, and 
conducting neuropathology autopsy evaluations. ADC researchers 
have also focused on evaluating cognitive changes associated 
with normal aging, the transitions to mild cognitive impairment 
and early dementia, and factors that contribute to changes in 
cognitive abilities. Relationships and commonalities between 
Alzheimer's and other neurodegenerative diseases are also 
emphasized as well as the contributions of non-neurological co-
morbid conditions such as cardiovascular disease, diabetes, and 
inflammation.
    By pooling resources and working cooperatively, the ADCs 
have produced research findings and developed resources 
resulting in accomplishments that could not have been achieved 
by individual investigators. In addition, the ADCs have 
provided resources for hundreds of research projects conducted 
outside of the ADC network. Shared resources include biological 
samples and data from longitudinal studies on the development 
of dementia in particular populations, brain and specimen banks 
comprised of well-characterized specimens collected under 
standardized protocols, and a National Cell Repository for 
Alzheimer's Disease which collects and stores blood, well-
documented phenotypic data, DNA, and cell lines from families 
that have multiple affected members. The repository is part of 
the NIA AD Genetics Initiative to identify genetic risk factors 
for late onset AD. Other ADC collaborative efforts that have 
led to the establishment of other research resources such as 
the Consortium to Establish a Registry for Alzheimer's Disease, 
the National Alzheimer's Coordinating Center, the Alzheimer's 
Disease Cooperative Study, and the Alzheimer's Disease 
Neuroimaging Initiative.
    Excellence: What makes this project exceptional?
    The ADC program has brought together the top experts in the 
country to accelerate progress in developing a more 
comprehensive understanding of the mechanisms that underlie the 
development of AD. The program has also greatly enhanced the 
work of many more researchers by providing much needed 
resources to the larger community of AD researchers as they 
search for better strategies to prevent and treat the disease.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Alzheimer's disease (AD) is the most common form of 
dementia among older people. It is a neurodegenerative disease 
that damages the parts of the brain controlling thought, 
memory, and language. AD is estimated to affect approximately 
4.5 million older people in the United States. Although 
occasionally it is diagnosed in patients in their forties and 
fifties, AD most frequently is associated with advancing age. 
The disease doubles in prevalence with every 5 years past the 
age of 65; thus, extending life by 10 years quadruples the 
probability of the disease occurring. AD is the most frequent 
cause of institutionalization for long-term care. It destroys 
the active productive lives of its victims and devastates their 
families financially and emotionally.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    The ADCs have produced research findings and developed 
resources that could not have been achieved by individual 
investigators working alone. Biological samples from 
Alzheimer's patients have provided the materials for hundreds 
of non-ADC funded projects including genetic projects currently 
underway. Several major longitudinal studies on the development 
of dementia in particular populations rely on ADC core 
facilities, and integrate their findings with those of the 
centers.
    Innovativeness: Why is this research exciting or 
newsworthy?
    It has been estimated that the United States spends as much 
as $148 billion per year for the direct and indirect costs of 
care for patients with AD. With the rapidly increasing 
percentage of the population over the age of 65, the number of 
people with AD will increase proportionately, as will the toll 
it takes. If interventions cannot be found, the large number of 
people who will develop AD will overwhelm the health care 
system. As we learn about the causes of AD, we are better 
positioned to finding new interventions and, ultimately, a cure 
for this devastating disease.

National Institute on Aging (NIA)/National Institutes of Health (NIH): 
          The Dynamics of Health, Aging, and Body Composition

    The Health ABC study will identify how increases in body 
fat and declines in lean mass and bone mineral yield a body 
susceptible to multiple diseases contributing to disability in 
old age. 3,075 men and women between the ages of 70-79 who are 
free of disability were selected for this study. Body weight, 
lean body mass, and body fat are quantified from computed 
tomography images using software developed by CIT's Biomedical 
Imaging Research Services Section (BIRSS), Division of 
Computational Bioscience (DCB).
    Lead Agency: National Institute on Aging (NIA), National 
Institutes of Health (NIH).
    Agency Mission:
     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.
    Principal Investigators: Tamara B. Harris, M.D., M.S., 
Senior Investigator, Intramural Research Program, National 
Institute on Aging, Laboratory of Epidemiology, Demography, and 
Biometry, Gateway Building, 3C309, 7201 Wisconsin Avenue, 
Bethesda, MD 20892.
    Partner Agency: NIH Center for Information Technology 
(CIT), National Institute of Diabetes and Digestive and Kidney 
Diseases (NIDDK), National Institute of Arthritis and 
Musculoskeletal and Skin Diseases (NIAMS), National Research 
Council of Italy, American Heart Association, American Diabetes 
Association, and Hologic Inc.
    General Description: The Center for Information Technology 
is collaborating with the National Institute of Aging to assist 
in image segmentation and quantification in a clinical research 
study, the Dynamics of Health, Aging and Body Composition 
(Health ABC). The Health ABC study will identify how increases 
in body fat and declines in lean mass and bone mineral yield a 
body susceptible to multiple diseases contributing to 
disability in old age. 3,075 men and women between the ages of 
70--79 who are free of disability were selected for this study. 
CIT is augmenting the analysis from computerized tomography 
scans. Lean body mass, and body fat are quantified from 
computed tomography images using software developed by CIT's 
Biomedical Imaging Research Services Section (BIRSS), Division 
of Computational Bioscience (DCB). Manual image segmentation is 
laborious and subject to inter and intra-observer variability 
when performing volumetric analysis. An extension of BIRSS' 
MIPAV software provides researchers with a multistage semi-
automatic process for image segmentation, quantification, and 
visualization.
    Excellence: What makes this project exceptional?
    The Health ABC study will identify how increases in body 
fat and declines in lean mass and bone mineral yield a body 
susceptible to multiple diseases contributing to disability in 
old age. This should help to address questions of morbidity 
related to body weight and weight related health conditions in 
old age.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Older people incur multiple health conditions as they age 
that affect multiple organ systems. Most studies of aging that 
had been performed prior to 1998 tended to emphasize the 
function of one organ system: heart, brain, bone rather than a 
comprehensive assessment. Health ABC used the principle of 
weight-related health conditions to organize a multi-
dimensional study.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    This research has shown that the same risk factors that 
cause early declines in function contribute to later, major 
losses in function and the onset of frailty. This is a powerful 
prevention message for aging.
    Innovativeness: Why is this exciting or newsworthy?
    Early interventions on weight, heart disease, diabetes, 
inflammation, and depression may prevent later declines to 
frailty in old age.

National Institute on Aging (NIA)/National Institutes of Health (NIH): 
   Exemplary Research Conducted through the Edward R. Roybal Centers

    Investigators at the Edward R. Roybal Centers for 
Translational Research in the Social and Behavioral Sciences 
are working to improve the health, quality of life, and 
productivity of middle-aged and older people by translating 
findings from the social and behavioral sciences into practical 
outcomes.
    Lead Agency: National Institute on Aging (NIA), National 
Institutes of Health (NIH).
    Agency Mission:
     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.
    Principal Investigators: Tamara Jones, Ph.D., National 
Institute on Aging, 7201 Wisconsin Avenue, Bethesda, MD 20892, 
NIA Legislative Officer.
    General Description: The Edward R. Roybal Centers for 
Translational Research in the Social and Behavioral Sciences, 
first authorized by Congress in 1993, are designed to improve 
the health, quality of life, and productivity of middle-aged 
and older people by facilitating the translation of knowledge 
learned in the social and behavioral sciences into practical 
outcomes. Investigators at the Roybal Centers have made a 
number of key discoveries in the emerging field of 
translational behavioral and social research. For example:
           The Roybal Center at the University of 
        Alabama at Birmingham has developed tools and 
        technologies for identifying older adults at risk for 
        automobile crash involvement, and is working with 
        industry partners to develop and disseminate products 
        based on these tools.
           The Roybal Center at the University of 
        Illinois at Chicago (UIC) has developed two evidence-
        based interventions from its in-depth work on physical 
        activity for older adults. One program, Fit and 
        Strong!, is targeted to older adults with lower 
        extremity osteoarthritis, and one is targeted to older 
        adults with developmental/intellectual disabilities 
        (primarily Down syndrome). Both programs are currently 
        being used in several states; in addition, the Center 
        has partnered with the National Arthritis Foundation 
        (NAF) to replicate Fit and Strong! through NAF chapters 
        nationwide.
           Another investigator at the UIC Roybal 
        Center has developed instruments for self-efficacy 
        appropriate for use with older adults with 
        developmental/intellectual disabilities, and these have 
        been adopted internationally.
           The Oregon Center for Aging and Technology 
        (ORCATECH), a Roybal Center, has developed a ``living 
        laboratory'' model methodology for in-home assessment 
        of activity to facilitate early detection of changes in 
        health or memory. This new technology provides a 
        continuous data stream, which provides a more complete 
        view of real-world function and an improved 
        understanding of the variability of in-home activity. 
        Other companies have used the ORCATECH model to develop 
        related products, and the model has spurred several new 
        grant-funded research projects, including the 
        development of a new medication tracker for older 
        adults.
    Excellence: What makes this project exceptional?
    As recent years have seen an explosion of fundamental 
insights in the basic social and behavioral sciences, 
translating this knowledge into practical advances to benefit 
the health and well being of older Americans has increasingly 
become a priority for the NIH. Since 1993, the Roybal Centers 
have been at the forefront of the NIH's efforts in 
translational behavioral and social science aimed at older 
Americans.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    The development and testing of interventions that will 
benefit the health and well being of older Americans, and the 
effective translation of these interventions into routine 
practice, is becoming increasingly important: Between now and 
2030, the number of individuals age 65 and older will likely 
double, reaching 71.5 million and comprising a larger 
proportion of the entire population, up from 13 percent today 
to 20 percent in 2030.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Because the mission of the Roybal Centers is the 
translation of scientific and technological findings into 
practical applications for older adults, their findings may be 
expected to have a widespread impact. For example, the tools 
for identifying at-risk older drivers (referenced above) are 
currently being translated into practice in several states, and 
the Roybal-developed instruments for self-efficacy among 
intellectually disabled older adults (also referenced above) 
are being used internationally.
    Innovativeness: Why is this exciting or newsworthy?
    By identifying ways to move interventions from the clinic 
to the mainstream, the Roybal Centers are poised to make a 
real-world difference in the lives of everyday Americans.

National Institute on Aging (NIA)/National Institutes of Health (NIH): 
              Useful Field of View Test for Older Drivers

    A new test of visual function may ultimately help older 
adults, their families, and physicians decide when it's okay 
for an older person to continue driving or when it may be time 
to hang up the car keys. Using a novel ``useful field of view'' 
measure to assess how drivers process visual information, 
researchers at the University of Alabama at Birmingham found 
that poor performance on the test was linked to an increased 
risk of car crashes. Drivers who showed a 40 percent or greater 
impairment in their useful field of view were more than twice 
as likely to be involved in a crash within 3 years of testing.
    Lead Agency: National Institute on Aging (NIA), National 
Institutes of Health (NIH).
    Agency Mission:
           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.
    Principal Investigators: Karlene Ball, Ph.D., University of 
Alabama at Birmingham, Campbell Hall/Suite 415, 1300 University 
Blvd., Birmingham, AL 32594-1170.
    General Description: A new test of visual function may 
ultimately help the elderly, their families, and physicians 
decide when it's okay for an older person to continue driving 
or when it may be time to hang up the car keys. Using a novel 
``useful field of view'' (UFOV) measure to assess how older 
adults process visual information, researchers at the 
University of Alabama at Birmingham (UAB) found that poor 
performance on the test was linked to an increased risk of car 
crashes. Drivers who showed a 40 percent or greater impairment 
in their useful field of view were more than twice as likely to 
be involved in a crash within 3 years of testing.
    The study marks the first time that scientists have 
attempted to find out whether or not a visual processing test 
can predict the likelihood of future crashes for individual 
older adults. The test differs substantially from standard eye 
exams, which measure acuity or visual function or the ability 
to see an object at a given distance. To assess their visual 
processing abilities, participants in this study looked at a 
computer screen with figures of cars, trucks, and other 
objects. The drivers were asked to identify a particular object 
amid different kinds of visual distractions on the screen. The 
useful field of view was defined as the area in which rapidly 
presented visual information can be used. People who had 
measured difficulty with the task were considered to have an 
impaired useful field of view.
    Some 294 drivers ranging in age from 55 to 87 participated 
in the study. In addition to being tested for visual function, 
information was collected on the participants' general health, 
mental status, and how often they drove so that the researchers 
could determine the factors involved in crashes over the three-
year follow-up period from 1990 to 1993. Crash reports 
involving the participants were collected from a state agency, 
and researchers compared the useful field of view scores and 
results from the other types of vision tests with the crash 
information.
    Performance on the useful field of view test was found to 
be directly related to involvement in a crash. People with a 40 
percent or greater impairment in their useful field of view 
were more than twice as likely to be involved in a crash. For 
every 10 points of reduction in a driver's useful field of view 
measure, his or her crash risk rose by 16 percent, regardless 
of age. Other vision tests did not predict the risk of future 
crashes.
    Excellence: What makes this project exceptional?
    The test used in this study differs substantially from 
standard eye exams, which measure acuity or visual function or 
the ability to see an object at a given distance. To assess 
their visual processing abilities, participants were asked to 
identify a particular object amid different kinds of visual 
distractions on a computer screen with figures of cars, trucks, 
and other objects. The useful field of view was defined as the 
area in which rapidly presented visual information can be used. 
People who had measured difficulty with the task were 
considered to have an impaired useful field of view.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Older drivers are over-represented in fatal crashes per 
mile driven, and those in oldest age groups are the fastest-
growing group in the United States. However, age alone is not a 
very good predictor of driving ability. There are large 
differences in the skills and abilities of older drivers, and 
denying an older adult a driver's license can have significant 
implications for their mobility and quality of life.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    This evidence-based UFOV test is being effectively 
translated into practice in the motor vehicle departments in 
three states to date: California, Maryland, and Florida. State 
Farm Auto Insurance Company is also using the test and offering 
insurance discounts for people who take the UFOV test and 
``qualify'' for a discount.
    Innovativeness: Why is this exciting or newsworthy?
    The useful field of view test is a demonstrated method of 
screening high-risk older drivers and may be a more appropriate 
way to address individual differences than using age-based 
restrictions on driving.

National Institute on Aging: Restricting Caloric Intake May Improve the 
                      Body's Metabolic Efficiency

    NIH-supported investigators demonstrated that restricting 
caloric intake may improve the body's metabolic efficiency, an 
effect that could contribute to slowing of adverse changes that 
often accompany aging.
    Lead Agency: National Institute on Aging, National 
Institutes of Health (NIH).
    Agency Mission: 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.
    Principal Investigator: Eric Rauvussin, Louisiana State 
University, Pennington Biomed Research, 6400 Perkins Rd., Baton 
Rouge, LA 70808.
    General Description:

 RESTRICTING CALORIC INTAKE MAY IMPROVE THE BODY'S METABOLIC EFFICIENCY

    Calorie restriction (CR) is the most robust, nongenetic 
intervention that increases lifespan and reduces the rate of 
aging in a variety of species. Mechanisms responsible for the 
antiaging effects of CR remain uncertain but effects on 
efficiency of energy metabolism and mitochondria (subunits 
within cells that are the primary source of cellular energy) 
remains a major focus of research. To understand CR's effects 
in energy metabolism and mitochondrial function in humans, NIH-
supported researchers studied its effects over six months in 
overweight people. They found that CR lowered body temperature 
and lowered metabolic rate by more than would be expected based 
on weight loss alone. They also found evidence of new 
mitochondria. Combined, these results suggest that CR may cause 
the body to shift to more ``efficient'' mitochondrial function, 
resulting in less energy expenditure and cooler body 
temperature. The latter is of particular interest because in 
one study, cooler body temperature was associated with longer 
human lifespan.
    Excellence: What makes this project exceptional?
    Numerous studies in laboratory animals have shown that 
chronic caloric restriction extends lifespan by as much as 40 
percent and delays age-related pathologies correspondingly. 
However, little has been known about the effects of CR in 
humans. This study is a first step in understanding whether 
CR's effects in people resemble those found in laboratory 
animals.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    By understanding the effects of caloric restriction in 
people, we may gain insights into interventions to slow the 
development of age-related diseases.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    There are no immediate clinical or public health 
applications. We need to learn more about the effects of 
caloric restriction in humans before evaluating its potential 
for improving health, aging, or lifespan.
    Innovativeness: Why is this research exciting or 
newsworthy?
    Caloric intake is a topic of broad interest as concerns 
increase regarding obesity and weight gain. This study sheds 
new light on the effects of decreased caloric intake on 
metabolic processes.

National Institute on Aging (NIA)/National Institutes of Health (NIH): 
             Clinical Practice Guidelines for Comorbidities

    Clinical practice guidelines (CPGs) are based on clinical 
evidence and consensus of experts to guide physicians and 
standard care. Most CPGs focus on a single disease, and don't 
always address the needs of the approximately half of persons 
65 years and older who have three or more concurrent medical 
conditions. An NIH-supported study demonstrated that for older 
patients with co-occurring medical problems, adherence to CPGs 
for individual diseases may be counterproductive and sometimes 
harmful.
    Lead Agency: National Institute on Aging (NIA), National 
Institutes of Health (NIH).
    Agency Mission:
     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.
    Principal Investigator: Linda P. Fried, M.D., Johns Hopkins 
University, Department of Medicine/Suite 2-700, 2024 E. 
Monument Street, Baltimore, MD 21205.
    General Description: In recent years, Clinical Practice 
Guidelines (CPGs), which are based on clinical evidence and the 
consensus of experts, have been developed to guide physicians 
regarding the management of common medical problems, thus to 
standardize care and improve its quality for many chronic 
conditions. However, most CPGs focus on a single disease, and 
approximately half of persons 65 years or older have three or 
more concurrent medical conditions. To explore the 
applicability of current CPGs to the care of older individuals 
with several co-occurring diseases, NIH-supported researchers 
identified the most common chronic medical problems among older 
adults and assessed whether the corresponding CPGs addressed 
issues relevant to older patients with combinations of co-
occurring diseases. Issues included goals of treatment, burden 
to patients and caregivers, patient preferences, and quality of 
life. Researchers discovered that most CPGs did not modify or 
discuss the application of their recommendations for older 
patients with comorbidities, did not comment on short- or long-
term goals of treatment or the burden of care associated with 
treatment, did not give guidance about incorporating patient 
preferences into the treatment plan, and in general did not 
``fit together'' well for patients with multiple medical 
problems. Overall, this study demonstrated that, for older 
patients with co-occurring medical problems, adherence to CPGs 
for individual diseases may be counterproductive and even 
sometimes harmful.
    Excellence: What makes this project exceptional?
    This research provides crucial information to better 
understand the special clinical care needs of older patients 
and improve their quality of care.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    This research is specific to the clinical care of patients 
65 years or older and addresses a crucial issue for the 
treatment of older patients with comorbidities for whom 
appropriate practice guidelines could lead to improved health.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Addressing the clinical management problems identified by 
this research could greatly improve the clinical care of older 
patients.
    Innovativeness: Why is this exciting or newsworthy?
    This research provides a dramatic illustration of the need 
to expand guidance for the management of health care specific 
to the needs of older patients.

National Institute on Aging (NIA)/National Institutes of Health (NIH): 
  Translating Resources for Enhancing Alzheimer's Caregiver Health to 
                           Community Settings

    REACH was a multi-site randomized clinical trial for family 
caregivers of patients with Alzheimer's disease or related 
disorders. The intervention is now being translated into 
various community settings and could provide a valuable and 
potentially cost-saving resource for caregivers and their care 
recipients.
    Lead Agency: National Institute on Aging (NIA), National 
Institutes of Health (NIH).
    Agency Mission:
           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.
    Principal Investigators: Richard Schultz, Ph.D., University 
of Pittsburgh, University Center for Social and Urban Research, 
121 University Place, Room 607, Pittsburgh, PA 15213.
    Partner Agency: National Institute of Nursing Research 
(NINR), Department of Veterans' Affairs, Administration on 
Aging.
    General Description: Resources for Enhancing Alzheimer's 
Caregiver Health to Community Settings (REACH) was a multi-site 
randomized clinical trial for family caregivers of patients 
with Alzheimer's disease or related disorders funded by NIA and 
the National Institute of Nursing Research. The intervention is 
designed to provide education, support, and skill building to 
help caregivers manage patient behaviors and their own stress. 
It includes 12 individual sessions in the home and by telephone 
and five telephone support groups over a six-month period.
    The Department of Veterans Affairs (VA) will provide nearly 
$4.7 million for eight ``caregiver assistance pilot programs'' 
across the country to expand and improve health care education 
and provide needed training and resources for caregivers who 
assist disabled and aging veterans in their homes. One of these 
programs will be a translation of the REACH intervention. The 
VA Medical Center (VAMC) at Memphis/University of Tennessee, 
one of the participating sites for REACH, will serve as the 
Coordinating Center for this program, providing evaluation and 
training to the clinical sites, with the assistance of the 
REACH investigators. Across the country, 17 Home Based Primary 
Care (HBPC) programs for treating frail dementia patients and 
their caregivers in the home are providing the intervention to 
200 caregivers. The VA Palo Alto Health Care System, which was 
also one of the REACH sites, will also participate, providing 
services to 150 caregivers.
    Specific objectives for the REACH VA translation are to:
     Assess the feasibility of translating a multi-
component, community-based intervention for family caregivers 
of patients with dementia in VA settings.
     For patients with dementia, evaluate the 
intervention's efficacy in decreasing health care utilization, 
including unanticipated admissions, unscheduled outpatient 
visits, ER visits, and placement.
     For family caregivers of patients with dementia, 
evaluate the intervention's efficacy in improving clinical 
outcomes relating to quality of life as measured by (1) 
emotional well-being and depression, burden, health, social 
support, and management of patient dementia-related behaviors 
and (2) time spent ``on duty'' and time providing actual care.
     Assess caregiver satisfaction with the services 
provided.
     Determine the cost of the intervention for VHA 
clinical staff.
    Materials and protocols from REACH have also been adapted 
for wide-spread community use by the Administration on Aging 
for use in their Area Agencies on Aging and the Alzheimer's 
Association through their ongoing contact with caregivers. 
Implementation at the community level can enhance the lives of 
caregivers, potentially delay institutionalization of care 
recipients, and decrease the need for professional intervention 
for both caregiver and care recipient. Cost analysis of the 
outcomes is ongoing and may provide additional evidence of the 
cost savings. By making such an intervention available, REACH 
implementation in community settings, with physician referral, 
can provide a valuable resource for caregivers and their care 
recipients.
    Excellence: What makes this project exceptional?
    The project involves a thoroughly tested and proven 
intervention that is being implemented through collaborative 
efforts across public and private organizations.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Family members and friends provide most of the care for 
millions of people with dementia who live at home, often facing 
challenges that can seriously compromise their own quality of 
life. REACH tells us that a well-designed, tailored 
intervention can make a positive, meaningful difference in 
caregivers' lives.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    The intervention is being translated into practice.
    Innovativeness: Why is this exciting or newsworthy?
    This novel research demonstrates that an intervention can 
readily address a significant need and benefit the diverse 
communities of people who provide care to individuals with 
Alzheimer's disease.

National Institute on Aging (NIA)/National Institutes of Health (NIH): 
 Hospital Quality and Racial Differences in Heart Attack Treatment and 
                                Outcomes

    Differences between black and white heart attack patients 
in quality of care received are due in part to the quality of 
the hospital in which they are treated. These results suggest 
that hospital-level interventions to improve quality of care 
may be needed.
    Lead Agency: National Institute on Aging (NIA), National 
Institutes of Health (NIH).
    Agency Mission:
     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.
    Principal Investigators: Jonathan Skinner, Ph.D., Center 
for Evaluative Clinical Sciences, Dartmouth Medical School, HB 
7251, Hanover, NH 03755; Amber E. Barnato, MD, MPH, MS, Center 
for Research on Health Care, University of Pittsburgh, 230 
McKee Place, Suite 600, Pittsburgh, PA 15213.
    Partner Agency: The Robert Wood Johnson Foundation.
    General Description: Black patients who have suffered a 
heart attack or are at risk are less likely than white patients 
to receive invasive procedures such as percutaneous coronary 
interventions (PCI) and coronary artery bypass grafts (CABG), 
and much evidence suggests that they are also less likely than 
whites on average to receive effective low-intensity treatments 
such as aspirin and beta blocker prescriptions. A key 
unresolved question is the extent to which these racial 
disparities result from physicians and hospitals providing 
poorer quality care for their black patients than for whites, 
or from black patients more often than whites being treated in 
facilities providing lower quality care for all their patients. 
In a recent study, NIH-supported researchers analyzed the 
records of more than one million adults who were treated for 
acute myocardial infarction (AMI) at over 4,000 non-federal 
hospitals from 1997 to 2001. They found that patients of all 
races were at higher risk of mortality in hospitals with a 
disproportionate share of African-American heart attack 
patients. Patients treated at largely minority-serving 
hospitals were not sicker and did not have more severe heart 
attacks than patients at other hospitals. The differences in 
outcomes also were not explained by patients' income, the 
hospitals' AMI patient volume, region of the country, or urban 
status.
    In related work, NIH-supported investigators reviewed data 
on Medicare patients treated for AMI in 1994 and 1995 to assess 
the extent to which differences in the actual hospitals where 
blacks and whites were treated explain the differences observed 
in the frequency of specific treatments and in subsequent 
mortality. They used statistical techniques that allowed them 
to study whether black and white patients treated at the same 
hospital received different care and had different outcomes, 
rather than--as in previous studies--whether patients treated 
at hospitals with similar measurable characteristics had 
similar outcomes. They found that the overall black-white gap 
in lower-intensity medical procedures such as prescription of 
beta-blockers and ACE inhibitors was entirely explained by 
differences in hospitals. However, blacks were given fewer 
surgical treatments requiring complex referrals and follow-up, 
such as catheterization, PCI, and CABG than whites attending 
the same hospitals. Both of these studies suggest that black-
white differentials in medical procedures known to be effective 
would be greatly reduced by hospital-level interventions to 
improve quality of care.
    Excellence: What makes this project exceptional?
    Previous studies have documented racial disparities in 
heart attack treatment among Medicare beneficiaries. However, 
it has not been clear whether these differences are due 
primarily to differential treatment of black and white patients 
within the same institutions or to differences in the quality 
of care across hospitals. These studies suggest that quality 
differences between hospitals (as opposed to differential 
treatment of races within the hospitals) accounts for the 
larger share of these disparities.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Age is a risk factor for heart disease, and over a million 
Americans have heart attacks each year and approximately half 
of these individuals die from the attacks. Heart attack is most 
common among African-American men and is more common among 
African-American women than white women.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Understanding the origins of health disparities is the 
crucial first step toward eliminating them. The development of 
effective hospital-level interventions to eliminate disparities 
in heart attack treatment may lead to improved outcomes for 
vulnerable groups.
    Innovativeness: Why is this exciting or newsworthy?
    This research helps explain treatment differences between 
black and white heart attack patients observed at the aggregate 
level and offers insight into avenues--i.e., hospital-level 
interventions--to ameliorate these differences.

National Institute on Aging (NIA)/National Institutes on Health (NIH): 
Improving the Quality of Health Care for Older Adults: Doctors May Not 
Diagnose and Manage Coronary Heart Disease As Actively for Women As for 
                                  Men

    Researchers used video vignettes to assess how primary care 
doctors' diagnostic questions differed significantly by patient 
gender. Results suggest that doctors' actions may contribute to 
gender disparities in health and health care. Investigators 
observed no influence of social class or race.
    Lead Agency: National Institute on Aging (NIA), National 
Institutes of Health (NIH).
    Agency Mission:
     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.
    Principal Investigators: Dr. Sara Arber, Department of 
Sociology, Centre for Research on Ageing and Gender, University 
of Surrey, Guildford, Surrey GU2 7XH, UK.
    General Description: Previous studies have established that 
women are less likely than men to receive thorough diagnostic 
investigations and surgical treatments for coronary heart 
disease (CHD). Few studies have focused on the exact points in 
the process at which disparities arise (initial access, 
interactions with physicians, hospitalizations) and few have 
examined the possibility of age-by-gender interactions in the 
process. The authors examined the influence of gender, age, 
race and social class, singly and in combination, on diagnostic 
and management decisions for patients presenting with symptoms 
of CHD. They trained professional actors to portray patients on 
videos in realistic first consultations with a doctor, 
presenting with symptoms either of CHD or of depression. 
Participating primary care physicians (256, selected randomly 
in Massachusetts and two regions in England) watched the 7-8-
minute tapes and answered questions about how they would 
diagnose and manage the patient. In the two countries combined, 
physicians reported fewer follow-up questions for women (mean 
5.7) than for men (7.0); proposed fewer examinations for women 
(4.3 compared with 5.1); proposed fewer diagnostic tests for 
the CHD diagnosis (80 percent for women; 90 percent for men), 
and were less likely to prescribe medications appropriate for 
treating heart disease for women than for men (52% of women; 
64% for men). In both countries, the female patient reported to 
be age 55 was less likely to have a medication prescribed, and 
doctors were less sure of the CHD diagnosis, than for men the 
same age. But even with lower certainty, in England (though not 
in the US) doctors reported that they would ask fewer questions 
of the woman aged 55 than of a man, and fewer than for a woman 
aged 75. The black patients and those portraying working-class 
men and women were not treated differently than white and 
middle-class patients in these simulations.
    This analysis was based on ``video vignettes,'' and the 
correspondence of self-reports to actual behavior is unknown. 
The clinical significance of differences in diagnosis and 
management after a first consultation is also not clear. But 
the finding of significant differences between the diagnostic 
and management activities that physicians think appropriate for 
women and for men warrants further research.
    Excellence: What makes this project exceptional?
    Previous studies have established that women are less 
likely than men to receive thorough diagnostic investigations 
and surgical treatments for coronary heart disease. This 
research represents an important step in clarifying the nature 
of these disparities, as well as the circumstances under which 
the disparities arise.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Coronary heart disease is the leading cause of death among 
both women and men in the United States and is particularly 
common in individuals over age 65. One in four American women 
die of heart disease.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    This research was based on ``video vignettes,'' and the 
extent to which physicians' reactions to the vignettes 
correlate with their actual behavior in the clinic remains 
unknown. However, this finding does underscore the need for 
women and their physicians to become aware of the risk factors 
and symptoms of heart disease and for physicians to ensure 
thorough diagnostic and treatment efforts for both men and 
women.
    Innovativeness: Why is this exciting or newsworthy?
    Few studies have focused on the exact points in the 
diagnostic process for CHD where disparities arise (initial 
access, interactions with physicians, hospitalizations) and few 
have examined the possibility of age-by-gender interactions in 
the process.

National Institute on Aging (NIA)/National Institutes of Health (NIH): 
   Integrating Effective Strategies to Prevent Falls Into Community 
                                Settings

    Two recent studies funded by the National Institute on 
Aging and the Administration on Aging on integrating fall risk 
evaluation and prevention strategies into community programs 
show promise for future development of public health and 
medical practice education, reducing barriers or obstacles to 
pursue fall risk evaluation, and application into practice 
settings.
    Lead Agency: National Institute on Aging (NIA), National 
Institutes of Health (NIH).
    Agency Mission:
     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.
    Principal Investigators: Mary E. Tinetti, M.D., Director of 
Yale Program on Aging, School of Medicine, 20 York Street, New 
Haven, CT 06504.
    Partner Agency: U.S. Administration on Aging (AoA).
    General Description: NIH-supported researchers tested the 
ability to integrate effective strategies to prevent falls in 
older persons into community care settings. The studies found 
that practitioners could adopt these strategies, although 
organizational and financial barriers limited the ability to 
implement them fully.
    Excellence: What makes this project exceptional?
    Translation to practice.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Among older adults, falls are the number one cause of 
fractures, hospital admissions for trauma, loss of independence 
and injury-related deaths. Only half of older adults 
hospitalized for a broken hip return home or live on their own 
after the injury, which is why prevention of falls is so 
important. Previous clinical trials showed that fall risk 
evaluation and management programs can lessen risk of falls in 
older persons, but application of these findings to the ``real 
world'' of health care practice faces significant challenges in 
integrating and organizing activities of health care providers 
from a variety of specialties and care settings.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    The results of these studies show that the fall risk 
evaluation and management strategies can be integrated into 
existing programs, although significant obstacles to full 
integration remain.
    Innovativeness: Why is this exciting or newsworthy?
    This research is an excellent example of evidenced-based 
outcomes translated to the community. This project is also an 
example of prevention research to address an important health 
risk for seniors and demonstrates an effective collaboration 
among federal agencies.

National Institute on Aging: Understanding the Genetic Underpinnings of 
                              Parkinson's

    NIA intramural scientists have successfully identified 
mutations of the LRRK2 gene that cause Parkinson's disease, 
first in five families in Spain and England and later in 
approximately 1 percent of sporadic PD and 5 percent of cases 
of PD with a positive family history in the United States and 
Canada, making it the most common genetic cause of PD 
identified to date. Ongoing work from NIA scientists is aimed 
at turning this genetic discovery into new avenues for 
treatment.
    Lead Agency: National Institute on Aging (NIA)/National 
Institutes of Health (NIH).
    Agency Mission:
     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.
    Principal Investigators: Andrew Singleton, Investigator, 
Molecular Genetics Section, Laboratory of Neurogenetics, NIA/
NIH, Building 35, Room 1A1014, 35 Convent Drive, Bethesda, MD 
20892; Mark R. Cookson, Investigator, Cell Biology and Gene 
Expression Unit, Laboratory of Neurogenetics, NIA/NIH, Building 
35, Room 1A116, MSC3707, 35 Convent Drive, Bethesda, MD, 20892-
3707.
    General Description:

         UNDERSTANDING THE GENETIC UNDERPINNINGS OF PARKINSON'S

    In November 2004, NIA intramural scientists discovered 
mutations in a gene called LRRK2 that cause Parkinson's disease 
(PD). The investigators studied four families with a history of 
PD who lived in the Basque region of Spain and one family with 
a similar disease in England. The LRRK2 gene encodes dardarin, 
a protein named by the researchers from the Basque word 
dardara, which means tremor, a major symptom of PD. In 
addition, the group identified a LRRK2 mutation, called G2019S, 
as a cause of disease in PD families in the United States and 
Canada. This single mutation causes disease in approximately 
one percent of all PD and five percent of cases of PD with a 
positive family history, an estimated 10,000 Americans. In 
other populations, the same mutation accounts for 9-30 percent 
of PD based on clinical analysis. As such, LRRK2 mutations are 
the most common genetic cause of PD identified to date, and 
they may represent an attractive target for developing new 
therapies for treating PD. NIA scientists have shown that the 
same mutations will trigger cell death in cultured neurons, and 
this can be limited by inactivating the protein. This suggests 
that a small, drug-like molecule might be developed to achieve 
the same goal. To develop this idea further, these 
investigators have started to explore the three dimensional 
structure of the protein so that drug-like compounds can be 
`designed' in the future. This work is ongoing and is 
stimulating a great deal of interest in the field.
    Excellence: What makes this project exceptional?
    Researchers demonstrated that LRRK2 is the gene commonly 
mutated in people with Parkinson's disease (PD) and that these 
mutations result in toxic effects to neurons that can result in 
PD.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Parkinson's disease (PD) is a neurological condition that 
typically causes tremor and/or stiffness in movement. The 
condition affects about 1 to 2 percent of people over the age 
of 60 years and the chance of developing PD increases as we 
age.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    The onset of Parkinson's disease (PD) most frequently 
occurs in older people. The long-term goal of NIH studies is to 
develop new ways to influence specific activity of LRRK2, which 
is a potential therapeutic target for PD.
    Innovativeness: Why is this research exciting or 
newsworthy?
    Further understanding the LRRK2 gene and mutations to that 
gene may enable us to identify molecules and pathways as 
targets for therapeutic and preventive interventions that could 
potentially benefit thousands of older Americans who have PD or 
are at risk.

National Institute on Aging (NIA)/National Institutes of Health (NIH): 
  Studies on the Potential of Resveratrol to Help Control Age-Related 
                            Disorders [NIA]

    Resveratrol (RSV) is an activator of a family of enzymes 
that may be able to control age-related disorders such as the 
aging process, obesity, metabolic syndrome, and type 2 
diabetes. In this study, middle-aged male mice on a high 
calorie diet and administered RSV lived longer than the mice 
who were on a high calorie diet but were not supplemented with 
RSV. The mice that were administered RSV also showed an 
improved metabolic profile and activity levels similar to those 
observed in mice on a standard diet. Although, the effect of 
this small molecule in humans is unknown, preclinical 
observations suggest that RSV is safe and has enormous 
potential in the treatment of obesity and insulin resistance in 
humans.
    Lead Agency: National Institute on Aging (NIA), National 
Institutes of Health (NIH).
    Agency Mission:
     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.
    Principal Investigators: Rafael de Cabo, National 
Institutes of Health, National Institute on Aging, Intramural 
Research Program, Biomedical Research Center, 251 Bayview 
Boulevard, Suite 100, Baltimore, MD 21224-6825.
    Partner Agencies: Salk Institute in La Jolla, CA and 
Sirtris Pharmaceuticals of Cambridge, MA, which is developing 
therapeutics to modulatesirtuins.
    General Description: Studies over the last few years have 
shown that resveratrol (RSV), a natural compound found in 
common foods such as grapes, wines, and nuts, can extend 
lifespan in yeast, worms, flies, and fish. Resveratrol is an 
activator of a family of enzymes known as sirtuins, which may 
be able to control age-related disorders such as the aging 
process, obesity, metabolic syndrome, and type 2 diabetes in 
various organisms and in humans. An NIH study placed middle-
aged male mice on one of three different diets: a standard 
mouse diet, a high calorie diet, and a high calorie diet 
supplemented with resveratrol. After six months, the scientists 
observed a clear trend toward increased survival and insulin 
sensitivity (important for the body's efficient processing of 
glucose into energy) in the high calorie diet supplemented with 
resveratrol relative to that seen in middle-aged male mice on 
the high fat diet without resveratrol supplementation. In 
effect, resveratrol shifted the physiology of middle-aged mice 
on a high calorie diet toward that of mice on a standard diet, 
essentially preempting most of the negative effects of the high 
calorie diet and extending the animals' lives. Although, the 
effect of this small molecule in humans is unknown, preclinical 
observations suggest that RSV is safe and has enormous 
potential in the treatment of obesity and insulin resistance in 
humans.
    Excellence: What makes this project exceptional?
    The findings are the first to demonstrate that resveratrol 
can affect the health and longevity of mammals. However, the 
safety and effectiveness of dietary supplementation with 
resveratrol in humans have not been established.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Since the beginning of the 20th century, life expectancy at 
birth in the United States has increased from less than 50 
years to more than 76 years. By the middle of the 21st century, 
the number of Americans over the age of 65 will double, and the 
number of Americans over age 85 will increase fivefold or more, 
placing a significantly greater number of people at risk for 
disease and disability.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Resveratrol has become the subject of intensive scientific 
inquiry for its potential to improve health among older adults. 
By activating sirtuins, resveratrol may be the first known 
compound that has the potential to control aging processes, 
obesity, and metabolic syndrome as well as potentially extend 
lifespan.
    Innovativeness: Why is this exciting or newsworthy?
    Compounds such as resveratrol, which may have protective 
effects against the aging process and certain age-related 
disorders and conditions such as obesity, may provide a new 
avenue for therapeutic intervention.

