Biennial Report of the Director
Centers of Excellence
Older Americans Independence Centers of Excellence
Establishment of the Claude D. Pepper Older Americans Independence Centers
In 1955, the Surgeon General of the United States established five Geriatric Research and Training Centers to advance research on the health care problems of the elderly and train future academic leaders in the field of geriatrics. In 1989, Congress passed legislation that redesignated these Geriatric Research and Training Centers as the Claude D. Pepper Older Americans Independence Centers (OAICs) to honor former Florida Senator and Representative Claude Denson Pepper for his efforts to promote the health and well-being of older Americans. Section 445A of the Public Health Service Act (42 U.S.C. 285e-3) authorizes the OAICs 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
NIH funding for the OAICs comes from NIA through a center grant mechanism (P30). The ultimate goal of the OAIC program is to translate research on aging to applications and interventions that increase or maintain independence for older persons. NIH currently targets a total of 12 OAICs for funding (see Table 4-2).
As Centers of Excellence in geriatrics research and training, the OAICs provide intellectual leadership in geriatrics research, encouraging and facilitating multidisciplinary and interdisciplinary collaborations in basic, translational, and clinical research relevant to the health and independence of older persons. In addition, each OAIC includes a Research Career Development Core to provide research training and career development opportunities in geriatrics and related fields.
Description of Disease or Condition
Age is a primary risk factor for many disabling diseases and conditions. However human aging is a highly variable process; there is no single disease or condition that is synonymous with aging. Understanding the process of aging is necessary to promote the health and well-bing of older adults. Aging research focuses on a range of conditions, including geriatric syndromes (e.g., involuntary weight loss, dizziness, and urinary incontinence) and diseases and disorders that are more common among older adults such as cancer, cardiovascular disorders, stroke, and loss of sensory function.
Burden of Illness
Currently, over 40 million Americans are older than 65 years. Of these, nearly 6 million are older than 85, and over 70,000 have reached their 100th birthday. By 2030, the number of individuals age 65 or older is likely to reach 70.3 million, and this group will comprise 20 percent of the entire U.S. population. The number of the “oldest old”, people age 85 or older, is expected to grow to at least 20.9 million by 2050.
Older Americans use more health care than any other age group, and researchers predict that increased longevity is likely to require more financing from federal health care systems, including Medicare and Medicaid. As life expectancy increases, the health care system will need to find new ways to address disease and disability during later life.
Scope of NIH Activities: Research and Programmatic
OAICs are designed to develop or strengthen each awardee institution’s programs 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. The program’s ultimate goal is to enhance translation of basic and developmental research on aging to applications and interventions that increase or maintain independence for older persons.
NIH expects each OAIC, in its selected area of focus, to:
- Provide intellectual leadership and innovation in geriatrics;
- Stimulate translation of basic and clinical research in aging;
- Facilitate and develop novel multidisciplinary and interdisciplinary research strategies to address current issues in geriatrics care;
- Stimulate incorporation of emerging technologies, methods, and scientific advances into research designs;
- Serve as a source of advice and collaboration to other institutions regarding technology, methodology, analysis, or other expertise relevant to research in aging; and
- Provide research training and career development for future leaders in geriatrics research.
NIH Funding for FY 2010 and FY 2011
NIH funding for the OAICs was $13.97 million in FY 2010 and $13.34 million in FY 2011 for non-ARRA (regular appropriations), and $0.21 million for ARRA appropriations.
FY 2010 and FY 2011 Progress Report
Programmatic and Research Activities and Outcomes
- The University of Florida OAIC focuses its aging research on sarcopenia (degenerative age-related muscle loss), including biological mechanisms and contributing factors, as well as the prevention and rehabilitation of disability resulting from sarcopenia. University of Florida researchers examine these issues from interdisciplinary perspectives across the entire spectrum of biomedical investigation, including molecular biology, animal studies, clinical research, behavioral and social sciences, and epidemiology.
- The Boston Medical Center at Boston University has established an OAIC in collaboration with Tufts University and the Joslin Clinic. This Center fosters collaborations among the universities’ multidisciplinary teams of investigators to improve physical mobility by covering the entire spectrum of drug discovery, from target identification to clinical trials and function-promoting therapies.
- The University of Pittsburgh OAIC provides support and resources for investigators to identify interventions to optimize mobility and balance and prevent fall-related injuries in the elderly. This OAIC provides an integrated, multidisciplinary approach by pooling resources from five schools at the University of Pittsburgh. The Center is currently conducting several studies of exercise and other interventions to improve balance and mobility in individuals with chronic low back pain and/or arthritis.
