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Happy 50th birthday to the National Institute on Aging : Where would geriatric medicine and care of older adults be without you?

2024; Wiley; Volume: 72; Issue: 5 Linguagem: Inglês

10.1111/jgs.18931

1532-5415

George A. Kuchel, Alexander K. Smith,

Health Systems, Economic Evaluations, Quality of Life

The field of aging will be celebrating an important milestone on May 31, 2024 with the 50th anniversary of the passage in the US Congress of Public Law 93-296 authorizing the establishment of a National Institute on Aging (NIA), mandating NIA to develop a national comprehensive plan to coordinate the involvement of the U.S. Department of Health, Education, and Welfare (succeeded by the Department of Health and Human Services) in aging research.1, 2 Most JAGS readers are clinicians, yet this anniversary should be of great interest to anyone who is passionate about improving the lives of older adults through research, education, or clinical care. The legislation establishing NIA was ahead of its time with a multidisciplinary vision highlighting the need to create "an institute for the conduct and support of biomedical, social, and behavioral research and training related to the aging process and the diseases and other special problems and needs of the aged."1 This vision took some time to mature and materialize with the creation of NIA taking place 30 and 26 years after the establishment of the National Cancer Institute and the National Institutes of Health in 1944 and 1948, respectively. Articles published as part of this Special Collection illustrate the remarkable impact of varied NIA initiatives and programs to our understanding of aging processes and the care of older adults. They also highlight a tremendous diversity in approaches involving many different disciplines in working together to solve some of the most pressing and challenging problems confronting all of us and our society in the context of aging. Given all of these laudable reports, how does one evaluate NIA's impact? From the perspective of JAGS readers, one could ask where would geriatric medicine and the care of older adults be today without the NIA? An equally important corollary would be to ask how can geriatricians and others providing care for older adults work with NIA, as well as NIA-funded investigators and centers of excellence in advancing priority issues of common interest in NIA's next 50 years? The answers to these and other important questions lie in a collection of exciting reports that address progress at NIA from the perspective of NIA-funded centers of excellence and major ongoing collaborative networks3-12; AGS/NIA Conference Series Advancing Geriatrics Research,13-15 as well as efforts to train the next generation of leaders in aging research.16-19 When evaluating the history of the NIA it is easy to be impressed by the sheer magnitude of the nation's investment in NIA's mission, which at $ 4.4 billion a year (9.3% of the entire NIH budget) makes NIA the largest funder of aging research around the globe. However, NIA's most important impact over the last 50 years is an influential legacy of ideas, concepts, principles, and innovation that has and will outlast any one specific financial investment. Starting with NIA's foundation in 1974, its very creation represented a powerful statement on the part of this country regarding the importance of aging when seeking to promote health for all. While much of this may seem obvious today, it should be noted that the creation of an aging institute at NIH set a precedent, with most other institutes focused on the study of specific diseases or individual organ systems. Moreover, NIA served as the model for the creation of aging institutes in other countries in some cases many decades later. The creation from the outset of robust extramural programs focused on Geriatrics and Clinical Gerontology; Behavioral and Social Research; Neuroscience, as well as Aging Biology established the vital importance of all of these different disciplines and perspectives. Furthermore, placing all of these research disciplines within a single high profile institute highlighted the importance of multidisciplinary collaborations in ensuring progress. By focusing on aging and older adults, NIA was able to become an advocate for research into geriatric syndromes and multifactorial conditions intimately familiar to all geriatricians that defy traditional boundaries between silos involving different organs and disciplines.20 For example, delirium cannot be viewed entirely as a brain problem, and geriatric incontinence is not merely a bladder disorder, while concepts such as frailty and resilience cut across all organ systems and functions. Without NIA support and leadership, together with the creation of review panels with relevant scientific expertise at both NIA and the Center for Scientific Review (CSR), important advances involving all of these geriatric syndromes over the last 50 years would not have been possible. AGS has been very involved in providing expertise for the NIA and CSR. Many have noted growing needs and opportunities for geriatricians as the US healthcare systems completes its transformation from fee for service to value-based care.21, 22 As recently stated in this journal, "CMS's recent commitment to shift 100% of Medicare beneficiaries into accountable (i.e., value-based) care relationships by 2030, if successful, will create strong financial incentives for healthcare provider organizations to adopt proven, cost-effective models of geriatric care, especially for their attributed, high-cost, chronically ill, older patients."21, 22 Although health services research is funded from a variety of different sources, without NIA's commitment to understanding the nature of the most common