         National Institute on Aging: NIHSeniorHealth Web Site

    NIHSeniorHealth is a website for older adults, designed in 
keeping with scientific evidence on the cognitive and vision 
changes that occur with age and the effect of these changes on 
computer use. The site makes aging-related health information 
easily accessible to those seeking reliable, easy to understand 
online health information. It also has specially designed 
features to make the web site easier for older adults to use 
such as large print, short, easy-to-read segments of 
information, simple navigation and a read-aloud feature.
    Lead Agency: National Institute on Aging (NIA) and National 
Library of Medicine (NLM)/National Institutes of Health (NIH).
    Agency Mission:
     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.
    Principal Investigator: Stephanie Dailey, Public Affairs 
Specialist, National Institute on Aging, Bldg. 31, Room 5C27 
MSC 2292, Bethesda, MD 20892-2292; Jennifer Heiland, Unit Head, 
Web & Information Management, National Library of Medicine, 
8600 Rockville Pike, MSC 3821, Bethesda, MD 20894.
    Partner Agency: National Library of Medicine, National 
Institute on Aging.
    General Description:

                          NIHSENIORHEALTH.GOV

    NIHSeniorHealth is a web site specifically designed for 
older adults. This site was developed by the National Institute 
on Aging (NIA) and the National Library of Medicine (NLM), both 
part of the National Institutes of Health (NIH). It features 
authoritative and up-to-date health information from institutes 
and centers (ICs) at NIH. In addition, the American Geriatrics 
Society provides expert and independent review of some of the 
material found on this web site. Each health topic includes 
general background information, quizzes and frequently asked 
questions (FAQs). Most topics include open-captioned videos. 
New topics are added to the site on a regular basis.
    A research-based approach guided the development of 
NIHSeniorHealth. The design of the site grew out of NIA's 
research on the types of cognitive and vision changes that are 
a part of the normal aging process. Changes in memory, text 
comprehension, information processing speed and vision can 
interfere with older adults' use of computers. Research 
indicates older adults can effectively use computers if 
information is provided in a cognitively-friendly manner. NIH 
extensively tested NIHSeniorHealth with adults age 60 to 88 to 
ensure that it is easy for them to see, understand and 
navigate.
    The web site features include large print, short, easy-to-
read segments of information and simple navigation. A 
``talking'' function reads the text aloud and special buttons 
to enlarge the text or turn on high contrast make text more 
readable. NIHSeniorHealth complies with Section 508 of the 
Rehabilitation Act of 1973, which aims to make federal 
electronic technology accessible for persons with disabilities.
    In the future, NIH intends to add more topics and more 
videos, as well as improve the navigation and accessibility of 
the site, using evidence from usability testing, customer 
satisfaction surveys and industry best-practices to ensure the 
site continues to be as senior-friendly in the future as it has 
been thus far.
    Excellence: What makes this project exceptional?
    NIHSeniorHealth.gov is exceptional because it was conceived 
as a website to meet the cognitive and visual needs of older 
adults, primarily 60 or older. Many web sites have information 
aimed at seniors, but few have carefully designed the entire 
user experience around that age group. The site's design grew 
out of research conducted and supported by the National 
Institute on Aging and others about cognitive and vision 
changes that people experience as they age. The site presents 
basic health information in easy-to-read, consumer-friendly 
language and then reinforces it with quizzes, videos, and FAQs 
to help counteract changes in memory. To address aging-related 
changes in text comprehension and information processing speed, 
the text is presented in short snippets of information (one or 
two paragraphs per page) using a large text size as default 
with a very simple navigation structure. Finally, to aid older 
adults with vision changes NIHSeniorHealth includes a set of 
accessibility buttons across the top of each page that users 
may use to enlarge the text, change the color contrast, or hear 
the text read aloud.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    By putting health information into a format that recognizes 
age-related changes, NIHSeniorHealth gives seniors tools to 
help understand their own health care and wellness concerns. 
Topics on the site range from diseases such as Alzheimer's 
Disease, Arthritis, and Glaucoma to wellness topics such as 
Eating Well as You Get Older and Exercise and Older Adults. 
NIHSeniorHealth also functions as a training resource for older 
adults. Many seniors are just beginning to use the Web. 
NIHSeniorHealth features a simple navigation structure and 
large text and navigation buttons, ``easing'' seniors into 
using the Internet. Older adults can then use the skills 
they've built on NIHSeniorHealth to effectively navigate the 
larger universe of government and health resources available 
online. In fact, the web site features a series of training 
materials called the Toolkit for Trainers developed by the 
National Institute on Aging. Trainers can use these free, easy-
to-use training materials to help older adults find reliable, 
up-to-date online health information on their own. The training 
features two web sites from the National Institutes of Health: 
NIHSeniorHealth.gov and MedlinePlus.gov. Trainers start 
students off with NIHSeniorHealth and then transition them to 
the more complex MedlinePlus web site.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    NLM and NIA have consistently sought to assure the 
effectiveness of NIHSeniorHealth. NIH extensively tested the 
site with adults age 60 to 88 before launching the site. As the 
site has grown, NIH determined that the top-level navigation 
needed an update so it could accommodate many more topics. 
Usability testing with adults aged 60 and above was again 
included as an integral part of the design process. NIH also 
employs the American Customer Satisfaction Index to regularly 
monitor the effectiveness of the site for older adults. Content 
is reviewed and updated every 18 months to make sure it remains 
authoritative. The increasing numbers of unique visitors to the 
website reflect the growing interest in and awareness of the 
website by the public. For example, during the first quarter 
after it was launched in 2003, NIHSeniorHealth had around 
94,000 unique visitors. As of March 2008, that quarterly total 
had risen to nearly a quarter million people.
    Innovativeness: Why is this research exciting or 
newsworthy?
    NIHSeniorHealth has been innovative in a number of ways. It 
was the first website developed for older adults using 
cognitive aging and vision research and has served as a model 
for web developers seeking to make their websites senior-
friendly. NIHSeniorHealth has also been innovative in its use 
of accessibility features. Not only does it allow users to 
easily change the font size--a feature now found on a number of 
senior-friendly sites--it also lets them change the color 
contrast and hear the text read aloud, functions not typically 
available on other websites targeted to older adults. NLM 
regularly reviews the pronunciation by the computerized voice 
that reads the text, continually improving the dictionary the 
system uses to include new terms as they are added to the web 
site. Finally, as a repository of health information from 13 
institutes and centers, NIHSeniorHealth is a unique and 
successful example of inter-Institute collaboration and was 
featured as a model for project managers at a STEP (Staff 
Training in Extramural Programs) forum presentation for NIH 
staff.

  National Institute on Alcohol Abuse and Alcoholism: Educating Older 
               Adults and Physicians About Alcohol Risks

    The project involves a unique approach in which brief 
advice will be provided both to older patients and their 
physicians who identify them as ``at-risk drinkers'' ( e.g., a 
single risk comprising drinking and using benzodiazepines, or 
multiple risks comprising drinking and using narcotics, 
drinking and having depression, etc.).
    Lead Agency: National Institute on Alcohol Abuse and 
Alcoholism (NIAAA)/National Institutes of Health (NIH).
    Agency Mission: NIAAA provides leadership in the national 
effort to reduce alcohol-related problems by:
           Conducting and supporting research in a wide 
        range of scientific areas including genetics, 
        neuroscience, epidemiology, health risks and benefits 
        of alcohol consumption, prevention, and treatment;
           Coordinating and collaborating with other 
        research institutes and Federal Programs on alcohol-
        related issues;
           Collaborating with international, national, 
        state, and local institutions, organizations, agencies, 
        and programs engaged in alcohol-related work;
           Translating and disseminating research 
        findings to health care providers, researchers, 
        policymakers, and the public.
    Principal Investigator: Alison Moore, M.D., University of 
California, Los Angeles, School of Medicine, Division of 
Geriatrics, 10945 Le Conte Avenue, Suite 2339, Los Angeles, CA 
90095-1687.
    General Description:

       EDUCATING OLDER ADULTS AND PHYSICIANS ABOUT ALCOHOL RISKS

    Older adults have risks associated with alcohol use that 
differ from those among younger persons. This increased risk is 
due to physiological changes with aging that increase the 
effects of a given dose of alcohol as well as age-associated 
increases in comorbid illnesses (e.g., hypertension, 
gastroesophageal reflux disease, impairments in gait and 
cognition) and medication use (e.g., sedatives, selected 
antihypertensives, analgesics). The occurrence of these 
conditions may cause adverse effects in individuals even when 
small amounts of alcohol are consumed. Clinical guidelines for 
alcohol use disorders in the elderly released by the American 
Geriatrics Society and the American Medical Association are 
targeted toward identification and management of those who 
drink above low risk drinking limits or who have symptoms of 
alcohol abuse and dependence. However, they do not specifically 
address risks associated with small amounts of alcohol in 
combination with other illness or disorders or medication use.
    In a current study, NIH-supported researchers are examining 
the effects of educating physicians and older at-risk drinkers 
about these risks. Although many older persons who drink 
alcohol may be at risk for adverse consequences, clinicians 
rarely ask questions about alcohol use in their older patients. 
Nor do they recognize many older persons who may be having 
alcohol related problems. The primary aims of the study are to 
reduce the risks of drinking (e.g., the amount of drinking, and 
associated problems) among older drinkers through screening and 
brief advice by their primary care providers. Findings indicate 
that these measures identify not only those older persons who 
are abusing or dependent on alcohol but also those persons 
whose moderate use of alcohol may be risky or causing harm.
    Excellence: What makes this project exceptional?
    Other studies of community-based samples in primary care 
have demonstrated the efficacy of providers' use of screening 
protocols to identify older adults at risk for alcohol problems 
and reduction in at-risk drinking following brief motivational 
interventions. However, current measures are not designed to 
identify older persons whose use of alcohol, in conjunction 
with their chronic conditions, medications and functional 
status, places them at risk or may be causing them harm. 
Because existing screening instruments are less relevant to the 
elderly, this project developed two new measures, the Alcohol-
Related Problems Survey (ARPS), and its shorter version 
(shARPS), that identify older drinkers whose use of alcohol 
alone, or in combination may be placing them at risk for harm.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Older persons differ biologically, psychologically and 
socially from younger people, resulting in different health 
needs and health care utilization patterns. Older men (and 
women of all ages) have a smaller volume of total body water 
than younger men; therefore, they attain a higher blood alcohol 
concentration from a given dose. The greater vulnerability of 
older persons to the effects of alcohol may be augmented by 
age-related changes in functional status, nutritional status, 
and psychological and cognitive status. Body composition 
continues to change with age; therefore an 85 year old may be 
more vulnerable to alcohol's effects than a 65 year old.
    While only 2 to 4 percent of persons aged 65 or older meet 
criteria for a diagnosis of alcohol abuse and dependence, some 
studies have reported that up to 10 percent of older people 
have other serious problems related to alcohol (e.g., 
hospitalizations, falls, insomnia, confusion and drug-alcohol 
interactions). In primary care settings, up to 15 percent of 
older persons have reported exceeding recommended drinking 
limits.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Up to 40 percent of older drinkers may be at risk for 
negative consequences either due to drinking above recommended 
limits or by experiencing illness or symptoms that could be 
worsened by alcohol use or use of medication that may 
negatively interact with alcohol. Alcohol also may affect the 
health of an older person by exacerbating sleep problems, 
elevating blood pressure, and negatively affecting bone mineral 
metabolism. Alcohol use in older adults is also associated with 
hip fractures due to falls and other unintentional injuries 
including automobile crashes. The increased risk of hemorrhagic 
stroke seen in the general population may be especially 
important in this age group. Consumption of over one to two 
drinks a day poses significant risks for cancer, liver 
cirrhosis, brain damage, and unintentional injuries.
    This study is the first to assess a preventive intervention 
among older adults in primary care aimed to reduce risks of 
alcohol use alone, or in conjunction with comorbid illness or 
medication use. Thus, at-risk status, as indicated by the 
screening instrument examined in this study, rather than 
alcohol consumption alone, may be the most relevant indicator 
of this intervention's success.
    Innovativeness: Why is this research exciting or 
newsworthy?
    The majority of older persons take medications, and alcohol 
interacts adversely with many prescription and over-the-counter 
drugs. Studies indicate that between 60 to 90 percent of 
elderly persons use some form of medication, often more than 
one at a time. Medications that have a high potential for a 
negative reaction with alcohol, and commonly are taken by older 
people, include: analgesics, antihypertensives, anticoagulants, 
diuretics, antiarthritics and psychoactive agents.
    Successful completion of this project can provide a 
valuable model for translation of alcohol-related screening and 
brief intervention conducted among older adults by community-
based, primary care physicians. The most innovative feature of 
the study is the use of a new instrument to both determine risk 
and evaluate changes in risk. Through feedback from physicians, 
investigators have streamlined the screening process (e.g., via 
telephone rather than in-person), thereby creating greater 
efficiency to conduct brief interventions.

  National Institute on Alcohol Abuse and Alcoholism: Retirement and 
                           Drinking Behavior

    The purpose of an NIH-supported study is to examine four 
risk perspectives associated with the retirement process and 
the evaluation of their impact on drinking behavior in a cohort 
of retirement-eligible blue-collar workers employed in the 
construction, service, and manufacturing sectors.
    Lead Agency: National Institute on Alcohol Abuse and 
Alcoholism (NIAAA)/National Institutes of Health (NIH).
    Agency Mission: NIAAA provides leadership in the national 
effort to reduce alcohol-related problems by:
           Conducting and supporting research in a wide 
        range of scientific areas including genetics, 
        neuroscience, epidemiology, health risks and benefits 
        of alcohol consumption, prevention, and treatment;
           Coordinating and collaborating with other 
        research institutes and Federal Programs on alcohol-
        related issues;
           Collaborating with international, national, 
        state, and local institutions, organizations, agencies, 
        and programs engaged in alcohol-related work;
           Translating and disseminating research 
        findings to health care providers, researchers, 
        policymakers, and the public.
    Principal Investigator: Samuel B. Bacharach, Ph.D., 
Director, Institute for Workplace Studies & Smithers Institute, 
Cornell University, ILR School, 16 E. 34th St., 4th Floor, New 
York, NY 10016.
    General Description:

                    RETIREMENT AND DRINKING BEHAVIOR

    Although studies have shown that the prevalence of 
excessive alcohol consumption declines with age, a substantial 
proportion of older adults engage in consumption patterns that 
exceed the suggested guidelines of one drink per day for senior 
adults. In addition to the risk of adverse interactions with 
comorbidities and medications, changes in life course 
conditions are believed to contribute to increased risk for 
alcohol problems among older adults. These conditions may 
include retirement-related unstructured free time and 
availability of disposable income, gambling associated with 
binge drinking, or losses due to death of loved ones. Rates of 
problem drinking vary widely depending on methods and 
definitions of alcohol abuse and dependence.
    A current longitudinal NIH-supported study aims to 
determine the impact of older blue-collar workers' transition 
to retirement on their post-retirement levels of alcohol 
consumption and associated alcohol-related problems. The focus 
of the research is to examine how four different risk 
perspectives (social isolation--depth and breadth of social 
support or lack thereof; social control--loss of or relief from 
work-based systems or rules governing drinking or permissive 
drinking norms; stress--e.g., financial, social role changes, 
marital strain; and social marginalization--e.g., lowered self 
efficacy, loss of self esteem) experienced over the course of 
retirement influence post-retirement drinking behavior.
    Excellence: What makes this project exceptional?
    Results of cross-sectional as well as longitudinal studies 
have shown that older adults consistently consume less than 
younger age groups. However, there is a paucity of published 
data on long-term trends in alcohol consumption among older 
adults. For example, one study comparing survey responses from 
two large national surveys showed increased prevalence of 
alcohol abuse but not dependence among respondents over 65 
years of age from 1992-2002. Another longitudinal study based 
on national survey data found that while alcohol consumption 
declined with age from 1975 to 1992, consumption declined more 
slowly among more recent birth cohorts. These results are 
suggestive of a potential shift in consumption patterns among 
older adults as birth cohorts continue to age. Thus, these data 
provide the basis for development of improved surveillance of 
consumption patterns through the latter part of the life 
course.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Population-level data show that about 48 percent of older 
men (age 65 or older) and 32 percent of older women drink. Most 
do so in moderation as defined by the US Dietary Guidelines. 
These studies have shown that only 10 percent of older men and 
2.4 percent of older women are heavier drinkers. However, 
population-level data could obscure problem-drinking occurring 
in certain populations. Studies suggest that a significant 
proportion of ``hidden'' alcoholics may be age 60 or older. The 
diagnosis of alcohol abuse and dependence can be difficult in 
older people because its symptoms can be erroneously attributed 
to other age-related medical or psychiatric conditions (e.g., 
depression, insomnia, poor nutrition, and frequent falls) or to 
medication side-effects.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Reported rates of alcohol consumption range from as low as 
4 percent among representative longitudinal samples to well 
over 50 percent among smaller targeted community samples of 
older at-risk drinkers (e.g., in primary care and hospitals, 
geriatric mental health clinics, nursing homes). The current 
study of older workers' transition into retirement found that a 
shift from full-time work to bridge employment and full 
retirement was associated with higher amounts of alcohol 
consumption per drinking occasion.
    Innovativeness: Why is this research exciting or 
newsworthy?
    This research has the potential to provide timely 
information on important, emergent social factors that may 
increase the risk for alcohol problems in a growing 
understudied group during a critical period of life transition. 
This research expands beyond a more limited, short-term 
examination of retirement in prior studies to a broader view of 
retirement as a changing process. For example, the extent to 
which the drinking-retirement relation is altered by retirement 
status, occupation, gender, ethnicity, and time will be 
determined. Investigators are providing valuable information on 
the differential effects of retirement patterns (e.g., early 
vs. late; forced vs. voluntary; followed by full-, part-time or 
no additional employment) on drinking behavior. Results of the 
study will provide a better understanding of life course 
processes underlying the non-negligible rates of alcohol 
problems among older adults, due in part, to the stressor of 
retirement.

National Institute on Alcohol Abuse and Alcoholism: Longitudinal Study 
          of Alcohol Use and Related Problems in Older Adults

    This is a longitudinal survey of alcohol use and alcohol 
related problems in older adults. The subjects were aged 55 to 
65 years when originally surveyed; they will be aged 75 to 86 
years when the 21 year longitudinal follow-up survey is 
administered. Thus, the survey permits an examination of the 
natural course of drinking behaviors between young-old age and 
old-old age.
    Lead Agency: National Institute on Alcohol Abuse and 
Alcoholism/National Institutes of Health.
    Agency Mission: NIAAA provides leadership in the national 
effort to reduce alcohol-related problems by:
           Conducting and supporting research in a wide 
        range of scientific areas including genetics, 
        neuroscience, epidemiology, health risks and benefits 
        of alcohol consumption, prevention, and treatment;
           Coordinating and collaborating with other 
        research institutes and Federal Programs on alcohol-
        related issues;
           Collaborating with international, national, 
        state, and local institutions, organizations, agencies, 
        and programs engaged in alcohol-related work;
           Translating and disseminating research 
        findings to health care providers, researchers, 
        policymakers, and the public.
    Principal Investigator: Rudolph Moos, Ph.D., Research 
Career Scientist, VA Palo Alto Health Care System, Professor of 
Psychiatry and Behavioral Sciences, Stanford University, Center 
for Health Care Evaluation, 152 MPD, 795 Willow Road, Menlo 
Park, CA 94025.
    General Description:

 LONGITUDINAL STUDY OF ALCOHOL USE AND RELATED PROBLEMS IN OLDER ADULTS

    The purpose of this research is to describe the long-term 
course of late-life problem drinking and to examine how health 
and help-seeking, life context and coping, and gender and 
family factors influence late-life drinking careers. 
Specifically, the applicants propose to extend an NIAAA-funded 
10-year study of late-life problem drinking to 21 years in 
order to determine the course of older adults' alcohol 
consumption and problem drinking as they move from being young-
old (55 to 65 years at baseline) to being old-old (75 to 86 
years at follow-up). Guided by a stress and coping model, the 
investigators will focus on four sets of issues: (1) They will 
examine the 21-year course of late-life alcohol consumption and 
problem drinking and identify high-risk patterns of alcohol 
consumption and the predictive validity of alternative alcohol 
consumption guidelines. In addition, they will focus on the 
rates and predictors of new late-life drinking problems and of 
remission, and consider the consequences of late-life drinking 
problems and remission, including whether stably remitted 
problem drinkers' functioning and life contexts normalize over 
time or whether there is permanent ``scarring'' associated with 
prior drinking problems. (2) They will examine health-related 
factors, such as medical conditions, medication use, pain, and 
depression and suicidal ideation, in relation to fluctuations 
in late-life drinking patterns. They will also focus on late-
life and the lifetime history of help-seeking for alcohol-
related and personal problems, as well as natural recovery of 
drinking problems. (3) They will consider the role of social 
context and coping, including friends and social resources, and 
life history factors, in fluctuations in late-life alcohol 
consumption, drinking problems, and remission and relapse. 
Finally, (4) they will examine gender and current family 
influences on the course of late-life problem drinking. By 
spotlighting the extent of at-risk drinking, late-onset problem 
drinking, and relapse among adults of advanced age, this 
research should help health care providers more readily 
recognize the existence and potential for drinking problems 
among their oldest patients. By providing insight into reasons 
adults at this life stage do or do not seek help for drinking 
problems, and patterns of help-seeking predictive of more 
favorable drinking outcomes, the research may help to provide 
the scientific underpinnings to promote development of more 
accessible and effective alcohol prevention programs for older 
adults.
    Excellence: What makes this project exceptional?
    Because the proportion of older people who drink is small 
and the amounts drunk by older people are typically small, 
there is a limited amount of useful epidemiological research on 
alcohol use in later life. This study will be one of the few 
alcohol studies focusing on older age groups. Also, the study's 
longitudinal design permits a rare opportunity to examine 
changes in drinking behavior as individual's transition between 
relatively young old age and older old age.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    This study is examining such important issues as: (a) The 
high risk patterns of drinking are over time; (b) the 
predictive validity of alternative alcohol consumption 
guidelines; (c) whether stable remission leads to normalization 
of life functioning, or whether there is permanent 
``scarring''; (d) long term health outcomes such as medical 
conditions, medication use, depression and suicidal ideation 
related to changes in drinking behavior; (e) the natural 
histories of help seeking and natural remission, and the role 
of social contexts, both concurrent and past, as well as of 
later life drinking adaptations. These data do not currently 
exist in any other prospective study, and this project has the 
potential to provide new findings of special import, given the 
increasing aging of the U.S. population.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Considering the aging of the American population, sound 
epidemiological information about drinking on later life will 
provide the critical basis for planning the health care needs 
of older Americans, recognizing the unique patterns of problems 
that attend on alcohol use in older age, developing age-
appropriate screening and brief intervention tools, and 
ensuring the availability of sufficient treatment capacity for 
these individuals.
    Innovativeness: Why is this research exciting or 
newsworthy?
    Again, the key element in innovativeness is the lack of 
comparable information from any other available sources. 
Although the research techniques are standard ones, they have 
not been applied to this segment of the population in previous 
research.

National Institute of Allergy and Infectious Diseases (NIAID)/National 
Institutes of Health (NIH): More Effective Flu Vaccines for the Elderly

    Influenza causes illness and death in elderly persons, who 
are at increased risk for serious complications associated with 
the flu. For this reason, finding flu vaccines that are more 
effective in elderly populations is an important public health 
concern. The findings of this study suggest that higher doses 
of seasonal influenza vaccine may be a safe and viable way to 
enhance protection against influenza among elderly persons.
    Lead Agency: National Institute of Allergy and Infectious 
Diseases (NIAID), National Institutes of Health (NIH).
    Agency Mission: The mission of the National Institute of 
Allergy and Infectious Diseases is to conduct and support basic 
and applied research to better understand, identify, treat, and 
prevent infectious and immune-related diseases.
    Principal Investigators: Dr. Wendy Keitel, Baylor College 
of Medicine, One Baylor Plaza, BCM-385, Houston, Texas 77030.
    Partner Agency: Sanofi Pasteur.
    General Description: NIAID has a longstanding commitment to 
advancing scientific research focused on the development of 
therapies, diagnostics, and devices needed to reduce the threat 
posed by both seasonal and pandemic influenza. Influenza causes 
significant morbidity and mortality in the elderly, a 
population at increased risk for serious flu complications, 
including pneumonia, bronchitis, and sinus infections. Support 
for the development of new influenza vaccines is a major focus 
of the NIAID Influenza Research Program. One aspect of this 
vaccine effort focuses on developing flu vaccines that are more 
effective in elderly populations, where influenza morbidity and 
mortality is significantly high. The findings from this NIAID-
funded study suggest that a higher dose of seasonal influenza 
vaccine can safely and significantly increase the immune 
responses of older people to the virus. Investigators observed 
that vaccinated, elderly patients produced higher levels of 
antibodies to influenza. These results suggest that larger 
doses of vaccine may be a safe and viable way to enhance 
protection against influenza among elderly persons.
    Excellence: What makes this project exceptional?
    This study provides a basis for further evaluation of 
enhanced potency vaccines in the elderly.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Influenza causes significant morbidity and mortality in the 
elderly, a population at increased risk for serious flu 
complications, including pneumonia, bronchitis and sinus 
infections. These findings are an important first step in 
developing new strategies to better protect the elderly against 
influenza-associated hospitalizations and mortality.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Influenza morbidity and mortality is significant in the 
elderly as they do not mount as robust an immune response as 
younger persons. Research looking at how to optimize the immune 
response in the elderly could lead to improved prevention 
strategies that could reduce the incidence rate of influenza in 
elderly persons.
    Innovativeness: Why is this exciting or newsworthy?
    This research helps provide the foundation for the support 
of influenza vaccines that may induce a higher antibody 
response in the elderly than the currently recommended vaccine.

National Institute of Allergy and Infectious Diseases: Effects of Aging 
           and Immune Suppression on the Innate Immune System

    This NIH-supported study has shown how the innate immune 
system may become less effective against infection as people 
age and stresses the importance of development of new vaccine 
formulations and other intervention strategies to boost the 
immune response.
    Lead Agency: National Institute of Allergy and Infectious 
Diseases (NIAID)/National Institutes of Health (NIH).
    Agency Mission: The mission of the National Institute of 
Allergy and Infectious Diseases is to conduct and support basic 
and applied research to better understand, identify, treat, and 
prevent infectious and immune-related diseases.
    Principal Investigator: Erol Fikrig, M.D., Department of 
Internal Medicine, Yale University, 300 Cedar Street, Room 
S525A, New Haven, CT 06520-8031.
    General Description:

  EFFECTS OF AGING AND IMMUNE SUPPRESSION ON THE INNATE IMMUNE SYSTEM

    Understanding the consequences of aging and immune 
suppression upon infection with, or vaccination against, West 
Nile virus or influenza is essential to the development of 
clinical tests and interventions aimed at individuals at 
particular risk for adverse outcomes in the event of an 
epidemic. This project focused on the effects of aging and 
immune suppression on the function of the innate immune system, 
which is responsible for the body's first response to 
infection. The NIH-supported project assessed how innate immune 
system proteins, such as Toll-like receptors (TLRs) and 
macrophage inhibitory factor (MIF)--two key molecules that 
direct the innate immune response--may change as people age. 
Initial findings suggest that the amount and function of 
different TLRs, such as TLR1, decrease during aging in human 
innate immune cells. Additionally, when TLR1 and TLR2 are 
stimulated in older adults, they produce less tumor necrosis 
factor alpha and interleukin 6, two important proteins that 
help defend against viral infections. This evidence indicates 
that lowered expression and function of certain TLRs may be 
associated with increased infection-related morbidity and 
mortality and the impaired vaccine responses observed in aging 
humans. As this project progresses, further studies will assess 
how these innate immune system mediators change during aging 
and how they affect the immune response to infection by West 
Nile Virus or vaccination against influenza.
    Excellence: What makes this project exceptional?
    This project assessed the components of the host response 
that are the first activated by infection; these components 
represent the initial contact between microbes and host immune 
cells. This project has identified key parts of the innate 
immune system that change during aging in humans.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Although it is known that the immune system becomes less 
effective as it ages, it is not known which specific elements 
of the immune system break down first. This NIH-supported 
project will provide an important definition of the changes 
that occur in host-pathogen interactions in the elderly. 
Results from this study could have vital implications for 
vaccine development and immunotherapeutics targeted for the 
protection of older individuals.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    West Nile Virus and influenza are known to cause greater 
morbidity and mortality in the elderly than in the general 
population. The information that is gained from these studies 
will guide future efforts to develop better diagnostics, 
vaccines, and immunotherapies for the elderly against these 
diseases.
    Innovativeness: Why is this research exciting or 
newsworthy?
    The innate immune system is critically important in the 
body's response to many pathogens. In addition to identifying 
potential mechanisms for augmenting immune responses to West 
Nile Virus infection and influenza vaccination, findings from 
this project may also be of general benefit to the treatment 
and prevention of other types of infections.

National Institute of Allergy and Infectious Diseases: Multicenter AIDS 
                          Cohort Study (MACS)

    The Multicenter AIDS Cohort Study (MACS) is an ongoing 
prospective study of the natural and treated histories of HIV 
infection in homosexual and bisexual men conducted since 1984 
by sites located in Baltimore, Chicago, Pittsburgh, and Los 
Angeles. The MACS is also one of the only cohorts that enrolled 
HIV-negative men who have sex with men to serve as controls. 
The broad scientific agenda of the MACS includes sub-studies on 
aging issues such as immune function, cardiovascular disease, 
brain structure and function, frailty, and hearing loss.
    Lead Agency: National Institute of Allergy and Infectious 
Diseases (NIAID)/National Institutes of Health (NIH).
    Agency Mission: The mission of the National Institute of 
Allergy and Infectious Diseases is to conduct and support basic 
and applied research to better understand, identify, treat, and 
prevent infectious and immune-related diseases.
    Principal Investigator: Joseph Margolick, M.D., Ph.D., 
Bloomberg School of Public Health, The Johns Hopkins 
University, 615 North Wolfe St., Baltimore, MD 21205; John 
Phair, M.D., Feinberg School of Medicine, Northwestern 
University, 645 N. Michigan Ave., Suite 900, Chicago, IL 60611; 
Roger Detels, M.D., Center for the Health Sciences, UCLA School 
of Public Health, Room 71-267, P.O. Box 951772, Los Angeles, CA 
90095-1772; Charles Rinaldo, Ph.D., Graduate School of Public 
Health, University of Pittsburgh, 130 DeSoto Street, 
Pittsburgh, PA 15261; Lisa Jacobson, Sc.D., Bloomberg School of 
Public Health, Johns Hopkins University, 615 N. Wolfe Street, 
E7646, Baltimore, MD 21205.
    Partner Agency: National Cancer Institute, National Heart, 
Lung, and Blood Institute, National Institute on Deafness and 
Other Communication Disorders.
    General Description:

                  MULTICENTER AIDS COHORT STUDY (MACS)

    The MACS is one of the oldest longitudinal cohorts of HIV-
infected men in the world that includes the natural and treated 
histories of HIV-1 infection in 6,973 homosexual and bisexual 
men conducted by sites located in Baltimore, Chicago, 
Pittsburgh and Los Angeles (4,954 men from April 1984-March 
1985; 668 men from April 1987-September 1991; and 1,351 men 
from October 2001-August 2003). In addition to a blood sample, 
more than 8,500 individual pieces of information are collected 
on each man during the biannual study visits. The more than 1 
million deposited specimens and corresponding data form a rich 
dataset that describes the clinical outcomes, treatment 
responses, and behavior of these HIV-infected gay men over a 
25-year period. The MACS is also one of the only cohorts that 
enrolled HIV-negative men who have sex with men to serve as 
controls. Finally, more than 650 initially HIV-negative men 
have become HIV-infected during the course of the study and 
their clinical and behavioral information and specimens form a 
very valuable subset of data in the MACS. MACS data and 
deposited specimens are available to outside investigators 
conducting research on HIV/AIDS.
    The broad scientific agenda of the MACS includes sub-
studies on aging issues such as immune function, cardiovascular 
disease, brain structure and function, frailty, and hearing 
loss.
    (1) Supply a three line summary of the research project 
using terms reasonable for an educated lay audience:

          The Multicenter AIDS Cohort Study (MACS) is an 
        ongoing prospective study of the natural and treated 
        histories of HIV infection in homosexual and bisexual 
        men conducted since 1984 by sites located in Baltimore, 
        Chicago, Pittsburgh, and Los Angeles. The MACS is also 
        one of the only cohorts that enrolled HIV-negative men 
        who have sex with men to serve as controls. The broad 
        scientific agenda of the MACS includes sub-studies on 
        aging issues such as immune function, cardiovascular 
        disease, brain structure and function, frailty, and 
        hearing loss.

    (2) Respond to the following questions in a narrative about 
the research project using terms reasonable for an educated lay 
audience:
    Excellence: What makes this project exceptional?
    The more than 1 million deposited specimens and 
corresponding data form a rich dataset that describes the 
clinical outcomes, treatment responses, and behavior of these 
HIV-infected gay men over a 25-year period.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    With a significant number of HIV-infected individuals now 
advancing toward old age, it is vital to examine the effects of 
the many years of HIV infection and HIV-treatment on the aging 
process. The median age of the men in the MACS is 52.7 years 
and the oldest participant is 82.2 years old. The MACS is 
mining its 25 years of data to evaluate how these HIV-infected 
men are aging in relation to their HIV-negative counterparts.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    This research will describe the impact of long-term HIV 
infection and treatment on the aging process and potentially 
identify clinical outcomes that could be prevented or treated 
to extend longevity and ensure a better quality of life for 
HIV-infected persons.
    Innovativeness: Why is this exciting or newsworthy?
    HIV-infected persons now live far longer than ever 
anticipated when the AIDS virus was first identified. As these 
individuals live into older age, the HIV community recognizes 
the need for more information on HIV and aging.

 National Institute of Allergy and Infectious Diseases: Increase with 
                Age: Women Interagency HIV Study (WIHS)

    This is the largest and longest ongoing NIH-supported study 
of HIV-infected women in the United States and one of few 
studies that follows minority women. The WIHS aims to 
understand how HIV/AIDS and its treatment affects women, the 
relationship between HIV/AIDS and other diseases, and the 
impact of hormonal factors on HIV disease.
    Lead Agency: National Institute of Allergy and Infectious 
Diseases (NIAID), National Institutes of Health (NIH)
    Agency Mission: The mission of the National Institute of 
Allergy and Infectious Diseases is to conduct and support basic 
and applied research to better understand, identify, treat, and 
prevent infectious and immune-related diseases.
    Principal Investigators: Steven Gange, Ph.D., Department of 
Epidemiology, Johns Hopkins Bloomberg School of Public Health, 
615 N. Wolfe Street, Baltimore, MD 21205; Kathryn Anastos M.D., 
Bronx WIHS, Montefiore Medical Center, 3311 Bainbridge Avenue, 
2nd Floor, Bronx, NY 10467; Howard Minkoff, MD, Department of 
Obsetrics and Gynecology, Maimonides Medical Center, 967 48th 
Street, Brooklyn, NY 11219.
    Partner Agency: National Cancer Institute, National Center 
for Research Studies, National Institute of Child Health and 
Human Development, National Institute of Deafness and Other 
Communication Disorders, National Institute of Drug Abuse.
    General Description:

                   WOMEN INTERAGENCY HIV STUDY (WIHS)

    The Women's Interagency HIV Study (WIHS) was established in 
August 1993 to investigate the impact of HIV infection on women 
in the United States. Approximately 3,700 women have been 
enrolled, of which 2,400 are still attending visits every six 
months (the remaining have either died or lost to follow-up). 
The core portion of this NIH-supported study includes a 
detailed and structured interview, physical and gynecologic 
examinations, and laboratory testing. The WIHS participants are 
also asked to enroll in various sub-studies, including 
cardiovascular, metabolic, and physical functioning.
    Excellence: What makes this project exceptional?
    WIHS is the largest and longest running NIH-supported study 
of HIV in minority women in the United States and closely 
reflects the population of American women infected with HIV.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Many subjects followed through the WIHS have gone, or are 
going, through menopause. The study allows the investigation of 
the interplay between hormonal changes in women, HIV therapy, 
and aging.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    The study allows investigators to sort out the effects of 
HIV infection and its therapy from the effects of aging on 
chronic disease outcomes.
    Innovativeness Why is this exciting or newsworthy?
    The results of WIHS studies are important in guiding 
research into the effects of HIV and clinical research into 
effective therapy or their adverse effects. The longitudinal 
WIHS study now has 15 years of data and more than 2 million 
biological specimens in frozen storage, permitting 
comprehensive studies of the natural history of HIV and its 
therapy.

