Aging Policy and Policy in U.S.

1
Aging Policy and Policy in U.S.

• June 2004
• Jinkook Lee, Ph.D.
• Professor, Consumer Science
• Center for Human Resource Research
• Ohio State University

2
Todays Agenda

• Aging Policy in U.S.
• Aging Research in U.S.
• Toward internationally harmonized study on aging

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Aging Policy in U.S.

• A historical perspective

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Aging policy in U.S.

• 1920's 
• 1920The Civil Service Retirement Act provided a
  retirement system for many governmental
  employees.  
• 1930's 
• 1935The Social Security Act passed provides for
  Old Age Assistance and Old Age Survivors
  Insurance.  
• 1950's 
• 1950 President Truman initiated the first
  National Conference on Aging.  
• 1952 First federal funds appropriated for social
  service programs for older persons under the
  Social Security Act.   
• 1956 Federal Council on Aging created by
  President Eisenhower.  

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Aging policy in U.S.

• 1960's 
• 1961First White House Conference on Aging held in
  Washington, D.C. Social Security Amendments
  lowered the retirement age for men from 65 to 62.
• 1965 Older Americans Act signed into law. It
  established the Administration on Aging.
• Medicare, Title XVIII, a health insurance program
  for the elderly was established as part of the
  Social Security Act.
• 1969 Older Americans Act Amendments provided
  grants for model demonstration projects, Foster
  Grandparents, and Retired Senior Volunteer
  Programs.

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Aging Policy in U.S.

• 1970's 
• 1971 Second White House Conference on Aging held
  in Washington, D.C.  
• 1973 Older Americans Act Comprehensive Services
  Amendments established Area Agencies on Aging.
  The amendments authorized grants to local
  community agencies for multi-purpose senior
  centers, and created the Community Service
  Employment grant program for low-income persons
  age 55 and older, administered by the Department
  of Labor.
• 1974 the Social Security Amendments authorized
  grants to states for social services. These
  programs included protective services, homemaker
  services, transportation services, adult day care
  services, training for employment, information
  and referral, nutrition assistance, and health
  support.
• 1974 National Institute on Aging created to
  conduct research and training related to the
  aging process, and the diseases and problems of
  an aging population.

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Aging policy in U.S.

• 1980's 
• 1981 Third White House Conference on Aging held
  in Washington, D.C. Older Americans Act
  reauthorized emphasized supportive services to
  help older persons remain independent in the
  community.
•   
• 1987Omnibus Budget Reconciliation Act provides
  for nursing home reform in the areas of nurse
  aide training, survey and certification
  procedures, pre-admission screening an annual
  reviews for persons with mental illness. Six
  additional services are added
• in-home services for the frail elderly
• long-term care ombudsman
• assistance for special needs
• health education and promotion
• prevention of elder abuse, neglect, and
  exploitation and
• outreach activities for persons who may be
  eligible for benefits under supplemental security
  income (SSI), Medicaid, and food stamps.
• Additional emphasis was given to serving those in
  the greatest economic and social need, including
  low-income minorities.

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Aging policy in U.S.

• 1990s
• 1990 Age Discrimination in Employment Act made it
  illegal, in most circumstances, for companies to
  discriminate against older workers in employee
  benefits.  
• 1995 White House Conference on Aging. The
  elevation of Commissioner on Aging to Assistant
  Secretary for Aging.
• 1999 International Year of Older Persons
• 2000's 
• 2000 Older Americans Act Amendments of 2000
  signed into law (P.L. 106-501), establishing the
  new National Family Caregiver Support Program.

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Aging Policy in U.S.

