An Aging Population:

Research Looks to the Future

National Press Foundation Training
Aging and Retirement: Understanding Generational Changes
Richard J. Hodes, M.D.
Director
National Institute on Aging
June 14, 2016

Looking to the Future

Current trends in demographics,
health, and costs
What will the trajectories be for
disease? wellness? where are
we achieving success?
Aging biology Can we increase
lifespan? healthspan?
Current and future directions

Looking to the Future

Current trends in demographics,
health, and costs
What will the trajectories be for
disease? wellness? where are we
achieving success?
Aging biology Can we increase
lifespan? healthspan?
Current and future directions

Worlds Older Population

is Growing
Americas 65-andover population is
projected to nearly
double, from 48 mill
to 88 mill by 2050
Global life
expectancy is
projected to
increase by almost
eight years, from
68.6 years in 2015
to 76.2 years in
2050
He et al. U.S. Census Bureau, International Population
Reports, P95/16-1,

The global
population of people

Life expectancy falling for the

poor, rising for the rich

From NIA Health

and Retirement

Midlife
Morbidity/Mortality Trends
From 1970-2013, mortality
rates for those aged 4554
have decreased by 44%.
All-cause mortality of
middle-aged white nonHispanic men and women
increased in the United
States between 1999-2013
this trend is unique to
the US.
Increases in drug and
alcohol poisonings,
suicide, and chronic liver

All-cause mortality, ages

4554

Case A and A Deaton. (2015) PNAS 112(49):1

Disability Trends at Older Ages

and Causes of Change, 19962.50
2010
2.02
1.87

Impairments/Person

2.00
Activities of
Daily Living

1.50

1.061.01

1.00
0.87

1.00

Mobility

IADL
0.99
0.82

199
6
201
0

0.50
0.00
Major
Causes

0.230.29

Ages

0.24
0.17

59-64

83-88

Psychiatric Diabetes
Education Education
Diabetes Arthritis

From NIA Health

and Retirement

59-64

83-88

59-64

PsychiatricEducation
Education Diabetes

83-88
PsychiatricEducation
Obesity Diabetes
Education Arthritis

Chen, YQ and FA Sloan (2015) Health Services Research, 50, 5: 1528

Prevalence of Dementia in the

U.S.
2003
data
2013
data

Hebert, LE et al. (2013) Neurology 80(19)

Hebert, LE et al. (2003) Arch Neurol 60(8

The Growing Cost of Dementia

Dementia costs the
US about $200 billion
per year. Half that
amount is the value of
unpaid care provided
by family members.

$s in Billions

- projections in 2010 dollars

From NIA Health
and Retirement

Hurd, MD et al. (2013) NEJM 368(14):132

The 5-year age-/sex-adjusted cumulative hazard

rates for dementia were:
3.6/100 persons 1st epoch (late 70s - early
80s)
2.8/100 persons 2nd epoch (late 80s - early
90s)
2.2/100 persons 3rd epoch (late 90s - early
00s)
2.0/100 persons 4th epoch (late 00s - early
10s)
Satizabal, CL et al. (2016) NEJM 374(6)

Questions?

Looking to the Future

Current trends in demographics,
health, and costs
What will the trajectories be
for disease? wellness? where
are we achieving success?
Aging biology Can we increase
lifespan? healthspan?
Current and future directions

Leading Causes of Death,

Adults 65+ Years, 2013
Rank

Cause of Death

Heart disease

Cancer

Chronic lower respiratory diseases

Stroke

Alzheimers disease

Diabetes

Influenza and pneumonia

Accidents (unintentional injuries)

Kidney disease

10

Septicemia

SOURCE: Heron M. Deaths: Leading causes for 2013. National vital statistics reports; vol 65 no 2. Hyattsville, MD: National
Center for Health Statistics. 2013

Diet and/or Exercise to Treat

Heart Failure With Preserved
Ejection Fraction

Kitzman, DW et al. (2016) JAMA 315(1

Randomized Trial of FinancialIncentive Programs for Smoking

Cessation

Reward
and
Commitme
nt
participants
quit more
often than
treatment as
usual
Halpern, SD et al.
(2015) NEJM

SPRINT Study
Systolic Blood Pressure Intervention
Trial
Primary Outcome

The SPRINT Research Group (2015) NEJM 373(22

Biomarkers Inform Our Understanding of

Alzheimers Progression

Jack, CR et al. (2013) Lancet Neurol 12(2

Questions?