 National Institute of Arthritis and Musculoskeletal and Skin Diseases 
Duration of Rheumatoid Arthritis and Functional Improvement in Clinical 
                                 Trials

    Rheumatoid arthritis patients often experience limitations 
in physical function, due to joint pain and swelling during 
active inflammation, or residual joint damage and deformity in 
the absence of active inflammation. Because joint damage is 
irreversible and increases over time, patients with 
longstanding rheumatoid arthritis would be expected to display 
less physical function improvement with treatment than patients 
with early rheumatoid arthritis.
    Lead Agency: National Institute of Arthritis and 
Musculoskeletal and Skin Diseases (NIAMS)/National Institutes 
of Health (NIH).
    Agency Mission: The mission of the National Institute of 
Arthritis and Musculoskeletal and Skin Diseases is to support 
research into the causes, treatment, and prevention of 
arthritis and musculoskeletal and skin diseases, the training 
of basic and clinical scientists to carry out this research, 
and the dissemination of information on research progress in 
these diseases.
    Principal Investigator: Anita M. Linde, Director, Office of 
Science Policy and Planning, National Institute of Arthritis 
and Musculoskeletal and Skin Diseases, National Institutes of 
Health, 9000 Rockville Pike, Bldg. 31, Rm. 4C13, Bethesda, MD 
20892.
    Partner Agency: Austrian Science Foundation.
    General Description:

DURATION OF RHEUMATOID ARTHRITIS AND FUNCTIONAL IMPROVEMENT IN CLINICAL 
                                 TRIALS

    Limitations in physical function are common in patients 
with rheumatoid arthritis, occurring either because of joint 
pain and swelling in patients with active inflammation, or due 
to residual joint damage and deformity in patients without 
active inflammation. Current measures of physical limitations 
do not reveal the cause of the limitations, or whether the 
limitations are due to inflammation or joint damage. Because 
joint damage is irreversible and increases over time, less 
physical function improvement with treatment would be expected 
in patients with longstanding rheumatoid arthritis, in 
comparison with patients with early rheumatoid arthritis. NIH-
supported researchers studied reports of patients enrolled in 
rheumatoid arthritis clinical trials to determine whether there 
was a lower degree of physical function improvement among 
patients with a longer duration of the disease. They selected 
articles from all clinical trials of disease-modifying anti-
rheumatic medications in rheumatoid arthritis published from 
1980 to 2004. Thirty-six trials that measured physical function 
using the Health Assessment Questionnaire Disability Index 
(HAQ: the most common measure of physical function for 
arthritis patients) were studied. The average duration of 
rheumatoid arthritis in these trials ranged from 2.5 months to 
12.2 years. Physical function, as measured by the HAQ, improved 
in all trials, but improved more in trials that studied 
patients with early rheumatoid arthritis. Each additional year 
of rheumatoid arthritis was associated with about a 7 percent 
decrease in physical function improvement; among trials of more 
contemporary medications, this decrease was approximately 14 
percent per additional year of rheumatoid arthritis. These 
findings indicate that physical function is less responsive to 
treatment in late rheumatoid arthritis than early rheumatoid 
arthritis. This difference is probably due to the various 
causes of physical limitations in early and late arthritis.
    Excellence: What makes this project exceptional?
    Physical function is an important component of health; it 
includes one's mobility and ability to wash, dress, and eat, 
and is often limited in patients with rheumatoid arthritis.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Current measures of these physical limitations do not 
distinguish whether they are due to active inflammation or 
joint damage. Because joint damage is irreversible and 
increases over time, it would be expected that older patients 
with longstanding rheumatoid arthritis would show less 
improvement than patients with early rheumatoid arthritis.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    This study is a significant contribution to the development 
of treatments aimed at improving physical function. The results 
indicate that it is important to consider the degree of joint 
damage when evaluating the ability of different treatments to 
improve physical function. This could lead to better targeting 
of treatments for older rheumatoid arthritis patients with 
longstanding disease.
    Innovativeness: Why is this research exciting or 
newsworthy?
    Physical function is a major driver of health care costs. 
Confounding factors in evaluating treatments, such as 
differences in the degree of joint damage and the sensitivity 
of physical function measures to change, may affect estimates 
of the relative cost-effectiveness of different rheumatoid 
arthritis medications.

 National Institute of Arthritis and Musculoskeletal and Skin Diseases 
     Bisphosphonates With Estrogen Show Additive Benefits Against 
                              Osteoporosis

    NIH-supported investigators identified the mechanism of 
action of bisphosphonates, used to treat osteoporosis. Unlike 
the effects of bisphosphonates and PTH, the effects of 
bisphosphonates and estrogen are additive; thus, combining 
these two medications may prove more effective than unpleasant 
and costly injections of PTH.
    Lead Agency: National Institute of Arthritis and 
Musculoskeletal and Skin Diseases (NIAMS)/National Institutes 
of Health (NIH).
    Agency Mission: The mission of the National Institute of 
Arthritis and Musculoskeletal and Skin Diseases is to support 
research into the causes, treatment, and prevention of 
arthritis and musculoskeletal and skin diseases, the training 
of basic and clinical scientists to carry out this research, 
and the dissemination of information on research progress in 
these diseases.
    Principal Investigators: Dr. Stavros C. Manolagas, Dr. Joel 
Finkelstein, Dr. Felicia Cosman, Dr. Dennis Black.
    Partner Agency: National Institute on Aging (NIA), 
Department of Veterans Affairs.
    General Description:

     BISPHOSPHONATES WITH ESTROGEN SHOW ADDITIVE BENEFITS AGAINST 
                              OSTEOPOROSIS

    The mechanism by which estrogen decreases cell death in 
bone forming cells, the osteoblast, has been identified, and 
new therapies based on this action of estrogen are being 
designed and tested as a result. However, increasing evidence 
indicates that the bone-maintaining and primary stress-sensing 
cell, the osteocyte, also contributes to the mechanical 
competence of the skeleton. Both estrogen and bisphosphonates, 
also used to treat osteoporosis, act to prevent death of 
osteocytes. However, until recently the bisphosphonate 
mechanism of action was not well understood, and questions 
remained as to how to optimize this therapy as well as how to 
best combine it with other osteoporosis therapies in order to 
achieve the best effect while minimizing drug use and cost.
    In a recent study, NIH-supported investigators found that 
bisphosphonates act through a novel intracellular signaling 
pathway triggered by opening of special channels in the 
osteocytes' membranes. Their findings demonstrate that estrogen 
and bisphosphonates act on osteocytes to prevent cell death via 
different mechanisms. The effects of the two drugs are additive 
in vitro. Thus, this work helps to explain clinical 
observations that the combination of these two drugs may be 
more effective than either drug alone as a treatment for 
osteoporosis.
    Earlier NIH-funded research has provided guidance about 
using bisphosphonates concurrently with another medication, 
PTH, which closely resembles human parathyroid hormone. Unlike 
bisphosphonates and estrogen which slow bone loss by preventing 
cell death, PTH stimulates bone formation. Many thought that 
bisphosphonates and PTH combined would be more protective than 
either taken separately. NIH-supported researchers refuted that 
belief, demonstrating that not only did the combined regimen of 
PTH injections and oral bisphosphonate therapy fail to provide 
more benefit than bisphosphonate alone, combining the oral drug 
and PTH injections somewhat diminished the therapeutic effect 
of PTH alone.
    Despite its health benefits, patients are reluctant to give 
themselves daily injections of PTH. Therefore, researchers 
continued to search for strategies to minimize the cost and 
burden of PTH therapies--with important results that provide 
good news for people with osteoporosis. In a subsequent study, 
women taking PTH for one year were given either no drug in the 
second year or were switched to bisphosphonate. Those who 
received no drug after a year of PTH began to lose the bone 
they had gained during treatment, while those who switched to 
bisphosphonate in the second year continued to gain bone, 
demonstrating that the sequential use of PTH as a bone building 
drug followed by bone-conserving bisphosphonate maximized the 
bone gain.
    In a related study in a different laboratory, researchers 
found that treatment with PTH does not need to be continuous 
throughout the year. In fact, cyclic treatment with PTH for 
three months followed by three months of bisphosphonate alone 
was as effective in stimulating bone gain as the continuous use 
of PTH for 12 months. Taking 3-month breaks from PTH not only 
provides cost benefits, but also improves quality of life for 
patients who do not need to inject the drug every day.
    Excellence: What makes this project exceptional?
    This new work demonstrates a novel mechanism of action of 
bisphosphonates and shows that this mechanism differs from and 
is additive to the action of estrogen. These new insights open 
the path for optimizing use of both types of drugs individually 
and in combination to achieve the best treatment for 
osteoporosis.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Osteoporosis affects over ten million people in the United 
States and is a major cause of morbidity, loss of function, and 
mortality among older adults.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Physicians and patients can use the results of these 
studies to strategize for the best therapeutic benefit while 
minimizing drug use and cost.
    Innovativeness: Why is this research exciting or 
newsworthy?
    Optimizing treatments for osteoporosis has the potential to 
affect quality of life and reduce costs of care for millions of 
Americans.

National Institute of Arthritis and Musculoskeletal and Skin Diseases: 
              Training Intervention for Family Caregivers

    A coping intervention (COPE) designed to support family 
caregivers of hospice patients may have a positive effect on 
patients' perceived symptom distress via a reduction in the 
perceived symptom and task burdens experienced by caregivers.
    Lead Agency: National Institute of Arthritis and 
Musculoskeletal and Skin Diseases (NIAMS)/National Institutes 
of Health (NIH).
    Agency Mission: The mission of the National Institute of 
Arthritis and Musculoskeletal and Skin Diseases is to support 
research into the causes, treatment, and prevention of 
arthritis and musculoskeletal and skin diseases, the training 
of basic and clinical scientists to carry out this research, 
and the dissemination of information on research progress in 
these diseases.
    Principal Investigators: Susan J. Diem, M.D., MPH, 450 
McNamara Alumni Center, 200 Oak Street, SE., Minneapolis, MN 
55455-2070; Elizabeth Haney, M.D., Sam Jackson Hall, 3rd Floor, 
3181 S.W. Sam Jackson Park Road.
    Partner Agency: National Institute on Aging (NIA).
    General Description:

    USE OF ANTIDEPRESSANT MEDICATION LINKED WITH INCREASED RISK FOR 
                              OSTEOPOROSIS

    In 2004 the Surgeon General's Report on Bone Health and 
Osteoporosis pointed to the need to identify secondary causes 
of osteoporosis in order to prevent fractures in the elderly. A 
number of diseases, conditions and treatments have consequences 
on bone that can be successfully mitigated if recognized. 
Depression was mentioned as a possible condition associated 
with lower bone mass and an increased risk of osteoporosis and 
fractures, although the mechanism is not completely understood. 
Now, recent papers from two large cohort studies, the 
Osteoporotic Fractures in Men (Mr. OS) Study and the Study of 
Osteoporotic Fractures (SOF), point to the deleterious effect 
on bone of selective serotonin re-uptake inhibitors (SSRIs), a 
very common treatment for depression, in both older men and 
women.
    The SSRIs account for over 60 percent of the prescriptions 
for depression particularly in the elderly since they have a 
better safety profile for cardiovascular disease. This could 
lead to a high exposure in a population vulnerable to bone loss 
and osteoporosis. Results of Mr. OS and SOF indicate that use 
of SSRIs is associated with reductions in bone mineral density 
among men and an increased rate of bone loss at the hip in 
women. Because bone loss is common among older people, with the 
most severe loss generally seen among post-menopausal women, 
the finding that SSRIs may be a significant contributing factor 
to osteoporosis could have major public health implications.
    Excellence: What makes this project exceptional?
    The finding that a common treatment for depression may 
contribute to or accelerate bone loss in this already 
vulnerable population has potentially major clinical 
implications.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Depression is common and 8.5 percent of Americans use anti-
depressive medication. The SSRIs account for over 60 percent of 
the prescriptions for depression, particularly in the elderly, 
since they have a better safety profile for cardiovascular 
disease. At the same time, some 10 million Americans currently 
have osteoporosis and 34 million more have low bone mass, 
placing them at increased risk for this disease.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    These provocative findings, if confirmed, could lead to 
major changes in the way depression is managed in middle aged 
and older individuals. For example, even if treatment with 
SSRIs appears to be clinically appropriate in a given case, 
measures to forestall bone loss may also be indicated. However, 
further research is needed to confirm these findings and to 
determine the best interventions to ameliorate depressive 
symptoms without compromising bone health among older 
Americans.
    Innovativeness: Why is this research exciting or 
newsworthy?
    A common treatment for depression may have unexpected and 
harmful side effects on bone. If the association between SSRI 
use and bone loss is confirmed through additional studies, this 
research could lead to major changes in the standard of care 
for depression in older people.

National Institute of Arthritis and Musculoskeletal and Skin Diseases: 
    Use of Antidepressant Medications Linked With Osteoporosis Risk

    Selective serotonin reuptake inhibitors (SSRIs), a 
commonly-prescribed class of antidepressants, have been 
associated with bone loss in women and reduced bone mineral 
density in men.
    Lead Agency: National Institute of Arthritis and 
Musculoskeletal and Skin Diseases (NIAMS)/National Institutes 
of Health (NIH).
    Agency Mission: The mission of the National Institute of 
Arthritis and Musculoskeletal and Skin Diseases is to support 
research into the causes, treatment, and prevention of 
arthritis and musculoskeletal and skin diseases, the training 
of basic and clinical scientists to carry out this research, 
and the dissemination of information on research progress in 
these diseases.
    Principal Investigators: Susan J. Diem, M.D., MPH, 450 
McNamara Alumni Center, 200 Oak Street, SE., Minneapolis, MN 
55455-2070; Elizabeth Haney, M.D., Sam Jackson Hall, 3rd Floor, 
3181 S.W. Sam Jackson Park Road.
    Partner Agency: National Institute on Aging (NIA).
    General Description:

    USE OF ANTIDEPRESSANT MEDICATION LINKED WITH INCREASED RISK FOR 
                              OSTEOPOROSIS

    In 2004 the Surgeon General's Report on Bone Health and 
Osteoporosis pointed to the need to identify secondary causes 
of osteoporosis in order to prevent fractures in the elderly. A 
number of diseases, conditions and treatments have consequences 
on bone that can be successfully mitigated if recognized. 
Depression was mentioned as a possible condition associated 
with lower bone mass and an increased risk of osteoporosis and 
fractures, although the mechanism is not completely understood. 
Now, recent papers from two large cohort studies, the 
Osteoporotic Fractures in Men (Mr. OS) Study and the Study of 
Osteoporotic Fractures (SOF), point to the deleterious effect 
on bone of selective serotonin re-uptake inhibitors (SSRIs), a 
very common treatment for depression, in both older men and 
women.
    The SSRIs account for over 60 percent of the prescriptions 
for depression particularly in the elderly since they have a 
better safety profile for cardiovascular disease. This could 
lead to a high exposure in a population vulnerable to bone loss 
and osteoporosis. Results of Mr. OS and SOF indicate that use 
of SSRIs is associated with reductions in bone mineral density 
among men and an increased rate of bone loss at the hip in 
women. Because bone loss is common among older people, with the 
most severe loss generally seen among post-menopausal women, 
the finding that SSRIs may be a significant contributing factor 
to osteoporosis could have major public health implications.
    Excellence: What makes this project exceptional?
    The finding that a common treatment for depression may 
contribute to or accelerate bone loss in this already 
vulnerable population has potentially major clinical 
implications.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Depression is common and 8.5 percent of Americans use anti-
depressive medication. The SSRIs account for over 60 percent of 
the prescriptions for depression, particularly in the elderly, 
since they have a better safety profile for cardiovascular 
disease. At the same time, some 10 million Americans currently 
have osteoporosis and 34 million more have low bone mass, 
placing them at increased risk for this disease.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    These provocative findings, if confirmed, could lead to 
major changes in the way depression is managed in middle aged 
and older individuals. For example, even if treatment with 
SSRIs appears to be clinically appropriate in a given case, 
measures to forestall bone loss may also be indicated. However, 
further research is needed to confirm these findings and to 
determine the best interventions to ameliorate depressive 
symptoms without compromising bone health among older 
Americans.
    Innovativeness: Why is this research exciting or 
newsworthy?
    A common treatment for depression may have unexpected and 
harmful side effects on bone. If the association between SSRI 
use and bone loss is confirmed through additional studies, this 
research could lead to major changes in the standard of care 
for depression in older people.

 National Institute of Arthritis and Musculoskeletal and Skin Diseases 
(NIAMS)/National Institutes of Health (NIH): Reducing the Morbidity and 
         Mortality From Pressure Ulcers Among Elderly Patients

    Pressure ulcers, particularly in hospitalized elderly 
patients, are one of the major contributors to the morbidity, 
mortality, and economic burden of skin diseases. Because these 
ulcers begin developing early in an elderly patient's 
hospitalization, NIH-supported researchers conducted a small 
study to identify patient risk factors for pressure ulcer 
development that could be addressed in wound prevention. This 
project revealed risk factors that included age, male gender, 
dry skin, urinary and fecal incontinence, difficulty turning in 
bed, nursing home residence prior to admission, recent 
hospitalizations, and poor nutritional status.
    Lead Agency: National Institute of Arthritis and 
Musculoskeletal and Skin Diseases (NIAMS).
    National Institutes of Health (NIH).
    Agency Mission: The mission of the National Institute of 
Arthritis and Musculoskeletal and Skin Diseases is to support 
research into the causes, treatment, and prevention of 
arthritis and musculoskeletal and skin diseases, the training 
of basic and clinical scientists to carry out this research, 
and the dissemination of information on research progress in 
these diseases.
    Principal Investigator: Mona Baumgarten, Ph.D., 
[email protected], (410) 706-1531.
    Partner Agency: National Institute on Aging (NIA).
    General Description: A group of patients 65 years or older, 
admitted through the emergency department to the inpatient 
medical service of four collaborating hospitals, were examined 
during the initial days of their admission for evidence of the 
development of pressure ulcers and studied for predisposing 
factors. The patients were examined by specially trained 
research nurses under the standard methodology used by most 
hospitals for determining the severity of pressure ulcers. Of 
the 201 patients studied, 6.2 percent developed a pressure 
ulcer within the first three days of hospitalization. The 
majority were on the sacral area (lower back) or on the heel. 
The primary predictive factors were age, male gender, dry skin, 
urinary and fecal incontinence, difficulty turning in bed, 
nursing home residence prior to admission, recent 
hospitalizations, and poor nutritional status. These findings 
will help hospitalists focus on those individuals at greatest 
risk for developing pressure ulcers soon after hospitalization, 
and should allow for the design of nursing care practices to 
reduce wound incidence.
    The ability to expand this to a much larger study would be 
limited by the training of additional personnel, unless some 
method of using less highly-trained individuals could be 
developed. The same research group analyzed photographs to 
determine whether they could be viewed remotely at a later time 
by a smaller number of research nurses, and provide dermatology 
information electronically (teledermatology), similar to that 
obtained by live-patient examination by the same nurses. The 
methodology allowed determination of the reliability of 
evaluations, comparing interrater (one research nurse to 
another) and intrarater (a particular nurse on several 
occasions). Overall, the sensitivity and specificity were quite 
high (97 and .81, respectively), and the inter- and intrarater 
reliability was also good (69 and .84, respectively). These 
data indicate that it would be possible to use photographs and 
teledermatology techniques to allow for the collection of a 
much larger number of participants, without requiring specially 
trained research nurses at each site. These methods would also 
allow multiple readings of the same patient materials by 
different research nurses, which should improve the reliability 
of data interpretation.
    Excellence: What makes this project exceptional?
    Pressure ulcers, particularly in hospitalized elderly 
patients, are one of the most significant contributors to 
morbidity, mortality, and economic burden of skin diseases. The 
development of these ulcers begins early in the hospitalization 
of an elderly patient, but this aspect had not been 
investigated until recently.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Identification of patients at risk for developing such 
pressure ulcers will focus preventive measures on patients who 
might obtain the most benefit. Continuation of these studies 
and application of their results to nursing care have the 
potential for greatly reducing the morbidity, mortality, and 
burden of such wounds.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Data collection on large numbers of patients is important 
in determining the appropriate criteria for pressure ulcer 
risk. This research also provided a methodology for extending 
these studies to a larger number of patients.
    Innovativeness: Why is this exciting or newsworthy?
    A limited number of specially trained research nurses can 
evaluate patients using photographs and teledermatology. This 
approach would minimize training of additional research nurses, 
and reduce staff time and other study costs, relative to the 
initial pilot study.

National Institute of Arthritis and Musculoskeletal and Skin Diseases: 
       Surgical Versus Non-Surgical Treatments for Low Back Pain

    Results from the Spine Patient Outcomes Research Trial 
(SPORT) will help patients who have low back pain determine if 
they should undergo surgery or try other, non surgical 
treatments.
    Lead Agency: National Institute of Arthritis and 
Musculoskeletal and Skin Diseases (NIAMS)/National Institutes 
of Health (NIH).
    Agency Mission: The mission of the National Institute of 
Arthritis and Musculoskeletal and Skin Diseases is to support 
research into the causes, treatment, and prevention of 
arthritis and musculoskeletal and skin diseases, the training 
of basic and clinical scientists to carry out this research, 
and the dissemination of information on research progress in 
these diseases.
    Principal Investigator: James N. Weinstein, M.S., D.O., 
Chair of Orthopaedic Surgery, Dartmouth-Hitchcock Medical 
Center, 1 Medical Center Drive, Lebanon, NH 03756.
    Partner Agency: Office of Research on Women's Health 
(ORWH), National Institute for Occupational Safety and Health 
(NIOSH), Centers for Disease Control and Prevention (CDC).
    General Description:

       SURGICAL VERSUS NON-SURGICAL TREATMENTS FOR LOW BACK PAIN

    The Spine Patient Outcomes Research Trial (SPORT) has 
provided evidence that will help patients who have low back 
pain determine if they should undergo surgery or try other, 
nonsurgical treatments. The 13-center study followed patients 
who had low back pain caused by herniated disk or spinal 
stenosis (with or without the forward slippage of one vertebra 
on top of another) and who were randomly assigned to undergo 
surgery or to receive non-surgical therapies, or who wanted to 
choose their own treatment but agreed to participate in an 
observation study. For people who have both spinal stenosis (a 
narrowing of the bony elements around the spinal cord and nerve 
roots in the lower back) and vertebral instability, SPORT 
clearly demonstrated that patients who underwent decompression 
and fusion surgery to relieve pressure on the spinal cord and 
to prevent additional slippage showed substantially greater 
improvement in pain and function during a 2-year period, as 
compared with those who received non-operative treatments. The 
benefits were particularly noteworthy for those patients with 
more severe disease, whereas patients with minor complaints 
appeared to do comparably well with non-operative treatments.
    Decompression surgery provided a similar benefit for 
patients for whom spinal stenosis was not complicated by 
vertebral slippage. Patients reported significantly less pain 
and disability, and increased physical functioning, within 6 
weeks of surgery--benefits that persisted for the 2-year study 
period. Of note, the functional status of patients who received 
non-surgical interventions improved slightly during the study, 
suggesting that people who are reluctant to have surgery to 
correct spinal stenosis are not subjecting themselves to 
further damage.
    Of the somewhat younger candidates for lumbar diskectomy 
for a herniated disk (an average age of 42 years), researchers 
found that those who opted to forego surgery for nonoperative 
care fared similarly to those who had the surgery. In general, 
surgery patients experienced slightly more improvement (i.e., 
less pain, better physical function) over the study period, and 
particularly in the first 3 months, than those who opted for 
other treatments. In other words, lumbar diskectomy was 
generally effective in relieving pain from herniated disks, but 
nonoperative therapies seemed to offer equivalent benefits for 
patients who could not or chose not to have surgery.
    Excellence: What makes this project exceptional?
    The study provides valuable information to patients, 
providers, and policy makers, when making treatment decisions 
about whether surgery would relieve pain associated with 
intervertebral disc herniation or degenerative 
spondylolisthesis with or without spinal stenosis (the three 
leading reasons people undergo surgery for low back pain).
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Low back disorders are common, costly, and often disabling. 
Back surgeries in aging Americans are one of the fastest 
growing areas of medical care, with hospital costs exceeding 
$21 billion per year. Spinal stenosis (a narrowing of the bony 
elements around the spinal cord and nerve roots in the lower 
back) is the most common reason for spinal surgery in Americans 
over age 65 years. Lumbar diskectomy--the surgical removal of 
all or part of an intervertebral disk--is commonly performed 
surgical procedure for patients of all ages who have back or 
leg pain due to a herniated disc. Despite the widespread use, 
the procedures' effectiveness in comparison with that of non-
surgical treatments had not been demonstrated in controlled 
trials.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Clinicians now have evidence that older patients who suffer 
from stenosis are likely to benefit more from decompression and 
surgery than from non-operative treatments, particularly if 
they are severely disabled by the disease. However, patients 
who have spinal stenosis that is not complicated by vertebral 
slippage and want to delay or avoid having surgery are not 
subjecting themselves to further damage.
    Innovativeness: Why is this research exciting or 
newsworthy?
    Before SPORT, many patients with back pain were conflicted 
about whether to undergo surgery. Now, people who have back 
pain due to a herniated disc can be assured that a surgical 
procedure called lumbar diskectomy is generally effective in 
relieving pain from herniated disks, but--if their pain is 
tolerable and their condition is not progressing--their 
symptoms will likely subside over time, even without surgery. 
On the other hand, older patients who suffer from stenosis are 
likely to benefit more from decompression and surgery than from 
non-operative treatments. However, surgical complication rates 
increase substantially after 80 years of age, and this must be 
considered when making treatment selections in older patients.

  National Institute of Child Health and Human Development: Combined 
           Surgery for Pelvic Organ Prolapse and Incontinence

    NICHD-supported investigators showed that continent women 
with advanced prolapse who received a procedure to prevent 
stress incontinence (called the Burch colposuspension) at the 
same time that abdominal sacral colpopexy is performed to 
correct prolapse, reduced postoperative symptoms of stress 
incontinence.
    Lead Agency: Eunice Kennedy Shriver National Institute of 
Child Health and Human Development (NICHD)/National Institutes 
of Health (NIH).
    Agency Mission: The mission of the NICHD is to ensure that 
every person is born healthy and wanted, that women suffer no 
harmful effects from reproductive processes, and that all 
children have the chance to achieve their full potential for 
healthy and productive lives, free from disease or disability, 
and to ensure the health, productivity, independence, and well-
being of all people through optimal rehabilitation.
    Principal Investigator: Morton B. Brown, Geoffrey Cundiff, 
Ingrid E. Nygaard, Linda Brubaker, Holly E. Richter, Halina M. 
Zyczynski, Paul Martin, Anthony G. Visco.
    General Description:

      COMBINED SURGERY FOR PELVIC ORGAN PROLAPSE AND INCONTINENCE

    By performing two surgical procedures during the same 
operation, researchers in NICHD's Pelvic Floor Disorders 
Research Network reduced the incidence of urinary incontinence 
by half in women with a condition known as pelvic organ 
prolapse. Ordinarily, a single surgery is performed to correct 
pelvic organ prolapse, and a second surgery is performed only 
if incontinence develops.
    Pelvic organ prolapse occurs when the pelvic muscles and 
connective tissue within the pelvic cavity weaken or are 
injured. The tissue ordinarily supports the vagina and holds it 
in place within the pelvis. Without normal support, however, 
the uterus, bladder, and bowel press down on the vagina, 
causing it to invert and, in some women, these organs 
eventually protrude through the vaginal opening. With advanced 
pelvic organ prolapse, the vaginal protrusion may cause a 
kinking of the urethra, blocking the flow of urine and 
preventing the bladder from emptying completely (called partial 
retention). This retention, in turn, may lead to frequent or 
persistent urinary tract infections. In other cases, depending 
on the individual, pelvic organ prolapse may occur along with 
stress incontinence--urine leakage from the bladder during a 
cough or a sneeze.
    To treat pelvic organ prolapse, gynecologists may recommend 
that patients have a surgical procedure known as 
sacrocolpopexy. In this procedure, surgical mesh and sutures 
are used to anchor the vagina to the sacrum. However, after 
sacrocolpopexy, many women experience incontinence, which makes 
them candidates for a second surgical procedure, the Burch 
colposuspension. With Burch colposuspension, additional sutures 
are sewn through the wall of the vagina and anchored to 
ligaments inside the pelvic cavity, near the pubic bone.
    The Network investigators undertook a study to determine if 
proactively performing the Burch colposuspension at the same 
time as sacrocolpopexy might prove effective at preventing 
incontinence in women with prolapse who did not have symptoms 
of stress incontinence before surgery. For their study, with 
the women's consent, the researchers randomly assigned women 
who were undergoing sacrocolpopexy to receive either Burch 
colposuspension or no additional surgery. Three months after 
their surgery, the women were evaluated according to 
standardized criteria for urinary stress incontinence. These 
criteria measured incontinence that occurred in response to 
such activities as coughing, sneezing, laughing, physical 
exercise, lifting, or bending over. Of the Burch group, 23.8 
percent met one or more criteria for stress incontinence. In 
comparison, of the group that underwent sacrocolpopexy alone, 
44.1 percent met one or more criteria for stress incontinence.
    Excellence: What makes this project exceptional?
    Pelvic organ prolapse is a common problem among older women 
that can lead to major surgical treatments. Women who do not 
have urinary stress incontinence before the surgery to treat 
pelvic organ prolapse may develop incontinence after the 
surgery. The research findings definitively resolve the 
question of whether performing a procedure to prevent 
postoperative stress incontinence (Burch colposuspension) at 
the same time as a procedure to treat pelvic organ prolapse 
(sacrocolpopexy) improved outcomes compared to performing the 
surgery to correct the prolapse alone.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    By performing both procedures at the same time, women may 
both avoid a second surgery and maintain their quality of life 
after surgery.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    In many cases, clinicians have adopted principles of care 
and surgical techniques before rigorous, objective, controlled 
evaluation has been conducted. The study findings enable 
healthcare providers to recommend an evidence-based treatment 
that not only remedies pelvic organ prolapse, but also prevents 
post-operative urinary incontinence.
    Innovativeness: Why is this research exciting or 
newsworthy?
    Pelvic organ prolapse is a common problem among older women 
that can lead to major surgical treatments. Women who do not 
have urinary stress incontinence before the surgery to treat 
pelvic organ prolapse may develop incontinence after the 
surgery. The research findings definitively resolve the 
question of whether performing a procedure to prevent 
postoperative stress incontinence (Burch colposuspension) at 
the same time as a procedure to treat pelvic organ prolapse 
(sacrocolpopexy) improved outcomes compared to performing the 
surgery to correct the prolapse alone.

   National Institute on Drug Abuse: Aging and the Effects of Abused 
                               Substances

    This animal research seeks to find differences in how 
opiates, the key ingredient in most pain medications, affect 
pain and produce pleasure in older populations, with 
implications for pain management and opiate abuse in the 
elderly.
    Lead Agency: National Institute on Drug Abuse (NIDA)/
National Institutes of Health (NIH).
    Agency Mission: The mission of the National Institute on 
Drug Abuse is to lead the Nation in bringing the power of 
science to bear on drug abuse and addiction. This charge has 
two critical components. The first is the strategic support and 
conduct of research across a broad range of disciplines. The 
second is ensuring the rapid and effective dissemination and 
use of the results of that research to significantly improve 
prevention, treatment, and policy as it relates to drug abuse 
and addiction.
    Principal Investigator: Conan Kornetsky, Ph.D., Professor, 
715 Albany Street, 560, Boston, MA 02118.
    General Description:

               AGING AND THE EFFECTS OF ABUSED SUBSTANCES

    Featured are two projects by the same principal 
investigator, which have informed each other and yielded 
interesting findings. The long-term objective of this basic 
research was to compare young and old rats' responses to 
opiates and cocaine. Considerable evidence shows that aging 
alters brain systems implicated in the pleasurable effects of 
abused substances. The first study examined the functional 
consequences of these brain alterations using a number of 
animal models for seeing how abused substances stimulate the 
brain. The second study looked at whether the hedonic potency 
(i.e., degree of pleasurable response) of opiates decreases 
with age, via experiments to determine differences in the 
hedonic effects of morphine--the prototypic opiate--as measured 
by the drug's effect on the threshold for rewarding 
intracranial stimulation in young, middle-aged, and aged rats. 
The pharmacokinetics (drug absorption, distribution, 
metabolism, and elimination) of morphine were compared.
    Excellence: What makes this project exceptional?
    These experiments were exceptional for being among the 
first to examine the relationship between analgesic and hedonic 
effects of opiates and aging.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    As the baby boomer generation (born 1946-1964) prepares to 
swell the ranks of older adults in this country, we will likely 
also see an increase in drug abuse among older Americans, 
including prescription medications and illicit substances. 
Indeed, studies suggest that 4.4 million Americans over the age 
50 will present with addiction problems by 2020, and even more 
will misuse painkillers and other prescription drugs.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    The basic research represented by these studies is needed 
to fill major gaps in our current knowledge. For while it is 
now evident that the brain changes continuously across life, 
how drugs of abuse interact with these age-related changes 
remains unclear. Substance abuse during older age may augment 
the risks and require unique considerations for diagnosis and 
treatment, which studies like these will begin to elucidate. In 
addition, baby boomers may be carrying forward into old age 
some risky behaviors that they've been living with and dying 
from since they were young adults.
    Innovativeness: Why is this research exciting or 
newsworthy?
    This research is exciting because it provides important 
clues about age-related brain differences, about how aging 
affects brain systems involved in drug abuse, and about the 
potential impact of drug abuse on the aging brain.

 National Institute on Drug Abuse: Role of Substance Abuse Patterns in 
         Clinical and Health Management of HIV in Older Adults

    This research will use novel statistical techniques for 
measuring substance abuse exposure to better capture 
trajectories of substance abuse over time and to assess their 
effects on relevant clinical and public health HIV outcomes.
    Lead Agency: National Institute on Drug Abuse (NIDA)/
National Institutes of Health (NIH).
    Agency Mission: The NIDA mission is to lead the Nation in 
bringing the power of science to bear on drug abuse and 
addiction. This charge has two critical components. The first 
is the strategic support and conduct of research across a broad 
range of disciplines. The second is ensuring the rapid and 
effective dissemination and use of the results of that research 
to significantly improve prevention, treatment and policy as it 
relates to drug abuse and addiction.
    Principal Investigator: Susan Weiss, Ph.D., Chief, Science 
Policy Branch, NIDA, Address: 6001 Executive Blvd., Suite 5230, 
Bethesda, MD 20892.
    General Description:

 ROLE OF SUBSTANCE ABUSE PATTERNS IN CLINICAL AND HEALTH MANAGEMENT OF 
                          HIV IN OLDER ADULTS

    The proposed study will measure and analyze substance abuse 
(alcohol and non-medical use of prescribed psychoactive drugs) 
over time among HIV positive and negative adults to 
characterize their distinct trajectory classes. Among those 
with HIV, the study will examine the role of substance abuse 
patterns in determining outcomes important to the clinical and 
health management of HIV in an aging, adult population. These 
include disease progression, adherence to HIV medication, and 
mortality. The study will use data accumulated from a large, 
multi-site prospective cohort study--the Veteran's Aging Cohort 
Study (VACS)--to derive a better understanding of the influence 
of substance use and abuse in HIV treatment and care. Analyses 
will also explore how broader contextual characteristics (e.g., 
perceived accessibility of one's healthcare provider and 
neighborhood-level disadvantage) interrelate with patterns of 
substance abuse and HIV outcomes.
    Excellence: What makes this project exceptional?
    A key problem with the data emanating from large 
observational cohort studies of HIV-infected people in the U.S. 
and Europe, which show an unequivocal relationship between 
substance abuse and HIV progression, is the varied definition 
of substance abuse used in the analyses.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    This study is exceptional in that it addresses these 
limitations using novel statistical techniques to better assess 
effects of substance abuse across time on health outcomes.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Results may help clinicians in making treatment decisions 
about their substance abusing HIV-positive patients and 
identify those at greatest risk for poor health outcomes. 
Findings may also suggest areas for more targeted public health 
prevention and treatment interventions for HIV-positive 
substance abusers and inform drug, alcohol, mental health, and 
HIV/AIDS treatment guidelines.
    Innovativeness: Why is this research exciting or 
newsworthy?
    This study also makes use of a large existing data set on 
aging veterans, making the most of extant information and 
extending knowledge about a high-risk subgroup.

National Institute on Drug Abuse: Functional Limitation Measures Among 
                             Women With HIV

    This research advances disability prevention by identifying 
subgroups at highest risk of functional decline and disability, 
providing a benchmark for future evaluations, and informing 
prevention and treatment strategies for planning or modifying 
services.
    Lead Agency: National Institute on Drug Abuse (NIDA), 
National Institutes of Health (NIH).
    Agency Mission: The NIDA mission is to lead the Nation in 
bringing the power of science to bear on drug abuse and 
addiction. This charge has two critical components. The first 
is the strategic support and conduct of research across a broad 
range of disciplines. The second is ensuring the rapid and 
effective dissemination and use of the results of that research 
to significantly improve prevention, treatment and policy as it 
relates to drug abuse and addiction.
    Principal Investigator: Arpi Terzian, student, Address: 220 
East 31st Street, Apt. 3E, Baltimore, MD 21218.
    General Description:

          FUNCTIONAL LIMITATION MEASURES AMONG WOMEN WITH HIV

    The proposed study will characterize functional limitation 
and disability among a cohort of women infected with HIV, who 
are part of the Women's Interagency HIV Study (WIHS). The study 
is nested as a cross-sectional study within the prospective 
WIHS study. Functional limitation measures include indices of 
hand grip strength and timed gait tests, while disability 
measures assess activities of daily living. Prevalence and 
severity are compared across groups of women according to HIV, 
HCV, and illicit drug use status. Women infected with HIV or 
HCV are also compared with uninfected WIHS participants and 
uninfected external' women from the Cardiovascular Health Study 
and the Women's Health and Aging Study. Epidemiologic 
associations will involve more than 3,000 WIHS women, 
representing the domestic epidemiology of HIV/AIDS in women. 
Logistic regression analyses will use HIV, HCV, drug use, and 
age-related predictors.
    Excellence: What makes this project exceptional?
    This study will provide vital, comprehensive data on the 
prevalence and severity of HIV- and HIV/HCV-coinfected women. 
Findings should help generate inferences about the etiology of 
particular disabilities and limitations.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Given that more than 60,000 Americans aged 50 or older are 
living with HIV, attention to disability prompts studies that 
look at people's functioning in the presence of disease as 
health outcome rather than disease onset and mortality.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    This study helps to fill a critical gap in that data on the 
epidemiology of disability among older HIV- and HIV/HCV-
coinfected women area particularly scarce.
    Innovativeness: Why is this research exciting or 
newsworthy?
    The study also takes advantage of other large data sets and 
promotes collaboration across disciplines.

