NIH Centers of Excellence
Claude D. Pepper Older Americans Independence Centers
Why the OAICs Were Established
In 1955, the U.S. Surgeon General established five Geriatric Research and Training Centers (GRTCs) to advance research on the
health care problems of the elderly and to train future academic leaders in geriatrics. In 1989, Congress enacted
legislation that redesignated the GRTCs as the Claude D. Pepper Older Americans Independence Centers OAICs), in honor of
former Florida Senator and Representative Claude Denson Pepper for his efforts to promote the health and well-being
of older Americans. The OAICs, which re funded in 5-year periods, are authorized under Section 445A of the Public Health
Service Act (42 U.S.C. 285e-3) to increase scientific knowledge leading to better ways to maintain
or restore independence in older adults (see Table 4-2).
How OAICs Function Within the NIH Framework
The OAICs are funded by NIA through a center grant mechanism (P30). The ultimate goal of the OAIC program is to enhance
the translation of basic and developmental research on aging to applications and interventions that increase or
maintain independence for older persons.
- Provides intellectual leadership and innovation
- Stimulates translation of basic research findings into clinical applications, e.g., research to develop or test
interventions or diagnostics based on new findings from aging research or other studies of fundamental
- Facilitates and develops novel multidisciplinary and interdisciplinary research strategies
- Stimulates incorporation of emerging technologies, methods, and scientific advances into research designs, as appropriate
- Serves as a source of advice to and collaboration with other institutions regarding technology, methodology, analysis, or other expertise
- Provides career development, guidance, and training for future leaders in basic, clinical, and translational research in
geriatrics and related fields
Description of Disease or Condition
Aging research focuses on a range of conditions, including geriatric syndromes such as involuntary weight loss, dizziness,
and incontinence, as well as diseases and disorders that are more common among older adults, such as cancer, cardiovascular
disorders, stroke, and loss of sensory functions such as hearing and sight. The ultimate goal is to advance the translation of
basic and developmental research on aging to applications and interventions that increase or maintain independence for older adults.
Burden of Illness
There are currently 35 million Americans older than age 65. Of these, more than 4 million are older than 85, and approximately
65,000 have attained their 100th birthday. By 2030, the number of individuals age 65 and older is likely to double
to 70.3 million and comprise 20 percent of the entire population, in contrast to 13 percent today. The number of
the “oldest old”—people age 85 and older—is expected to grow to at least 19.4 million by
The ratio of older people to other age groups is important to society because older people, particularly the oldest old,
may be dependent on family members, the government, or both for financial, physical, and emotional support. In addition,
a large part of older people's security depends on programs such as Social Security and Medicare, which are financed
through the contributions of working-age individuals. When the entire population of “baby boomers”
enters older age, around 2030, the challenge to meet their needs through social, governmental, and other health care services
will expand markedly5.
Data compiled in 2003 indicate that U.S. health care expenditures totaled approximately $1.87 trillion, more than any other
Researchers predict that increased longevity is
likely to require more financing from Federal health care systems, including Medicare and Medicaid
As life expectancy increases, it will be necessary to find ways to keep the additional years of life free of disease
and disability. Today, for example, more than half of all Americans older than age 65 show evidence of osteoarthritis
in at least one joint8. Over half of Americans older than
age 50 have osteoporosis or low bone mass9.
Cardiovascular disease, cancer, and diabetes remain common among older Americans.
