Richard J. Hodes, director of the National Institute on Aging, speaks with APA

Richard J. Hodes, MD, has served since 1993 as director of the National Institute on Agingopens in new window (NIA) within the National Institutes of Health. NIA leads the federal effort supporting and conducting research on the biological, clinical, behavioral, and social aspects of aging. Hodes is a diplomate of the American Board of Internal Medicine, a member of the Dana Alliance for Brain Initiatives, a fellow of the American Association for the Advancement of Science, and a member of the National Academy of Medicine at the National Academies of Sciences, Engineering and Medicine.

Dr. Hodes answers questions posed by staff of the American Psychological Association, covering topics ranging from the impact of COVID-19 on the NIA to protecting older Americans from the virus to research being conducted on issues critical to seniors and their families, including the effects of social isolation. His responses were provided on Sept. 16, 2020, as the nation continued to battle a virus that has kept people across the country, particularly older Americans, in isolation.

How has the COVID-19 pandemic affected NIA’s activities and priorities?

The COVID-19 pandemic and resulting closures at institutions around the world have presented significant challenges for NIA-funded researchers managing existing studies. NIA is working with National Institutes of Health (NIH) and other Department of Health and Human Services colleagues to help ease this burden and provide guidance and policies to ensure research can continue as much as is safe during the pandemic and can resume with minimal negative impact, including on data already collected, after the immediate impact of this crisis is better understood. NIH is regularly updating overarching guidelines for all granteesopens in new window. NIA encourages its grantees to visit the NIH Office of Extramural Research (OER) websiteopens in new window for the latest guidance and to contact their NIA program officers with specific questions. 

Additionally, there are NIH-wide research initiatives on how COVID-19 research is particularly affecting older adults. At NIA, understanding the basis of older adult vulnerabilities to this pandemic and the impact of the pandemic and its mitigation strategies on diverse older adult populations have become an important part of our research portfolio. Socially isolated adults such as those living with disability in the community or in long-term care facilities may face unique challenges. Older adults and people who have severe underlying medical conditions such as chronic lung disease, serious heart conditions, or diabetes, seem to be at higher risk for developing more serious complications from COVID-19 illness. NIA released a funding opportunity announcementopens in new window that focuses on interventions that would address aging-related issues to reduce the transmission, risk, morbidity, mortality, severity or complications of COVID-19.

NIA recommends that caregivers for older adults, including those with Alzheimer’s or related dementias, follow the guidance of the Centers for Disease Control and Prevention to help keep themselves and their loved ones safe. In addition, NIA has a list of federal resources for older adults, including information on caregiving, financial and housing issues, and safety and emergency response. 

As investigators across the nation quickly responded to the crisis by launching rapid data collection efforts, NIA, in collaboration with the NIH Office of Behavioral and Social Sciences Research (OBSSR) and other NIH partners, helped coordinate and catalogue the large number of pandemic-specific questionnaires, modules, and scales about COVID-19 experiences and impacts, hoping to encourage coordination and harmonization and discourage the development of one-off survey instruments. These efforts resulted in curated COVID-19 survey repositories at PhenXopens in new window and DR2. NIH recently published a related Notice of Special Interestopens in new window for COVID-19 data harmonization and sharing to encourage the use of these resources. 

NIA has made research on health disparities a priority for many years. Are there recent research findings or lines of inquiry that you are especially interested in or hopeful about?

The COVID-19 pandemic has served to highlight the barriers to equal health for all within our nation. NIA is co-leading the recently released Rapid Diagnostic Accelerator for Underrepresented Populations (RADxUP) funding opportunity announcementsopens in new window, which are focused on NIH-designated health disparities and other COVID-19 vulnerable populations, with our partners at the National Institute of Minority Health and Health Disparities and other NIH institutes, centers, and offices. We are also co-leading NIH efforts to strengthen data collection on COVID-19opens in new window to rapidly assess the needs and impact of COVID-19 across different population groups, including health disparities populations and other COVID-19 vulnerable populations, including essential workers. We encourage the scientific community to carefully look at and consider responding to these funding opportunity announcements (FOAs) as it is imperative that we move quickly in attacking this public health crisis.