   National Institute of Diabetes and Digestive and Kidney Diseases: 
        Understanding Anemia of Inflammation and Chronic Disease

    NIH-supported investigators have identified mechanisms 
underlying disturbances of iron balance that cause ``anemia of 
inflammation and chronic disease'' (AICD), a common and 
debilitating form of anemia in older people. These research 
findings have laid the groundwork for developing novel 
therapeutic drugs with which to effectively treat this common 
type of anemia in the elderly.
    Lead Agency: National Institute of Diabetes and Digestive 
and Kidney Diseases (NIDDK)/National Institutes of Health NIH).
    Agency Mission:
     Conduct and support basic, clinical, and 
translational research on diseases of internal medicine and 
related subspecialty fields, including diabetes and other 
endocrine and metabolic diseases; liver and other digestive 
diseases; nutritional disorders; obesity; kidney and urologic 
diseases; and hematologic diseases; as well as fundamental 
research in many basic science disciplines.
     Foster research training and mentoring at multiple 
career stages to maintain pipeline of outstanding investigators 
in these research fields.
     Disseminate science-based knowledge gained from 
NIDDK-funded research to health care providers and the public 
through outreach and communications.
    Principal Investigator: Tomas Ganz, MD, PhD, Division of 
Pulmonary and Critical Care Medicine, David Geffen School of 
Medicine at UCLA, 37-055 Center for Health Sciences, 10833 Le 
Conte Avenue, Los Angeles, CA 90095-1690.
    Partner Agency: National Heart Lung and Blood Institute.
    General Description:

        UNDERSTANDING ANEMIA OF INFLAMMATION AND CHRONIC DISEASE

    Many chronic diseases and inflammatory conditions are 
associated with anemia (abnormally decreased numbers of 
circulating red blood cells). This type of anemia has been 
called ``anemia of inflammation and chronic disease'' (AICD) 
and is characterized by disturbances in iron metabolism that 
impair red blood cell production. AICD is particularly common 
among the elderly, and it can seriously limit not only the 
function and quality of life but also the longevity of those 
affected. Until recently, the underlying cause of disturbed 
iron metabolism in AICD was unknown and a longstanding unsolved 
mystery in medicine. Research supported by the NIH identified 
Hepcidin (a small molecule hormone produced by the liver) as a 
central regulator of iron balance in humans. This research has 
also determined the mechanisms by which Hepcidin negatively 
regulates the transport of iron into the blood stream from the 
GI tract, where dietary iron is absorbed, and from tissue sites 
where recycled iron is stored. Moreover, this research has 
defined signaling pathways by which Hepcidin production in the 
liver is regulated, including those responsible for the 
abnormally elevated circulating levels of Hepcidin that are now 
recognized to be hallmarks of AICD. This research has not only 
provided new insights into the causes of AICD and anemia of the 
elderly, but has also laid the groundwork for the development 
of novel therapeutic drugs that may provide the means to 
effectively treat AICD and anemia of the elderly in the future.
    Excellence: What makes this research exceptional?
    By determining the cause of AICD, a very common form of 
anemia, this research has not only solved a longstanding 
medical mystery, it has provided the basis for developing new 
effective treatments for this form of anemia, which is 
particularly common and debilitating in elderly people.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Analysis of the most recent National Health and Nutrition 
Examination Survey (NHANES III) data indicates that 
approximately 10 per cent of all non-hospitalized men and women 
older than 65 in the United States anemic and that a 
substantial proportion of these have laboratory evidence of 
AICD as the cause of anemia. This research has not only defined 
the underlying mechanisms for this common form of anemia, it 
has also provided the basis for developing novel, effective 
treatments.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Further research is now underway to realize the promise of 
this basic research with respect to developing new and more 
effective approaches to detect, prevent, and treat AICD, a 
common and debilitating form of anemia among the elderly.
    Innovativeness: Why is this research exciting or 
newsworthy?
    Effective approaches for accurately detecting and 
effectively preventing or treating the so-called ``anemia of 
inflammation and chronic disease'' (AICD) have the potential to 
positively affect the quality of life and longevity of millions 
of Americans. This research has provided for the first time a 
clear path forward to achieve these goals.

   National Institute of Diabetes and Digestive and Kidney Diseases: 
      Biofeedback for Managing Constipation and Fecal Incontinence

    Randomized controlled clinical trials of biofeedback to 
self-monitor pelvic floor muscle contraction exercises have 
demonstrated the benefits of this treatment for constipation 
and fecal incontinence. Biofeedback was shown to work even 
better than some standard treatments such as laxatives or 
unmonitored exercises. Additional analyses of data from these 
trials continue to yield new information on long-term benefits 
of this treatment.
    Lead Agency: National Institute of Diabetes and Digestive 
and Kidney Diseases (NIDDK)/National Institutes of Health 
(NIH).
    Agency Mission:
    a. Conduct and support basic, clinical, and translational 
research on diseases of internal medicine and related 
subspecialty fields, including diabetes and other endocrine and 
metabolic diseases; liver and other digestive diseases; 
nutritional disorders; obesity; kidney and urologic diseases; 
and hematologic diseases, as well as fundamental research in 
many basic science disciplines.
    b. Foster research training and mentoring at multiple 
career stages to maintain pipeline of outstanding investigators 
in these research fields.
    c. Disseminate science-based knowledge gained from NIDDK-
funded research to health care providers and the public through 
outreach and communications.
    Principal Investigator: William E. Whitehead, PhD, Center 
for Functional GI and Motility Disorders, University of North 
Carolina, Campus Box 7080, Chapel Hill, NC 27599-7080, USA.
    Partner Agency: NIH Office of Research on Women's Health, 
National Center for Research Resources (General Clinical 
Research Center Program), Milan Pharmaceuticals, Jansen 
Pharmaceuticals, Sandhill Scientific Incorporated.
    General Description:

      BIOFEEDBACK FOR MANAGING CONSTIPATION AND FECAL INCONTINENCE

    Constipation, lodging of stool in the rectum, and fecal 
incontinence, an inability to control bowel movements, are more 
common in older adults. These conditions can lead to 
embarrassment and social isolation, and they often go 
untreated. Constipation commonly causes fecal incontinence, 
such that approaches to managing these conditions are similar. 
One of the available treatments for these conditions is 
biofeedback, which involves the use of monitors that record 
contractions of the pelvic floor muscles in order to help 
individuals to train these muscles and achieve better control 
over their bowel movements. In this study, NIDDK-supported 
researchers tested the use of biofeedback to assess whether it 
was truly effective relative to other treatment options in 
managing constipation and fecal incontinence.
    Biofeedback sessions were used in a randomized controlled 
clinical trial to teach patients with constipation to relax 
their pelvic floor muscles in order to reduce straining. The 
trial showed that this treatment was helpful to patients with a 
type of constipation known as pelvic floor dyssynergia, 
associated with inappropriate contraction rather than 
relaxation of the pelvic floor muscles during defecation. 
Biofeedback treatment in these patients resulted in 
improvements in terms of their bowel movement frequency and 
straining, bloating, and abdominal pain. Compared to continuous 
use of a laxative or muscle relaxant, biofeedback was shown to 
be more effective, and its benefits were sustained in one study 
throughout 2 years of follow up.
    This project also demonstrated a benefit for biofeedback in 
patients with fecal incontinence, which commonly results from 
constipation. Results from a randomized controlled clinical 
trial indicated that biofeedback is better at alleviating fecal 
incontinence than the standard practice of Kegel exercises 
(contractions of the pelvic floor muscles) performed without 
the benefit of biofeedback monitoring. Individuals with fecal 
incontinence found that biofeedback improved their symptoms, 
including reducing episodes of incontinence. Continuing 
analyses of the information collected in these trials have 
assessed the long-term durability of biofeedback's effects on 
fecal incontinence and analyzed the health care costs 
associated with this condition.
    Excellence: What makes this project exceptional?
    The researchers showed that biofeedback works better than 
some commonly used treatments to reduce symptoms of 
constipation or fecal incontinence.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Older persons are at increased risk for developing 
constipation and fecal incontinence. These conditions can lead 
to embarrassment and isolation, severely reducing quality of 
life and preventing individuals from seeking medical care to 
alleviate them.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Research to identify which available treatments are 
effective and safe for alleviating constipation and fecal 
incontinence can improve the clinical management of these 
conditions in older persons, who are commonly affected by them.
    Innovativeness: Why is this research exciting or 
newsworthy?
    Prior to this research, findings from uncontrolled studies 
suggested, but did not conclusively prove, that biofeedback 
might be helpful for individuals suffering from constipation or 
fecal incontinence. Biofeedback is an attractive treatment 
option because it carries very little risk of adverse events 
compared with other possible treatments. These randomized, 
controlled clinical trials were the first to provide definitive 
support for the efficacy of biofeedback as a treatment for 
these conditions.

   National Institute of Diabetes and Digestive and Kidney Diseases 
   (NIDDK)/National Institutes of Health (NIH): Diabetes Prevention 
                  Program (DPP) and DPP Outcomes Study

    NIH-supported investigators found in a clinical trial that 
type 2 diabetes could be prevented or delayed in people at high 
risk of the disease. A lifestyle intervention of diet, 
exercise, and behavior modification was most effective at 
diabetes prevention, especially in older Americans. Ongoing 
research with the clinical trial participants is revealing more 
information about diabetes risk, onset, prevention, and 
outcomes.
    Lead Agency: National Institute of Diabetes and Digestive 
and Kidney Diseases (NIDDK)/National Institutes of Health 
(NIH).
    Agency Mission:
     Conduct and support basic, clinical, and 
translational research on diseases of internal medicine and 
related subspecialty fields, including diabetes and other 
endocrine and metabolic diseases; liver and other digestive 
diseases; nutritional disorders; obesity; kidney and urologic 
diseases; and hematologic diseases; as well as fundamental 
research in many basic science disciplines.
     Foster research training and mentoring at multiple 
career stages to maintain pipeline of outstanding investigators 
in these research fields.
     Disseminate science-based knowledge gained from 
NIDDK-funded research to health care providers and the public 
through outreach and communications.
    Principal Investigators: David M Nathan, M.D., DPP/DPPOS 
Study Chair, Professor of Medicine, Harvard Medical School, 
Director, Diabetes Research Center, Massachusetts General 
Hospital, 50 Staniford Street, Suite 340, Boston, MA 02114.
    Partner Agency: NIDDK, Eunice Kennedy Shriver National 
Institute of Child Health and Human Development (NICHD), 
National Institute on Aging (NIA), National Eye Institute 
(NEI), National Center on Minority Health and Health 
Disparities (NCMHD), NIH Office of Research on Women's Health 
(ORWH), NIH Office of Behavioral and Social Sciences Research 
(OBSSR), Indian Health Service (IHS), Centers for Disease 
Control and Prevention (CDC), National Heart, Lung, and Blood 
Institute (NHLBI). Non-federal funding partners: Warner-Lambert 
(WL), Bristol-Meyers Squibb (BMS), American Diabetes 
Association (ADA), National Center for Research Resources 
(NCRR), Merck & Co., Hoechst Merion Roussel, Sankyo, Life Scan, 
Slim Fast, and Health-O-Meter.
    General Description:

        DIABETES PREVENTION PROGRAM (DPP) AND DPP OUTCOMES STUDY

    Understanding and preventing type 2 diabetes and its health 
complications is an important public health goal being 
addressed by NIH-supported research. Researchers continue to 
gain new insights into type 2 diabetes and its prevention from 
the landmark Diabetes Prevention Program (DPP) clinical trial 
and the follow up DPP Outcomes Study. The DPP was a randomized, 
controlled clinical trial that examined the effects of 
lifestyle and medical interventions on the development of type 
2 diabetes in over 3,200 adults at risk for this disease. The 
DPP compared intensive lifestyle modification, treatment with 
the medication metformin, and standard medical advice. 
Published in 2002, the striking results of the DPP trial tell 
us that millions of high-risk people can use diet, exercise, 
and behavior modification to avoid or delay developing type 2 
diabetes. In its most dramatic result, participants in the DPP 
lifestyle intervention group--those receiving intensive 
counseling on effective diet, exercise, and behavior 
modification--reduced their risk of developing diabetes by 58 
percent. This finding was true across all participating ethnic 
groups and for both men and women. Lifestyle changes worked 
particularly well, in fact best, for participants aged 60 or 
older, reducing their risk by 71 percent. The DPP also found 
that metformin is effective in delaying the onset of diabetes, 
but the study suggests it works best in younger, more 
overweight individuals and was much less effective in those 
over 60.
    During the study, the DPP collected a broad array of health 
data and biological samples from the large, racially and 
ethnically diverse group of participants--some of whom 
developed diabetes during the course of the trial. This 
tremendous diabetes research resource is supporting informative 
analyses of diabetes risk factors and disease development. For 
example, recent analyses of DPP data have shown that steps 
taken to prevent or delay type 2 diabetes can also apparently 
help reduce risk factors for diabetes complications. In one 
study, it was found that hypertension, a classic risk factor 
for cardiovascular disease, was present in nearly one third of 
all DPP participants at the beginning of the trial, and 
increased in the patients who received either placebo or 
metformin--however, it significantly decreased in the lifestyle 
intervention group. The DPP data and samples have also enabled 
researchers to examine the influence of genetic risk factors 
for type 2 diabetes on progression to disease in trial 
participants, and to investigate more readily the possible 
biological mechanisms associated with genetic risk.
    Currently, the majority of DPP participants are being 
followed in the ``DPP Outcomes Study'' (DPPOS). The DPPOS is 
examining longer-term effects of the trial interventions on 
prevention of type 2 diabetes and its health complications--
including heart disease, eye and kidney disease, and nerve 
damage. The DPPOS will also compare outcomes for women and men, 
by age and ethnicity.
    Excellence: What makes this project exceptional?
    The Diabetes Prevention Program clinical trial is the 
largest and most racially and ethnically diverse study of 
people at high risk for developing type 2 diabetes (based on 
impaired glucose metabolism). There has been high retention of 
the DPP volunteers in both the clinical trial phase and the 
outcomes study phase. The collection of health and biological 
information obtained from the DPP volunteers is an invaluable 
diabetes research resource that is still being analyzed to 
understand development of this disease and its complications in 
people at high risk.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    The risk of developing type 2 diabetes increases 
dramatically with age. According to recent estimates by the 
Centers for Disease Control and Prevention, diabetes affects 
over 23.6 million Americans, approximately 90-95 percent of 
which is type 2 diabetes, and in the 60 and over age group, 
about 12.2 million, or 23.1 percent, have diabetes. 
Approximately 57 million more adults are at risk for developing 
diabetes. In 1988-1994, among U.S. adults aged 40-74 years, 
40.1 percent had pre-diabetes (impaired glucose metabolism). In 
2003-2006, 35.4 percent of adults aged 60 years or older had 
impaired fasting glucose (one form of pre-diabetes). Moreover, 
it was recently estimated that costs of diabetes in 2007 were 
$174 billion, including direct medical costs of $116 billion. 
After adjusting for population age and sex differences, average 
medical expenditures among people with diagnosed diabetes were 
2.3 times higher than what expenditures would be in the absence 
of diabetes. According to the analysis, over half (56 percent) 
of all health care expenditures attributed to diabetes are for 
health resources used by the population age 65 years or older, 
much of which is borne by the Medicare program (Diabetes Care 
31:1-20, 2008).
    Diabetes is the leading cause of kidney failure and new 
onset blindness in adults. Heart disease and stroke together 
are the leading cause of death in people with diabetes. The DPP 
results showed that type 2 diabetes could be prevented or 
delayed in people at high risk, including older people. Through 
its ``Small Steps. Big Rewards. Prevent Type 2 Diabetes'' 
campaign, the National Diabetes Education Program has turned 
the DPP results into a message of diabetes prevention tailored 
to different populations in the United States, including older 
Americans, in order to help decrease the burden of type 2 
diabetes and its health complications on our society.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Older Americans at risk of type 2 diabetes now have 
evidence-based information and tools that can enable them to 
take steps to prevent or delay this disease and its 
complications.
    Innovativeness: Why is this exciting or newsworthy?
    This work was the first evidence that type 2 diabetes could 
be prevented in an ethnically and racially diverse population 
at high risk. The interventions tested were effective for 
people of all ages, particularly older Americans. Analyses of 
health and biological information collected from the DPP 
participants during the clinical trial have continued to reveal 
new information about diabetes development and risk factors. 
The DPPOS should provide new insights into the sustainability 
of the DPP interventions and their long-term effects on 
diabetes health complications.

 The National Institute of Environmental Health Sciences: Mouse Models 
         To Study DNA Repair Following Environmental Exposures

    The objective of this NIH supported project is to develop 
mouse models containing human genes. The mice are used to study 
the ability of cells to repair DNA damage in response to 
environmental exposures. DNA repair is a major component in 
diseases influenced by aging such as cancer.
    Lead Agency: The National Institute of Environmental Health 
Sciences (NIEHS)/National Institutes of Health (NIH).
    Agency Mission: The mission of the NIEHS is to reduce the 
burden of human illness and disability by understanding how the 
environment influences the development and progression of human 
disease.
    Principal Investigator: Warren C Ladiges, DVM, Professor, 
Department of Comparative Medicine, T-140 HSB, University of 
Washington, Box 257190, Seattle, Washington 98195-7190.
    Partner Agency: Fred Hutchinson Cancer Research Center.
    General Description:

   MOUSE MODELS TO STUDY DNA REPAIR FOLLOWING ENVIRONMENTAL EXPOSURES

    DNA repair is a major component in diseases influenced by 
aging such as cancer. The overall objective of this NIH 
supported project is to develop mouse models for studying the 
biological function of environmentally sensitive DNA repair/
cell cycle control gene variants found in the human population. 
The capacity for DNA repair is a major influence in the 
sensitivity to carcinogenic stimuli, so genetic variants must 
be considered in risk assessment. The concept that common 
variants in the population contribute to genetic risk for 
common diseases has triggered intense interest in identifying 
DNA sequence variants known as single nucleotide polymorphisms 
(SNPs). However, the functional significance of SNP variants in 
relation to environmental carcinogens is largely unknown. This 
study is designed to establish a genetically engineered mouse 
system as a mammalian model for human functional genomics and 
SNP variant-environment interactions. The development of these 
mouse models will mirror specific human, environmentally 
responsive polymorphic gene variants found in the general 
population, and provide a biological system for understanding 
the functional significance of these polymorphic variants.
    Excellence: What makes this project exceptional?
    Mitochondria are organelles found in most cells that are 
responsible for chemical energy production. They are involved 
in a range of processes including cellular signaling, 
differentiation, cell cycle control, growth, and death. 
Mitochondria dysfunction has been implicated in several human 
disorders including neurological diseases, cardiac dysfunction, 
cancer, diabetes, and may play a role in the aging process.
    Results from this research project contradict a widely-
believed theory that mitochondrial mutations drive the aging 
process. In the study, mice with mitochondrial mutations 500 
times higher than normal levels did not show signs of premature 
aging.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    As organisms age, some cellular processes are perturbed and 
don't work as well as they do in younger organisms. Previous 
research led to the theory that accumulated mitochondrial 
mutations throughout life eventually cause the decline in 
tissue functioning associated with aging. However, this 
research shows that transgenic mice engineered to have a high 
degree of mitochondrial mutation age the same as normal mice.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    This basic research may have future impacts on the 
prevention or treatment of diseases in aging populations. It 
provides knowledge on what is considered normal for cells in 
aging organisms.
    Innovativeness: Why is this research exciting or 
newsworthy?
    This research opens new pathways for discovery in the aging 
process and questions what was previously accepted as normal. 
It could be the first step in developing new preventive methods 
or drugs and interventions that could stop or reverse declines 
in cellular function as an organism ages.

    The National Institute of Environmental Health Sciences (NIEHS)/
   National Institutes of Health (NIH): Environmental Exposures and 
                       Decline in Renal Function

    The primary focus of this research project is to study the 
contributions of a variety of environmental agents in the 
development of end-stage renal disease. The project is being 
conducted with a cohort of people occupationally exposed to the 
element lead. The investigators have also found other health 
affects including declines in mental ability as the cohort 
ages.
    Lead Agency: The National Institute of Environmental Health 
Sciences (NIEHS)/National Institutes of Health (NIH).
    Agency Mission: The mission of the NIEHS is to reduce the 
burden of human illness and disability by understanding how the 
environment influences the development and progression of human 
disease.
    Principal Investigators: Virginia M. Weaver, MD, Assistant 
Professor Environmental Health Science Department, Bloomberg 
School of Public Health, Johns Hopkins University, 615 N. Wolfe 
Street, W7041, Baltimore, Maryland 21205.
    Partner Agency: Institute of Industrial Medicine 
Soonchunhyang University, Republic of Korea, Mt. Sinai Medical 
Center, New York.
    General Description: End stage renal disease (ESRD) is 
associated with substantial morbidity and mortality. Strategies 
to prevent the renal function decline that can ultimately 
result in ESRD are essential. The impact of environmental 
exposures has received relatively little attention in this 
regard, despite the fact that exposures such as cadmium and 
lead are known renal toxicants that are stored long-term in the 
body and ubiquitous in humans. In fact, the lead and cadmium 
dose-effect curves for renal function remain uncertain for the 
low to moderate range of doses. The project will investigate a 
broad set of causes of renal function decline, including lead, 
cadmium, blood pressure, diabetes, nephrotoxic medication use, 
genetic polymorphisms, and age. This research project will 
build on data, from the large cohort of current and former lead 
workers and participants without occupational lead exposure in 
the originally funded grant. Study subjects have a wide range 
of lead exposure and dose measures and renal outcome data from 
three visits each over an average of 2.2 years. Analysis of 
existing data has already provided very important results, 
including longitudinal decline in renal function associated 
with lead dose measures; interaction between age and lead dose 
on renal function and renal function decline; interaction 
between ALAD genotype and lead dose on renal function; and 
associations of environmental level cadmium dose with elevated 
NAG in a subset of lead workers. We believe the proposed work 
will allow a more complete understanding of the causes of renal 
function decline and lead to the development of public health 
interventions to prevent this considerable public health 
problem.
    Excellence: What makes this project exceptional?
    Results from this project suggest that the ``normal'' 
cognitive decline experienced as people age may be related to 
recent and life-time exposure to lead. In three separate 
independent epidemiologic studies, bone lead content was 
associated with poorer measures of cognitive function.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Lead exposure is widely known to cause problems in learning 
in children along with reducing the peak intelligence children 
can obtain. Lead is readily stored in bone tissue and there are 
few effective treatments for removing lead from the body once 
exposure has occurred. It can be released from bone during 
gestation and milk production and in aging people if osteopenia 
or osteoporosis develops. The neurological effects of long-term 
lead exposure on aging populations have not been well 
described.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Added to the knowledge that exposure to lead lowers the 
peak IQ a person reaches, these studies show that lead exposure 
is a life-long issue. The researchers point out that the 
current occupational safety standards for lead workers are 
inadequate to protect them. The researchers believe that blood 
lead levels in adults should be kept below 20 micrograms per 
deciliter of blood and tibia lead should be kept below 15 
micrograms per gram to prevent cognitive function loss.
    Innovativeness: Why is this research exciting or 
newsworthy?
    This research draws into question that cognitive decline as 
people age is normal and that their life-long exposure to lead 
may influence their mental abilities later in life. It 
demonstrates again that there is no safe level of lead exposure 
at any age and that current efforts to protect adult workers 
from lead exposure may be inadequate.

The National Institute of Environmental Health Sciences: Socio-Economic 
         Disadvantages and Risk for Poor Health and Disability

    The study aims are to identify neighborhood conditions that 
have an adverse affect on health and to examine the stress 
levels by which living in disadvantaged neighborhoods lead to 
increased risk for poor health and disability in an older, 
urban, and ethnically diverse population.
    Lead Agency: The National Institute of Environmental Health 
Sciences (NIEHS)/National Institutes of Health (NIH).
    Agency Mission: The mission of the NIEHS is to reduce the 
burden of human illness and disability by understanding how the 
environment influences the development and progression of 
disease.
    Principal Investigator: Mendes De Leon, Carlos F., Rush 
Institute for Health Aging, 1645 W. Jackson Blvd, Suite 675, 
Chicago, IL 60612.
    General Description:

  SOCIO-ECONOMIC DISADVANTAGES AND RISK FOR POOR HEALTH AND DISABILITY

    These NIEHS-funded researchers will investigate the effect 
of socio-economic disadvantages and neighborhood conditions on 
disability in older blacks and whites. The project takes place 
in a population of persons aged 65 years and over who live in 
an urban, biracial community in Chicago. The overall aims of 
this study are to identify the specific nature of neighborhood 
conditions that have an adverse affect on health and to examine 
the stress-related physiological mechanisms by which living in 
disadvantaged neighborhoods lead to increased risk for poor 
health and disability in an older, urban, and ethnically 
diverse population. To accomplish this aim, the investigators 
propose to collect yearly disability data and obtain blood 
samples and salivary cortisol from over 7,000 participants. 
These data will be integrated with a rich set of existing data 
on personal characteristics, health conditions, and 
neighborhood factors to test a series of specific hypotheses 
related to the overall goals. Disability is a common and highly 
prevalent consequence of age-related chronic diseases, and a 
critical indicator of overall health among older people. 
Prevention of disability is essential to improve the lives of 
older people and reduce health care costs. The proposed work 
will contribute to a better understanding of the specific 
neighborhood conditions that are associated with increased 
disability, laying the foundation for more effective policies 
to prevent disability in future generations of older adults.
    Excellence: What makes this project exceptional?
    This project is exceptional as it relates to measures of 
neighborhood environment, social cohesion and neighborhood 
disorder and the effects upon disability and stress levels. 
Other associations are being explored more fully such as the 
association between neighborhood conditions and walking 
behavior in older adults. In addition the researchers are 
investigating the role of body weight in aging-related decline 
in physical and cognitive function as well as racial 
differences in quality of life. The association between 
perceived discrimination and mortality are also examined along 
with ongoing analyses on perceived discrimination and blood 
pressure, on neighborhood conditions and psychosocial outcomes, 
and on SES related differences in mortality and disability.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    This research focuses on disability in older adults. 
Disability is the result of the impact of chronic diseases on a 
person's ability to perform specific tasks and activities that 
are essential for self-care and independent living. Because 
disability forms the common consequence of different, and often 
co-occurring chronic conditions, it is an essential indicator 
of overall physical health in older adults. Disability and 
resulting loss of independence is a condition of enormous 
consequence for older people. It is highly prevalent; affecting 
about 10% of persons aged 65-74 to about 50% of those aged 85 
and over. It is the primary cause of institutionalization, and 
accounts for a large amount of the informal and formal health 
care needs of older adults.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    The existence of major health disparities in the U.S. 
population is widely accepted, and elimination of these 
disparities is a primary objective of Healthy People 2010. 
Disparities are evident across major indicators of health at 
all stages of life, including conditions that affect infants 
and children, adult-onset chronic diseases, such as 
cardiovascular disease, diabetes, and cognitive impairment and 
Alzheimer's disease, mental disorders, and all cause-mortality. 
Previous studies indicate that there are substantial 
socioeconomic and racial disparities in disability. This 
project will provide a better understanding of how to reduce 
and ultimately prevent disability in regard to the built 
environment of older persons that addresses racial disparities 
and socioeconomic status.
    Innovativeness: Why is this research exciting or 
newsworthy?
    This study examines disability in older persons, 
disparities among whites and blacks, neighborhood factors and 
health, and socioeconomic differences in health among older 
adults. Prevention of disability is essential to improve the 
lives of older people and reduce health care costs. The 
proposed work will contribute to a better understanding of the 
specific neighborhood conditions, including differences in 
socioeconomic status and race, which may directly affect 
increased disability, laying the foundation for more effective 
policies to prevent disability in future generations of older 
adults.

   National Institute of Mental Health (NIMH)/National Institutes of 
      Health (NIH): Antidepressant Administration for Older Adults

    This study found that people age 70 or older who continued 
taking the antidepressant that helped them to initially recover 
from their first episode of depression were 60 percent less 
likely to experience a new episode of depression than those who 
stopped taking the medication.
    Lead Agency: National Institute of Mental Health (NIMH), 
National Institutes of Health (NIH).
    Agency Mission: The mission of NIMH is to transform the 
understanding and treatment of mental illnesses through basic 
and clinical research, paving the way for prevention, recovery, 
and cure.
    Principal Investigators: Dr. Charles Reynolds, Departments 
of Psychiatry and Neurology, Western Psychiatric Institute and 
Clinic, 3811 O'Hara Street, Room E-1135, Pittsburgh, PA 15213.
    Partner Agency: National Center for Minority Health and 
Health Disparities (NCMHD).
    General Description: There is controversy over the benefits 
and risks of administering long-term antidepressant treatment 
to elderly patients who have only one lifetime occurrence of 
major depression. Currently, the consensus has been that older 
patients experiencing their first episode of depression should 
be treated to full remission, after which they should have a 
limited period of continuation treatment for 6 to 12 months to 
ensure the stability of the remission and further improve 
recovery. This clinical trial tested whether maintenance 
therapy--long-term treatment given to patients to enable them 
to maintain a symptom-free or disease-free state--is effective 
in preventing future episodes of depression in patients 70 
years or older. It also tested whether antidepressant 
medication and psychotherapy were effective, and whether the 
extent of patients' medical burden had an impact on rates of 
recurrence.
    Patients ages 70 or older with depression who achieved full 
remission of symptoms after treatment using a combination of 
paroxetine (a selective serotonin reuptake inhibitor) and 
interpersonal psychotherapy (IPT) (psychotherapy that focuses 
on interpersonal relationships) were administered maintenance 
treatment where researchers tested the effectiveness of 
different treatment regimens in keeping patients symptom-free 
for up to two years. These patients were randomly assigned to 
one of four maintenance treatment groups: (1) Paroxetine; (2) 
placebo; (3) paroxetine and monthly IPT; and (4) placebo and 
IPT.
    The study found maintenance treatment was effective in 
older people with depression. Across all four treatment groups, 
rates of remission significantly differed. Among patients who 
received paroxetine in the maintenance phase, 63 percent 
remained in remission; 42 percent of those who received placebo 
remained in remission; 65 percent of patients who received 
paroxetine and IPT remained in remission; and 32 percent of 
patients who received placebo and IPT remained in remission.
    The study also showed that older people with multiple 
chronic physical disorders did not do as well on paroxetine as 
those with fewer medical problems, although they did show some 
benefit. The burden associated with more chronic and disabling 
diseases often drives the depression, making it more difficult 
to treat. Despite this, the researchers indicate that 
maintenance antidepressant medication may be effective in 
primary care settings where patients have multiple chronic 
diseases.
    Excellence: What makes this project exceptional?
    This study is one of the few that shows the practical 
benefits of continued treatment for depression in older adults 
after they become symptom free. The study also helps to 
establish some clinical guidelines for the long-term treatment 
of older adults with late life depression. This research adds 
substantially to our knowledge on how best to treat older 
adults with late life depression and helps to build practical, 
clinical utility for the treatment of depression.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    This study, which focused on older adults with depression, 
is part of an overall NIMH effort to conduct practical clinical 
trials in ``real world'' settings that address public health 
issues important to persons affected by major mental illnesses.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    This study demonstrates the benefits of keeping older 
patients on an antidepressant long after they become symptom-
free. What makes this study practical is that it shows that 
physicians can combine chronic disease management of depression 
with the chronic disease management of other illnesses to 
benefit the older individual as a whole--addressing both the 
patient's mental illness and his or her physical well-being.
    Innovativeness: Why is this exciting or newsworthy?
    The study addresses a major question in the treatment of 
depression--when to discontinue medication. People age 70 or 
older who continued taking the antidepressant that helped them 
to initially recover from their first episode of depression 
were 60 percent less likely to experience a new episode of 
depression than those who stopped taking the medication.

   National Institute of Mental Health (NIMH)/National Institutes of 
  Health (NIH): Preventive Treatment To Reduce Depression Following a 
                                 Stroke

    NIMH-funded researchers have shown that preventive 
treatment with an antidepressant medication or talk therapy can 
significantly reduce the risk or delay the start of depression 
following an acute stroke.
    Lead Agency: National Institute of Mental Health (NIMH), 
National Institutes of Health (NIH).
    Agency Mission: The mission of NIMH is to transform the 
understanding and treatment of mental illnesses through basic 
and clinical research, paving the way for prevention, recovery, 
and cure.
    Principal Investigators: Dr. Robert Robinson, Department of 
Psychiatry, University of Iowa, 200 Hawkins Drive 2887 JPP, 
Iowa City, IA 52242-1057.
    General Description: Over 700,000 people in the United 
States suffer a stroke every year. Those who suffer an acute 
stroke are at increased risk for developing post-stroke 
depression, which can impede rehabilitation and recovery of 
functional skills, reduce quality of life, and may also shorten 
an individual's lifespan. Thus, prevention of post-stroke 
depression is an important goal.
    Recent NIMH-funded research has shown that preventive 
treatment with an antidepressant medication or talk therapy can 
significantly reduce the risk or delay the start of depression 
following an acute stroke. The study compared the effects of 
the antidepressant medication escitalopram (Lexapro) with 
placebo in adults, ages 50-90, who had suffered an acute stroke 
within the previous three months. Another group of individuals 
were randomly selected to receive Problem Solving Therapy 
(PST), a talk therapy that helps people identify problems that 
interfere with daily living and contribute to depressive 
symptoms. PST then helps the individuals develop strategies to 
solve those problems. People who received either escitalopram 
or PST were less likely to develop depression (8.5 percent and 
11.9 percent, respectively) than those who received the placebo 
(22.4 percent).
    This is the first study of its kind to show some cases of 
post-stroke depression can be preempted with early 
intervention. In addition to the need for further studies, 
greater attention needs to be given to improving the early 
detection of and interventions for depression during standard 
stroke care.
    Excellence: What makes this project exceptional?
    For the first time, researchers show that preventive 
treatment with an antidepressant medication or talk therapy can 
significantly reduce the risk or delay the start of depression 
following an acute stroke. These findings differ from past 
studies attempting to prevent post-stroke depression because 
the researchers included larger numbers of patients, multi-site 
enrollment to achieve a more varied sample, and a comparison of 
both psychological and pharmacological intervention.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    The chance of having a stroke approximately doubles for 
each decade of life after age 55, so a large proportion of 
stroke patients are elderly. In addition, more than half of all 
stroke patients develop symptoms of depression. Post-stroke 
depression has been demonstrated in previous studies to impair 
recovery in activities of daily living and increased mortality. 
Thus, depression is a common problem in this population and 
early detection and intervention for depression, including 
preventive methods, must be considered important components of 
post-stroke treatment for older adults.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Post stroke depression can impede rehabilitation and 
recovery of functional skills, reduce quality of life, and may 
also shorten a person's lifespan. While further studies are 
needed, this research has shown that multiple forms of 
preventive intervention can be effective in reducing depression 
and its associated problems during standard stroke care in 
elderly populations. The researchers specifically chose PST 
over other forms of talk therapy because it was developed for 
use in elderly people with depression.
    Innovativeness: Why is this exciting or newsworthy?
    This is the first study of its kind to show that some cases 
of post-stroke depression can be preempted with early 
intervention. In addition to pointing the way toward further 
studies, the research has demonstrated the value of specific 
clinical methods in improving the early detection of and 
interventions for depression during standard stroke care.

   National Institute of Neurological Disorders and Stroke: Warfarin 
             Aspirin Symptomatic Intracranial Disease Trial

    Aspirin was shown to be equally as effective as warfarin at 
preventing stroke in patients with partial blockage of arteries 
in the brain and more effective at preventing other major 
adverse events including hemorrhage and death.
    Lead Agency: National Institute of Neurological Disorders 
and Stroke (NINDS)/National Institutes of Health (NIH).
    Agency Mission: The mission of the NINDS is to reduce the 
burden of neurological disease through research.
    Principal Investigator: Marc I. Chimowitz, MB ChB, 
Department of Neurology, Emory Clinic, 4th Floor, Clinic A 
Bldg., 1365 Clifton Rd., Atlanta, GA 30322.
    General Description:

        WARFARIN ASPIRIN SYMPTOMATIC INTRACRANIAL DISEASE TRIAL

    Intracranial stenosis, or partial blockage of arteries in 
the brain resulting in restricted blood flow, has long been 
considered a risk factor for stroke, causing about 10 percent 
of stroke cases annually (between 70K and 90K). Reducing 
stenosis has historically been achieved by treatment with 
agents that decrease the function of clot forming cells in the 
blood (e.g., aspirin) or those that inhibit the clotting 
process (e.g., warfarin); however, until recently, physicians 
were lacking the evidence necessary to make an informed 
decision about which treatment was best.
    In the Warfarin Aspirin Symptomatic Intracranial Disease 
(WASID) trial, a double-blind, randomized, multi-center 
clinical trial sponsored by the NINDS, investigators compared 
warfarin to aspirin in a total of 569 patients for an average 
of 1.8 years. All of the participants had a greater than 50 
percent blockage of a major artery in the brain, and all had 
experienced a non-disabling stroke within the 90 days prior to 
their enrollment in the trial. This trial demonstrated that 
patients treated with aspirin were equally protected from a 
secondary stroke compared to those treated with warfarin, but 
were significantly less likely to experience a major hemorrhage 
or death, further contributing to the ability of physicians to 
make informed decisions regarding patient care.
    Excellence: What makes this project exceptional?
    This study provides new insights and clarity to the ability 
of clinicians to effectively manage patient care in stroke 
prevention.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Although ischemic stroke can affect individuals of all 
ages, the chance of having a stroke nearly doubles every decade 
after the age of 55, making the identification of safe and 
effective measures for reducing patient risk an imperative.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    This study suggests clear therapeutic benefits of utilizing 
aspirin over warfarin as a measure for preventative stroke 
care. While this treatment strategy may not apply to all 
patients at risk for stroke, it is clearly advantageous in a 
subpopulation of patients with a high degree of risk.
    Innovativeness: Why is this research exciting or 
newsworthy?
    This study provides unequivocal evidence that a low-cost, 
relatively safe therapeutic regimen is a preferred measure in 
stroke prevention. It has been estimated that in addition to 
reducing the risk of death and the occurrence of other major 
adverse events in patients with arterial blockage in the brain, 
that preventative therapy with aspirin could save $20 million 
dollars annually in health care costs in the United States.