conditions affecting the lives of older adults in a way that can lead to meaningful interventions, none of these advances involving clinical practice across healthcare systems and sites of care would be possible. The "geroscience hypothesis" states that interventions which modify biological mechanisms of aging (gerotherapeutics) may prevent, delay, or alleviate different age-related diseases simultaneously.23 Without a dedicated focus on the study of basic biological processes of aging supported by NIA, the concept of geroscience might not have emerged, and we would not be in a position to be conducting dozens of different clinical trials involving gerotherapeutics in older adults.12 Thanks to NIA's investment in the Translational Geroscience Network, dozens of promising gerotherapeutics are in various stages of human clinical trials.12 As a result, all health providers providing care for older adults will need some basic familiarity with these concepts since it is only a matter of a few years before FDA-approved gerotherapeutics become available for clinical use,24 providing additional opportunities for geriatricians who wish to develop deeper content expertise in this area.24 Finally, the leadership role played by NIA in training the next generation of leaders in aging research including clinician-scientists cannot be overstated. NIA-funded and inspired programs continue to expose and attract undergraduates to careers in aging. Similarly, the Butler-Williams Scholars Program has for decades offered an intense summer exposure to aging research for promising early stage investigators.16 NIA has played a vitally important role in helping to attract geriatricians, physicians in other specialties, as well as health professionals from varied backgrounds into careers focused on geriatric and aging research. All of this has been taking place in the context of far broader concerns regarding decreasing numbers of physicians entering careers in research,25, 26 together with discussions regarding the future of academic geriatrics.22, 27 The challenges confronting academic medicine and geriatrics involve multitudes of different factors and considerations beyond NIA's core mission and control. Nonetheless, the fact that as of 2024 the future has never been brighter for geriatricians and other health providers who wish to improve the lives of older adults through research is in very large part thanks to the NIA. AGS played seminal roles in the development of the Franklin T. Williams and Jahnigen Awards, which provided early career research support to physicians trained in Internal Medicine and Surgery, respectively. Thanks to NIA's commitment and leadership these private sector awards became a foundation for the GEMSSTAR program, a unique and remarkably important opportunity for physicians, and more recently also dentists, to obtain their first NIH support to help jumpstart their academic careers in geriatric research.17 The more recent Clin-STAR program has provided a vehicle for attracting health professionals from varied clinical disciplines into aging research,17 while also helping to provide a transition into the NIA Paul B. Beeson Emerging Leaders Career Development Program.17, 18 The Beeson program has also represented an unprecedented success, having now supported 284 scholars who have moved on to positions of leadership and prominence in the field of aging.18 As editors of the special collection to celebrate the NIA's 50th anniversary, we asked authors to look not only backward to celebrate prior successes, but also forward, to address ongoing challenges and opportunities. We all hope that the next 50 years of NIA leadership will be as or more successful as the prior 50. Challenges faced in the next 50 years will be in some ways similar and in other ways different from those faced during the first 50 years. In particular, we direct readers' attention to the big-picture current and future priorities identified by the NIA2: recruiting and training a diverse and inclusive next generation of aging researchers and mentors; supporting small business integrated research; focusing research on extending health span versus life span; a vision for precision medicine as individualizing treatments; supporting open-science open-source research; leading the nation in advancing dementia care and caregiving research; leading palliative care research at the NIH, including creation of a new palliative care research consortium; understanding the influence of the exposome on health and disparities, from environmental exposures to social relationship; a rigorous approach to the science of behavior change grounded in the NIH Stage model for Behavioral Intervention Development; and supporting the integration of artificial intelligence into research to improve the health and well-being of older adults.2 In 1897, a New York journalist confronted Mark Twain with a copy of Twain's own obituary. It turns out that this confusion arose from hospitalization of Twain's cousin while visiting London. Not knowing whether to be more amused or annoyed, Twain made his now famous comment stating "The reports of my death are greatly exaggerated." Although the field of academic geriatrics is certainly facing important challenges, the vision that led to the establishment of NIA 50 years ago has prepared the foundations for a future with unprecedented opportunities for geriatricians and other clinicians providing care for older adults. In addition to the development of a growing body of high-quality research in support of evidence-based geriatric medicine, NIA has also laid the foundations for geriatricians who wish to make an impact by obtaining deeper focused expertise through additional training beyond that is currently present in 1 year geriatric medicine fellowships across the United States.