If you have had a chance to review the draft of the NIA Strategic plan at
http://www.nia.nih.gov/AboutNIA/strategic_plan_draft.htm,
you might have noticed that psychological science may not be as well integrated into the plan as it could be. To take one example, on the first page of the document, it is claimed that "we need to explore 'aging' not as a single process but rather as an intricate web of interdependent genetic, biological, and physiological processes," with no mention of psychological, social, or behavioral processes. The Executive Committee has drafted a response that will be sent to NIA on behalf of Division 20 that develops this point and highlights some other areas of the document that may need rethinking. We have sent these comments to Pat Kobor to consider as she writes the APA response as well. I am circulating this letter on the listserv in the hope that it will encourage you to look over the strategic plan and send your own commentary to NIA (please copy Pat Kobor at pkobor@APA.ORG).
As always, we are grateful to Deb DiGilio and CONA, and to Pat Kobor in the Science Government Relations Office at APA for being on top of this!!
Thank YOU for your attention to this important issue.
With best regards, Liz
To: Richard J. Hodes Director, National Institute on Aging
From: APA Division 20 (Adult Development and Aging)
Date: June 22, 2007
Subject: National Institute on Aging Strategic Plan
Thank you for the opportunity to provide commentary on Living Long and Well in the 21st Century – Strategic Directions for Research on Aging. Members of the Executive Committee for Division 20 (Adult Development and Aging) of the American Psychological Association have reviewed this document and have had some discussion about its potential impact. In this letter, we summarize some of the reactions to the plan as written.
First, this an exciting document that is broad in scope, and in many ways sets the right tone for a science of aging that is interdisciplinary, sensitive to the dynamic and highly contextualized nature of aging, and committed to a deep understanding of basic principles and mechanisms that stimulate translational research to make a difference in the lives of aging individuals and their families. Particular strengths include the call for translational interventions, the focus on eliminating health disparities, and the recognition that continued progress in aging research depends on establishing effective mechanisms of professional training. The Committee appreciates the care and thought that went into preparing this visionary document.
At the same time, we had some ideas for strengthening the strategic plan that we hope you will consider.
Psychological Science Is Critical to Promoting Health and Preventing Disability in an Aging Population
We would like to express deep concern about what might be perceived as an underestimation of the role for psychological sciences in understanding the nature of aging. Potential contributions from the social and behavioral sciences are woven through the arguments in the document, but they are not well integrated into the conceptualization. We believe that this is critical to an effective science of aging. For example, on the first page in the Introduction, the claim is that "we need to explore 'aging' not as a single process but rather as an intricate web of interdependent genetic, biological, and physiological processes," and in the introduction to Research Goal A (to improve understanding of healthy aging, disease, and disability among older people), aging appears to be defined in terms of biologically driven senescence processes ("a set of dynamic biological and physiological processes and systems – interactive and interdependent – that result in wide variation among individuals," p. 3). Both of these statements neglect the centrality of psychological and social systems for an integrated study of aging. We believe that the document would be strengthened by revising these statements to: "We need to explore 'aging' not as a single process but rather as an intricate web of interdependent genetic, biological, physiological, and psychosocial processes" (p. 1) and "Aging comprises a set of dynamic biological, physiological, and psychosocial processes and systems – interactive and interdependent – that result in wide variation among individuals."
There are specific examples of how this neglect of psychological science plays out in research goals in ways that could stimulate lines of research that may not be as fruitful as they would be if the problems were conceptualized so as to include psychosocial mechanisms. For example, under Research Goal A-2 (accelerate discovery of risk factors for disease, pp. 7-8), the role of psychological processes (e.g., stress) in inflammatory and immune response is not considered. Also, under Research Goal B-1 (pp. 10-12), which focuses on the development of interventions to maintain health and prevent disease, the role of behavioral change is not considered in any depth. The first bulleted point under this goal calls for the development of "efficacious and cost effective strategies for promoting healthy and safe behaviors," but the text of that section does not acknowledge how complex the problem of behavioral change is. For example, the development of "cost effective dietary measures" is a good first step, but as we all know, "knowing what a healthy diet is" is not the same thing as "adhering to a healthy diet." Arguably, obesity and inactivity are among the leading causes of disease and disability in the US, and presumably, are rooted in behavior. The development of interventions to change unhealthy behavioral patterns will require understanding of cognitive factors (e.g., comprehension, decision-making), predispositional factors (e.g., personality), and their interaction, so that real people in real contexts can adhere to "behavioral prescriptions."
Psychological mechanisms have a critical role in determining how older adults adapt to aging-related changes. Health psychologists understand that management of illness is fundamentally influenced by how people construe the disease and its causes, and how ingrained patterns of behavior afford or clash with treatment regimens. Successful adherence to new medication or exercise regimens requires goal commitment and specific plans for how to implement that regimen and integrate it into one's style of life. Inertial health-detracting behavioral patterns (e.g., diet), dysfunctional attitudes, and conditioned emotional responses toward aging and one's own aging can play a major role in thwarting effective health interventions for middle-aged and older adults. Prevention of negative health outcomes in old age may require interventions to change attitudes and health-related behaviors early in adulthood.