   National Institute of Neurological Disorders and Stroke Extremity 
              Constraint-Induced Therapy Evaluation Trial

    The results of the EXCITE trial identify the potential for 
constraint-induced movement therapy to alter the clinical 
practice of stroke rehabilitation. By combining constraint and 
training of the weaker limb, patients experience a clinically 
meaningful improvement to limb and hand motor function.
    Lead Agency: National Institute of Neurological Disorders 
and Stroke (NINDS)/National Institutes of Health (NIH).
    Agency Mission: The mission of the NINDS is to reduce the 
burden of neurological disease through research.
    Principal Investigator: Steven L. Wolf, Ph.D., Center for 
Rehabilitation Medicine, Emory University School of Medicine, 
1441 Clifton Rd. NE, Atlanta, GA 30322.
    Partner Agency: National Institute of Child Health and 
Human Development (NICHD).
    General Description:

         EXTREMITY CONSTRAINT-INDUCED THERAPY EVALUATION TRIAL

    It is estimated that 750,000 Americans suffer a new or 
recurring stroke each year. Up to 75 percent of surviving 
stroke patients experience partial paralysis affecting the 
upper extremity on one side of their body that results in 
diminished health-related quality of life. Until recently, 
stroke rehabilitation strategies generally relied on 
experiential approaches rather than scientifically-validated 
evidence. NINDS and NICHD supported the EXCITE (Extremity 
Constraint-Induced Therapy Evaluation) trial, a multisite, 
randomized study, to determine the effectiveness of a 
rehabilitation-based intervention in post-stroke care.
    Constraint-induced movement therapy, the basis for the 
EXCITE trial, evolved out of the observation that monkeys with 
partial paralysis affecting one extremity appear to learn ``non 
use'' when their attempts to use the limb immediately after 
injury are met with failure. Subsequent research suggested that 
this ``non use'' could be unlearned by immobilizing or 
constraining the unaffected arm for a period of two weeks.
    Investigators used the principles of these findings to 
inform the design of the EXCITE trial, which resulted in a 
treatment of constraint-induced intervention where movement in 
the less affected arm was restricted for 90 percent of waking 
hours for a period of 14 consecutive days. With the constraint 
in place, patients practiced performing functionally-relevant, 
repetitive tasks with the paralyzed limb for up to six hours 
each workday. Results from the EXCITE trial indicate that 
patients treated with constraint-induced movement therapy 
following stroke experienced a significant degree of 
clinically-meaningful improvement to their upper limb and hand 
motor function compared with patients who received alternative 
forms of customary therapy. As the benefits of constraint-
induced therapy were still evident up to 24 months following 
treatment, it may form the foundation for the future 
development of evidence-based stroke rehabilitation.
    Excellence: What makes this project exceptional?
    The EXCITE trial is the first multi-site randomized study 
to demonstrate the efficacy of a rehabilitative intervention in 
the treatment of stroke patients with deficits to their upper 
extremities. This trial moves neurorehabilitative care into the 
area of evidence-based medicine.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    The risk of stroke nearly doubles each decade over 55, and 
up to 75 percent of patients that survive a stroke experience 
functional limitations in the upper extremity, which are 
associated with diminished health-related quality of life. 
Developing effective, evidence-based strategies to treat these 
quality of life deficits is critical to the well-being of the 
aging population.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    The participants in the EXCITE trial experienced lasting 
(up to 24 months), clinically-significant improvements in 
upper-extremity motor function and in real-world arm use. 
Constraint-induced movement therapy has the potential to 
significantly benefit stroke patients affected by upper 
extremity deficits if moved into the clinic.
    Innovativeness: Why is this research exciting or 
newsworthy?
    The results of the EXCITE trial will potentially provide 
clinicians and rehabilitation specialists with the tools 
necessary to apply evidence-based treatment strategies to 
patients that experience upper limb paralysis following stroke.

  National Institute of Nursing Research: Acute Coronary Syndrome and 
                            Type 2 Diabetes

    Older patients with type 2 diabetes experience less chest 
pain during acute coronary syndrome than those without 
diabetes. This indicates that type 2 diabetics may need 
additional training in recognizing other symptoms of ACS to 
reduce their chances of adverse health outcomes.
    Lead Agency: National Institute of Nursing Research (NINR)/
National Institutes of Health (NIH).
    Agency Mission: The mission of NINR is to support research 
to establish the evidence base for patient care across the 
lifespan. From premature infants in the neonatal intensive care 
unit to middle-aged adults with chronic illness and elders at 
the end of life, NINR-supported research focuses on developing 
innovative and effective techniques and interventions that 
prevent disease and disability and improve quality of life and 
health outcomes for patients and their caregivers.
    Principal Investigator: Dr. Holli A. DeVon, College of 
Nursing, Marquette University, PO Box 1881.
    General Description:

              ACUTE CORONARY SYNDROME AND TYPE 2 DIABETES

    Twenty-two percent of persons with type 2 diabetes have 
cardiac autonomic neuropathy. Cardiac autonomic neuropathy 
(CAN) involves damage to autonomic fibers innervating blood 
vessels and the heart. It is hypothesized that this damage may 
affect sensory pathways that carry pain messages from the heart 
to the brain, leading to diminished or absent chest pain 
(silent myocardial ischemia). The consequences of silent 
ischemia in diabetic patients are particularly serious because 
a lack of symptoms or symptom recognition such as chest pain 
can lead to delays in seeking medical assistance during acute 
coronary syndrome (ACS).
    This study examined symptoms of ACS in patients with and 
without diabetes. A convenience sample of 256 patients from two 
large medical centers in the Midwest participated. An inventory 
of ACS syndromes, classification of angina, and medical record 
reviews were used to collect data over a 25-month period. The 
results indicated that patients with diabetes were nearly half 
as likely to experience chest pain and more than twice as 
likely to experience unusual fatigue compared to a patient of 
the same age and sex without diabetes. Patients with diabetes 
experienced diminished physical functioning and higher levels 
of angina and were more than 2 times as likely to experience 
unusual fatigue during ACS.
    Long-standing fatigue resulting from diabetes may present 
an added risk for patients with diabetes by masking the 
symptoms associated with ACS. Patients who had diabetes for at 
least 10 years were more likely to experience difficulty 
breathing compared to either patients who had diabetes for less 
than 10 years or patients without diabetes.
    The most significant predictors of the absence of chest 
pain were age and diabetes. Given that the incidence of 
coronary heart disease increases (CHD) with age, this finding 
is important as an older person with or without diabetes is 4 
percent less likely to suffer chest pain as a person with the 
same diabetes status who is one year younger.
    This study demonstrated that patients with type 2 diabetes 
experience silent myocardial ischemia. Patients with diabetes, 
therefore, may need to receive training in recognizing other 
symptoms of ACS to reduce their chances of experiencing adverse 
health outcomes.
    Excellence: What makes this project exceptional?
    This study demonstrated that patients with type 2 diabetes 
experience silent myocardial ischemia. Patients with type 2 
diabetes, therefore, may need to receive training in 
recognizing other symptoms of ACS to reduce their chances of 
experiencing adverse health outcomes
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Heart disease is the foremost public health issue in the 
United States for both women and men. Age is a significant risk 
factor for coronary heart disease and diabetes, both underlying 
factors in heart acute coronary syndromes.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    The most significant predictors of the absence of chest 
pain were age and type 2 diabetes. Given that the incidence of 
CHD increases with age, this finding is important as an older 
person with or without diabetes is 4 percent less likely to 
suffer chest pain as a person with the same diabetes status who 
is one year younger.
    Innovativeness: Why is this research exciting or 
newsworthy?
    Type 2 diabetes and obesity, twin epidemics and major risk 
factors for heart disease in the elderly, have increased 61 
percent and 74 percent respectively in only 10 years. 
Furthermore, in every year since 1984, more women than men have 
died from cardiovascular disease. By identifying aging and/or 
symptom differences in acute coronary syndromes and determining 
if these differences persist after controlling for age, type 2 
diabetes, functional status, and mood, may lead to age-specific 
assessment and treatment tools.

National Institute of Nursing Research: Depressive Symptoms in Spousal 
                               Caregivers

    The researchers utilize a specific type of longitudinal 
analysis (`Latent Class Trajectory Analysis' or LCTA) in an 
effort to improve understanding of the changes over time in the 
depressive symptoms of spousal caregivers of elderly men with 
dementia.
    Lead Agency: National Institute of Nursing Research (NINR)/
National Institutes of Health (NIH).
    Agency Mission: The mission of NINR is to support research 
to establish the evidence base for patient care across the 
lifespan. From premature infants in the neonatal intensive care 
unit, to middle-aged adults with chronic illness and elders at 
the end of life, NINR-supported research focuses on developing 
innovative and effective techniques and interventions that 
prevent disease and disability, and improve quality of life and 
health outcomes for patients and their caregivers.
    Principal Investigator: Dr. Donald Taylor, Duke University, 
112 Rubenstein Hall, Box 90253.
    General Description:

               DEPRESSIVE SYMPTOMS IN SPOUSAL CAREGIVERS

    Approximately 7 million persons in the United States 
provide informal care to a family member aged 65 or older who 
is suffering from a long-term debilitating illness or 
disability. Virtually all of the more than 5 million Americans 
living with Alzheimer's disease in the community receive such 
care. Caregiving has been found to be costly and, on balance, 
impacts caregivers. As the prevalence of caregiving is 
anticipated to increase to 40 million persons caring for 28 
million elderly disabled persons by 2050, development of 
statistical procedures such as `Latent Class Trajectory 
Analysis (LCTA),' provides new techniques to identify the 
effects of spousal caregiving on caregiver depressive symptoms.
    Respondents to the National Longitudinal Caregiver Survey 
were used to identify data on 1,580 spousal caregivers of 
veterans with dementia. The mean number of depressive symptoms 
was measured using the Center for Epidemiologic Studies 
Depression Scale (CES-D, 20-item scale). Although the overall 
mean depressive symptoms of wife caregivers (6.2 of 20) was 
below the minimum value (8 or 9 of 20) associated with clinical 
depression, approximately one in three caregivers, throughout 
the study period, had a number of depressive symptoms that were 
consistent with true clinical depression.
    Excellence: What makes this project exceptional?
    Although there is a significant body of research on the 
relationship between caregiver burden and depressive symptoms, 
little is understood about how these depressive symptoms change 
over time for the caregiver population as well as for specific 
subgroups of caregivers. In this study the researchers utilized 
an innovative statistical analysis method (LCTA) to examine and 
uncover key trends in depressive symptoms experienced by 
spousal caregivers of men with dementia.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    As the U.S. population ages and there are fewer younger 
persons to care for the elderly, spousal caregiving is likely 
to become more prevalent. More work is needed to determine the 
need for and feasibility of screening for depressive symptoms 
in these caregivers.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Methods such as LCTA may help improve the understanding of 
caregiver symptoms over time, as well as identify caregivers at 
risk for depression.
    Innovativeness: Why is this research exciting or 
newsworthy?
    Through their use of an innovative statistical method for 
studying trajectories in longitudinal data (`Latent Class 
Trajectory Analysis' or LCTA), the researchers have 
successfully identified important depressive symptom subgroups 
of spousal caregivers.

    Office of Portfolio Analysis and Strategic Initiatives: Patient-
            Reported Outcomes Measurement Information System

    Through the Patient-Reported Outcomes Measurement 
Information System (PROMIS), NIH-supported investigators are 
developing a short and accurate computer-based questionnaire 
for patients to report their symptoms and responses to 
therapies. The answers will more accurately reflect the 
patient's perspective than previously possible.
    Lead Agency: Office of Portfolio Analysis and Strategic 
Initiatives (OPASI)/Common Fund, NIH Office of the Director.
    Agency Mission:
     Strategic planning and implementation of trans-NIH 
initiatives that seek to transform the way health research is 
conducted.
     Development and distribution of tools and 
methodologies to NIH Institutes and Centers for analysis and 
evaluation of NIH programs.
    Principal Investigator: James F. Fries, M.D., Professor, 
Stanford University, School of Medicine, 1000 Welch Rd, Suite 
203, Division of Immunology & Rheumatology, Stanford, CA 94305.
    General Description: The NIH Roadmap funds research that 
has the potential to transform biomedicine. The Patient-
Reported Outcomes Measurement Information System (PROMIS) is 
designed to revolutionize the way patient-reported outcomes are 
used for clinical research and evaluation of medical practice. 
PROMIS is improving the precision of patient-reported outcome 
assessment while reducing the burden on respondents. A problem 
with many patient-reported assessment approaches is that they 
are either too broad to capture precise symptoms or too labor 
intensive for patients to complete. One major goal of PROMIS is 
to develop measures that can be used for many different 
conditions so that responses from patients with different 
conditions can be compared. PROMIS will shorten the assessment 
that each patient answers by using a computer program to ask 
only questions most relevant to the previous response of the 
patient.
    The project led by NIH-supported investigators is defining 
the measures to be used to assess physical function, pain, and 
cognitive functioning, three critical concerns of seniors. 
These investigators will contribute their work on two of these 
measures, physical functioning and pain, to a larger project 
that includes teams working on other aspects of outcomes 
measures to generate the full PROMIS assessment tool. Because 
PROMIS will be used for many conditions, NIH-supported 
investigators have assessed many previously used measures for 
their ability to give insights into different conditions. They 
have tested their new collection of measures and are now 
developing a computer-based tool to select from those measures 
the ones that are relevant to the patient answering the 
questionnaire. The outcome from this work will be a computer-
based questionnaire that adapts to the condition of the 
patients to obtain the most useful information without 
burdening the patient with unnecessary questions.
    Excellence: What makes this project exceptional?
    The PROMIS initiative funds six groups of investigators to 
work together to develop a new, scientifically rigorous and 
validated method of measuring patient-reported outcomes. Each 
group will work in its area of expertise to contribute to the 
main goal. The work by 2 of the NIH-supported investigators 
focuses on two areas of deep concern to elders: pain and 
physical function. These investigators are experts in the 
assessment of measures of arthritis, making their contribution 
to the PROMIS especially relevant to seniors. Incorporated into 
the PROMIS assessment tool, measures in pain and physical 
function will allow precise measurement of these critical 
aspects of senior health.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Physical function, pain and cognitive functioning are very 
important for older people, yet historically difficult to 
measure.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    PROMIS will allow health care professionals to more 
accurately assess the conditions of older persons and to 
develop strategies to improve their lives while reducing the 
burden on patients to report their outcomes.
    Innovativeness: Why is this research exciting or 
newsworthy?
    Patient-reported assessment approaches are either too broad 
to capture precise symptoms or too labor intensive for patients 
to complete. Moreover, it is difficult to compare results 
between different assessment tools. PROMIS is expected to 
profoundly improve clinical research by making more accurate 
diagnoses of patient conditions and response to therapies while 
reducing the burden on respondents. PROMIS has the potential to 
revolutionize the way patient-reported outcomes are used for 
clinical research and evaluation of medical practice.

National Human Genome Research Institute (NHGRI)/National Institutes of 
  Health (NIH) Risk Evaluation and Education for Alzheimer's Disease 
                             (REVEAL) Study

    The Risk Evaluation and Education for Alzheimer's Disease 
(REVEAL) study is a clinical trial funded by the National Human 
Genome Research Institute (NHGRI) and the National Institute on 
Aging (NIA). The goal of REVEAL is to provide healthy adults 
with genetic susceptibility testing and information about their 
chances of developing Alzheimer's disease. Participants in 
REVEAL were pre-screened for psychological problems and early 
signs of Alzheimer's disease.
    Lead Agency: National Human Genome Research Institute 
(NHGRI)/National Institutes of Health (NIH).
    Agency Mission: The National Human Genome Research 
Institute (NHGRI) led the National Institutes of Health's (NIH) 
contribution to the International Human Genome Project, which 
had as its primary goal the sequencing of the human genome. 
This project was successfully completed in April 2003. Now, the 
NHGRI's mission has expanded to encompass a broad range of 
studies aimed at understanding the structure and function of 
the human genome and its role in health and disease.
    To that end NHGRI supports the development of resources and 
technology that will accelerate genome research and its 
application to human health. A critical part of the NHGRI 
mission continues to be the study of the ethical, legal and 
social implications (ELSI) of genome research. NHGRI also 
supports the training of investigators and the dissemination of 
genome information to the public and to health professionals.
    Principal Investigator: Green, Robert C., Professor, Boston 
University Medical Campus, 715 Albany Street, M-921, Boston, MA 
02118-2394.
    Partner Agency: Boston University, Cornell University, Case 
Western University, Howard University.
    General Description:

  RISK EVALUATION AND EDUCATION FOR ALZHEIMER'S DISEASE (REVEAL) STUDY

    Genes and other biological markers are rapidly being 
identified that can provide presymptomatic estimates of risk 
for the eventual development of late-onset diseases. There is 
widespread public interest in obtaining risk information, 
particularly as treatments are developed to slow or prevent the 
onset of degenerative diseases. Many of the recently discovered 
gene markers are not deterministic genes, but rather 
susceptibility genes that interact with other, as yet 
unidentified genes, and with factors such as age, gender, race, 
family history and environmental exposures. Therefore 
genotyping individuals for susceptibility genes will require 
different protocols for providing risk assessment and 
counseling than those that have been used with deterministic 
genes. With few restrictions on the marketing and utilization 
of such tests, their usage may soon increase. Yet, there are 
almost no data available to understand who (e.g. age, gender, 
race) would seek susceptibility risk information once it is 
available; and why they would do so (e.g. to alleviate anxiety, 
to prepare financially). Nor is there information on the 
benefits or negative consequences of providing susceptibility 
risk information that could guide rational clinical decisions 
or public policy.
    In its first finding period, the REVEAL (Risk Evaluation 
and Education for Alzheimer's Disease) Study created original 
educational and counseling protocols, and enrolled over 150 
adult children of patients with Alzheimer's disease (AD) into a 
randomized clinical trial to examine (1) the characteristics of 
those persons who sought risk assessment with genetic 
susceptibility testing, including APOE genotype disclosure, and 
(2) the impact of this disclosure. The next funding period of 
the Study (REVEAL II) will include siblings of patients with AD 
in the study, and will randomize adult children or siblings to 
the current Extended Protocol or to a new Condensed Protocol 
that will more closely monitor clinical interactions that could 
be implemented on a large scale. It will also explore how the 
impact of genetic susceptibility testing with APOE disclosure 
varies between younger and older relatives, and between 
relatives of African American and European American patients 
with AD. REVEAL II will take place at four clinical centers of 
care (Boston University, Cornell University, Case Western 
University and Howard University). Risk assessment using 
genetic susceptibility testing with APOE genotyping and 
disclosure, because of its inherent uncertainties, is an ideal 
model to develop new guidelines for whether and how best to use 
susceptibility gene markers in this and other diseases where 
such markers are, or will be, available in the near future.
    Excellence: What makes this project exceptional?
    REVEAL is the first multi-center trial designed to evaluate 
the impact of Alzheimer's genetic risk testing on healthy 
adults. Previously there was no data on this important issue.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Alzheimer's, the most common form of dementia, is most 
common in those over 65 with an estimated 26 million people 
afflicted worldwide, and is expected to increase.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    It was crucial to gauge the public's reaction to genetic 
information on Alzheimer's. Understanding the reactions can 
help healthcare professionals better inform their senior 
patients and encourage healthy behaviors.
    Innovativeness: Why is this research exciting or 
newsworthy?
    REVEAL found that disclosing APOE status and its 
association with Alzheimer's risk to participants did not 
result in a significant increase in distress or depression. In 
fact, participants who discovered they had the high risk APOE 
e4 allele proved more likely to be proactive in changing their 
lifestyles and planning for long term care.

National Institute on Aging: Social Networks Influence Smoking Behavior 
                              and Obesity

    NIH-supported researchers demonstrated that an individual's 
social network can have a strong influence on his or her 
behavior change. Changes in smoking behavior and obesity spread 
quickly through networks of people defined by adult respondents 
as close friends. These network influences proved much stronger 
than previously suspected and stronger even than those of 
spouses, siblings, co-workers, and neighbors.
    Lead Agency: National Institute on Aging (NIA)/National 
Institutes of Health (NIH).
    Agency Mission:
     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.
    Principal Investigator: Nicholas A. Christakis, PhD, 
Harvard Medical School, 180 Longwood Avenue, Boston, MA 02115.
    General Description:

         SOCIAL NETWORKS INFLUENCE SMOKING BEHAVIOR AND OBESITY

    NIH-supported investigators conducted analyses on a densely 
interconnected social network of 12,067 people assessed 
longitudinally from 1971 to 2003 as part of the Framingham 
Heart Study. Researchers conducted two projects to examine the 
influence of social networks on individual behavior, one 
related to obesity and the other to smoking. The results of 
both studies demonstrated that social networks are important in 
behavior change and decision making--with effects beyond those 
between spouses, siblings, and neighbors. The first study 
demonstrated that obesity ``spreads'' in social networks in 
measurable ways and is related to the nature of the social tie. 
Findings showed that the chance of becoming obese over time 
increased by 171 percent for an individual who had a friend of 
the same sex who became obese. Among pairs of adult siblings, 
if one sibling became obese the chance that the other would 
become obese increased by 40 percent. Similarly, among married 
couples, if one spouse became obese, the likelihood that the 
other spouse would become obese increased by 37 percent. A 
``neighbor'' becoming obese had no effect on an individual's 
change in weight.
    The second study by the same NIH-supported investigators 
analyzed changes in smoking behavior and found that smokers 
quit in groups and not in isolation and that those who 
continued to smoke formed clusters that shifted their social 
connections over time to those who also smoked. For example, 
when a spouse quit, it decreased the chance of his or her 
spouse smoking by 67 percent. When a sibling quit, it reduced 
the chance of smoking by 25 percent among his or her brothers 
and sisters. In the work setting, size of the organization was 
a factor. In small firms, a co-worker quitting could decrease 
smoking among peers by 34 percent, but in larger firms, the 
influence was insignificant. The findings indicate that the 
closeness of the relationship in the network, regardless of 
geographic location, was key to spreading behaviors.

    Understanding, Preventing, Diagnosing, and Treating Alzheimer's 
      Disease: A Multidimensional Alzheimer's Disease Brain Atlas

    This project developed a digital atlas of Alzheimer's 
disease using a framework to correlate disease observations 
from diverse images in a single probabilistic brain model. The 
research led to landmark papers and novel methods to 
characterize and track Alzheimer's disease that are used at 
imaging centers nationally and overseas.
    Lead Agency: National Library of Medicine (NLM), National 
Institutes of Health (NIH).
    Agency Mission: The mission of NLM is to acquire, organize, 
disseminate, and preserve the biomedical knowledge of the world 
for the benefit of the public health. Toward this mission, NLM 
offers extramural grants for research in biomedical informatics 
and information sciences, bioinformatics and public health 
informatics, and supports informatics research training at 
twenty universities.
    Principal Investigator: Arthur W. Toga, Professor, 
Laboratory of Neuro Imaging, Department of Neurology, UCLA 
School of Medicine, 635 Charles E. Young Drive South, Suite 
225, Los Angeles, CA 90095-7334.
    Partner Agencies: National Institute on Aging (NIA), 
National Institutes of Health (NIH).
    General Description: This project created an atlas of 
Alzheimer's disease by developing a framework to correlate 
disease-specific observations from different types of images 
(such as MRI scans, PET scans, and frozen sections of brain 
tissue) into a probabilistic brain model presented as a digital 
atlas. The developed tool set and product are applicable not 
only to the basic and clinical science of Alzheimer's disease, 
but to the general problem of mapping the structure and 
function of any dynamic process in health or disease in whole 
populations of subjects. This work led to hundreds of 
publications on new measures to track Alzheimer's disease 
progression and novel methods for creating digital image 
atlases. The work combines data from post mortem tissue with 
images from the various modalities to create a probabilistic 
model of the brain that provides which regions are most likely 
to be affected by Alzheimer's. This in turn allows a scientist 
to compare new images to the atlas and assess the probability 
that what they are comparing has the disease. The project also 
developed 4D visualization tools that incorporate spatial and 
temporal data into profiling how the brain regions degenerate 
with Alzheimers. The researchers published landmark papers, now 
very highly cited, in 3 areas: (1) The first time lapse maps of 
the trajectory of Alzheimer's disease in the living brain; (2) 
the first reports tracking the spread of plaque and tangle 
pathology in the living brain; and (3) registration and 
analysis of unique brain tissue scans of Alzheimer's disease, 
which they incorporated into the probabilistic brain atlas. 
This body of work is now widely cited in the Alzheimer's field. 
Their methods for tracking Alzheimer's disease are now used at 
imaging centers nationally and overseas.
    Excellence: What makes this project exceptional?
    In developing a brain atlas of Alzheimer's disease, the 
researchers developed the first time lapse maps of the 
trajectory of Alzheimer's disease in the living brain; 
published the first reports tracking the spread of plaque and 
tangle pathology in the living brain; and perfected methods of 
registration and analysis of unique brain tissue scans into a 
probabilistic brain model. Their methods for tracking 
Alzheimer's disease are now used at imaging centers nationally 
and overseas.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Alzheimer's disease looms as the greatest threat to public 
health in the first half of the 21st century. Dementia doubles 
in frequency every five years after age 60, afflicting 1 
percent of those aged 60-64 but rising to 30-40 percent of 
those 85 years or older. The marked growth in the elderly 
population and the dramatic rise in the frequency of dementia 
are warnings of an approaching socioeconomic disaster with no 
cure. The annual cost (direct and indirect) of Alzheimer's 
disease in the United States alone is over $113 billion.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    This tool set and product are highly applicable to the 
basic and clinical science of Alzheimer's disease, which 
remains a significant public health threat for older persons. 
Future large-scale studies of neuroanatomy in Alzheimer's 
disease will greatly benefit from this new atlas-based 
framework for analysis. The time savings for an automated 
assessment of multiple brain regions over manual brain region 
delineation methods are enormous.
    Innovativeness: Why is this research exciting or 
newsworthy?
    The manual generation of brain region information for the 
20 datasets used to construct the probabilistic atlas took over 
3000 man-hours to generate. Using the tools and techniques 
developed in this project, a researcher now needs roughly 15 
hours of processing time and 1 hour of visualization of 
registration accuracy to achieve similar results. Thus, this 
automated assessment allows a profound time savings. The 
computational atlas imaging tool accommodates growth in its 
population data. The population distribution data is made 
available to the users of this assessment method contingent 
upon their sharing of their data with other users, which is now 
the goal of the Alzheimer's Disease Neuroimaging Initiative 
(ADNI). Through open sharing of similar assessment tools and 
longitudinal populations, researchers achieve sufficient 
statistical power to evaluate individual patients against the 
population. Studies using the ADNI database are now testing the 
predictive power of this and other assessment tools in 
identifying incipient Alzheimer's disease within the elderly 
population.

    Understanding, Preventing, Diagnosing, and Treating Alzheimer's 
      Disease: Alzheimer's Disease Neuroimaging Initiative (ADNI)

    Neuroimaging Initiative is a major public-private 
partnership to determine whether sophisticated imaging 
technologies, other biological markers, and other assessments 
can improve our understanding of the progression of mild 
cognitive impairment and Alzheimer's disease and in turn 
facilitate the efficiency of clinical trials.
    Lead Agency: National Institute on Aging (NIA)/National 
Institutes of Health (NIH).
    Agency Mission:
     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.
    Principal Investigator: Michael W. Weiner, M.D., MRS Unit, 
114M, VA Medical Center, 4150 Clement St., San Francisco, CA 
94121.
    Partner Agencies: National Institute of Biomedical Imaging 
and Bioengineering (NIBIB), Food and Drug Administration, 
Foundation for the National Institutes of Health, Pfizer Inc., 
Wyeth Research, Eli Lilly and Company, Merck & Co. Inc., 
GlaxoSmithKline, AstraZeneca AB, Novartis Pharmaceuticals 
Corporation, Eisai Global Clinical Development, Elan 
Corporation plc, Institute for the Study of Aging (ISOA), 
Alzheimer's Association.
    General Description:

           ALZHEIMER'S DISEASE NEUROIMAGING INITIATIVE (ADNI)

    In October 2004, the National Institute on Aging, in 
conjunction with several other federal agencies, private 
companies, and organizations, launched the Alzheimer's Disease 
Neuroimaging Initiative (ADNI) to test whether serial magnetic 
resonance imaging (MRI), positron emission tomography (PET), 
other biological markers, and clinical and neuropsychological 
assessment can be combined to measure with greater sensitivity 
the progression of mild cognitive impairment (MCI) and early 
Alzheimer's disease (AD). The study could help researchers and 
clinicians develop new treatments and monitor their 
effectiveness as well as lessen the time and cost of clinical 
trials. The project is the most comprehensive effort to date to 
find neuroimaging and other biomarkers for the cognitive 
changes associated with MCI and AD. The study, which is taking 
place at 57 sites across the United States and Canada, began 
recruitment in April 2005. Approximately 800 individuals ages 
55 to 90 are participating over the five years of the study.
    Nearly three years into the study, ADNI continues to be a 
major venue for facilitating neuroimaging research relevant to 
AD. Early results from ADNI show that, in addition to aiding 
early diagnosis, researchers may be able to reduce the time and 
expense associated with clinical trials by improving methods 
and developing uniform standards for imaging and biomarker 
analysis. For example, one ADNI study found that a standard 
physical model can be used successfully to monitor performance 
of MRI scanners at many different clinical sites. This will 
help ensure accuracy of the MRI images produced from ADNI 
volunteers. Investigators on another ADNI study compared 
changes over time in PET scans of brain glucose metabolism in 
people with normal cognition, mild cognitive impairment, and AD 
and found that scans correlated with symptoms of each condition 
and that images from different clinical locations were 
consistent across sites, suggesting the validity of PET scans 
for use in future clinical trials.
    An important achievement of ADNI is the creation of a 
publicly accessible database available to qualified researchers 
worldwide. The database contains thousands of MRI and PET scan 
brain images and clinical data and will include biomarker data 
obtained through blood and cerebrospinal fluid analyses. ADNI 
includes samples and brain scans from 200 people with 
Alzheimer's, 400 people with mild cognitive impairment, and 200 
healthy people. All volunteers are between ages 55 and 90. 
Confidentiality of the participants is rigorously protected. To 
date, over 200 researchers have signed up for database access.
    Excellence: What makes this project exceptional?
    This five-year study is the most comprehensive to date to 
identify brain and other changes associated with cognitive 
decline in mild cognitive impairment and Alzheimer's disease. 
In addition, the Alzheimer's Disease Neuroimaging Initiative is 
the largest public-private partnership on brain research at NIH 
and represents an innovative model for other such efforts in 
the sciences.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    As many as 4.5 million Americans currently suffer from AD. 
Many more suffer from MCI, a precursor condition. Results from 
the Alzheimer's Disease Neuroimaging Initiative could help 
researchers and clinicians develop new treatments and monitor 
their effectiveness as well as decrease the time and cost of 
clinical trials.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Early work through the Alzheimer's Disease Neuroimaging 
Initiative has addressed the ``nuts-and-bolts'' of clinical 
imaging research technologies that have the potential to 
improve methods and decrease time and expense related to 
clinical trials. Final results are not yet available from the 
ongoing ADNI clinical study, but we anticipate that the results 
will have a tremendous impact on our understanding of AD and 
the best ways to monitor and treat it.
    Innovativeness: Why is this research exciting or 
newsworthy?
    The Alzheimer's Disease Neuroimaging Initiative is the 
largest, most comprehensive study to date to identify brain and 
other changes associated with cognitive decline in MCI and AD. 
The study has already begun to identify ways to reduce the time 
and expense associated with clinical trials and is expected to 
provide a wealth of information about cognitive impairment and 
AD.

    Understanding, Preventing, Diagnosing, and Treating Alzheimer's 
    Disease: Delaying Progression from Mild Cognitive Impairment to 
                    Alzheimer's in a Clinical Trial

    Among people with mild cognitive impairment, an NIH-
supported study of donepezil therapy was associated with a 
lower rate of progression to Alzheimer's disease during the 
first year of treatment, although the apparent benefit 
disappeared after the first year.
    Lead Agency: National Institute on Aging (NIA)/National 
Institutes of Health (NIH).
    Agency Mission:
     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.
    Principal Investigator: Ronald C. Petersen, Ph.D., M.D., 
Alzheimer's Disease Research Center, Mayo Clinic College of 
Medicine, 200 First St., SW., Rochester, MN 55905.
    Partner Agencies: Pfizer, Inc., Esai, Inc.
    General Description:

DELAYING PROGRESSION FROM MILD COGNITIVE IMPAIRMENT TO ALZHEIMER'S IN A 
                             CLINICAL TRIAL

    Amnestic mild cognitive impairment (MCI), characterized by 
memory problems not severe enough to be classified as dementia, 
is considered to be a transitional state that occurs between 
the cognitive changes of normal aging and the very early stages 
of Alzheimer's disease (AD). Previous studies have shown that 
approximately 8 in 10 people who meet criteria for MCI progress 
to AD within 6 years of diagnosis and that people with the 
apolipoprotein E-e4 (APOE-e4) gene, the only known genetic risk 
factor for late-onset AD, progress to AD more rapidly.
    The first NIH secondary AD prevention trial, comparing the 
effects of vitamin E and donepezil (Aricept) in preventing AD 
in people diagnosed with amnestic MCI, was conducted at 69 
sites across the United States and Canada. The investigators 
found that individuals who took donepezil were at reduced risk 
of progressing to a diagnosis of AD during the first year of 
the trial, but by the end of the three-year study there was no 
benefit from the drug. Vitamin E was found to have no effect on 
AD risk when compared with placebo. As part of the trial, the 
researchers examined the effect of donepezil and vitamin E on 
delaying diagnosis of AD among a subset of people with APOE-e4. 
While the overall rate of progression to AD was greater in this 
group, use of donepezil in the APOE-e4 subset was beneficial 
for up to three years in reducing the risk of an AD diagnosis.
    These findings are the first to suggest that an agent can 
delay the clinical diagnosis of AD in people with MCI. However, 
because too little is known about the effects of taking 
donepezil so early in the disease course on subsequent 
progression, the results, although promising, do not support a 
recommendation for the generalized use of donepezil to 
forestall the diagnosis of AD in people with MCI. Further 
studies are needed of donepezil and other therapies that may 
benefit patients at risk of developing AD.
    Excellence: What makes this project exceptional?
    This is the first study to demonstrate a benefit for any 
chemopreventive agent in the treatment of AD.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    As many as 4.5 million Americans ages 65 or over suffer 
from Alzheimer's disease (AD) and many more have mild cognitive 
impairment (MCI), AD's precursor condition. Approximately 80 
percent of those who meet the criteria for amnestic mild 
cognitive impairment will have Alzheimer's disease within six 
years, and the presence of one or more apolipoprotein (APOE) e4 
alleles is associated with a more rapid rate of progression. 
Therefore, the ability to prevent or delay the development of 
AD among people with MCI is of tremendous public health 
importance.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Although too little is known at present about donepezil's 
long-term effects to support a recommendation for its routine 
use to forestall the diagnosis of AD in people with mild 
cognitive impairment, these findings suggest that 
chemoprevention of AD is possible and provide hope that future 
clinical studies will lead to the development of effective drug 
interventions.
    Innovativeness: Why is this research exciting or 
newsworthy?
    These findings are the first to suggest that an agent such 
as donepezil can delay a diagnosis of AD among people with MCI, 
and they indicate that chemoprevention of AD is possible.

    Understanding, Preventing, Diagnosing, and Treating Alzheimer's 
  Disease: Two Additional Late-Onset Alzheimer's Disease Risk Factor 
                            Genes Identified

    Two new risk factor genes, SORL1 and GAB2, for late-onset 
Alzheimer's disease have been discovered. Their discovery was 
made possible through the use of new technology, large 
databases, and collaboration involving scientists around the 
world.
    Lead Agency: National Institute on Aging (NIA)/National 
Institutes of Health (NIH).
    Agency Mission:
     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.
    Principal Investigator:

                                 SORL1

    Richard Mayeux, MD, MSc., Gertrude H. Sergievsky Center, 
Columbia University College of Physicians and Surgeons, 630 W. 
168th St., New York, NY 10032.

                                  GAB2

    Eric M. Reiman.
    Partner Agencies: National Human Genome Research Institute.

                                  GAB2

    Kronos Life Sciences Laboratories.