Looking to the Future

Current trends in demographics,
health, and costs
What will the trajectories be for
disease? wellness? where are we
achieving success?
Aging biology Can we
increase lifespan? healthspan?
Current and future directions

Disease Prevalence as a
Function
of
Age
Chroni
Osteopor
COPD
Stroke
Cong.
Heart
Failure

c
Kidne
y
Diseas
e
Hyperlip
id.

Arthrit
is

osis

Depress
ion

HTN

Cance
r

Schizophr
enia

Diabet
es

Cardiac
Arrhythm
ias

CAD

St. Sauver, JL et al. (2015) BMJ Open Feb 3;5(2):e00

Geroscience is the
Convergence of
Two Fields of Study
Vascular
Disease

Neurological
Disease
Arthritis

Macular
Degeneration

Biology
of
Disease
CKD

Sarcopenia

Hearing

Cancer

Immunity

Heart
Disease

COPD

Stem
Cells

Proteostasis

Biology
of
Aging

Epigenetics

Metabolism

Inflammation

Stress
Response

Macromolecular
Damage
Epigenetics

Other
Biology

Stem
Cells

Metabolism

Proteostasis
Inflammation

Immunity

Damage
(Repair)
Genetics

Stress
(Adaptation)

Burch, JB et al. (2014) J Gerontol A Biol Sci Med

Sci Jun; 69 Suppl 1:S1-3; Kennedy, BK et al.

Lifespan is Plastic -Interventions in mice

Rapamycin -ITP

17-a estradiol
-- ITP

Ad Libitum
Restricted

Aspirin ITP

Acarbose

Calorie

Intermittent Fasting:
A Promising Lead

Brandhorst, S et al. (2015) Cell Metabolism 22,

Comprehensive Assessment of Long-term

Effects of Reducing Intake of Energy

First human
trial of longterm CR on
effects on
aging-related
outcomes
Tested
feasibility and

CALERIE Results

Ravussin, E et al. J Gerontol A Biol Sci Med Sci 2015

Questions?

Looking to the Future

Current trends in demographics,
health, and costs
What will the trajectories be for
disease? wellness? where are
we achieving success?
Aging biology Can we increase
lifespan? healthspan?
Current and future directions

Prevention is One Goal

of NIAs Alzheimers
For example, aTrialsNon-Carriers, late 30s
family in
Colombia that
develops AD
early is
generously
Beta-amyloid, late 20s
working with
researchers

Gene Carriers, late 30s

Dementia onset is in late 40s

Fleisher, AS et al. (2012) Lancet Neurology 11(12):1057-65.

NIAs Alzheimers-related
Trials Explore Many Different
Disease Pathways

In addition to anti-amyloid therapies, NIA

is studying:
o Compounds with other actions, such as
Preventing loss of nerve connections
Restoring function of damaged synapses
Promoting new neuron growth
o Dietary and physical activity interventions
o Blood pressure control
o Repurposing of drugs that were not
successful for their original indications

Other Projects in the AD

Pipeline
A consortium to look at how vascular risk factors
influence AD
New translational centers to develop and share
the next generation of animal models of AD
A biomarkers consortium to study AD in
individuals with Down syndrome
Discovery and development of novel
therapeutics for AD against a wide range of
targets
Development of novel disease-monitoring and
care support interventions, such as new in-home
technologies

NIA Aging-related Clinical

Trials
in
Process
Examples include:
Strategies to Reduce Injuries
and Develop Confidence in
Elders (STRIDE)
Aspirin in Reducing Events in
Elderly (ASPREE)
Enabling Reduction of LowGrade Inflammation in
Seniors (ENRGISE)- Pilot
Study
Study To Understand Fall

Participation in Research is
Essential!
NIA, CDC, and ACL
collaboration -- Recruiting
Older Adults into
Research (ROAR)
Encourages older adults,
family caregivers to
consider joining studies
First focus is Alzheimers;
a new toolkit is available
to facilitate research
participation:
https://www.nia.nih.gov/h

-- Putting Research
in Action
Encourages sedentary
older adults to be
active every day
Based on the science
Includes
people with chronic
health conditions
older people who
traditionally have not
embraced exercise
(shows them how to do

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