Scope of NIH Activity: Research and Programmatic
OAICs are designed to develop or strengthen each awardee institution's programs to focus and sustain progress in a key area
of aging research, contribute to greater independence for older persons, and offer opportunities for training and career
development in aging research for young scientists. OAICs select a specific focus for their research activities from a range of topics, including:
- Specific aging-related physiologic changes, other factors, or interventions (e.g., physical activity) that affect risk for
multiple conditions or disabilities in old age
- Interactions of multiple diseases, disabilities, and interventions (e.g., medications) in older persons and their relationship
to the risk of morbidity, progression of disability, and efficacy of prevention or treatment strategies
- Factors contributing to the amelioration or delay of multiple deleterious aging changes by modulating risk factors or
fundamental aging mechanisms
- Causes, prevention, and treatment of a geriatric syndrome that is related to multiple pathologies or disabilities
- Causes, assessment, prevention, and treatment (including rehabilitation) of a specific type of disability in older people
- Issues related to specific conditions that contribute to a loss of independence in older persons, e.g., the role of
aging changes in the etiology of debilitating physical condition(s); special problems in the diagnosis, treatment, or
prevention of the condition in old age; complications, disability, or symptoms from the condition found principally in
NIH Funding for FY 2006 and FY 2007
NIH funding for the OAICs was $13.6 million in FY 2006 and $13.7 million in FY 2007.
Outcomes: FY 2006 and FY 2007 Progress Report
Programmatic and Research Accomplishments
- The Duke University OAIC
supports studies to develop and evaluate interventions designed to help older Americans anticipate, cope with, and recover from
disability arising from late-life disease and aging. An analysis of several biomarkers has linked these biomarkers to osteoarthritis;
research is continuing to evaluate genes for their potential association with osteoarthritis and facioscapulohumeral dystrophy,
one of the most common inherited neuromuscular disorders, which primarily affects the skeletal muscles of the face and upper arms.
A Demonstration and Information Dissemination Project has helped to translate research findings from programs such as the
Osteoporosis Intervention Study into clinical practice. The Genetic Ascertainment of Large African American Family for
Osteoarthritis and Early Onset Cardiovascular Disease project of the Duke OAIC has analyzed the genetics of one of the largest
intact extended families in the United States and is evaluating this family for evidence of osteoarthritis and
early-onset heart disease.
- The Harvard University OAIC promotes research to help elderly individuals maintain independence well into late life by
supporting a series of studies focused on the development of interventions to overcome common disabling geriatric conditions.
Examples include studies of the causes and consequences of delirium after coronary bypass surgery; the relationship between
cardiovascular risk factors and the development of frontal lobe dysfunction (impairments in executive function, gait, and
continence) in African American elders; and the use of subsensory mechanical noise to improve somatosensation—such as the
ability to perceive pain and temperature variations—and balance in healthy older people and patients with diabetes
and stroke. For example, one study indicates that caution should be used in administering isoflurane, a common inhalation
anesthetic, to individuals with excessive levels of amyloid-beta protein in the brain, including AD patients,
- The Johns Hopkins University OAIC supports research to determine causes and potential interventions for frailty in
older adults. New studies include a project to develop methods that will infer parameters to measure
frailty and to test hypotheses about the causes of frailty in older adults. Another project involves compiling
genetic data from several resources, including the Women's Health and Aging I and II studies, InCHIANTI, the
Baltimore Longitudinal Study of Aging, and HealthABC, to provide sufficient analytical power to detect causes
of frailty. A pilot study to describe the relationship between brain-derived and peripheral cholesterol levels
and cognitive and physical frailty found that high, not low, total cholesterol was associated with better psychomotor
speed. The next step is to determine whether these findings also extend to physical speed and might be a
predictor of physical frailty. Another pilot study to evaluate the role of glucocorticoid resistance in frail
elderly people demonstrated that frailty is strongly associated with increased daytime salivary cortisol levels
and that it is much more strongly related to these increases than to chronological age.