                                 SORL1

    Alzheimer Association, Blanchett Hooker Rockefeller 
Foundation, Charles S. Robertson Gift from the Banbury Fund, 
Canadian Institutes of Health Research, Howard Hughes Medical 
Institute, Canadian Institutes of Health Research, Japan 
Science and Technology Trust, Alzheimer Society of Ontario, 
Canada Foundation for Innovation, Ontario Research and 
Development Challenge Fund, Ontario Mental Health Foundation; 
Genome Canada, Alzheimer Society of Canada, Fonds de la 
Recherche en Sante Assessorato Regionale alla Sanita-Regione 
Calabria, Finalized Project of the Ministry of Health (2003-
2005), Fondation pour la Recherche Medical, Robert and Clarice 
Smith, Abigail Van Buren, Alzheimer Disease Research Program, 
W. Garfield Weston Fellowship.
    General Description:

    TWO ADDITIONAL LATE-ONSET ALZHEIMER'S DISEASE RISK FACTOR GENES 
                               IDENTIFIED

    The etiology of Alzheimer's disease (AD) is complex, likely 
involving both genetic and environmental components. Until 
recently, only one gene, APOE-e4, had been linked with late-
onset AD, the more common form of the disease. In the past 
year, multinational research teams using state-of-the-art 
genome-wide association study (GWAS) technology, which involves 
rapidly scanning for markers across the complete set of DNA of 
many people to find genetic variations related to a particular 
disease, have identified two new genes that may influence risk 
of late-onset AD, the more common form of the disease.
    SORL1: Researchers found evidence suggesting that faulty 
versions of the SORL1 gene contribute to formation of amyloid 
plaques, a hallmark sign of Alzheimer's in the brains of people 
with the disease. They identified 29 variants that mark 
relatively short segments of DNA where disease-causing changes 
could lie. The study did not, however, identify specific 
genetic changes that result in Alzheimer's.
    GAB2: Investigators found that the GAB2 gene modifies late 
onset AD risk in APOE-e4 carriers and influences AD 
neuropathology.
    Excellence: What makes this project exceptional?
    A particularly compelling aspect of these findings is the 
use of publicly available data from a genome-wide association 
study to confirm the identification of a risk factor gene. 
These findings demonstrate the tremendous benefit of highly 
collaborative interaction, sample sharing, and rapid analysis 
which greatly increase the likelihood of finding new risk 
factor genes more quickly and inexpensively.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    As many as 4.5 million Americans currently have Alzheimer's 
disease. A better understanding of its underlying causes may 
ultimately lead to preventive interventions.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Further research is needed to determine the specific 
mutations and pathways through which genes for late-onset AD 
influence risk.
    Innovativeness: Why is this research exciting or 
newsworthy?
    Previously, only one gene for late-onset AD had been 
identified. These discoveries provide new clues as to AD's 
pathogenesis.

 Understanding the Biological Processes of Aging: Quantitative Studies 
                    of Protein Aggregation and Aging

    The NIH Director's Pioneer Award Program is intended to 
support creative, innovative investigators who bring their 
ideas to bear on significant research challenges. The Ismagilov 
project is a multi-disciplinary research program that aims to 
develop, validate, and disseminate microfluidic technologies 
for quantitative studies of protein aggregation and aging.
    Lead Agency: Office of Portfolio Analysis and Strategic 
Initiatives (OPASI)/Common Fund, NIH Office of the Director.
    Agency Mission:
           Strategic planning and implementation of 
        trans-NIH initiatives that seek to transform the way 
        health research is conducted
           Development and distribution of tools and 
        methodologies to NIH Institutes and Centers for 
        analysis and evaluation of NIH programs
    Principal Investigator: Rustem F. Ismagilov, Ph.D., 
University of Chicago, Dept of Chemistry, 929 E. 57th Street 
GCIS E 305, Chicago, IL 60637.
    Partner Agencies: All NIH Institutes and Centers 
participate in the planning and implementation of NIH Common 
Fund/Roadmap Programs. The NIGMS plays a lead role in 
implementing the NIH Director's Pioneer Awards. The Ismagilov 
Pioneer Award is jointly funded by the Common Fund and the NIA.
    General Description: The NIH Director's Pioneer Award 
Program is intended to support creative, innovative 
investigators who bring their ideas to bear on significant 
research challenges. The program includes multiple awards 
focused on problems of aging; the Ismagilov project is an 
example. This is a multi-disciplinary research program that 
aims to develop, validate, and disseminate microfluidic 
technologies for quantitative studies of protein aggregation 
and aging. Protein aggregation is associated with aging and 
with a number of human diseases that affect both quality and 
duration of life. Many fundamental aspects of protein 
aggregation remain elusive, including connections between 
protein aggregation and toxicity, and the connection between 
protein aggregation and initiation and progression of diseases. 
Microfluidic platforms will be developed to understand these 
complex processes from both bottom-up and top-down 
perspectives. Bottom-up, new droplet-based microfluidic systems 
will be developed to characterize quantitatively the connection 
between protein aggregation and toxicity in vitro.
    This system will allow the reproducible real-time 
generation, manipulation, and characterization of aggregates 
for in vitro and in vivo toxicity screens. Multidimensional 
statistical analysis of toxicity patterns obtained in these 
devices may elucidate the connection between protein 
aggregation and toxicity, clarify the mechanism of action of 
existing drug candidates that target aggregation, and 
accelerate development of new drugs and drug cocktails. Top-
down, microfluidic technologies will be developed to induce and 
monitor aggregation in vivo with high spatiotemporal 
resolution, and to observe the effects of aging, physiological 
state, neuronal activity, and presence of drug candidates on 
the initiation and progression of protein aggregation diseases. 
These two technologies will be used together to understand 
protein aggregation and aging, and may lead to new hypothesis 
and molecules for controlling these processes.
    Excellence: What makes this project exceptional?
    The NIH Director's Pioneer Award Program is a highly 
competitive program that seeks the most creative, innovative 
investigators through a combined process of written application 
and interviews. The combination of excellence, innovation, and 
creativity on the part of the investigator and significance on 
the part of the research project determine success in the 
competition. Dr. Ismagilov was chosen as a Pioneer Awardee 
because of his history of innovation and the fundamental 
challenges of studying mechanisms of protein aggregation 
associated with aging.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    The approaches Dr. Ismagilov has proposed offer the 
potential for fundamentally new ways of understanding how 
protein aggregation occurs during aging, how it exerts its 
pathological effects, and how it may be reversed. Microfluidic 
technologies will be developed to induce and monitor 
aggregation in vivo with high spatiotemporal resolution, and to 
observe the effects of aging, physiological state, neuronal 
activity, and presence of drug candidates on the initiation and 
progression of protein aggregation diseases.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    These technologies will be used to understand protein 
aggregation and aging, and may lead to new hypothesis and 
molecules for controlling these processes.
    Innovativeness: Why is this research exciting or 
newsworthy?
    Dr. Ismagilov combines elements of chemistry, physics, 
engineering, and biology to understand the protein aggregation 
and misfolding that occurs during aging and which underlies the 
pathology of diseases such as Alzheimer's Disease and 
Parkinson's Disease. The application of engineering and 
physical sciences to the understanding of the aging process and 
the ability to use the new technologies to be developed as an 
early indicator of therapeutic efficacy represents a pioneering 
approach with potential for very high payoff.

  Understanding the Social and Behavioral Processes of Aging: Native 
  Elder Research Center/Resource Centers for Minority Aging Research 
                                (RCMAR)

    The Native Elder Research Center (NERC) is focused on 
increasing capacity, improving networks, and expanding active 
partnerships among Native American and Alaska-Native researcher 
focused on studying issues pertinent to Native elder health.
    Lead Agency: National Institute on Aging (NIA)/National 
Institutes of Health (NIH).
    Agency Mission:
     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.
    Principal Investigator: Spero Manson, Ph.D., American 
Indian & Native Alaskan Programs, Nighthorse Campbell Native 
Health Building, Mail Stop F800, P.O. Box 6508, Aurora, CO 
80045.
    Partner Agencies: National Center for Minority Health and 
Health Disparities (NCMHD).
    General Description: This Resource Center for Minority 
Aging Research (RCMAR) is coordinated through the University of 
Colorado and has the following programmatic aims: (1) To 
enhance the administrative structure, supported by a large, 
comprehensive array of relevant AI/AN programs, required to 
direct and coordinate a culturally relevant, scientifically 
meritorious effort of this nature; (2) to expand active 
partnerships with AI/AN communities that insure continuous 
access to and involvement of Native elders, their families, and 
local systems of care in the aging research process; (3) to 
expand an extensive network of collaborative links to identify, 
recruit, and to promote a cadre of AI/AN investigators willing 
to commit themselves to developing their potential as 
scientists specializing in aging research; (4) to improve a 
carefully crafted set of mechanisms, informed by nearly two 
decades of experience, to equip AI/AN investigators for 
successful research careers at the interface of aging, health, 
and culture; (5) to enlarge an existing group of investigators 
to include even more diverse disciplinary expertise of an 
exceptionally qualified nature that can address a broad range 
of high-priority questions related to the aging of Native 
elders, and (6) to promote a program of research that holds 
promise for reducing the differentials in health status and 
care which now plague this special population.
    Excellence: What makes this project exceptional?
    This is one of the few sustained projects in Indian County 
that focuses upon training native investigators for careers in 
research on AI/AN older populations. They have been extremely 
successful in attracting and keeping outstanding native 
investigators.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    In comparison to their counterparts in the general 
population, Native elders are at greater risk for numerous 
acute as well as chronic illnesses, suffer more frequent 
comorbidities, have less access to high quality and needed 
services, and are slower to seek care which often leads to more 
serious and complicated presentations. the NERC RCMAR has 
contributed significantly to closing these gaps and to 
increasing the participation of Native people in related 
research.
    Innovativeness: Why is this research exciting or 
newsworthy?
    Several significant findings have been published in peer-
reviewed journals.

 Understanding the Social and Behavioral Processes of Aging: Exploring 
                   the Mistreatment of Native Elders

    Exploring the Mistreatment of Native Elders is a project 
focused on exploring the issues of mistreatment among rural and 
urban Native elders in order to evaluate measurement 
methodologies and develop recommendations for future research.
    Lead Agency: National Institute on Aging (NIA)/National 
Institutes of Health (NIH).
    Agency Mission:
     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.
    Principal Investigator: Lori Jervis, Ph.D., Department of 
Psychiatry, University of Colorado Health Sciences Center, MS 
F800, P.O. Box 6508, Nighthorse Campbell-NH Building, Denver, 
CO 80045-0508.
    General Description: Little is known about the prevalence/
incidence of elder mistreatment in any U.S. population, let 
alone American Indian/Alaska Natives (AI/ANs). The few 
available studies on elder mistreatment among this group 
suggest that the phenomenon is likely common, but rigorous 
studies on its prevalence/incidence are sorely needed. Further, 
there is a dearth of knowledge about cultural understandings of 
elder mistreatment in AI/AN.
    Excellence: What makes this project exceptional?
    Although this is the first year of the two year grant, Dr. 
Jervis is undertaking a project with generic implications for 
measuring elder mistreatment in any diverse population group. 
Further, she has been highly successful in gaining access to a 
typically difficult to reach population group.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    The three specific aims of this project are: (1) To explore 
the feasibility of conducting a study of the prevalence/
incidence of mistreatment among rural and urban Native elders, 
and to identify measurement approaches that can be employed; 
(2) to conduct a pilot study of the prevalence/incidence of 
mistreatment among Native elders in order to evaluate the 
usefulness and effectiveness of several methods of measuring 
mistreatment in this population; and (3) to use the information 
generated by the project to develop recommendations for future 
research that estimates the prevalence/incidence of elder 
mistreatment in AI/AN and other minority and diverse 
communities. The collaboration between researchers and 
Community Experts will ensure that scientific approaches to 
conducting a prevalence/incidence study of Native elder 
mistreatment will be grounded in local realities.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    By understanding the extent of elder mistreatment among AI/
ANs, we may gain insights into interventions to prevent these 
events.
    Innovativeness: Why is this research exciting or 
newsworthy?
    There is a dearth of knowledge about cultural 
understandings of elder mistreatment in AI/AN or other minority 
communities. Since what constitutes mistreatment is culturally 
defined, this lack of knowledge likely hinders researchers' 
ability to detect and evaluate mistreatment.

      National Cancer Institute: Cancer and Aging Planning Grants

    The goal of this program is to expand the capacity of the 
NCI-designated Cancer Centers to carry out research that 
concentrates on aging and age-related aspects of human cancer 
through support of new investigators, pilot projects, and 
shared resources focused on aging and cancer. Grantees are 
expected to develop a formal research program that would become 
a stable component of the cancer center dedicated to 
collaborative research in aging and cancer and translation of 
findings into the clinical and population settings.
    Lead Agency: National Cancer Institute/National Institutes 
of Health.
    Agency Mission: The National Cancer Institute coordinates 
the National Cancer Program, which conducts and supports 
research, training, health information dissemination, and other 
programs with respect to the cause, diagnosis, prevention, and 
treatment of cancer, rehabilitation from cancer, and the 
continuing care of cancer patients and the families of cancer 
patients.
    Principal Investigator: Linda K. Weiss, Ph.D., Chief, 
Cancer Centers Branch, Office of the Director, National Cancer 
Institute, Suite 700, 6116 Executive Boulevard, Bethesda, MD 
20892.
    Partner Agency: National Institute on Aging/National 
Institutes of Health.
    General Description:

  PLANNING AND DEVELOPMENT (P20) GRANTS INTEGRATING AGING AND CANCER 
               RESEARCH IN NVI-DESIGNATED CANCER CENTERS

    The goal of this program is to expand the capacity of 
Cancer Centers to engage in pioneering research that 
concentrates on aging- and age-related aspects of human cancer 
through support of new investigators, pilot projects, and 
shared resources focused on aging and cancer. Grantees are 
expected to design and coordinate a research effort in a five-
year project period that will result in a formal aging/cancer 
``Program'' or an equally effective integrated research 
activity that becomes a component of the NCI-funded Cancer 
Center. A solid, focused infrastructure for the conduct and 
continued development of an aging/cancer research program, 
allowing for incorporation of multiple disciplines and creative 
exploration of new approaches to cancer, is also expected. A 
broad range of cancer research falls under this scientific 
initiative, based on seven thematic areas defined in a 2001 
NIA/NCI Workshop Report: Treatment Efficacy and Tolerance; 
Effects of Comorbidity; The Biology of Aging and Cancer; 
Patterns of Care; Prevention, Risk Assessment and Screening; 
Psychosocial and Medical Effects; and Palliative, End-of-Life 
Care, and Pain Relief.
    Excellence: What makes this project exceptional?
    It was specifically designed to build research capability 
in aging-and age-related aspects of human cancer through the 
NCI-designated Cancer Centers, building upon their abilities to 
work across organizational boundaries, foster transdisciplinary 
research, create long-term stability for scientists and 
research programs, provide extensive core resources to 
investigators, and link to their communities.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    There is a clear need to encourage research which draws 
from expertise in many disciplines to focus on the problems of 
cancer in older persons. This initiative is an effort to 
mobilize expertise through a planning and implementation effort 
that accelerates research at the aging/cancer interface. The 
research initiative provides the initial resources to develop 
and create an integrated, interactive research capability with 
a significant base of externally funded, peer reviewed research 
projects in NCI-designated Cancer Centers that focuses on 
problems of cancer in the elderly. The unique cancer center 
infrastructure and its critical mass of multidisciplinary 
expertise provide an ideal research setting for meeting the 
challenges inherent in integrating aging and cancer research. 
Cancer Centers have well-established interactive research 
environments, and they have the leadership, space, equipment, 
structure and resources available to take advantage of new 
research directions as opportunities arise.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Persons 65 and older are at highest risk for cancer and 
have a higher mortality rate than younger persons. This 
initiative is still under way and it will be some time before 
the true and long-term impact can be assessed; however, it 
should accelerate research specifically focused on in cancer 
and aging research.
    Innovativeness: Why is this research exciting or 
newsworthy?
    This program is the culmination of several years of effort 
by NIA and NCI and extramural scientists with expertise in many 
areas relevant to cancer and aging. It should stimulate 
research capability in this area in the funded institutions and 
visibility for aging/cancer issues, build a cadre of future 
investigators at the cancer/aging research interface, and 
identify important focal areas for further research and 
infrastructure support, thus serving as a platform for 
additional efforts in the future.

 National Cancer Institute: Effectiveness of Prostate Radiation Therapy

    Prostate-specific antigen screening has led to an increase 
in the diagnosis and treatment of localized prostate cancer. 
However, the role of active treatment of low- and intermediate-
risk disease in elderly men is controversial. This study 
estimates the association between treatment (with radiation 
therapy or radical prostatectomy) compared with observation and 
overall survival in men with low- and intermediate-risk 
prostate cancer. This study suggests a survival advantage is 
associated with active treatment for low- and intermediate-risk 
prostate cancer in elderly men aged 65 to 80 years.
    Lead Agency: National Cancer Institute/National Institutes 
of Health.
    Agency Mission: The National Cancer Institute coordinates 
the National Cancer Program, which conducts and supports 
research, training, health information dissemination, and other 
programs with respect to the cause, diagnosis, prevention, and 
treatment of cancer, rehabilitation from cancer, and the 
continuing care of cancer patients and the families of cancer 
patients.
    Principal Investigator: Stacey Vandor, Planning Officer, 
National Cancer Institute.
    General Description: Prostate-specific antigen screening 
has led to an increase in the diagnosis and treatment of 
localized prostate cancer. However, the role of active 
treatment of low- and intermediate-risk disease in elderly men 
is controversial. This study estimates the association between 
treatment (with radiation therapy or radical prostatectomy) 
compared with observation and overall survival in men with low- 
and intermediate-risk prostate cancer using the U.S. cohort 
from Surveillance, Epidemiology, and End Results Medicare data. 
A total of 44,630 men aged 65 to 80 years who were diagnosed 
between 1991 and 1999 with organ-confined, well- or moderately 
differentiated prostate cancer and who had survived more than a 
year past diagnosis. Patients were followed up until death or 
study end and were classified as having received treatment if 
they had claims for radical prostatectomy or radiation therapy 
during the first 6 months after diagnosis. They were classified 
as having received observation if they did not have claims for 
radical prostatectomy, radiation, or hormonal therapy. Patients 
who received only hormonal therapy were excluded. At the end of 
the 12-year study period, 37% of men in the observational group 
and 23.8% in the treatment group had died. The treatment group 
had longer 5- and 10-year survival than the observation group. 
After using propensity scores to adjust for potential 
confounders (tumor characteristics, demographics, and 
comorbidities), there was a statistically significant survival 
advantage associated with treatment. A benefit associated with 
treatment was seen in all subgroups examined, including older 
men (aged 75-80 years at diagnosis), black men, and men with 
low-risk disease. This study suggests a survival advantage is 
associated with active treatment for low- and intermediate-risk 
prostate cancer in elderly men aged 65 to 80 years. Because 
observational data cannot completely adjust for potential 
selection bias and confounding, these results must be validated 
in randomized controlled trials of alternative management 
strategies in elderly men with localized prostate cancer.
    Excellence: What makes this project exceptional?
    This observational study suggests a reduced risk of 
mortality associated with active treatment for low- and 
intermediate-risk prostate cancer in the elderly Medicare 
population examined. Although a randomized controlled trial 
design is needed to confirm these findings, they help begin to 
answer the long-standing questions regarding treatment 
decisions for older men.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    This study is relevant to older populations because 
prostate cancer primarily affects older men. In fact, from 
2001-2005, the median age at diagnosis for cancer of the 
prostate was 68 years of age, with over 62% of all persons 
diagnosed over 65. This study supports the use of treatment to 
prolong life for these older men.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    This research is especially applicable to older men because 
of the large percentage of prostate cancer cases in this 
population. Upon further study, confirmation of these results 
will lead to more effective treatment of older men.
    Innovativeness: Why is this research exciting or 
newsworthy?
    This study suggests a survival advantage is associated with 
active treatment for low- and intermediate-risk prostate cancer 
in elderly men aged 65 to 80 years. By helping to answer long-
standing questions about appropriate types of treatment for 
prostate cancer, especially for older men, these findings 
propel researchers to begin to confirm these findings. Through 
future randomized studies, the finding that treatment is 
effective for older men can be confirmed and put into practice, 
holding the promise to affect countless older men diagnosed 
with this disease.

 National Science Foundation: Home Monitoring While Maintaining Elder 
                                Privacy

    This research will enable elders to maintain their privacy, 
while taking full advantage of home-based computing for their 
health and personal safety.
    Lead Agency: National Science Foundation, Directorate for 
Computer and Information Science and Engineering, Division of 
Information and Intelligent Systems.
    Agency Mission: NSF's mission is to promote the progress of 
science: to advance the national health, prosperity and 
welfare; to secure the national defense (NSF Act of 1950).
    Principal Investigators: Dr. L. Jean Camp, University of 
Indiana, School of Informatics, 901 E. 10th St., Bloomington, 
IN 47405; Dr. Katherine Connelly, University of Indiana, School 
of Informatics, 901 E. 10th St., Bloomington, IN 47405; Dr. 
Lesa Lorenz-Huber, University of Indiana, School of 
Informatics, 901 E. 10th St., Bloomington, IN 47405; Dr. 
Kalpana Shankar, University of Indiana, School of Informatics, 
901 E. 10th St., Bloomington, IN 47405.
    Partner Agencies: N/A.
    General Description: This project addresses the acute 
privacy challenge of home-based health care based on ubiquitous 
computing, or ubicomp, where vulnerable populations risk 
enforced technological intimacy. It will employ the well-
defined ``design for values'' method to create an innovative 
toolkit that can be used by our aging population, their 
caregivers, and designers to ensure privacy and autonomy in 
home-based ubicomp.
    Ubiquitous computing integrates technology into our 
everyday environments, fundamentally altering privacy by 
creating continuous, detailed data flows. Ubicomp will result 
in an environment that is aware, active and responsive. It 
creates an aware environment through the pervasive distribution 
of sensors. It is active because sensor data are processed and 
examined. It is responsive in that the technology acts on the 
environment based on processed data. As the ubiquitous 
computing devices are networked, the data and decisions have 
the potential to be observed from any connected locale on the 
planet. Thus privacy becomes a major concern.
    Design for privacy is complicated by the fact that privacy 
is a socially constructed value that differs significantly 
across environments and individuals. Currently, design for 
privacy requires a user who understands the social implications 
of ubicomp technology, demands a design that respects privacy, 
and articulates specific technical design requirements. Design 
for privacy also requires a ubicomp designer with mastery of 
privacy enhancing technologies, security mechanisms, and a 
profound understanding of privacy. Neither of these is a 
reasonable burden. This research will decrease the burdens for 
both parties.
    This project will create a system for designing highly 
customized privacy-enhancing ubicomp. The privacy framework 
consists of three integrated, complementary components. The 
first component is a participant tool for eliciting individual 
elder privacy concerns, making it easy for non-technical people 
to express privacy concerns. The second is a designer tool that 
translates elder concerns into technical choices or 
suggestions. The third is a privacy-enhancing code library for 
ubicomp sensors that vastly simplifies privacy-sensitive 
design, including data filtering, access control list creation, 
and integration of cryptographic privacy enhancing 
technologies.
    The broader impacts of the project include: (1) Development 
of a multidisciplinary curriculum that will engage over 40 
students in the research project; (2) a living laboratory to 
enable research and curricular activities in business, nursing, 
health and other disciplines; (3) expansion of the potential 
for privacy-enhanced home-based healthcare; (4) the development 
of tools to ensure that older people make their own choices 
about home monitoring and protection of their privacy and 
autonomy; and (5) a design tool and computer code library that 
enable ubicomp designers to easily embed appropriate privacy-
enhancing and strong security-protecting mechanisms in home-
based ubicomp without requiring expertise in privacy or 
security.
    This project examines the role of information technology in 
the homes of elders with an emphasis on design and evaluation 
for privacy. The interdisciplinary team of computer scientists, 
clinical researchers on geronotology, and information 
scientists and their students are creating a digital toolkit 
that enables elders to maintain their privacy, while taking 
full advantage of home-based computing for their health and 
personal safety. Elders have been shown to systematically 
underestimate their electronic privacy risk.
    The tools will serve two functions. They will help elder 
make appropriate decisions about home-based computing and guide 
designers in creating privacy-respecting technologies. Three 
current prototypes are being evaluated by a set of volunteers 
from a local retirement center. These tools facilitate social 
networks, encourage healthy behaviors, decrease isolation and 
support independence.
    One prototype mimics a wall mirror and provides reminders 
and encourages social interaction. There is a motion sensor 
device so that when the person moves away from the mirror, the 
screen disappears. This Mirror Motive provides an interface 
that provides a way to arrange events with other individuals. 
The messages disappear when the person makes a waving hand 
gesture at the mirror. This exposure to events outside the home 
provides an opportunity to be more involved. The level of 
interaction by the user is shown to the user as a growing 
plant.
    A second prototype encourages elders to increase their 
levels of physical activity while staying more tightly 
connected to a community of their peers. Older adults can 
seamlessly track the indicators of well-being of community 
members by looking at the e equivalent of a wristwatch. The 
elder can choose to share personal information with peers 
without concern that the data will show up in an internet 
search.
    The team is also constructing a ``living Lab'', in which 
elders from the local community will interact with the previous 
prototypes and others embedded in the home, which preserves the 
look and feel of a historic house near campus. These volunteers 
will provide critical feedback about the technology's 
usability, appropriateness and privacy implications.

National Science Foundation: Stroke Victim Rehabilitation and Socially 
                           Assistive Robotics

    This research project will develop principles for human-
robot interaction to benefit victims of strokes, both as part 
of rehabilitation and to assist stroke victims in coping with 
their disabilities.
    Lead Agency: National Science Foundation, Directorate for 
Computer and Information Science and Engineering, Division of 
Information and Intelligent Systems.
    Agency Mission: NSF's mission is to promote the progress of 
science: to advance the national health, prosperity and 
welfare; to secure the national defense (NSF Act of 1950).
    Principal Investigator:
    Maja J Mataric, Computer Science Department, University of 
Southern California, Ronald Tutor Hall (RTH) 407, 3650 
McClintock Avenue, OHE 200, Los Angeles, CA 90089-1450 USA.
    Partner Agencies: N/A.
    General Description: This research project focuses on the 
development and understanding of human-robot interaction (HRI) 
systems to benefit victims of strokes--disturbances in the 
blood supply to the brain resulting in some degree of loss of 
brain function. Robotics has the potential of positively 
impacting quality of life, especially for people with special 
needs, like those coping with the effects of strokes. If we are 
to meet the demand for personalized one-on-one care for the 
growing populations of elderly individuals and those with 
special cognitive and social needs throughout life, great 
strides must be made in human-robot interaction in order to 
bring robotics into everyday application domains.
    This interdisciplinary project identifies a specific set of 
human-robot interaction research questions in the study of 
robotic systems capable of providing help through social rather 
than physical interaction. The research foci of the study are: 
embodiment, personality, empathy, and adaptivity toward the 
development of an assistive human-robot interaction model for 
customized time-extended assistive interaction. The research 
will be grounded in the stroke rehabilitation domain, where 
personalized and dedicated care is needed to provide 
supervision, motivation, and training during the critical post-
stroke period and beyond, and where assistive human-robot 
interaction can play a key role. A novel assistive human-robot 
interaction model will be developed based on personality 
matching between the user and the robot, in order to optimize 
the user's task performance on rehabilitation exercises.
    Excellence: What makes this project exceptional?
    The work is the first to study the role of personality and 
empathy in assistive human-robot interaction with human 
subjects, as well as to engage in longitudinal assistive human-
robot interaction research to assess time-extended human-
machine interaction in the assistive context.
    Most novel is the use of a socially assistive robotic agent 
as a rehabilitation coach. The researcher has built a bio-
mimetic humanoid robot capable of expressing emotion and making 
human-like gestures plus software for the robot that allows it 
to behave in an empathetic manner. This empathetic behavior 
will allow the robot to endear itself to the user during 
rehabilitation.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Strokes are far more common among elderly people, and they 
may face greater challenges coping with life after their 
strokes than do younger people.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Project outcomes will provide pilot data necessary for 
translating the methodologies developed toward clinical 
applications.
    Innovativeness: Why is this research exciting and 
newsworthy?
    Currently there are about 750,000 new strokes per year in 
the United States, and some expect the number to double in the 
next twenty years with the growing elderly population.

 National Science Foundation: ``Smart Homes'' Research for Independent 
                           Living of Seniors

    This research on ``smart homes'' will make it possible to 
develop systems that monitor the elderly in their homes, in 
order to assess their changing needs and capabilities, in a 
noninvasive manner that balances the needs of health, safety 
and privacy.
    Lead Agency: National Science Foundation (NSF), Directorate 
for Computer and Information Science and Engineering, Division 
of Information and Intelligent Systems.
    Agency Mission: NSF's mission is to promote the progress of 
science: to advance the national health, prosperity and 
welfare; to secure the national defense (NSF Act of 1950).
    Principal Investigators: Dr. Marjorie Skubic, Associate 
Professor, Electrical and Computer Engineering Dept. and 
Computer Science Dept., Director, Center for Eldercare and 
Rehabilitation Technology, College of Engineering, University 
of Missouri-Columbia, Columbia, MO 65211-2060, 221 Engineering 
Building West.
    Partner Agencies: N/A.
    General Description: This long-term research effort is 
developing ``smart home'' technologies to help older adults 
remain independent at home while controlling costs. Smart homes 
enhance residents' safety and monitor health conditions using 
sensors and other devices. Such technology can help keep older 
adults independent while controlling costs. The technologies 
must be aligned with the needs and capabilities of the elderly 
users, in order to be most beneficial, but those needs and 
capabilities change over time, as the aging process progresses. 
The key is early identification of changing conditions that 
indicate impairments. The continuous assessment of physical 
function is a key indicator of initial decline in health and 
functional ability. Identifying and assessing problems while 
they are still small can provide a window of opportunity for 
interventions that will alleviate the problem areas before they 
become catastrophic.
    Objectives of the first phase of the project included: 
development of an integrated monitoring system that reliably 
captures data about the elder residents and their environment 
in a noninvasive manner and balances the needs of health, 
safety and privacy; collection of data in typical independent 
living, elder settings, using an integrated monitoring system; 
development of algorithms to extract patterns of activity from 
the collected sensor data; and evaluation of the usability of 
the technology and investigation of fundamental issues in 
human-computer interaction for the population of older adults. 
Project objectives in the second phase included: To collect 
video data of staged scenarios in realistic multi-person 
settings using older adult participants, thereby producing a 
body of labeled data; to utilize the collected labeled data, 
develop and evaluate algorithms for analyzing video in a way 
that preserves privacy, extracts the pose sequences of multiple 
persons, tracks the movement of inanimate objects, and 
generates assessments and summarizations of the observed 
activities and physical function; to evaluate the effectiveness 
of the summarization and assessments by showing the video and 
extracted information to gerontology experts and obtaining 
feedback; and to assess the perceptions and attitudes of older 
adults towards video monitoring by showing them the processed 
(``anonymized'') video and extracted information.
    This research will impact technology, health care, policy, 
quality of life for older adults, and peace of mind for their 
families. Advances in technology have implications for other 
areas, including fitness and physical rehabilitation. These 
strides will assist health care providers to identify potential 
health problems and keep older adults independent longer. This, 
of course, means happier lives for the older adults and their 
families. Offering a model for eldercare technology may also 
provide policy makers with information to guide decisions about 
services for older people.
    Excellence: What makes this project exceptional?
    The knowledge and technical capabilities achieved by this 
long-term project will be valuable for several fields of 
research concerning the elderly, and ultimately for the 
development and deployment of ``smart home'' monitoring systems 
that ensure the safety and support the independence of aging 
citizens. As a research tool, a smart home can greatly increase 
our understanding of how elderly people at various levels of 
impairment handle the tasks of life, thereby providing the 
knowledge required to design more appropriate products and 
services for them. As a diagnostic tool, it can assess how well 
individuals handle their daily challenges over time, providing 
advice about actions to improve their well being and actually 
using functions of the smart home to compensate directly for 
some kinds of increasing disability. As smart home technology 
is deployed, it will improve the safety of elderly individuals 
living at home, for example by warning family members or 
emergency services when something has gone wrong the elderly 
person cannot cope with, covering a much wider range of 
dangerous or potentially costly situations than current devices 
that may merely monitor when a person falls down.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    The central focus of this research is monitoring elderly 
individuals in their home environments, to have the timely 
information needed to provide assistance and to compensate for 
changing levels of disability.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Smart home technologies will be developed on the basis of 
this research for direct use by elderly persons in their homes, 
at the same time that the research provides excellent data for 
improved professional understanding of the aging process. 
Fundamental to this research project is respect for the privacy 
and self-respect of elderly people, using automatic monitoring 
in a manner designed to maximize their independence and 
autonomy.
    Innovativeness: Why is this research exciting and 
newsworthy?
    The big challenge in this work is how to maximize the 
independence of elderly people in a way that also maximizes 
their safety and privacy. Success in this difficult balancing 
act will benefit them with better quality of life, while 
reducing costs such as the personnel expenses in assisted 
living facilities and nursing homes.

  National Science Foundation: Collaborative Research and Intelligent 
            Systems & Cognitive Robotics Used for Assistance

    Quality of Life Technology Engineering Research (QoLT) 
Center will develop intelligent systems and assistive 
technologies in concert with a person to enable aging and 
disabled population to perform daily living activities more 
independently and to participate in society more fully.
    Lead Agency: National Science Foundation (NSF).
    Agency Mission: NSF's mission is to promote the progress of 
science: to advance the national health, prosperity and 
welfare; to secure the national defense (NSF Act of 1950).
    Pricipal Investigators: Prof. Takeo Kanade, Carnegie-Mellon 
University, 500 Forbes Avenue, WH 405, Pittsburgh, PA 15213-
3890; Prof. Rory Cooper, University of Pittsburgh, 5042 Forbes 
Tower, Room 5042, Atwood & Sennott Streets, Pittsburgh, PA 
15260.
    Partner Agencies: University of Pittsburgh, Bosch Research, 
Honeywell Life Systems, Sanyo North America Corp., Sony Corp., 
Blueroof Technologies, Etovia Systems Inc.
    General Description: The Quality of Life Technology 
Engineering Research (QoLT) Center will transform lives in a 
large and growing segment of the population--people with 
reduced functional capabilities due to aging or disability. 
Future compassionate intelligent QoLT systems will monitor and 
communicate with a person, understand her daily needs and 
tasks, and provide reliable and happily-accepted assistance by 
compensating and substituting for diminished capabilities.
    Many previous attempts to use sophisticated assistive 
technology failed due to lack of basic understanding of human 
functions (psychological, physiological, physical, and 
cognitive) and how to relate them to the design of intelligent 
devices and systems that aid, interact, and work in symbiosis 
with a person of diminished capacity. Traditional robotic 
advances have been made without cognitive human component. the 
goal of QoLT is to develop assistive technologies in concert 
with a person. That fundamental difference defines the QoLT 
research. QoLT systems are person-aware as well as environment-
aware. The focus will be on four areas of research: Perception 
and Awareness--performs research on sensing and perception 
technology that not only reliably detects, tracks and 
recognizes objects in cluttered real-life environments, but 
also understands the person's motion, activities, emotions, and 
intentions; Mobility and Manipulation seeks hardware and 
software that are not only capable of dealing with everyday 
life objects, but also are inherently safe for physical 
interaction of machines and people, so that robotic effectors 
touch people gently, even while moving them; Human System 
Interaction addresses the challenge of dynamically adjusting 
interfaces on the fly to account for changes in an individual 
over time. It also seeks methods for support providers to 
modulate the level of compensation that QoLT systems provide in 
order to achieve desired clinical outcomes; Person and Society 
research brings socioeconomic considerations to the forefront 
of advanced technology research and into the system design from 
the beginning. QoLT systems respond to the population with the 
largest variety of functional support needs--older people and 
people with disabilities, and for the most diverse needs--
everyday life. Testing the systems in Natural Environment 
Testbeds, the research is not only integrating components and 
subsystems, but is integrating systems with people's lives.
    The technologies developed will enable older adults and 
people with disabilities to more independently perform 
activities of daily living and give them opportunity to 
participate in society longer and more fully. QoLT will augment 
the capabilities and extend the reach of professional and 
informal caregivers, increasing their cost effectiveness and 
improving their own quality of life. Having more people 
gainfully employed and reducing the need for or delaying the 
onset of institutionalization will have an even more profound 
impact on the national economy. QoLT will transform and 
eventually subsume the present assistive technology industry, 
one that is fragmented and composed primarily of very small 
companies serving a small market, into a space with a large 
consumer base including the soon-to-retire Baby Boomers. In 
terms of clinical impact, QoLT will accelerate the trend of 
engineers and clinicians collaborating for better treatment and 
will add computer and robotics specialists to patient care 
teams.
    Excellence: What makes this project exceptional?
    The exceptional nature of this project lies in the fact 
that it will not only assist the older adults and people with 
disabilities but will also augment the capabilities of 
professional and informal caregivers thus increasing their cost 
effectiveness. QoLT will also transform the current assistive 
technology industry. Other point of importance is that it will 
accelerate the trend of research collaboration between 
engineers and clinicians to provide better treatment of 
patients that includes computer and robotics specialists.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    The research is very relevant to aging population as it is 
expected to increase substantially every year. We are facing an 
unprecedented shift in age demographics that has the potential 
to disrupt every business, industry, and economy. Modern 
medical and agricultural technologies have extended human life-
spans into the 80s and 90s, but most countries will soon face 
an enormous care giving crisis. Perceptual, cognitive and 
musculoskeletal diseases that impair motor skills dramatically 
increase with age. Presently there are about 35 million 
people--one in eight--over the age of 65 in the United States. 
By 2030, those numbers will double to 70 million with older 
Americans accounting for 20% of the U.S. population. By then, 
one in two working adults will serve as informal caregivers. 
The aging U.S. Baby Boomers, those born between 1945 and 1964 
and accounting for 39% of adult Americans, will find severe 
physician shortages in the specialties they most need. Of all 
of the challenges faced by older individuals, dementia--a 
chronic condition characterized by cognitive decline sufficient 
to affect functioning--is often most feared and has the largest 
negative impact on both older persons and their family members. 
Whereas due to longer life-expectancy the probability of a 65 
year old woman living to age 85 is 65%, and correspondingly 53% 
for a man, nearly half of persons over age 85 suffer 
Alzheimer's disease (AD). In addition to AD, there are many 
other pathologies that affect cognitive function as well as 
movement ability--strength, coordination, and balance--such as 
stroke (2.5 million) and traumatic brain injury (5.3 million). 
In the United States disability affects 48.9 million people who 
have limitation in a functional activity or social role, 
whereas 24.1 million report having a severe disability and are 
unable to perform one or more activities of daily living. Their 
unemployment rates are notably high: 37.5% overall disability; 
47.3% sensory disability; 31.8% physical disability; and 28.5% 
mental disability.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    The technologies developed will assist the older population 
and people with disabilities directly in performance of their 
daily activities. Specifically this will be achieved through 
intelligent systems.
    Innovativeness: Why is this research exciting and 
newsworthy?
    The research is transformative and innovative because this 
is the first time that assistive technologies will be developed 
in concert with human cognition.