Additionally, we have had research programs in place for many years that were specifically designed to enhance the diversity of the scientific research workforce and of the populations who are studied in the research that we support, allowing examination of the bases for health disparities and potential remedies to achieve health equity. The Resource Centers for Minority Aging Researchopens in new window (RCMAR) represent a long-standing program established to enhance the diversity of the aging research workforce by mentoring promising scientists from under-represented groups for sustained careers in aging research. RCMAR centers have a long track record of supporting the study of aging in diverse communities. NIA recently expanded the program to address Alzheimer’s disease and related dementias given rising cases of the disease due to worldwide increases in the older adult population; the disproportionate burden in communities of color; and the need for a strong, diverse workforce to tackle this pressing challenge.

NIA’s Alzheimer’s Disease Research Centersopens in new window  make  outreach and education effortsopens in new window  in minority and underserved communities a high priority, working with local churches, community health centers, and other organizations for recruitment of a diverse research population. Our  Alzheimer’s Clinical Trials Consortiumopens in new window  is similarly dedicated, with a specific focus on increasing recruitment and support of minority scientists. And as part of our  National Strategy for Recruitment and Participation in Alzheimer's and Related Dementias Clinical Researchopens in new window , we are piloting new means of making outreach to communities underrepresented in research to overcome barriers to participation in Alzheimer’s and related dementia clinical trials.

NIA has been a lead agency supporting research on social isolation and social support. How is NIA working to strengthen this area of science?

NIA has long been supporting research on both loneliness and social isolation and ways to combat them, because these are both pervasive and complex conditions that require a public health response. Even before the recommendation to stay away from other people to lower the risk of infection with the novel coronavirus, loneliness and social isolation affected Americans of all ages. Through the NIH OppNet, NIA recently joined other NIH institutes and centers in issuing a funding opportunity focused on the links between social connectedness and health, and NIA continues to encourage investigator-initiated applications to NIA in this area.

NIA-supported researchers are studying the differences between social isolation and loneliness, their mechanisms and risk factors, and how to help people affected by these conditions. We are interested in exploring potential interventions to address social isolation and loneliness, which are both risk factors for poor aging outcomes. A key scientific question is whether social isolation and loneliness are two independent processes affecting health differently, or whether loneliness provides a pathway for social isolation to affect health.

Research  has linked social isolation and loneliness to higher risks for a variety of physical and mental conditions:  high blood pressure ,  heart disease ,  obesity , a weakened immune system, anxiety,  depression ,  cognitive decline ,  Alzheimer’s disease , and even death. And people who find themselves unexpectedly alone due to the death of a spouse or partner, separation from friends or family, retirement, loss of mobility, and lack of transportation are at particular risk.

Still, people can be isolated and maintain connections to ward off loneliness through phone or video chat, social media, or conversing with others from a safe distance. They can also address medical concerns through telehealth interventions, which use video calling and other technologies to help patients see their doctors or other healthcare providers from home instead of at a medical facility. Telehealth may be particularly helpful for older adults with limited mobility and for those living in rural areas, and this approach can also help support family caregivers who are taking care of their loved ones either close by or from afar, although it must be acknowledged that not all individuals and communities have access to these technologies.

Are there new developments in NIA’s support of research training? What should psychologists know about training opportunities through NIA?

NIA supports a robust and thriving pipeline of diverse scientists addressing aging research issues through a variety of training and career development opportunitiesopens in new window for students, early-career investigators, and clinician-researchers.  Some highlights include our research career development awardsopens in new window; the Medicine, Science, Technology, Engineering, and Mathematics (MSTEM) program, designed to enhance diversity in undergraduate science education; our Butler Williams Scholars programopens in new window; the Grants for Early Medical/Surgical Specialists' Transition to Aging Research (GEMSSTAR) programopens in new window; and the NIA diversity supplement programopens in new window to foster a diversity of scientists at multiple levels of training.

In addition, NIA has supported a variety of short courses in the social and behavioral sciences, both to facilitate entry into Alzheimer's researchopens in new window and to build skills in transdisciplinary domains such as genomics for social scientistsopens in new window. And, several NIA-funded Research Networksopens in new window offer opportunities to conduct pilot projects and participate in methods workshops and seminars in emerging areas of science. Recently, the NIA National Advisory Council on Aging cleared concepts—Networks to Develop Behavioral and Social Science Research in Agingopens in new window and Short Courses on Interdisciplinary Behavioral and Social Sciences Research on Agingopens in new window—that support continuation of these programs in several priority areas of behavioral and social science.