- The theme of the Duke University OAIC is to understand and modify different causes of decline in physical functioning. The Duke OAIC develops and evaluates interventions designed to help older Americans prepare for, cope with, and recover from disability arising from late-life disease and aging.
- The Johns Hopkins University OAIC supports research to determine the causes of and potential interventions to reduce frailty in older adults. To support frailty intervention studies, the university created a clinical translation unit and a registry of older adults who might be willing to participate in research. Recently, Center investigators reported that the drug losartan, commonly used to treat high blood pressure, may be an effective treatment for loss of muscle mass and strength in older adults.
- The University of California, Los Angeles OAIC supports the development and testing of interventions to prevent disability. The center emphasizes research that bridges basic biomedical and clinical science. Current projects are addressing the underlying causes of bone loss in osteoporosis and the effects of stroke on nerve-repair genes in the aged brain.
- The University of Maryland, Baltimore OAIC is studying rehabilitation approaches involving exercise and motor learning. The goal is to improve the recovery of older adults who have suffered a stroke, hip fracture, or other chronic debilitating disease. The Center plans to translate these findings into effective community-based rehabilitation programs.
- Research at the University of Texas Medical Branch–Galveston OAIC focuses on age-related sarcopenia and its contribution to loss of independence in older persons.
- The Wake Forest University OAIC’s mission is to assess the risk factors of physical disability in older adults and to develop and test effective preventive interventions. Several current studies are exploring the effects of diet and exercise on diverse health parameters.
- The Yale University OAIC’s research theme is the investigation of geriatric health conditions that have several causes. This focus includes single conditions resulting from several contributing factors or affecting several outcomes, and multiple conditions occurring at the same time.
- The University of Michigan OAIC, the first OAIC funded by NIH, advances research on health care problems of older adults. Recent findings from the Michigan OAIC suggest that the proportion of certain inflammatory cells in visceral fat increases with age, which may explain why age-related weight gain has been associated with chronic inflammatory disease.
- The Mount Sinai School of Medicine OAIC focuses on pain management and palliative care. Ongoing studies are exploring the relationships among postoperative pain, pain treatment, delirium, and cognitive impairment in older adults as well as the effect of inpatient palliative care consultation teams on hospital costs, hospital and intensive care unit lengths of stay, and readmission rates.
- The OAIC at the University of Arkansas for Medical Sciences is collaborating with the University of Oklahoma Health Sciences Center as the most recently established Center. This Center studies the causes of declining skeletal and heart muscle function with aging and is developing new interventions for these conditions by targeting protein metabolism and other approaches.
Recommendations for Improving the Effectiveness, Efficiency, and Outcomes of the OAICs
The OAIC Coordinating Center at Wake Forest University facilitates information exchange and research collaborations among OAICs. The Coordinating Center helps develop and implement projects in shared areas of interest. Its major activities include developing and maintaining Web-based resources to facilitate collaboration among OAIC sites and interface with the public; coordinating and enhancing OAIC training programs; and organizing seminars and other activities for senior investigators and trainees at the OAIC Annual Scientific Meeting.
NIH program staff review the progress of each OAIC every year as part of the non-competing renewal process. In addition, each OAIC is required on a yearly basis to convene an external advisory board of expert scientists outside the OAIC institution(s) to evaluate the Center’s progress and suggest any necessary changes in its scientific or administrative directions to achieve its stated goals.
NIH plans to continue to fund new and existing Claude D. Pepper OAICs and to continue to develop and strengthen the progress in key areas of aging research in order to discover new and effective ways to promote healthy and productive aging.
Table 4-2. Claude D. Pepper Older Americans Independence Centers (OAICs)
|Institution and Location
|Duke University, Durham, NC
|University of Michigan, Ann Arbor, MI
|University of California, Los Angeles, CA
|Wake Forest University, Winston‐Salem, NC
|Yale University, New Haven, CT
|University of Maryland, Baltimore, MD
|University of Texas Medical Branch, Galveston, TX
|Johns Hopkins University, Baltimore, MD
|University of Pittsburgh, Pittsburgh, PA
|University of Florida, Gainesville, FL
|Boston University, Boston, MA
|Mt. Sinai Medical Center, New York, NY
|University of Arkansas for Medical Sciences, Little Rock, AR