 National Science Foundation: Data of Economical and Social Well-Being 
                           of Older Americans

    The Panel Study of Income Dynamics (PSID) has collected 
data on a representative group of American families since 1968. 
Researchers use the PSID's unique data to study the economic 
and social well-being of older Americans.
    Lead Agency: National Science Foundation (NSF).
    Agency Mission: NSF's mission is to promote the progress of 
science: to advance the national health, prosperity and 
welfare; to secure the national defense (NSF Act of 1950).
    Principal Investigator: Frank P. Stafford, Ph.D., Institute 
for Social Research, P.O. Box 1248, Ann Arbor, MI 48109-1248.
    Partner Agencies: Panel Study of Income Dynamics (PSID), 
National Institute on Aging, National Institute of Child Health 
and Human Development, United States Department of 
Agriculture--Economic Research Service.
    General Description: The Panel Study of Income Dynamics 
(PSID) is a nationally representative long-term study of nearly 
8,000 U.S. families and the individual men, women, and children 
who make up these families. It emphasizes the dynamic aspects 
of economic and demographic behavior, but its content is broad. 
It gathers information from participants about their income, 
wealth, employment, pensions, time use, health status, spending 
patterns, psychological well-being, health insurance, 
demographic and sociological outcomes, and more.
    The PSID began to follow the first group of 4,800 families 
in 1968. As of 2008, the PSID has collected information about 
more than 40,000 individuals spanning as much as 40 years of 
their lives. Because the PSID follows entire families, it is a 
``telescope'' that allows us to see how individuals and their 
families evolve and change through the entire life cycle. Over 
the past 10 years, the PSID has been redesigned to track mid- 
to long-term U.S. household-socioeconomic dynamics while 
remaining nationally representative. In addition, content was 
expanded in six major areas; intergenerational studies, savings 
and consumption, technology and capital formation, health and 
aging, child development, and immigration.
    It is one of the most widely used social science data sets 
in the world; thousands of articles, books and papers have been 
based on the data. These data are available freely via the 
Internet to researchers, including economists, demographers, 
sociologists, developmental psychologists, geographers, social 
psychologists, and others. The web-based data center is itself 
a valuable educational resource and has been used by colleges 
and high schools to illustrate how data analysis and 
statistical methods are used to analyze human behavior.
    Using the PSID, researchers study the effects of aging on 
both individuals and families. They examine the economic well-
being of older Americans, including research on pensions, 
retirement savings, and decisions about whether or not to work 
part-time after retirement. They conduct research on the extent 
of poverty among the elderly. They study how families cope with 
the needs of aging individuals. Researchers can study people as 
they move from independent living to living with their children 
or to institutional care, and they can also measure the time 
and money children allocate to their aging parents. Researchers 
can also study elderly Americans who are the primary guardians 
of their grandchildren; how does child-rearing affect their 
lives? Geographical and demographic information allows 
researchers to study how all these things vary with race and 
location. For example, we can study how older people respond to 
deteriorating neighborhoods; are they `trapped' if their 
neighborhood changes while younger families move to safer 
places?
    Excellence: What makes this project exceptional?
    The PSID is unique. It is the world's longest running 
nationally representative panel survey of families. The survey 
has now gathered forty years of data on the same families and 
their descendents. These data are available to the entire 
scientific and educational community, and hundreds of 
researchers from disciplines ranging from economics to medicine 
have used the PSID as a `telescope' that allows them to see how 
American families have fared and changed. The PSID is truly a 
cornerstone of empirically-based social science research in the 
U.S. and the world. Through its long term measures of economic 
and social behavior and well-being, the study has compelled 
both researchers and policy makers to confront and learn from 
the dynamism inherent in social and behavioral processes. Using 
the PSID, researchers have been able to study American families 
throughout the life cycle. People who joined the sample as 
grandparents are now deceased; people who joined as young 
parents are now at or past retirement age and their children 
are now parents themselves.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Research using the PSID is directly relevant to older 
persons and to our aging society. Using PSID data, researchers 
have been able to measure whether or not aging baby boomers are 
financially prepared for retirement. They have been able to 
reconcile the apparent puzzle of a low saving rate but high 
wealth in some families. The data have been used to test the 
life-cycle consumption theory in economics, which predicts how 
people will make financial decisions in their working adult 
years that determine their retirement income. The PSID has also 
allowed researchers to see how wealth and health status vary 
across older Americans from different socio-economic and 
demographic groups.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Most importantly, by using the PSID researchers are able to 
study older people not as isolated individuals but as members 
of families. They can examine how families meet care-giving 
responsibilities, both in how they care for their elderly and 
how older members of the family care for their children and 
grandchildren. Researchers can consider not just how money and 
wealth are shared across generations, but also how family 
members contribute time and effort to each others' care.
    Innovativeness: Why is this research exciting and 
newsworthy?
    The PSID has been used to show that a large group of senior 
Baby Boomers are unprepared for retirement, with little in the 
way of household wealth accumulation. This research result has 
spurred the development of educational programs designed to 
encourage retirement savings. PSID data on health expenditures 
helped us forecast the eventual cost of the Medicare 
prescription drug benefit. The PSID allows us to study whether 
or not a wide variety of government programs designed to assist 
older Americans have the desired effects. This research is key 
for evidence-based public policy.

          Smithsonian Institution: The Bracero History Project

    The Bracero History Project collects, preserves, and shares 
the experience of a ``greatest generation'' of American 
workers. By recognizing the contributions of the elderly we do 
much to raise their self esteem and improve their mental 
health. Through intergenerational learning the general public 
gains an appreciation of elderly Americans.
    Lead Agency: Smithsonian Institution, National Museum of 
American History, Division of Work and Industry.
    Agency Mission: The National Museum of American History 
dedicates its collections and scholarship to inspiring a 
broader understanding of our nation and its many peoples. We 
create learning opportunities, stimulate imaginations, and 
present challenging ideas about our country's past.
    Principal Investigator: Peter Liebhold, Chair, Division of 
Work and Industry, NMAH, MRC 629 P.O. Box 37012, Smithsonian 
Institution, Washington, DC 20013-7012.
    Partner Agency: Smithsonian Latino Center, University of 
Texas, El Paso, Brown University, George Mason University.
    General Description: The Bracero History Project collects, 
preserves, and shares the experience of a ``greatest 
generation'' of American workers. In place between 1942 and 
1964 the bracero program allowed millions of Mexican men to 
come to work in the US on short term labor contracts. Many of 
these workers eventually settled and brought families to the US 
or married locals. The Bracero History Project sends historians 
into communities across the country to interview these now 
elderly men and women and record their stories of hard work and 
hope for the future.
    The Bracero History Project is important for both the 
nation and the individuals involved. By recognizing the 
contributions of the elderly we do much to raise their self 
esteem and improve their mental health. By then preserving and 
making the stories available to all through a website 
(braceroarchive.org) and a traveling exhibition (Bittersweet 
Harvest: The Bracero History Program 1942-1964) the general 
public gains a growing appreciation of an often overlooked 
cohort of the American population. Intergenerational learning 
projects like this are one of the most important ways that we 
as a nation come to value the lives of the elderly.
    Excellence: What makes this project exceptional?
    This project is exceptional on many levels--in 
organization, in execution, and in accessibility.
    Organizationally the Bracero History Project is unusual for 
being a consortium of museums, universities, and cultural 
institutions. While the Smithsonian has taken a leadership role 
the project is in fact truly collaborative and owned by all.
    In execution the Bracero History Project is also 
exceptional. Members of the team go out into the field to 
conduct interviews, often in remote rural locations. With over 
600 recorded oral histories (the majority in Spanish) this is 
the largest Latino oral history project to date.
    Finally in execution the Project is quite unusual. All the 
materials are being made available through the web so 
interested parties can access them from home or school. The 
traveling exhibition has been carefully designed to be both 
inexpensive and low security meaning that this important show 
will be able to travel to communities that rarely see museum 
exhibitions.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    The project research is extremely relevant to older people 
because it values their experiences. Braceros and their 
families have been overlooked by historians for years. This 
project will help put their sacrifices back into the central 
story of American history where they belong.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    There are many ways in which the Bracero History Project is 
impacting those involved but perhaps the most interesting is 
the development of intergenerational learning. In the Town Hall 
Meetings and Collection Days held around the country we are 
struck by the number of older braceros and wives coming to tell 
their stories at the behest of a child or grandchild. The 
project helps send a strong message of family importance and 
worth.
    Innovativeness: Why is this research exciting or 
newsworthy?
    The project is helping document and preserve an important 
chapter of American history. Known by only a few historians the 
Bracero History Project is recording the details of an 
important piece of work and immigration history. Additionally 
the Project is groundbreaking in its open source use of the web 
to share collected materials with all.

        Smithsonian Institution: America's Post WWII Family Life

    Strengthen the museum's representation of the thematic area 
of aging in America. Document how major demographic changes 
since World War II impacted how Americans create and maintain 
family and home life with a focus on the elderly and their 
families. Begin to form a material record of America's aging 
population.
    Lead Agency: Smithsonian Institution, National Museum of 
American History, Division of Home and Community Life.
    Agency Mission: The National Museum of American History 
dedicates its collections and scholarship to inspiring a 
broader understanding of our nation and its many peoples. We 
create learning opportunities, stimulate imaginations, and 
present challenging ideas about our country's past.
    Principal Investigator: William H. Yeingst, Chair, Division 
of Home and Community Life, Smithsonian Institution, P.O. Box 
37012, NMAH, Room 4127, MRC 615, Washington, DC 20560-7012.
    General Description: The National Museum of American 
History collects artifacts to preserve for the American people 
an enduring record of their past. As part of the museum's 
effort to document the major historical developments in home 
and family life from 1945 to the present, the Division of Home 
and Community Life is conducting a case study titled, ``The 
Population Ages: Remaking Home and Family Life.'' The aging of 
the American population is a demographic fact that reveals the 
intersection between home and family life, public policy, 
cultural and material change, science and other aspects of 
American life. Aging in America has differed according to 
gender, class, race, and ethnicity. Increasingly senior 
citizens have created an identity as a group that has been 
reflected both in policy and in the market for housing and 
consumer products for the home. This was reflected in the 
establishment of AARP that helped define an identity and 
influence policy in 1958, and the founding of the activist Gray 
Panthers in 1970. The project takes the following avenues for 
implementation:
    --Documentation through Collaboration. This is an 
opportunity to go beyond artifacts to collect stories through 
oral history and photography by seeking a partnership with a 
group such as AARP and a university or other ethnographic 
project.
    --Iconic Household Artifacts. Identify the significant 
artifacts that represent the stories of aging and their 
distinctive impact on American society. Although much research 
on the material culture of aging remains to be done, some 
iconic artifacts developed for an aging population may be 
identified. OXO good grips kitchen utensils reflect an 
important mainstream product that will be collected. Other 
objects designed for the health, safety and mobility of the 
aging in their homes have provided alternatives for the larger 
population.
    --Retirement communities. The aging of the population has 
had a major impact on housing and housing types. The concept of 
retirement communities as a national phenomenon is a post-1945 
development. The development of retirement communities should 
be documented with a collecting effort related to early 
residents of the first retirement communities in Sun City, 
Arizona and Leisure World. Recreation objects prevalent in 
these retirement facilities such as the Wii video game would 
serve as a lens for documenting social life, exercise, and the 
role of technology in our aging population.
    --Public policy: Public policy decisions related to social 
security, employment opportunities and health care have 
increasingly reacted to the aging population's needs. How 
families cope with aging members in response to these policies, 
in the redesign of their homes, the accommodation of 
multigenerational families within one household, and long term 
care is an important area for oral history activity.
    Excellence: What makes this project exceptional?
    The project gives representation to how older Americans 
shaped history and were shaped by history in the course of 
their everyday lives.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    The project acknowledges the role of the elderly in 
American society and gives representation to their stories and 
actions.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    This project encourages a reinforcement of memory and 
recall with its emphasis on oral history and a response to 
objects. It encourages engagement and connection to the larger 
world.
    Innovativeness: Why is this research exciting or 
newsworthy?
    The research is accomplished while this generation's 
stories can be collected on tape and video. It is the first 
generation whose stories and points of view about home life and 
objects can be documented in this way.

  Smithsonian Institution Division of Physical Anthropology: Historic 
                         Causes of Osteoporosis

    This research pertains to bone density in 17th and 18th 
century human skeletons from Maryland and Virginia. The study 
will help determine whether osteopenia, or low bone mass, is 
present in Colonial period remains. Preliminary results show 
that low bone density was present in remains from various 
archaeological sites dating to these periods.
    Lead Agency: Smithsonian Institution's National Museum of 
Natural History Department of Anthropology (Division of 
Physical Anthropology).
    Agency Mission: The Smithsonian Institution's Department of 
Anthropology is dedicated to advancing and sharing knowledge 
about humanity in all its dimensions, from the evolution and 
biological variation of the human species to the diversity of 
the world's cultures and languages, both past and present.
    Principal Investigator: Douglas W. Owsley, Ph.D., Curator, 
Physical Anthropology Div. Head, Department of Anthropology, 
10th and Constitution Avenue, NW., MRC 112 P.O. Box 37012, 
Washington DC 20013-7012.
    Partner Agency: Institute for Technology in Health Care and 
Dr. James S. Jelinek, Chair of Radiology of the Washington 
Hospital Center.
    General Description: Osteoporosis is a disease 
characterized by low bone density, or ``porous bones,'' placing 
an individual at high risk for fractures by weakening the 
structural matrix of bones and diminishing their ability to 
withstand the day to day stresses and strains we place on them. 
The intermediate stage between normal bone and osteoporosis is 
classified as ``osteopenia,'' which refers simply to low bone 
density.
    Dual Energy X-ray Absorptiometry (DXA) scanning equipment 
was developed for clinical use and is currently the most widely 
used method for measuring bone density in patients at risk for 
osteoporosis. The scanner directs x-ray energy from two 
different sources towards the bone being examined. The mineral 
density weakens or prolongs the transmission of the x-ray 
energy through a filter onto a photon counter in a degree 
related to the amount of bone mass present. The greater the 
bone mineral density, the greater the signal picked up by the 
counter.
    A DXA scan report compares the bone mineral density values 
with those of a young normal individual (T-score) and with an 
age-matched normal individual (Z-score). According to the World 
Health Organization standards, an individual with a T-score at 
or above -1.0 has normal bone density, while a T-score between 
-1.0 and -2.5 is osteopenic. Osteoporosis is clinically 
diagnosed when the T-score is at or below -2.5.
    Various factors are linked to low bone density including a 
diet low in vitamin D, insufficient calcium, smoking, moderate 
alcohol consumption, sedentary lifestyle, genetics (sex, race, 
and family history), hormones, and pregnancy.
    Nearly 150 historic and modern forensic specimens from 
various institutions and locations including the Smithsonian 
Institution, Jamestown, and Maryland Historical Trust 
collections have been included in this survey. Of the femora 
DXA scanned thus far, over twenty meet the World Health 
Organization's definition of osteopenia, and four classify as 
osteoporotic
    DXA scanning has recently been used in a number of studies 
involving archaeological material (Lees et al, 1993; Ekenman et 
al, 1995; Mays et al, 1998; Poulson et al, 2001; Gonzlez-
Reimers et al, 2002) as it offers a precise and non-destructive 
method of quantitatively measuring bone mineral density.
    Excellence: What makes this project exceptional?
    This study provides temporal information on the frequency 
of low bone density in eastern North America.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    This is basic research designed to investigate the causes 
of osteopenia and osteoporosis in historic populations from 
Maryland and Virginia over the last four hundred years. It is 
one component of a multifaceted study of health and diet with 
emphasis on the transition from European and African diets 
following colonization of the New World.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    This basic research provides a new long-term view of the 
implications of how we understand health and diet. As basic 
research it will articulate with other studies from areas of 
medical research.
    Innovativeness: Why is this research exciting or 
newsworthy?
    This research makes use of museum collections to provide 
answers to health issues of concern to millions of Americans.

Social Security Administration: Effect of Institutions and Policies on 
                           Retirement Choices

    This project offers an explanation for the continuing 
effect of institutions and policies on retirement choices. The 
largest effects of the policies examined are from increasing 
the early entitlement age from 62 to 64 and reducing benefits 
to 75 percent of their promised levels.
    Lead Agency: Social Security Administration.
    Agency Mission: To advance the economic security of the 
Nation's people through compassionate and vigilant leadership 
in shaping and managing America's Social Security programs.
    Principal Investigator: Alan Gustman, Professor of 
Economics, Dartmouth College, Hanover, NH 03755.
    General Description: This paper is based on a structural 
model of retirement and saving, estimated with data for a 
sample of married men in the Health and Retirement Study. It 
explains the relation of specific features of Social Security--
the benefit amount, the early entitlement age, the normal 
retirement age, earnings test parameters, and the delayed 
retirement credit--to work and retirement decisions. A full 
range of work and retirement outcomes are considered, including 
continued work on the main job, full-time work outside the main 
job, and partial or full retirement. The authors consider not 
only the effect of Social Security on movement from States of 
greater to lesser work, but also the reverse flows from States 
of lesser work to States of greater work.
    The largest effects of the policies examined are from 
increasing the early entitlement age from 62 to 64 and reducing 
benefits to 75 percent of their promised levels, the 
approximate amount benefits would have to be reduced when the 
trust fund runs out if there are no changes in funding. With 
the increase in the early entitlement age, about 5 percent more 
of the population continues to work full time at their main job 
at age 62 and 63 than would otherwise. In addition, another 4.5 
percent of the male population works full time after having 
retired, as does another 4 percent at age 63. Partial 
retirement is reduced at ages 62 and 63 by about 3 percentage 
points when the early entitlement age is 64. Overall, complete 
retirements are about 6 percentage points lower at age 62 and 
63 when the early retirement age is higher. From age 64 on, the 
percent completely retired is about two percentage points lower 
in each year when the early entitlement age is 64 rather than 
62.
    The effects of reducing promised Social Security benefits 
by about a quarter are also large. The probability of remaining 
on the main job is higher for those in their sixties, with the 
difference ranging from 3 to 5 percentage points for those ages 
62 and older. At each year of age, an additional 1 percentage 
point will be in full-time work after having retired. There is 
little difference in the fraction partially retired, so the 
probability of being fully retired is reduced by 4 to 6 
percentage points when benefits are reduced by a quarter.
    Decisions of when to retire will have an important bearing 
on overall labor supply in the future and are increasingly 
important given declining birth rates and increasing longevity. 
This project studies the effect of the changing landscape of 
retirement incentives on retirement behavior. The results are 
based on a careful calibration of a structural model of 
retirement and saving. The research is significant, because it 
relates the effects of specific features of the Social Security 
program on work and retirement decisions. It is innovative in 
that several levels of work are examined, including moving from 
less work to more work.
    Excellence: What makes this project exceptional?
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Innovativeness: Why is this research exciting or 
newsworthy?
    Decisions of when to retire will have an important bearing 
on overall labor supply in the future and are increasingly 
important given declining birth rates and increasing longevity. 
This project studies the effect of the changing landscape of 
retirement incentives on retirement behavior. The results are 
based on a careful calibration of a structural model of 
retirement and saving. The research is significant, because it 
relates the effects of specific features of the Social Security 
program on work and retirement decisions. It is innovative in 
that several levels of work are examined, including moving from 
less work to more work.

   Social Security Administration: Financial Eligibility Model (FEM)

    The FEM is a flexible tool of evidence-based decision-
making in SSI program policy that has also been used to analyze 
Medicare buy-in programs and the Medicare Part D Low Income 
Subsidy.
    Lead Agency: Social Security Administration.
    Agency Mission: To advance the economic security of the 
Nation's people through compassionate and vigilant leadership 
in shaping and managing America's Social Security programs.
    Principal Investigator: Paul S. Davies, Director, Division 
of Policy Evaluation, Office of Research, Evaluation, and 
Statistics, 500 E Street, SW., 9th Floor, Washington, DC 20254-
0001.
    General Description: The Financial Eligibility Model (FEM) 
was developed by researchers at the Social Security 
Administration (SSA) as a flexible tool of evidence-based 
decision-making in Supplemental Security Income (SSI) program 
policy. SSI provides a minimum income guarantee for elderly and 
disabled persons with limited resources. SSI helps many older 
people to escape poverty and to gain access to public health 
insurance coverage. In December 2006, roughly 2 million people 
aged 65 and over received SSI payments. For some elderly 
individuals, SSI is the main source of cash benefits. For 
others it supplements Social Security benefits. In most cases 
SSI beneficiaries are categorically eligible to receive 
Medicaid.
    The FEM was designed to assist policy makers in evaluating 
whether SSI is reaching the target population and whether the 
program can be improved by changing program rules. The FEM uses 
a representative sample of older persons in the United States 
from the Survey of Income and Program Participation matched to 
SSA administrative records. An innovative aspect of the FEM is 
its ability to analyze tradeoffs between program cost and 
program outcomes, such as poverty reduction. For example, it 
allows for the comparison of the poverty-reducing effects of 
alternative policy modifications on the basis of a given budget 
scenario.
    One analysis using the FEM found that changing the Federal 
benefit rate, the general income exclusion, and the asset 
threshold appear to be roughly equally effective in reducing 
poverty among the elderly on a cost-equivalent basis, whereas 
relaxing the earned income exclusion would be less effective 
(Davies, Rupp, and Strand, 2004). Another analysis assessing 
Social Security minimum benefit proposals found that simplified 
administrative procedures to establish eligibility for minimum 
benefits may result in poor targeting and substantial 
additional program costs (Rupp, Davies, and Strand, 2007). In a 
third analysis, Strand and Rupp (2007) found that the 
relationship between Social Security and SSI needs to be 
explicitly considered in assessing the potential effects of 
alternative reform scenarios. Analysts also use the FEM to 
study eligibility for Medicare buy-in programs and the Low 
Income Subsidy (LIS) under the Medicare Part D prescription 
drug benefit program.
    Excellence: What makes this project exceptional?
    This project is exceptional, because it provides a 
versatile tool for assessing various policy options to improve 
an important program, SSI, for older people with limited income 
and resources. It supports the analysis of program design 
options in a manner that provides a credible, unbiased, and 
nonpartisan foundation for evidence-based decision-making. It 
is adaptable to various budget realities, such as budget-
neutral approaches to improving the target-effectiveness of the 
program. The project also is exceptional because it has 
demonstrated adaptability to newly emerging policy issues with 
potentially large effects on the economic well-being of older 
people, such as the introduction of the LIS program under 
Medicare Part D or Social Security reform options.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    This project is of major significance for developing policy 
options to reduce poverty and improve various aspects of 
economic well-being in an era of limited resources and 
demographic pressures on the safety net for older people. The 
FEM allows for identifying low-cost or budget-neutral 
approaches to reduce poverty among the elderly. It also allows 
policy makers to assess the pros and cons of alternative 
approaches regardless of their political orientation in an 
objective manner. The FEM is significant for elderly people, 
because about 2 million elderly individuals with low income and 
resources currently benefit from the SSI program. Ignoring SSI 
in discussing policy options for related programs such as 
Social Security, Medicaid, and Medicare could lead to adverse 
effects on the well-being of the elderly. SSI reform options 
also are relevant because of changing realities, such as 
increased reliance on individual retirement accounts and other 
defined contribution plans in retirement security. Without 
attention to the equitable treatment of defined contribution 
pension assets, access to the SSI program among older people 
with low income and assets might be adversely affected in the 
future. The FEM provides an opportunity to address issues of 
this kind in a budget-neutral or low-cost manner.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    The project is highly effective in that it provides an 
opportunity for policy makers to explore budget-neutral or low-
cost options to improve targeting in SSI and related programs. 
Policy makers need to reassess program policies continuously as 
our economy and society go through rapid changes. They need to 
have tools to assess policy options in an objective and 
balanced manner. The FEM provides an important tool for 
considering the role of SSI in assessing various Social 
Security options, an important area for the economic well-being 
of the elderly in the future that previously has been neglected 
in Social Security reform discussions and assessments.
    Innovativeness: Why is this research exciting or 
newsworthy?
    This research is innovative, exciting, and newsworthy for 
several reasons. It provides an excellent example of a unified 
framework for assessing important aspects of program design, 
such as outreach, targeting, distributional effects on the 
economic well-being of the elderly, administrative complexity, 
and program cost. The researchers developed an innovative 
metric of ``cost-equivalent'' comparisons that facilitates the 
fair comparison of policy and program design options. The 
project provides a tool for assessing complex program 
interactions between critical public programs for the elderly, 
such as SSI, Social Security, Medicaid and Medicare. It also 
provides an innovative tool for assessing the interactions 
between program design and broader trends in the economy and 
society, such as changing marital patterns and shifts in 
pension systems from defined benefit to defined contribution 
plans. Using evidence from the FEM is useful for developing 
consensus among policy makers of differing political persuasion 
about cost-effective ways of improving the effectiveness of SSI 
and other programs, and debunking--positive or negative--myths 
and exaggerations about potential effects of program reform 
that do not hold up under the closer scrutiny provided by FEM-
based policy evaluation applications.

Social Security Administration: Health and Mortality of Retirement-Aged 
                                Workers

    This research project investigates mortality and health of 
male Social Security covered workers who claim benefits at 
different retirement ages, and life expectancy of male Social 
Security covered workers aged 60 and older by socioeconomic 
status.
    Lead Agency: Social Security Administration.
    Agency Mission: To advance the economic security of the 
Nation's people through compassionate and vigilant leadership 
in shaping and managing America's Social Security programs.
    Principal Investigator: Hilary Waldron, 500 E Street, SW., 
9th Floor, Washington, DC 20254-0001.
    General Description: This research project investigates 
mortality and health differences among Social Security covered 
workers. Past work studied how mortality and health differed 
between men claiming Social Security benefits at different 
Social Security entitlement (retirement) ages. The most recent 
work analyzed trends in male life expectancy by socioeconomic 
status for male Social Security covered workers aged 60 and 
older. Mortality and health differences among Social Security 
covered workers can impact the Social Security program in many 
ways, including possible effects on disability applications, 
mortality projections, and possible behavioral responses to any 
hypothetical future increases in Social Security's Early 
Entitlement Age (EEA) or Full Retirement Age (FRA).
    Mortality and health differences among Social Security 
covered workers can impact the Social Security program in many 
ways, including effects on disability applications, mortality 
projections, and behavioral responses to possible future 
increases in Social Security's EEA or FRA.
    The retirement policy community is currently debating the 
advisability of raising Social Security's EEA as a means of 
encouraging greater work participation at older ages in the 
U.S. Knowledge of differences in health and mortality risk 
among older persons is crucial when analyzing such proposals. 
Many studies have found health to be a powerful factor in 
retirement decisions, leading to conjectures that improving 
health levels should make retirement later than age 62 more 
desirable and more feasible for workers. Most studies of health 
trends, however, have looked only at average health levels 
among workers nearing retirement, concluding that average 
health is improving and that only a minority of individuals are 
in poor health as they reach age 62.
    The studies in this project delve beneath the population 
averages. The earlier work looked at the health and mortality 
of workers retiring at 62 compared to those who retired later, 
finding there was substantial evidence that the early retirees 
tended to be less healthy and to die earlier than those who 
retired later. The most recent work looked at trends in life 
expectancy. Although average life expectancies have been 
increasing, the study found significant evidence that life 
expectancies at lower socioeconomic status have not been 
increasing as fast as those at higher socioeconomic status.
    The life expectancy trends have wider implications than the 
determination of early entitlement policy. The U.S. currently 
lags in life expectancy behind most wealthy developed nations, 
while simultaneously spending more on health care than these 
other nations. This project compared U.S. life expectancy to 
that of other countries. Other relevant work under way in this 
area includes a National Academy of Sciences panel of prominent 
researchers investigating ``Divergent Trends in Longevity in 
High-Income Countries.''
    In addition, trends in life expectancy by socioeconomic 
status may have implications for future Social Security 
expenditures. This project's study of life expectancy trends 
was cited in this regard in the April 2008 CBO issue brief, 
``Growing Disparities in Life Expectancy.''
    Excellence: What makes this project exceptional?
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Innovativeness: Why is this research exciting or 
newsworthy?
    Mortality and health differences among Social Security 
covered workers can impact the Social Security program in many 
ways, including effects on disability applications, mortality 
projections, and behavioral responses to possible future 
increases in Social Security's EEA or FRA.
    The retirement policy community is currently debating the 
advisability of raising Social Security's EEA as a means of 
encouraging greater work participation at older ages in the 
U.S. Knowledge of differences in health and mortality risk 
among older persons is crucial when analyzing such proposals. 
Many studies have found health to be a powerful factor in 
retirement decisions, leading to conjectures that improving 
health levels should make retirement later than age 62 more 
desirable and more feasible for workers. Most studies of health 
trends, however, have looked only at average health levels 
among workers nearing retirement, concluding that average 
health is improving and that only a minority of individuals are 
in poor health as they reach age 62.
    The studies in this project delve beneath the population 
averages. The earlier work looked at the health and mortality 
of workers retiring at 62 compared to those who retired later, 
finding there was substantial evidence that the early retirees 
tended to be less healthy and to die earlier than those who 
retired later. The most recent work looked at trends in life 
expectancy. Although average life expectancies have been 
increasing, the study found significant evidence that life 
expectancies at lower socioeconomic status have not been 
increasing as fast as those at higher socioeconomic status.
    The life expectancy trends have wider implications than the 
determination of early entitlement policy. The U.S. currently 
lags in life expectancy behind most wealthy developed nations, 
while simultaneously spending more on health care than these 
other nations. This project compared U.S. life expectancy to 
that of other countries. Other relevant work under way in this 
area includes a National Academy of Sciences panel of prominent 
researchers investigating ``Divergent Trends in Longevity in 
High-Income Countries.''
    In addition, trends in life expectancy by socioeconomic 
status may have implications for future Social Security 
expenditures. This project's study of life expectancy trends 
was cited in this regard in the April 2008 CBO issue brief, 
``Growing Disparities in Life Expectancy.''

     Social Security Administration Contribution to the Health and 
                         Retirement Study (HRS)

    The HRS provides an ongoing source of longitudinal data for 
research on retirement and aging. SSA provides substantial 
funds through interagency agreements with the National 
Institute on Aging.
    Lead Agency: Social Security Administration.
    Agency Mission: To advance the economic security of the 
Nation's people through compassionate and vigilant leadership 
in shaping and managing America's Social Security programs.
    Principal Investigator: Irena Dushi, Project Officer, 500 E 
Street, SW., 9th Floor, Washington, DC 20254-0001.
    Partner Agency: National Institute on Aging.
    General Description: The Health and Retirement Study (HRS) 
provides an ongoing source of longitudinal data for research on 
retirement and aging. HRS is an outgrowth of a prior 
longitudinal study undertaken by the Social Security 
Administration (SSA) in the late 1960s that interviewed 
respondents biennially between 1969 and 1979. At that time, 
SSA's Retirement History Study was a unique source of data to 
understand retirement decisions and retirement behavior in a 
period when a growing number of individuals were taking Social 
Security benefits before reaching age 65. The HRS has made many 
improvements to the design of the Social Security study, 
learning from the strengths and limitations of the prior study. 
HRS is now the premier data set in this area.
    Through interagency agreements with the National Institute 
on Aging, SSA provides substantial support for the HRS. SSA 
supports several areas: (1) Basic support to maintain sample 
size, improve data quality, assure the confidentiality of the 
data, and develop restricted access administrative data on 
benefits and earnings, (2) production of a user-friendly 
public-use file that requires substantially less time and 
effort to use than the underlying HRS data releases, especially 
for longitudinal analysis, (3) collection of longitudinal 
information on consumption to understand how consumption 
changes through retirement and whether people have adequate 
retirement income to meet their consumption needs, (4) efforts 
to improve the linking of survey information to SSA 
administrative records on benefits and earnings that is crucial 
for many analyses of effects of specific policy reforms, and 
(5) development of longitudinal weights and improved 
imputations of earnings and pensions that improve the quality 
of the resulting data.
    Excellence: What makes this project exceptional?
    The HRS is exceptional in numerous ways. The survey 
collects a wealth of data across a wide range of subjects, 
follows people from age 50 until death allowing for the study 
of the retirement and aging processes, and adds new cohorts 
every 6 years so that demographic and societal changes can be 
tracked. Government experts and academic researchers from a 
diverse set of disciplines, including economics, demography, 
sociology, psychology, medicine, epidemiology, health services, 
and survey methodology, collaborate on the design of the 
survey. The questionnaire employs innovative design features 
and experimental modules to improve the quality of the data and 
cover an extensive set of narrowly focused topics. The survey 
data are linkable to important administrative data files on 
earnings histories and benefits from SSA for respondents who 
have provided their consent, and to information on health costs 
from the Centers for Medicare and Medicaid Services, and 
pension plan provisions from employers. SSA also supports 
production of user-friendly public-use data files that greatly 
simplifies analysis of data across interviews. And the HRS has 
become a model for similar data collections in other countries, 
allowing for the study of trends in aging and retirement 
worldwide.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    This survey has been expressly designed to provide the data 
needed to understand the dynamics of retirement and the aging 
of the population. HRS data are helping SSA assess a wide range 
of issues: preretirement savings, health status, health 
insurance and pension coverage, retirement transitions, and 
retirement income, including benefits and projected benefits of 
retired workers, their dependents and auxiliary beneficiaries. 
Of particular interest among the older cohorts are questions of 
the economic impact of health problems or age-related declines 
in health, the impact of widowhood on economic well-being, and 
the extent of dissaving and Medicaid spend down as people age.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    SSA supports a great deal of research on program issues 
using the HRS. Recent work using the HRS has addressed such 
topics as changing consumption at retirement, planning for 
retirement and financial literacy, managing risks in 
retirement, assessing the effects of the changing pension 
environment, adequacy of saving for retirement, effects of 
Social Security reform options, and differences in the 
distribution of wealth holdings, pension participation and plan 
characteristics, and long term care preparations across cohorts 
of near retirees. The HRS is also an important database for 
estimating some of the relationships underlying SSA 
microsimulation models. For example, labor force retirement, 
financial wealth, and housing equity in Modeling Income in the 
Near Term are based on relationships estimated from HRS.
    Innovativeness: Why is this research exciting or 
newsworthy?
    The U.S. is one of many countries worldwide that is facing 
an aging population and, in particular, the challenge of a baby 
boom generation that is on the brink of retirement. Major 
programs, such as Social Security and Medicare, must make 
changes in order to remain solvent. The HRS is exciting and 
newsworthy, because it is a powerful tool for assessing the 
programs and policies of the present and future.

Social Security Administration: Modeling Income in the Near Term (MINT)

    MINT is a microsimulation model that projects the economic 
and demographic circumstances of older Americans through the 
year 2099 based on data developed by SSA and the Census Bureau 
to study their economic well-being and to assess the effects of 
Social Security reform proposals.
    Lead Agency: Social Security Administration.
    Agency Mission: To advance the economic security of the 
Nation's people through compassionate and vigilant leadership 
in shaping and managing America's Social Security programs.
    Principal Investigator: Howard M. Iams, Ph.D., 500 E 
Street, SW., RM 914, Washington, DC 20254-0001.
    General Description: MINT (Modeling Income in the Near 
Term) is a microsimulation model that allows researchers and 
analysts to examine the economic and demographic circumstances 
of current retirees and the projected circumstances of future 
retiree populations. It began initially as a model to document 
the probable experience of baby boomers in their retirement 
years, but has recently been expanded to include projections 
over a longer time horizon. Depending on the analysis year and 
the group under study, MINT uses actual data, projections, or a 
combination of the two. Special, detailed databases developed 
jointly by the Social Security Administration (SSA) and the 
Census Bureau underlie the model. To create these databases, 
the two agencies exactly match household survey information 
from the Survey of Income and Program Participation (SIPP) to 
administrative records maintained by SSA.
    MINT is updated and improved on a continual basis:
     In 2004, the large 1996 SIPP panel was added to 
the base of MINT data which allows for examination of even 
relatively small subgroups.
     In 2008, projection techniques were developed that 
allow MINT to simulate retirement income for older Americans 
through calendar year 2099.
     In 2008, a beta version of a detailed tax module 
was created for analysis of benefit taxation issues.
     In 2008, fertility histories were added that allow 
for the addition of some Social Security child beneficiaries to 
the model.
     In 2008, the pension model was refined to take 
account of trends with regard to defined benefit pensions.
     SSA administrative records through 2005 are now 
available in the underlying database.
    MINT is used to study the economic well-being of older 
Americans. For example, it is used to estimate the poverty 
rate, or more generally the level of income, of older Americans 
in future years. It is also used to estimate the 
characteristics of subgroups. For example, it is used to 
estimate the percentage of women in various marital status 
groups in future years (married, widowed, divorced, and never 
married). Because of the detailed underlying data and its long 
time horizon, MINT is used extensively to measure the impact of 
large-scale, complicated Social Security reform proposals. This 
type of analysis provides policymakers information that 
complements the standard cost analysis conducted for reform 
proposals. It allows for an assessment of how subgroups would 
fare under different reform plans.
    Excellence: What makes this project exceptional?
    MINT is exceptional because of the level of detail and the 
quality of the projections. It projects several sources of 
income, including Social Security benefits, Supplemental 
Security Income payments, defined contribution and defined 
benefit pensions, earnings, and income from accumulated assets. 
MINT provides the most comprehensive measures of retirement 
income and the most complete characterization of economic well-
being for future populations of older Americans. MINT also 
captures complete lifetime earnings and marital history 
information, allowing for the analysis of large-scale and 
complex reform plans that would change retirement and auxiliary 
benefits under the Social Security program.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    MINT provides a comprehensive assessment of the economic 
well-being of older Americans well into the future. It is a 
flexible and well-developed tool that policymakers can use as 
they craft policies designed to deal with the consequences of 
an aging society. Any number of Social Security reform 
proposals can be evaluated using MINT.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    SSA has used MINT to provide analysis for the National 
Economic Council, the Office of Management and Budget, the 
House Ways and Means Committee, the Senate Finance Committee, 
and the Government Accountability Office, as well as the Social 
Security Administration and the Social Security Advisory Board. 
Several papers using MINT appear in the Social Security 
Bulletin, edited book volumes, and professional peer-reviewed 
journals. MINT information has influenced discussions of Social 
Security reform topics.
    Innovativeness: Why is this research exciting or 
newsworthy?
    MINT has influenced the development of other 
microsimulation models. Research teams studying MINT created 
other important policy simulation models, such as the 
Congressional Budget Office's long-term model (CBOLT). The 
influence continues today because of ongoing improvements to 
the model. For example, MINT's focus on measuring the detailed 
components of income will force other models to seek 
improvements (other current simulation models have only limited 
measures of income). MINT is also innovative in that it 
combines actual data on households with sophisticated 
projection techniques. The incorporation of rich underlying 
data improves the quality of the projections.
    The continuing series of papers and analysis based on MINT 
are innovative. They reveal the changing landscape of 
retirement for older Americans. For example, policymakers 
concerned with the economic well-being of older women have 
focused on the widowed population. Research from MINT reveals 
that another segment of the population--never married women--is 
growing in number and is projected to experience relatively 
high levels of poverty. This type of research allows 
policymakers to craft policies designed to deal with newly 
developing demographic and economic trends.