The growth in the federal investment in research on Alzheimer’s and related dementias has expanded NIA’s budget and scientific reach. The federal planning effortopens in new window on Alzheimer’s research, care, and services has set an ambitious goal of a prevention and treatment for Alzheimer’s disease by 2025. What are some most promising discoveries that are advancing the science?

Through the recent substantial federal investments in research, NIA continues to advance scientific growth and discovery to improve the diagnosis, treatment, and care of those living with dementia. NIA-supported scientists are identifying and testing new drug candidates, advancing comprehensive models of care, developing new biomarker tests, exploring disease risk and protective factors throughout the life course that might serve as targets for preventive interventions, examining disparities in dementia prevalence as well as disparities in access to and quality of dementia care, and improving the understanding of the role of genetics and other disease mechanisms. We also have developed programs to make data, knowledge, and research tools widely available to all researchers. 

NIA currently supports more than 40 trials testing drug candidates that target many different aspects of the disease, and more than 100 trials testing behavioral and lifestyle interventionsopens in new window. These include studies of the impact of physical activity, cognitive training, blood pressure control, and other behavioral changes on delaying cognitive decline and preventing mild cognitive impairment and dementia. 

To better understand the etiology of the disease and to distinguish its manifestation from changes associated with normal cognitive aging, NIA has invested in a range of approaches to elucidate and measure early psychological changes in the disease trajectory. These include changes in decision-makingopens in new window and emotional function as well as memory and other cognitive functions. We also are sponsoring a major initiative to enhance our ability to detect cognitive change via mobile devicesopens in new window and use these tools to inform prevention and treatment strategies for maintaining cognitive health. 

Additionally, the federal investment has enabled significant recent progress in developing, testing, and validating biomarkers for diagnosing Alzheimer’s and related dementias. These technological advances have helped scientists discover that changes in the brain that occur during Alzheimer’s are evident long before a person shows outward signs of cognitive impairment or dementia. Other research has shown that some changes in cognition associated with APOE e4 status arise even in adolescence (Reynolds, et al., 2019) and personality features predictive of future dementia can be detected by age 18 (Chapman et al., 2020). Together with sensitive measures of cognition and function, these biomarkers will play an important part in prevention trials that aim to determine whether the onset of cognitive decline or dementia can be delayed or its progression slowed at early stages of the life course, before the onset of dementia symptoms.  

A new Network on Resilience and Reserveopens in new window is involved in investigating how experiences or exposures earlier in life that are prospectively associated with improvements in cognitive outcomes (and thus reductions in dementia) later in life. This network is one of many NIA transdisciplinary efforts focused on resilience in agingopens in new window. 

NIA also has a long history of supporting research on dementia caregiving and dementia care. NIA recently expanded the network of Edward R. Roybal Centers for Translational Research in the Behavioral and Social Sciences of Agingopens in new window to include a group of centers designed to serve as an incubator for new dementia care and caregiving interventions. The purpose of the network is to translate findings from basic behavioral and social research into evidence-based interventions and programs that can be shared and implemented in the community. Another recently funded program is NIA’s Imbedded Pragmatic Alzheimer’s Disease and Related Dementias Clinical Trials Collaboratoryopens in new window, which is designed to bolster the nation’s capacity to conduct pragmatic clinical trials to improve dementia care within health care systems. Through this effort, researchers will test care interventions in real-world settings such as hospitals, assisted living facilities, nursing homes, and adult day centers. 

With the steady growth in the number of human studies comes the urgent need to recruit far more participants who represent the diversity of the U.S. population. NIH invests in a range of methods, resources, and research to optimize recruitment efforts. NIH recently funded eight projects at research institutions nationwide to help inform scientists about how to overcome barriers to enrolling and retaining research participants from underserved communities. These projects include approaches to build trust in communities and engage specific ethnic and racial groups in Alzheimer’s and related dementias research.