House of Representatives Considering Sweeping Changes to NIH; AGS Expresses Concern and Encourages JGN Readers to Take Action
Introduction
This year, the American Geriatrics Society (AGS) has been celebrating the 50th anniversary of the National Institute on Aging (NIA), which has been the intellectual home and primary source of funding for the innovative aging research that its members conduct. Research funded by the NIA has improved clinical care of older adults across health care settings—contributing to the collective health, independence, and quality of life as we age. Chronic diseases related to aging, such as diabetes, heart disease, and cancer, continue to affect 80% of people aged ≥65 years (National Prevention Council, 2024). Further, approximately 40% of Medicare beneficiaries who have four or more chronic conditions account for >75% of Medicare expenditures (Centers for Medicare & Medicaid Services, 2021). Interventions from NIA–funded research have helped reduce declines in function and susceptibility to disease or frailty and in turn delayed the onset of costly age-related diseases.
I was delighted to see that the Journal of the American Geriatrics Society devoted its May 2024 issue to invited papers and letters detailing the remarkable ways in which the NIA has advanced our understanding of aging (Kuchel & Smith, 2024), and I was honored to share the “virtual” main-stage with NIA Director Dr. Richard Hodes who delivered the AGS Public Policy Plenary at our annual meeting last May. In my inaugural “From Our President” column in AGSNews, I chronicled how those advances are contributing to my own health as I age (Supiano, 2024). It is truly remarkable how taking a whole person approach to older adults, as the NIA does, has fostered advances that are contributing to health and well-being as we all age (Butler et al., 2024; Kelley et al., 2024; Nagy et al., 2012).
Throughout its history, the NIA has taken a whole person approach to the diseases and disorders of aging. This approach appears to be under threat in a recent proposal, “Reforming the National Institutes of Health: Framework for Discussion,” (Framework) that was released in June 2024 by the U.S. House of Representatives Committee on Energy & Commerce (Energy & Commerce Committee) with a request for input. The proposal is recommending sweeping changes to the structure of the Institutes and Centers that comprise the National Institutes of Health (NIH). Among the changes being proposed is replacing the NIA with a disease-centric “National Institute on Dementia.” The proposal has no specificity as to how the aging research portfolio that is not focused on dementia would be distributed across the newly organized NIH, which accounts for approximately one half of the NIA's current grant activity. Table A (available in the online version of this article) shows just how sweeping the proposed changes are to reorganize the NIH (U.S. House of Representatives Committee on Energy & Commerce, 2024).
| Current Institute/Center | Proposed Institute/Center |
|---|---|
| National Cancer Institute (NCI) | National Cancer Institute (NCI) |
| National Institute on Body Systems Research |
| National Institute on Neuroscience and Brain Research |
| National Institute of Allergy and Infectious Diseases (NIAID) |
|
| National Institute of General Medicine Sciences |
| National Institute for Disability Related Research |
| National Institute on Aging (NIA) | National Institute on Dementia |
| National Institute on Substance Use |
| National Institute of Mental Health (NIMH) | National Institute of Mental Health |
| National Institute on Health Sciences Research |
| National Institute on Innovation and Advanced Research |
| NIH Clinical Center (CC) | NIH Clinical Center (CC) |
| Center for Scientific Review (CSR) | Center for Scientific Research (CSR) |
| Center for Information Technology (CIT) | Center for Information Technology (CIT) |
I, as well as many other AGS members, am concerned about the implications of this proposed reconfiguration of the NIH and in particular, the proposal to eliminate the NIA. Our collective cognitive dissonance is how to align the stated premise for the restructuring proposal—the need for the NIH to take a whole person approach to the research that it funds—with a plan to eliminate the very Institute that has had that perspective since it was established.
In an editorial in STAT News, Representatives Cathy Anne McMorris Rodgers, chair of the Energy & Commerce Committee, and Robert B. Aderholt, chair of the House Appropriations Labor, Health & Human Services, Education, and Related Agencies Subcommittee (LHHS Appropriations Subcommittee) (Congressional sponsors of the proposal) provided this perspective: “It's time to move away from a demographic-or disease-specific siloed approach and ensure each institute or center is considering the whole individual and all populations across the entire life span” (McMorris Rogers & Aderholt, 2024, para. 8). The STAT News editorial is in stark contrast to some elements of the proposed restructuring, including the plan to narrow the focus of the NIA and replace it with a “National Institute on Dementia.” Although age is a significant risk factor for Alzheimer's disease and Alzheimer's disease-related dementias, age also increases our risk of cardiovascular disease, cancer, arthritis, osteoporosis, and pain. A singular focus on dementia does not align with the reality that the most common age-associated condition is multiple chronic conditions. In fact, <5% of Medicare beneficiaries who have Alzheimer's disease do not also have other chronic conditions (Alzheimer's Association, 2022). Historically, because it has taken a whole person perspective on biomedical research, the NIA has been able not only to advance discoveries that can prevent or delay the onset of diseases, conditions, and functional decline associated with growing older, but also identify factors throughout the life course that can promote healthy aging and enable us to remain independent throughout most, if not all, of our lives.