   Social Security Administration: Health Care Costs, Taxes, and the 
                          Retirement Decision

    This research simulates how much longer the typical worker 
aged 65 in the year 2030 would have to work to have the same 
financial resources in a high tax burden and health cost 
scenario as in a low tax and health cost scenario.
    Lead Agency: Social Security Administration.
    Agency Mission: To advance the economic security of the 
Nation's people through compassionate and vigilant leadership 
in shaping and managing America's Social Security programs.
    Principal Investigators: Richard Johnson, Senior Research 
Associate, Urban Institute, Washington, 2100 M Street, NW., 
Washington, DC 20037.
    General Description: This research estimates the effects of 
rising taxes and health care costs on the timing of retirement. 
Higher tax burdens or health costs may delay retirement, as 
older people have to work longer to save enough money for 
retirement. On the other hand, if people anticipate these 
higher costs, they may work and save more while younger and 
retire when planned. To answer this question, the researchers 
consider two possible scenarios--one with high taxes and health 
costs, and one with low taxes and health costs. The low-cost 
scenario assumes that the tax burden in 2030 is roughly the 
same as in 2000 by adjusting exemption amounts and the standard 
deduction by the change in the average wage index. It also 
assumes health care costs increase at the same rate as 
inflation. In the high-cost scenario, there is no change in 
thresholds used for the alternative minimum tax or for taxing 
Social Security benefits, so more people would be subject to 
these taxes, and health costs increase by 3.2 percent each year 
between 2000 and 2030. Using representative cases for low, 
moderate, and high earners and single and married individuals, 
they simulate how much longer the typical worker would have to 
work to have the same financial resources at age 65 in the 
high-cost scenario as in the low-cost scenario. In most cases, 
workers will have to delay retirement by 2.4 to 2.8 years in 
the high-cost scenario to receive as much annual retirement 
income as in the low-cost scenario. The only group that would 
not be affected is low-income single adults, because they would 
not pay Federal income taxes in either case, and most of their 
health costs are paid for by Medicaid.
    Private individuals face large and growing health care 
costs. Despite near-universal Medicare coverage, these costs 
can be particularly burdensome for older Americans, who face 
out-of-pocket expenses for Medicare premiums, private 
supplemental premiums, and direct payments to health care 
providers for deductibles and copayments. Additionally, 
increasing public costs are likely to boost future tax burdens. 
Some of this increase will probably fall on older Americans, 
subjecting them to a double burden. This study is important, 
because it considers how rising tax burdens and out-of-pocket 
health care costs will affect the timing of retirement. How 
well people anticipate future increases in taxes and health 
care costs, and how they react at younger ages, will crucially 
affect retirement income. If households are farseeing rational 
planners, higher health costs and tax burdens will likely 
induce more saving and harder work while young, muting effects 
on retirement decisions.
    Excellence: What makes this project exceptional?
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Innovativeness: Why is this research exciting or 
newsworthy?
    Private individuals face large and growing health care 
costs. Despite near-universal Medicare coverage, these costs 
can be particularly burdensome for older Americans, who face 
out-of-pocket expenses for Medicare premiums, private 
supplemental premiums, and direct payments to health care 
providers for deductibles and copayments. Additionally, 
increasing public costs are likely to boost future tax burdens. 
Some of this increase will probably fall on older Americans, 
subjecting them to a double burden. This study is important, 
because it considers how rising tax burdens and out-of-pocket 
health care costs will affect the timing of retirement. How 
well people anticipate future increases in taxes and health 
care costs, and how they react at younger ages, will crucially 
affect retirement income. If households are farseeing rational 
planners, higher health costs and tax burdens will likely 
induce more saving and harder work while young, muting effects 
on retirement decisions.

   Social Security Administration: Measurement of Reliance on Social 
                           Security Benefits

    This project evaluates how different data sources and 
methodologies affect estimates of the relative importance of 
Social Security benefits to the elderly.
    Lead Agency: Social Security Administration.
    Agency Mission: To advance the economic security of the 
Nation's people through compassionate and vigilant leadership 
in shaping and managing America's Social Security programs.
    Principal Investigator: Lynn Fisher, Economist, 500 E St., 
SW., 9th Floor, Washington, DC 20254-0001.
    General Description: This research project establishes the 
extent to which statistics on the economic well-being of the 
elderly, in particular the importance of Social Security 
benefits relative to other sources of income received by the 
elderly, are affected by the choice of data source and the 
methodology employed.
    Official statistics on income and poverty come from the 
March Supplement to the Current Population Survey (CPS) 
conducted by the U.S. Census Bureau. This project compares the 
Social Security Administration's (SSA) published statistics on 
the relative importance of Social Security for the elderly 
derived from the CPS with statistics produced using the U.S. 
Census Bureau's Survey of Income and Program Participation 
(SIPP) and the Federal Reserve Board's Survey of Consumer 
Finances. This project also uses administrative data on Social 
Security and Supplemental Security Income benefits linked to 
the CPS and SIPP to compare survey responses with 
administrative records for the same individuals. Comparison of 
estimates across surveys and the use of administrative data aid 
in evaluating the effect of variations in survey reporting on 
the perceived economic well-being of the elderly. Future 
research includes examination of survey reporting of asset 
income and pensions using Internal Revenue Service (IRS) 
administrative data linked to the CPS.
    This project also examines how methodological choices, such 
as the unit of observation, influence estimates of the relative 
importance of Social Security. SSA traditionally has analyzed 
aged units when estimating the proportion of the elderly 
population receiving 50, 90, or 100 percent of its income from 
Social Security. An aged unit may be a married couple or a 
nonmarried person; resources from non-spouse family or other 
members of the household are excluded. In contrast, estimates 
of the relative importance of Social Security produced by the 
Congressional Research Service use only the income received by 
a person. Other measures of well-being, such as the official 
poverty measure, take into account all family income of a 
person.
    Another methodological decision is the determination of 
which resources count as income. Many assume that those elderly 
who receive all of their income from Social Security have no 
other resources. Current measures, however, do not reflect lump 
sum withdrawals from individual retirement accounts and 
defined-contribution pensions (e.g., 401ks) or spending from 
savings--both of which are important elements of a financially 
secure retirement. SSA funded an experimental battery of 
questions to the Census Bureau's 2007 CPS on irregular sums 
paid out of such accounts. SSA is analyzing these data to 
evaluate the prevalence of lump-sum withdrawals. This research 
project is also examining the importance of noncash benefits 
(food, energy, and housing assistance) that provide a safety 
net for the elderly. Future research will analyze the relative 
importance of Social Security on an after-tax basis.
    The results of this project, based on income data for 1996, 
indicate that the percentage of the elderly receiving all of 
their income from Social Security varies from under 5 percent 
to over 19 percent, depending on the data source and 
methodology.
    Excellence: What makes this project exceptional?
    This project is exceptional, because it brings together 
multiple sources of survey and administrative data, including 
new survey questions on irregular income from pension accounts 
and linkages of IRS data on pension and asset income, to 
explore what is actually measured by a frequently reported 
statistic--the relative importance of Social Security for the 
elderly. Using a number of accepted methodologies and data 
sources, estimates of the proportion of the elderly who are 
``completely reliant on Social Security'' in 1996 vary from 
less than 1 in 20 to nearly 1 in 5. Because this statistic is 
so often reported by the press, researchers, and policymakers, 
it is important to understand how the estimates can differ to 
such a large degree.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Research into the financial resources available to the 
elderly is vitally important to policymakers and the public. 
Providing assistance to the elderly who are economically 
vulnerable requires an accurate understanding of the size of 
the vulnerable population and the resources that are available 
to them. One popular measure requested by the media and 
policymakers is the proportion of the elderly receiving all of 
their income from Social Security.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Better understanding of how estimates of the economic 
vulnerability of the elderly are constructed is necessary to 
make fully informed decisions for public policy. Wide 
discrepancies between estimates based on different data sources 
also indicate that further improvements in data collection are 
necessary to better assess the economic vulnerability of the 
elderly.
    Innovativeness: Why is this research exciting or 
newsworthy?
    The proportion of the elderly receiving all of their income 
from Social Security is frequently reported in the media, 
usually as the elderly completely reliant/dependent on Social 
Security. Over the 1990s and early 2000s, the published 
proportion of aged units (married couples and nonmarried 
persons) 65 or older receiving all of their income from Social 
Security grew from 12 percent to 21 percent. Many interpret 
this rise as growing economic vulnerability of the elderly 
population. Results from this research project thus far 
indicate that this rise is most likely due to growing 
underreporting of the receipt of asset income in the March 
Supplement of the CPS. The estimate of the proportion of the 
elderly receiving all of their income from Social Security is 
highly sensitive to the data source and methodology used. In 
1996, 19.4 percent of elderly individuals surveyed in the CPS 
received all of their income from Social Security compared to 
9.4 percent in the SIPP. If the resources under consideration 
for the relative importance of Social Security were the same as 
for poverty estimates (the family income of the person), then 
11.3 percent of the elderly in the CPS would have been 
considered completely reliant on Social Security; the same 
methodology in SIPP would have yielded 4.9 percent of the 
elderly completely reliant on Social Security.

       Social Security Administration: Benefit Claiming Behavior

    This project investigates how changes in Social Security 
program rules affect benefit claiming behavior and labor force 
activity of older workers by examining the retirement earnings 
test rule change in 2000 and the gradual increase in the full 
retirement age.
    Lead Agency: Social Security Administration.
    Agency Mission: To advance the economic security of the 
Nation's people through compassionate and vigilant leadership 
in shaping and managing America's Social Security programs.
    Principal Investigator: Jae Song, Economist, 500 E Street, 
SW., 9th Floor, Washington, DC 20254-0001.
    General Description: The challenge of an aging population 
is likely to require changes in policy rules in both Social 
Security and Medicare going forward, but how people will 
respond to policy changes is largely unknown. An increasing 
number of analysts advocate working longer to balance the needs 
of retirees with the tax burdens placed on younger workers. 
But, will people choose to work longer and continue to be 
productive members of society, or will they choose to spend 
some of the rewards of growing prosperity by retiring at 
younger ages? Evidence on behavioral responses to policy 
changes to the Social Security program became available in the 
last few years when two changes designed to encourage people to 
delay retirement came into effect.
    This multi-year project analyzes responses to two recent 
changes in rules governing the Social Security program: the 
retirement earnings test was eliminated in 2000 for people aged 
65-69, and the full retirement age (FRA) for people born in 
1938 or later is gradually increasing in 2-month increments 
until reaching age 67. We examine changes in the age at which 
people claim Social Security retirement benefits in response to 
those changes. Data come from a 1 percent sample of 
administrative data from the Social Security Administration 
(SSA) for 1997 to 2007.
    Descriptive and statistical analyses show that the largest 
effect of eliminating the earnings test in 2000 occurs at age 
65. At that age, the proportion of people who claim retirement 
benefits increases by 4.6 percentage points among men and 2.4 
percentage points among women. In addition, eliminating the 
earnings test significantly increases--by more than 20 
percent--the probability that people who have not yet claimed 
Social Security benefits when they turn the full retirement age 
will claim those benefits.
    Responses to the increase in the full retirement age are 
quite dramatic and show the power of policy changes. Among 
people born in 1937, about 18 percent of men and 12 percent of 
women claimed benefits at age 65, the FRA for that cohort. As 
the FRA increased by 2 months per year for the 1938, 1939, 
1940, and 1941 cohorts, the bulge of people who claimed 
benefits at the FRA moved out as well. About 16 percent of men 
and 10 percent of women claimed benefits at age 65 and 8 
months, the FRA for the 1941 cohort. People who previously 
would have claimed benefits at age 65 but waited until their 
new, higher FRA are most likely responding to both the benefit 
reduction and the signaling aspect of the Social Security 
retirement age. Moreover, the response to the gradual increase 
in the FRA occurs not only among those who are close to the FRA 
but also among those who are aged 62, 63 or 64.
    In the future we plan to examine how the earnings of older 
workers have changed in response to the rule changes. We also 
want to explain why the work behavior of high-income older 
workers moves in the opposite direction from other workers.
    Excellence: What makes this project exceptional?
    This project uses unique data and topnotch empirical 
methods to examine responses to policy changes that affect 
every American who will receive Social Security retirement 
benefits. Changes in the full retirement age and the retirement 
earnings test were made for two reasons: to improve solvency of 
the Social Security system and to encourage older people to 
work longer so that their earnings can supplement Social 
Security benefits. We examine changes in the age at which 
people claim Social Security retirement benefits as well as 
long-term and short-term effects on labor supply in response to 
the two Social Security rule changes. Findings from the project 
are essential not only for examining the effectiveness of the 
two rule changes, but also for designing future program rules 
to further improve solvency of entitlement programs.
    The project relies on highly accurate administrative data 
maintained by SSA. The administrative files include annual 
earnings for each individual over his/her lifetime, the month 
and year of birth, month and year of benefit entitlement, and 
the type of beneficiary status (primary or auxiliary), which 
are typically not available in survey data. Innovative 
implementation of a simple regression model paired with 
historical data reflecting responses to the policy changes 
produces highly reliable and convincing results, and allows us 
to estimate the uneven impact of the rule changes across 
different earnings groups.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    The gradual increase in the full retirement age affects 
everyone born in 1938 or later who will claim retirement 
benefits from Social Security. For example, everyone born in 
1943 has to wait until age 66 to receive full Social Security 
benefits. If they choose to claim benefits at age 65, they 
would receive only about 93 percent of their full benefit for 
the rest of their life. If they choose to claim their benefits 
at age 62, they would receive just 75 percent of their full 
benefit. The reductions affect spousal benefits and widow 
benefits as well.
    The change in the retirement earnings test had widespread 
effects also. In 2000, approximately 10 million older workers 
aged 65-69 were affected by the elimination of the retirement 
earning test.
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Results of the project are essential to understanding 
likely outcomes following reforms of the earnings test and full 
retirement age, and designing effective reforms in the future. 
Outcomes of interest include actual changes in retirement ages, 
additional hours or years in the labor force, and consequent 
effects on the economic welfare of older workers.
    The retirement earnings test continues to affect those who 
claim Social Security benefits before they reach the full 
retirement age. Because early claimants constitute more than 80 
percent of all those who ever claim retirement benefits, most 
individuals are potentially subject to the earnings test for a 
few years after claiming benefits. More individuals are likely 
to be affected in the future as the full retirement age 
gradually rises to 67, increasing the breadth of the age range 
where the earnings test applies.
    Innovativeness: Why is this research exciting or 
newsworthy?
    Unlike other studies, this study uses highly representative 
and accurate data generated from program administration that 
covers periods of time both before and after the earnings test 
and FRA rule changes. Such an extended period can help us 
understand dynamic responses by older workers, some of whom 
face substantial constraints on remaining in or reentering the 
labor force because of deteriorating health and outdated 
skills.
    In addition, most past studies of the earnings test rely on 
a simple regression with a focus on likely effects on average 
individuals. Such studies have failed to detect the uneven 
impact of removing the earnings test across the earnings 
distribution predicted by the structure of the earnings test. 
Our innovative implementation of regression techniques allows 
us to examine the uneven impact of the earnings test removal 
across the distribution of earnings and consequently identifies 
strong effects at particular regions of the earnings 
distribution.

      Social Security Administration: 401(k) Automatic Enrollment

    This paper summarizes the empirical evidence on automatic 
enrollment in 401(k) plans. The evidence strongly suggests that 
automatic enrollment affects savings outcomes at every step 
along the way.
    Lead Agency: Social Security Administration.
    Agency Mission: To advance the economic security of the 
Nation's people through compassionate and vigilant leadership 
in shaping and managing America's Social Security programs.
    Principal Investigator: Brigitte Madrian, Professor of 
Public Policy, Harvard University, Cambridge, MA 02138.
    General Description: This project assesses the impact on 
savings behavior of several different 401(k) plan features, 
including automatic enrollment, automatic cash distributions, 
employer matching provisions, eligibility requirements, 
investment options, and financial education. The author 
presents new survey evidence on individual savings adequacy, 
basing many of the conclusions on an analysis of micro-level 
administrative data on the 401(k) savings behavior of employees 
in several large corporations that implemented changes in their 
401(k) plan design. The analysis identifies a key behavioral 
principle that should partially guide the design of 401(k) 
plans: Employees often follow ``the path of least resistance.'' 
For better or for worse, plan administrators can manipulate the 
path of least resistance to powerfully influence the savings 
and investment choices of their employees.
    The paper presents empirical evidence on how automatic 
enrollment affects retirement savings outcomes at all stages of 
the saving lifecycle, including savings plan participation, 
savings rates, asset allocation, and post-retirement savings 
distributions. The paper is significant, because it is able to 
show why defaults have such a tremendous impact on savings 
outcomes. The paper concludes with a discussion of the role of 
public policy towards retirement saving when defaults matter. 
This research has had a direct effect on policy. The Pension 
Protection Act of 2006 provides statutory authority for 
employers to automatically enroll workers in defined 
contribution plans.
    Excellence: What makes this project exceptional?
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Innovativeness: Why is this research exciting or 
newsworthy?
    The paper presents empirical evidence on how automatic 
enrollment affects retirement savings outcomes at all stages of 
the savings lifecycle, including savings plan participation, 
savings rates, asset allocation, and post-retirement savings 
distributions. The paper is significant, because it is able to 
show why defaults have such a tremendous impact on savings 
outcomes. The paper concludes with a discussion of the role of 
public policy towards retirement saving when defaults matter. 
This research has had a direct effect on policy. The Pension 
Protection Act of 2006 provides statutory authority for 
employers to automatically enroll workers in defined 
contribution plans.

       Social Security Administration: Alternative Poverty Rates

    This research creates a consumption-based poverty measure. 
This is relevant to the elderly population, who are likely to 
receive income-in-kind, such as Medicare, and have savings or 
home equity to draw from.
    Lead Agency: Social Security Administration.
    Agency Mission: To advance the economic security of the 
Nation's people through compassionate and vigilant leadership 
in shaping and managing America's Social Security programs.
    Principal Investigator: Michael Hurd, Senior Economist and 
Director, RAND Center for the Study of Aging, RAND Corporation, 
1776 Main Street, Santa Monica, CA 90407.
    General Description: This research uses income and 
consumption data from the Consumption and Activities Mail 
Survey (CAMS) and Health and Retirement Study (HRS) to 
calculate alternative poverty rates. These are compared to the 
poverty rates computed using pre-tax income from the Current 
Population Survey (CPS). The consumption-based measure is the 
sum of expenditures on non-durable goods and consumption flows 
from durable goods, such as cars and housing. It is related to 
income since consumption cannot exceed after-tax income. For 
groups such as the elderly, a consumption-based measure of 
poverty may be more reliable since it takes into account 
income-in-kind, such as Medicare, spending out of wealth, and 
consumption flows from durable goods. The authors check the 
validity of the CAMS data and find very high response rates for 
questions on different types of expenditures. In addition, the 
patterns of consumption are consistent with younger households 
saving more while the oldest spend more.
    The authors find that poverty rates computed from pre-tax 
and after-tax incomes are similar for most age ranges. However, 
the consumption-based poverty rate is much lower than an 
income-based rate. Overall, 6.16 percent of households fall 
below the poverty threshold based on income, but when 
consumption is used, only 2.85 percent would fall below the 
poverty line. The consumption-based poverty measure accounts 
for differences in wealth. Of those in poverty based on income, 
those also in poverty based on consumption have, on average, 
$187 of non-housing wealth. This is much lower than the average 
non-housing wealth of $158,202 for those who are not in poverty 
according to consumption.
    Excellence: What makes this project exceptional?
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Innovativeness: Why is this research exciting or 
newsworthy?
    Policy makers have long relied on income-based measures of 
poverty. Consumption is arguably a much more accurate measure 
of material well-being than income. For example, households can 
consume more than their income if they have savings. In this 
case, if we looked at income, we would form a different 
impression of the well-being of the household than if we looked 
at consumption. This project finds that consumption-based 
poverty rates are considerably lower than income-based rates, 
especially for single people. A consumption-based measure of 
poverty would actually decrease the percentage of people 
categorized as poor, and this is especially true in advanced 
old age as people spend increasingly out of savings.

           Social Security Administration: Financial Literacy

    Financial literacy in the older than 50 population is 
lacking. Most respondents are able to calculate a percentage, 
but only 55 percent can divide and less than 20 percent can 
computer compound interest. Solutions to remedy this situation 
and encourage retirement planning are still needed.
    Lead Agency: Social Security Administration.
    Agency Mission: To advance the economic security of the 
Nation's people through compassionate and vigilant leadership 
in shaping and managing America's Social Security programs.
    Principal Investigator: Annamaria Lusardi, Professor, 
Dartmouth College, Department of Economics, Hanover, NH 03755-
3514.
    General Description: Using survey data from the Health and 
Retirement Study, the authors find that financial literacy in 
the older than 50 population is lacking. Their results are 
based on several simple questions that ask respondents to 
calculate a percentage, divide two numbers, and compute 
compound interest. Most respondents are able to correctly 
calculate a percentage, while about 55 percent can divide, and 
less than 20 percent can compute compound interest correctly. 
These findings are consistent with other financial literacy 
surveys, both in the U.S. and in other developed countries, 
that find that many people do not understand interest rates or 
the terms of their investments. These results are not 
promising, since this age group should have financial 
experience and retirement planning is relevant for this group. 
Respondents who are financially literate are more likely to 
have planned for retirement. Furthermore, it is unclear how to 
remedy this situation. Other researchers have found that the 
effectiveness of financial education seminars is low and since 
they are voluntary, may not reach those who are most in need of 
retirement planning.
    This project studies workers' levels of financial literacy 
and finds that strikingly many respondents display particularly 
low levels of financial knowledge. Moreover, people who plan 
for retirement and execute their plans successfully are those 
who are more financially literate. Other countries have 
undertaken initiatives to enhance financial literacy, with the 
goal of enhancing retirement security. The information that 
this research produces on the level of financial literacy in 
different subgroups in the population will be useful for 
efforts aimed at providing financial education and improving 
financial literacy.
    Annamaria Lusardi and Olivia Mitchell were awarded the 2007 
Fidelity Research Institute Pyramid Prize for their work on 
advancing understanding of the importance of financial literacy 
and planning in helping Americans reach their financial goals. 
The prize is presented to authors of published applied research 
that the Institute believes best helps address the goal of 
improving lifelong financial well-being for Americans. The 
award-winning paper ``Baby Boomer retirement security: The 
roles of planning, financial literacy, and housing wealth'' 
first appeared as a working paper and was subsequently 
published in the Journal of Monetary Economics.
    Excellence: What makes this project exceptional?
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Innovativeness: Why is this research exciting or 
newsworthy?
    This project studies workers' levels of financial literacy 
and finds that strikingly many respondents display particularly 
low levels of financial knowledge. Moreover, people who plan 
for retirement and execute their plans successfully are those 
who are more financially literate. Other countries have 
undertaken initiatives to enhance financial literacy, with the 
goal of enhancing retirement security. The information that 
this research produces on the level of financial literacy in 
different subgroups in the population will be useful for 
efforts aimed at providing financial education and improving 
financial literacy.
    Annamaria Lusardi and Olivia Mitchell were awarded the 2007 
Fidelity Research Institute Pyramid Prize for their work on 
advancing understanding of the importance of financial literacy 
and planning in helping Americans reach their financial goals. 
The prize is presented to authors of published applied research 
that the Institute believes best helps address the goal of 
improving lifelong financial well-being for Americans. The 
award-winning paper ``Baby Boomer retirement security: The 
roles of planning, financial literacy, and housing wealth'' 
first appeared as a working paper and was subsequently 
published in the Journal of Monetary Economics.

   Social Security Administration: Social Security Tax Payments and 
                            Benefit Receipts

    This project identifies how much each cohort of workers and 
retirees, past and projected, has paid or will pay in Social 
Security taxes, and how much each cohort has received or will 
receive in benefits under present law and alternative reform 
proposals.
    Lead Agency: Social Security Administration.
    Agency Mission: To advance the economic security of the 
Nation's people through compassionate and vigilant leadership 
in shaping and managing America's Social Security programs.
    Principal Investigator: Dean Leimer, Economist, 500 E 
Street, SW., 9th Floor, Washington, DC 20254-0001.
    General Description: This project develops a comprehensive 
accounting of Social Security tax payments and benefit receipts 
across and within birth cohorts and identifies the implications 
of these payments for Social Security reform. The first part of 
the project developed all historical tax payments and benefit 
receipts by race, gender, and year of birth under the Old-Age 
and Survivors Insurance (OASI) program, under the Disability 
Insurance (DI) program, and under these combined programs 
(OASDI). These estimates allow the identification of historical 
redistribution under these programs across these race, gender, 
and generation groups, and the extent to which each of these 
groups received their ``money's worth'' from the programs. 
Although aggregate tax and benefit payments by year are readily 
available, the breakdown into payments by year, age, race, and 
gender--requirements for cohort, money's worth, and 
redistributional accounting--is not. This project draws on a 
variety of administrative data sources, some readily available 
in electronic format but others available only in hard copy 
publications, and develops techniques to allocate the taxes and 
benefits to the appropriate race, gender, and age group each 
year from these disparate data sources.
    The second part of the project develops cohort accounting 
estimates of lifetime money's worth and redistributional 
outcomes under the OASI program for all past, present, and 
future birth cohorts affected by the program through the cohort 
born in 2100. These estimates combine, (1) the comprehensive 
and authoritative accounting of historical OASI taxes and 
benefits developed in the first part of the project with (2) 
projected taxes and benefits by birth cohort that are 
consistent with recent Trustees Reports. Cohort accounting 
estimates are also developed under alternative tax increase and 
benefit award reduction policies that bring the program into 
long-run financial balance over the Trustees Report projection 
period and beyond. Cohort accounting estimates are developed 
both from the perspective of cohort members, indicating the 
extent to which each birth cohort has received or can expect to 
receive their ``money's worth'' from the program, and from the 
perspective of the Social Security program, indicating the 
extent of redistribution across these cohorts under present law 
and alternative reform proposals.
    Excellence: What makes this project exceptional?
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Innovativeness: Why is this research exciting or 
newsworthy?
    The data developed for this project represent more 
comprehensive and authoritative measures of historical taxes 
and benefits under the Social Security program than previously 
had been available. Previous analyses were based on less 
definitive estimates, resulting in less accurate and often 
misleading descriptions of Social Security program outcomes for 
specific race, gender, and birth cohort groups. An accurate 
accounting of such outcomes is crucial to understanding how the 
program has worked, its effects on groups of policy interest, 
and how various reform proposals could affect those outcomes. 
The projection of lifetime outcomes by birth cohort developed 
in the second phase of the project extend these results for 
past, present, and future cohorts consistent with recent 
Trustees Report projections under present law and alternative 
reform proposals.
    Such authoritative projections are central to informing the 
current policy debate. The historical and projected data, and 
the associated money's worth and redistributional estimates 
developed under this project, have been cited frequently by the 
policy and research communities, as well as the popular press, 
as part of the current debate, and have made significant 
contributions to informing policy and advancing research by: 
(1) Identifying the money's worth and redistributional effects 
of Social Security programs in the past, (2) illustrating the 
OASI program's potential effects in the future under 
alternative reform proposals, and (3) developing empirical and 
analytical approaches relevant to redistributional and money's 
worth analyses.
    Social Security is one of the most wide-reaching government 
programs and is obviously crucial to the well-being of the aged 
and to many economically vulnerable population groups. 
Consequently, an accurate understanding of the past effects of 
the program on groups of policy interest and projections of how 
those effects could change under alternative reform proposals 
is of utmost importance to the aged and to the economically 
vulnerable groups affected by Social Security programs. This 
project has made significant contributions in understanding and 
projecting those effects and, more generally, helping advance 
related research.

 Substance Abuse and Mental Health Services Administration: Integrated 
                          Primary Health Care

    PRISM-E was a federally funded multi-site randomized 
behavioral health services research study that compared 
effectiveness of an integrated primary health care approach to 
an enhanced version of specialty behavioral health services 
accessed through referral for older adults.
    Lead Agency: Substance Abuse and Mental Health Services 
Administration (SAMHSA).
    Agency Mission: SAMHSA's mission is to build resilience and 
facilitate recovery for people with or at risk for mental or 
substance use disorders.
    Principal Investigator: Sue E. Levkoff, Sc.D., Harvard 
Medical School, Brigham and Women's Hospital, Department of 
Psychiatry, 1249 Boylston Street, 3rd Floor, Boston, MA 02215.
    Partner Agency: Department of Veterans Affairs (DVA) was a 
key co-partner, Health Resources and Services Administration 
(HRSA), Centers for Medicare and Medicaid Services (CMS).
    General Description: Although prevalence rates vary in 
epidemiological studies, elderly individuals experience high 
rates of depression, anxiety disorders, and alcohol use 
disorders. Older adults are high utilizers of health care 
services who seek and receive mental health and substance abuse 
services more often from their primary care providers than from 
specialty providers. At that time there was great interest in 
whether integrating behavioral health care into primary health 
care settings might provide better access to care and/or better 
outcomes. To examine this issue, SAMHSA developed and funded a 
large randomized multisite study to add critical knowledge 
about how to best organize and deliver mental health and 
substance abuse services for older adults. The study was titled 
Primary Care Research in Substance Abuse and Mental Health for 
the Elderly (PRISM-E). PRISM-E was developed to compare the 
effectiveness of two common service delivery models to treat 
behavioral health care problems. The first model, Integrated 
Care, was set within generalist primary health care settings. 
The comparison model was an enhanced form of care provided in 
behavioral health specialist settings through referral from 
primary health care providers. The study aimed to identify 
differences in clinical and cost outcomes between these two 
models for targeted conditions common in older adults, 
depression, anxiety, and problem or at-risk alcohol use. This 
6-year study included clinical screenings on 25,000 persons age 
65 years and older; random assignment of 2,300 persons 
identified with mental health or substance abuse issues to 
either Integrated Care or Enhanced Specialty Referral treatment 
models; and, assessments at baseline, 3 and 6 months, to 
determine changes in clinical symptoms and functioning over the 
course of treatment.
    Key findings of the study:
     Many older adults in primary care settings have 
behavioral health problems that can be easily identified by 
screening.
     Both treatment approaches succeeded in improving 
participant's mental health and resulted in participants' 
report of high satisfaction. An advantage of the Enhanced 
Specialty Referral model was found for persons with the most 
severe forms of depression.
     Integrated Care led to greater access to 
behavioral health services.
    Policy implications of the study:
     Both Integrated Care and Enhanced Specialty 
Referral provide good options or choices for older adult 
consumers. Many consumers prefer Integrated Care because of 
concerns about stigma, transportation or coordination with 
other providers. The Enhanced Specialty Referral model better 
meets needs of consumers with more serious illnesses. Consumers 
demand choices and PRISM-E demonstrates two good choices for 
mental health and alcohol treatment services.
     Funding issues identified during the study 
included need for training opportunities for providers on 
integrated care, current prohibition of billing for both a 
primary care and psychiatry visit on the same day, and no 
funding options for administrative case management which is 
critical for Enhanced Specialty Referral.
    Future plans include dissemination of findings through a 
SAMHSA-sponsored evidence-based practice KIT (Knowledge 
Informing Transformation) specific for the treatment of 
depression in older adults, brochures and web material for 
providers and older adult consumers.
    Excellence: What makes this project exceptional?
    PRISM-E was a large-scale behavioral health services study 
conducted with high standards of scientific rigor to enhance 
credibility and generalizability. The study was conducted as a 
randomized trial; all sites underwent rigorous independent peer 
review; and the large number of study participants provided 
statistical power to address the study questions. A 
Coordinating Center provided oversight of the entire study and 
a Steering Committee, composed of Federal representatives, the 
Coordinating Center, all study sites and older adult consumers, 
provided ongoing collaborative planning for the study. A common 
research protocol and assessment battery was used with well-
validated measures including culturally sensitive research 
instrument. A comprehensive cost study was included in the 
research. The primary findings of the study were published 
quickly after study completion in high-quality peer-reviewed 
journals.
    Significance: How is this research relevant to older 
persons, populations and/or an aging society?
    The study made significant contributions to the fields of 
aging, mental health, and substance abuse because it was:
     Largest study of depression in the elderly.
     Largest study of at-risk drinking and alcohol use 
in the elderly.
     First study of behavioral health integration vs. 
referral specialty care in the elderly.
     Past studies look at usual specialty care vs. 
collaborative care.
     First effectiveness study of behavioral health 
care integration for older adults.
     Other major studies focus on compliance to complex 
clinical guidelines.
     PRISM-E focused on behavioral health care services 
enhancements that were easily adoptable across diverse real-
world clinical sites.
     Large sample of ethnic minority elderly (42 
percent of total sample).
    Effectiveness: What is the impact and/or application of 
this research to older persons?
    Detailed findings from the study will contribute to better 
identification and treatment of older persons with behavioral 
health needs. Lessons learned include the following:
     Nearly 20 percent of the 25,000 persons screened 
presented significant levels of psychological distress and 
about 5 percent endorsed suicidal thoughts. Only 11 percent of 
those who screened positive for psychological distress and 14 
percent of those with suicidal thoughts reported receiving care 
from a mental health professional during the past three months 
prior to the time of screening.
     Over 8 percent of older primary care patients 
consumed seven or more drinks per week or had more than four 
drinks in a day more than two times in the past 3 months, a 
level above the NIAAA guidelines for persons over the age of 
65. Heavy drinkers or binge drinkers were more likely to become 
depressed or have poorer health status.
     Overall, patients in the Integrated Care group 
averaged more visits over the 6-month follow-up period than the 
Enhanced Specialty Referral group and initial engagement 
(making the first visit) was greater for Integrated Care than 
Enhanced Specialty Referral care.
     The comparison of two system intervention models 
of care (i.e., Integrated Care vs. Enhanced Specialty Referral) 
for older adults found comparable clinical rates of meaningful 
depression remission and decreases in depression severity over 
6 months. However, for major or more severe forms of 
depression, the Enhanced Specialty Referral resulted in greater 
reduction in depressive symptoms than Integrated Care.
     The average quantity and frequency of drinking 
declined significantly over 6 months for consumers in both 
treatment groups. Similarly, binge drinking also declined over 
time with no differences in drinking between Integrated Care 
and Enhanced Specialty Referral.
     This study surveyed provider preference for the 
Integrated Care or the Enhanced Specialty Referral models. 
Almost all primary care providers stated that Integrated Care 
led to better communication between primary care and mental 
health providers, less stigma for patients, and better 
coordination of mental/physical care. Fewer thought that 
Integrated Care led to better management of depression, 
anxiety, or alcohol problems.
    Innovativeness: Why is this research exciting or 
newsworthy?
    The study demonstrated innovativeness in the following 
ways:
     Development and implementation of Consumer 
Advisory Councils at local and national levels; Active 
participation of consumers in many aspects of study.
     Study addressed multiple behavioral health 
conditions in context of one study and its two comparison 
models.
     Study had input from many constituencies including 
policymakers, providers, funders, consumers, advocates, 
cultural competence experts, and a variety of research 
specialties.
     Randomized trial conducted in real world settings 
typically not the focus of large scale funded research 
projects.
     In addition to primary Federal leadership from 
SAMHSA Project Officer, study included an array of additional 
expertise and participation of Federal staff from all three of 
SAMHSA's Centers and from participating Federal agencies.
     Study databases are publicly available and 
detailed manuals are available for understanding their 
organization. This will foster analysis by additional outside 
investigators for years to come.

      VI. Appendix II: List of Agencies Contacted for Submissions

    Department of Agriculture
    Department of Commerce
          Census Bureau
    Department of Defense
    Department of Education
    Department of Energy
    Department of Health and Human Services
          Administration on Aging
          Administration for Children and Families
          Agency for Healthcare Research and Quality
          Agency for Toxic Substances and Disease Registry
          Centers for Disease Control and Prevention
                  National Center for Environmental Health/
                Agency for Toxic Substances and Disease 
                Registry
                  National Center for Health Statistics
          Centers for Medicare and Medicaid Services
          Food and Drug Administration
          Health Resources and Services Administration
          Indian Health Service
          National Institutes of Health
                  National Institute on Aging
          Office of the Assistant Secretary for Planning and 
        Evaluation
          Substance Abuse and Mental Health Services 
        Administration
    Department of Homeland Security
    Department of Housing and Urban Development
    Department of the Interior
    Department of Justice
    Department of Labor
          Bureau of Labor Statistics
          Employee Benefits Security Administration
    Department of State
    Department of Transportation
    Department of the Treasury
    Department of Veterans Affairs

                          INDEPENDENT AGENCIES

    Agency for International Development
    Appalachian Regional Commission
    U.S. Arctic Research Commission
    Commission on Civil Rights
    Congressional Budget Office
    Consumer Product Safety Commission
    Corporation for National Service
    Environmental Protection Agency
    Equal Employment Opportunity Commission
    Federal Communications Commission
    Federal Reserve System
    Federal Trade Commission
    General Accounting Office
    Interagency Council on Homelessness
    Legal Services Corporation
    Library of Congress
    National Aeronautics and Space Administration
    National Archives and Records Administration
    National Council on Disability
    National Endowments for the Arts
    National Endowment for the Humanities
    National Science Foundation
    Pension Benefits Guaranty Corporation
    Postal Service
    Railroad Retirement Board
    Small Business Administration
    Smithsonian Institution
    Social Security Administration

                                  
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