- The University of California, Los Angeles OAIC supports the development and testing of clinical interventions to
prevent disability. Its activities include a study to refine an intervention for optimizing ursing home staff
efficiency in providing feeding assistance to residents and then to test the efficacy of this model in a randomized
clinical trial to determine quality of life and health outcomes. A separate, pilot, randomized clinical trial involves
an intervention to improve visual functioning in older people. Information from this preliminary study will be
utilized in a larger randomized clinical trial to determine whether visual and verall functioning of older people can be
enhanced through a multidimensional intervention that corrects reversible causes of visual impairment, improves lighting
in the home environment, and provides access to low-vision aids. Another ongoing study evaluates an age-appropriate
intervention designed to improve diabetes self-care practices by enhancing the self-efficacy, empowerment, and
diabetes-specific knowledge among African Americans older than age 65, a group that tends to experience
substantially worse process and outcomes of care. The OAIC provides ongoing operational assistance to the new
Resource Center for Minority Aging Research, one of six centers funded for the 2002-2007 cycle of this NIH initiative.
- The University of Maryland, Baltimore OAIC conducts mechanistic and outcome-based research in exercise rehabilitation
and provides research training in gerontology and geriatrics to improve the lifestyle and functional independence of older
Americans with disabilities. The center emphasizes exercise rehabilitation based on preliminary findings that exercise
can improve the devastating health consequences and functional declines associated with stroke, hip fracture, and peripheral
arterial occlusive disease—chronic conditions that often decrease functionality and independence in the elderly.
Preliminary studies show that specific exercises such as treadmill exercise training improves lower body strength
and increases fitness reserves among gait-impaired stroke patients and that an upper body workout improves motor
function in the partially paralyzed upper extremities of stroke atients who have completed conventional rehabilitation
and are 1-5 years beyond the incident stroke. Evidence of improved brain function accompanying task-specific
exercise provides further support to the observation that recovery not only is enhanced through exercise but also
continues months and years after the stroke. Thus, task-oriented exercise programs that improve upper and lower
body functional capabilities and quality of life might allow these patients to remain at home and function independently,
maintaining their lifestyle, reducing caregiver burden, and lowering their utilization of health care resources.
- The University of Texas OAIC research focuses on age-related sarcopenia, a progressive loss of muscle mass that leads to muscle
weakness, limited mobility, and increased susceptibility to injury, and the contribution of sarcopenia to loss of independence
in older persons. OAIC researchers discovered in an animal model that a specific protein, UNC-45, previously demonstrated to
be critical to the proper formation of muscle, acts as a chaperone for muscle proteins known as myosins and helps
myosins fold into stable structures that clump together to form thicker filaments that give heart and skeletal muscle
its striated appearance. Normally, electrochemical signals cause the myosin filaments to contract, producing, for example,
a heartbeat or an arm movement. When myosin proteins are not yet fully stable, a cellular cleanup system, known as the
ubiquitin proteasomal system, may mistake them as unstable or malfunctioning and break down the myosin. Further
study of the cellular basis of muscle weakness and loss of muscle mass in aging is under way. Researchers affiliated
with another study are using a porcine model to clarify the mechanisms by which amino-acid supplementation can regulate
muscle protein synthesis with the goal of designing appropriate nutritional support in a variety of clinical
settings. The OAIC also supports the Longitudinal Study of Mexican American Elderly Health, a population-based
longitudinal study that focuses on predictors of continued physical independence among 3,000 older Mexican Americans
living in five southwestern States.
- The Wake Forest University OAIC mission is to assess the risk factors of physical disability in older adults
and to develop and test effective prevention therapies. Among the studies supported by the center is research on chronic
obstructive pulmonary disease, a major cause of morbidity and mortality in the United States. Investigators are
evaluating the effectiveness of a lifestyle intervention to increase physical activity to a greater extent than
a traditional exercise therapy program and are comparing the impact of these two interventions on physical function,
self-reported disability, health-related quality of life, and exercise capacity. The Pharmacological Intervention
in the Elderly is a randomized controlled trial in older patients with diastolic heart failure to evaluate the
effect of the drug enalapril on heart structure and function, exercise tolerance, and quality of life. Enalapril
is one of the angiotensin-converting enzyme inhibitor drugs primarily used to treat hypertension and congestive heart
failure. The goal of an observational pilot study is to examine physical function in obese individuals after a
specific type of gastric bypass surgery to determine whether intensive weight loss associated with bariatric surgery
will improve physical function. In addition, the Wake Forest center established the Maya Angelou Research Center
on Minority Health to address issues related to racial and ethnic health disparities.
