Dear Colleagues,
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
http://apadiv20.phhp.ufl.edu/
http://www.ed.uiuc.edu/all/
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