One implication of these arguments is that funding for basic psychological research remains critical. No one would argue with the tenet that multidisciplinary research will be needed to promote life-long health, but at the same time, psychological science as a discipline must continue to make progress. It would be difficult, indeed, to create effective behavioral interventions without understanding the mechanisms that need to be affected.
We Must Understand "Vital" Aging, not just "Normal" Aging
Another area of concern is a lack of attention to enhancing vitality, in addition to preventing disease. There are many places in the document where the focus is understanding and promoting "normal" aging by preventing disease. For example, in the introduction to Research Goal A, the challenge is characterized as a need "to develop a clearer understanding of the normal changes that accompany aging and distinguish them from the diseases and disabilities that are prevalent among older adults" (p. 3). Later in the document, the claim is that "the overall integrity of brain structure and many neural systems are largely preserved in normal aging, [while disease process disrupt neural integrity" (p. 17). This distinction between normal and pathological aging has been with us for sometime, but may not reflect current views of aging that acknowledge the wide range of variability within the "normal" range. Research developments in animal research and cognitive neuroscience are suggesting that experience sculpts the brain throughout the life span. Epidemiological work suggests enduring effects of early educational experiences. In other words, it is probably not the case that neural systems are simply "preserved" with "normal" aging – but rather they are continually "rewiring" themselves with "vital" aging. This perspective is perhaps implied from (or may be read into) language embedded in Research Goal A-1 (second and third sub-points under the eighth bullet, p. 6), but needs to be more forcefully integrated into the strategic plan. Given the surge of elders on the horizon, it is critical that aging research not simply address the elimination of disease, but develop principles of optimization within what was once considered the normal range. We need to understand the factors that promote wellness and vitality in late life to enhance quality of life and workforce effectiveness, for example – as well as to buffer against disease. This idea may be planted early in the document; the sentence, "As life expectancy increases…, diseases and conditions among older people remain a concern" (p. 1, second paragraph) could be strengthened by revising to, "… diseases and conditions that threaten vitality among older people remain a concern." More generally, the use of the term "normal aging" needs to be reconsidered. Under Research Goal A-1 we suggest a fourth bulleted sub-goal, p. 4): "• Understand the influence of environmental processes (e.g., educational experiences, enriched environments, stressors) through the life span on the pace of aging processes." This would follow nicely after the third point that focused on the effects of early life experiences and better set the stage for Research Goal D considering aging at the societal level, under which D-1 will "explore the effect of education and other social and demographic factors on health and well-being at older ages" (p. 21).
A pragmatic reason to focus on vital aging is that scientists and health care professionals are themselves aging (see the recent NSF report on the labor force in science and engineering,
http://www.nsf.gov/statistics/seind06/c3/c3s3.htm;
e.g., Figure 3-33). Maintaining the vitality of the workforce in science, math, engineering, and the health professions will depend on our ability to promote cognitive vitality. We need basic research on how aging affects memory, problem solving, and other cognition processes in order to develop effective training techniques that can support research scientists and health care practitioners to function at high levels, both to maintain and to continue to develop expertise over their increasingly lengthening careers (age 67 for full social security for those born after 1960). In short, basic research on cognition is essential to ensuring a high functioning professional workforce capable of continuing critically needed health research and of delivering superior care to our aging population.
We Cannot Lose Sight of the Important Role Played by Environmental Influences
With the mapping of the human genome, understanding the role of environment has only grown in importance. Heritable influences on complex diseases are often hard to verify. In a recent article in Nature Reviews: Genetics, Hemmink, and Forsti (2006) work with the example of cancer etiology to argue that it is often the environmental influences that are stronger. They suggest (p. 961) that, "Eradication of hereditary cancer syndromes would reduce the cancer burden by 1%, and up to 10% of the population would be saved if all familial cancers could be avoided." By contrast, "[i]f the western population was to live in the same conditions as the populations of developing countries, the risk of cancer would decrease by 90%, provided that viral infections and mycotoxin exposures could be avoided." Now that we have the ability to identify single singles and clusters of genes that may increase risk for disease, it is imperative that we assess the environment correctly. Unfortunately, this is arguably a more difficult task. For aging, we must understand how environments change (and interact with social, psychological, socioeconomic, physical, and behavioral factors) before we can understand gene expression in late life, and the role of genes in the context of this shifting environment.
We May Not Know as Much as We Think We Do
Finally, there are certain arenas in which the document seems to overstate what we may know. For example, contrary to the sidebar of p. 5, the causal link between social networks and health may not be clear.
Thank you…
Thank you again for inviting input into this process. We hope that this is helpful to you as you continue to develop a framework for aging research and to set priorities at the National Institute on Aging.
Elizabeth A. L. Stine-Morrow APA Division 20 President Department of Educational Psychology 226 Education Building 1310 S. Sixth Street University of Illinois at Urbana-Champaign Champaign, IL 61820
(217) 244-2167 (office) (217) 244-7620 (fax)
eals@uiuc.edu
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