- The Yale University Center OAIC focuses on causes, prevention, treatment, and disability outcomes of multifactorial
geriatric conditions. Research from this OAIC has contributed significantly to understanding the extent and frequency of
transitions in and out of disability by identifying factors influencing these transitions and those predicting
successful recovery from disability affecting activities of daily living. Findings from the studies provide a
basis for developing multifactorial interventions to prevent disability. Multifactorial interventions to prevent falls in
community settings are currently supported through the Yale OAIC; injuries and fractures resulting from falls are a
major cause of disability among older adults. Epidemiologists and biostatisticians at the Yale OAIC are developing new
statistical approaches to analyze data from multifactorial interventions and to identify contributions from individual
components and thus to guide the refinement of these interventions.
- The University of Michigan Center OAIC seeks to advance research on health care problems of older adults.
Among their projects is one to study the loss of balance and its consequences in older adults and to utilize a wearable motion
sensor to capture important parameters of this process. A pilot project on elucidating the cellular and molecular events that
regulate normal epidermal growth seeks to determine how alterations in these events precipitate hyperplastic growth,
particularly as it occurs in aged skin. In another pilot study, investigators are examining genetic factors in
hypertension among three generations of African American women.
- The OAIC Coordinating Center at Wake Forest University strengthens the OAIC program by facilitating information exchange
and research collaborations among individual OAICs. The Coordinating Center builds on elements that are common to
individual OAIC themes and assists in the development and implementation of projects in shared areas of interest.
Major activities of the Coordinating Center are the coordination and enhancement of the training programs across OAIC sites and
the organization of seminars and other activities for trainees at the OAIC Annual Scientific Meeting
Recommendations for Improving the Effectiveness, Efficiency, and Outcomes of the OAICs
One recommendation of NIA's Geriatrics and Clinical Gerontology Program is to establish the Coordinating Center function as
a part of the competitive OAIC Request for Applications (RFA) process. RFA AG-07-008 includes requests for applications for
continuing the Coordinating Center functions. Another effort is to explore plans to expand the OAIC program.
The general progress of each OAIC is reviewed by program staff at the time of noncompeting renewal. In addition, a formal
midcycle review is conducted by a panel of experts external to the OAICs at 2-3 years into the funding cycle of each OAIC. The
purpose of the review is to assess the progress of individual OAICs in meeting the goals set forth in their funded applications
and to identify areas of concern that could be addressed prior to the next competing renewal. A written summary of the review
is provided to each OAIC principal investigator for use in directing his or her center.
The number of qualified applicants for OAIC sites is increasing, and NIH expects that additional centers will be added
gradually to bring the total number to 12 by 2010. NIH plans to continue funding the Claude D. Pepper OAICs through a continued,
competitive peer-reviewed process open to new and renewal applications.
4Federal Interagency Forum on Aging Related Statistics. Older Americans 2000: Key Indicators of Well-Being. 2000.
5U.S. Department of Health and Human Services. 65+ in the United States: 2005, Current Population Reports, Special Studies. U.S. Department of Health and Human Services/NIH/NIA and the U.S.
Department of Commerce/Economics and Statistics Administration/U.S. Census Bureau: December 2005.
6 For more information, see https://www.cdc.gov/nchs/products/pubs/pubd/hus/healthexpenditures.htm
7Spillman BC, Lubitz J. N Engl J Med 2000;342:1409-15,
PMID: 10805827; Feder J, et al. Health Aff 2000;19:40-56, PMID: 10812780
8For more information, see https://www.niams.nih.gov/Health_Info/Osteoarthritis/default.asp
9For more information, see https://www.nof.org/advocacy/prevalence/index.htm
10Xie Z, et al. J Neurosci 2007;27:1247-54, PMID: 17287498