Shortly after the Framework was released, the House LHHS Appropriations Subcommittee passed a fiscal year (FY) 2025 budget proposal (along party lines with all Democrats voting against the budget) allocating funding to Institutes and Centers at the NIH according to the Energy & Commerce Committee's restructuring proposal. At the FY 2025 appropriations hearing, Representative Rosa DeLauro, a steadfast champion for older adults, spoke eloquently about the need for public hearings and a thoughtful bipartisan, bicameral process on any proposal for such sweeping changes before such changes appear in a partisan appropriations bill, noting that the current proposal falls far short of that benchmark (“Ranking member DeLauro…,” 2024).
The AGS believes that there has been insufficient input from the scientific community to inform the Energy & Commerce Committee proposal and that it will not achieve the positive changes that its sponsors seek. This proposal will damage the progress that is being made by existing NIH Institutes and Centers in increasing our understanding of the diseases and disorders of all Americans across the lifespan (NIH, 2017). I encourage readers of the Journal of Gerontological Nursing to join me in educating your representatives and senators in our AGS Advocacy Center and urge them to oppose the proposed restructuring of the NIH at https://bit.ly/Oppose_Elimination_of_NIA (Health in Aging Advocacy Center, 2024). As a bit of historical context for why I believe it is so important that we take collective action, in FY 2006, Congress eliminated all funding for the Title VII geriatrics health professions programs. Thanks to concerted collective action from AGS members and those of other organizations, funding was restored the following year. Almost 20 years later, we are still grateful to the members who called and emailed their members of Congress to educate them about geriatrics and the importance of the Title VII geriatrics programs in ensuring our health care workforce is prepared to care for older adults.
In 1977, Dr. Robert Butler, the first Director of the NIA, penned the following:
In the words of Congress, “The National Institute on Aging was established for the conduct and support of biomedical, social, and behavioral research and training related to the aging process and diseases and other special problems and needs of the aged.” Congress demonstrated foresight when it placed this Institute within the National Institutes of Health, enabling it to share in the NIH's history, experience, and recognized excellence. The Institute finds itself different from most of the eleven Institutes and four Divisions of the National Institutes of Health. Its mandate reflects the concept that the study of aging is not just the study of decline, loss, and decrement—which do indeed accompany aging—and not just the study of disabilities or diseases which may in part be due to social adversities. Rather, it is also the study of the normal processes of development which are fundamental to life and about which we know all too little, including creativity, life experience, perspective, and judgment. Indeed, a major overall objective of research is to examine the variety of factors—biologic, social and psychologic—which constitute the aging process, and to translate this knowledge into ways of preventing, promoting, modifying, or reversing these various factors so that life is better and more dignified in the later years.
(p. 2)Incredible progress has been made toward improving our healthspan (i.e., the portion of our lives spent in good health) because of the NIA. Since inception, the NIA has been a force for change across the Institutes through its collaborations with other Institutes that are focused on ensuring that all NIH research is inclusive of older people. That progress is thanks, in large part, to the foresight of Congress in establishing an Institute that would take a whole person focus and work toward a healthier future for all of us as we age. I encourage the proponents of this effort to restructure the NIH to pay heed to the first recommendation in their own proposal, which is that Congress should establish a commission to conduct a comprehensive review of the NIH with clear actionable recommendations for improvement. To that recommendation, I would add that the commission should be nonpartisan and housed within an independent body, such as the National Academies of Sciences, Engineering, and Medicine. The Directors of all NIH Institutes and Centers should be engaged, and the commission should be inclusive of scientists, particularly those who have championed a whole person approach to research, are well-versed in multiple chronic conditions, and who have focused their work across the lifespan.
It is critically important for all of us who have dedicated our lives to the health and well-being of older Americans to weigh in on this proposal. In the view of the AGS, the entire proposal lacks adequate input from the scientific community. For older adults, the proposal to eliminate the NIA is particularly shortsighted given the NIA's historic focus on all of the diseases and disorders of aging and its whole person approach to scientific investigation. We look forward to providing input to Congress about the work of the NIA, which has been at the forefront of scientific discovery that supports us all to age with independence, health, and quality of life.
Mark A. Supiano, MD, AGSF
President, American Geriatrics Society
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