• The White House
• Administration on Aging
• Congress
• The U.S. Senate Special Committee on Aging
• National Institute on Aging

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The Presidents Agenda

• Strengthening Medicare
• Strengthening retirement security
• Strengthening Social Security

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President's Plan to Strengthen Medicare

• Building on the proposed Medicare Rx Drug Card to
  give seniors access to drug discounts of 10 to 25
  percent
• Helping states implement comprehensive drug
  coverage for low-income beneficiaries as quickly
  as possible, as part of the Medicare drug
  benefit.
• Giving seniors access to two additional Medigap
  (supplemental coverage) plans, with updated
  benefits that provide better protection against
  high medical expenses and assistance with
  prescription drugs at a more affordable cost

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President's Plan to Strengthen Retirement Security

• An important component of the President's
  economic security agenda is providing American
  workers and retirees new tools to protect their
  pensions, investments, and retirement security.
• The President has announced the implementation of
  rules that require workers to receive a 30-day
  notification before any "blackout" restrictions
  are placed on their 401(k) plans.

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President's Plan to Strengthen Retirement Security

• The President has proposed other important,
  commonsense proposals to help protect the
  retirement savings of American workers
• Allowing workers to diversify their investments
  in employer stock after three years.
• Providing workers quarterly benefit statements
  that explain the value of diversified
  investments.
• Giving workers better access to much-needed
  investment advice from professional advisers
  acting in the workers' best interest.

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President's Plan to Strengthen Social Security

• The President's Plan to Strengthen Retirement
  Security includes
• Expanding Ownership of Retirement Assets
• Ensuring Freedom of Choice
• Creating a Society of Stakeholders
• Minimizing Risk through Diversification
• Strengthening Womens Retirement Security
• Helping Future Generations to Achieve the
  American Dream
• Spurring National Saving and Economic Growth

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Administration on Aging (AoA)

• AoA is an agency in the U.S. Department of Health
  and Human Services, one of the nation's largest
  providers of home- and community-based care for
  older persons and their caregivers.
• Created in 1965 with the passage of the Older
  Americans Act (OAA), AoA is part of a federal,
  state, tribal and local partnership called the
  National Network on Aging.

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Administration on Aging (AoA)

• This network, serving about 7 million older
  persons and their caregivers, consists of 56
  State Units on Aging 655 Area Agencies on Aging
  233 Tribal and Native organizations two
  organizations that serve Native Hawaiians 29,000
  service providers and thousands of volunteers.
• These organizations provide assistance and
  services to older individuals and their families
  in urban, suburban, and rural areas throughout
  the United States.
• While all older Americans may receive services,
  the OAA targets those older individuals who are
  in greatest economic and social need the poor,
  the isolated, and those elders disadvantaged by
  social or health disparities.

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The U.S. Senate Special Committee on Aging

• It was first established in 1961 as a temporary
  committee, then granted permanent status in 1977.
  
• While special committees have no legislative
  authority, they can study issues, conduct
  oversight of programs, and investigate reports of
  fraud and waste.
• Throughout its existence, it has served as a
  focal point in the Senate for discussion and
  debate on matters relating to older Americans.
• Often, the Committee will submit its findings and
  recommendations for legislation to the Senate.
• The Committee publishes materials of assistance
  to those interested in public policies which
  relate to the elderly.
• The Committee has a long and influential history.

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The U.S. Senate Special Committee on Aging

• Medicare
• The Committee was exploring health insurance
  coverage of older Americans prior to the
  enactment of Medicare in 1965.
• Since the legislation, the Committee has
  continually reviewed Medicare's performance on an
  almost annual basis.
• Labor
• The Committee has also regularly reviewed pension
  coverage and employment opportunities for older
  Americans.
• Public programs
• It has conducted oversight of the administration
  of major programs like Social Security and the
  Older Americans Act.
• Fraud
• It has crusaded against frauds targeting the
  elderly and Federal programs on which the elderly
  depend.

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The U.S. Senate Special Committee on Aging

• Currently,
• Chairman Larry Craig (R-Idaho)
• Current issues include
• Senator Frank Moss (D-Utah) brought to light
  unacceptable conditions in nursing homes.
• Senator Frank Church (D-Idaho) worked on adding
  more protections for seniors in the area of age
  discrimination.
• Senator John Heinz (R-Pennsylvania) reviewed
  Medicare's Prospective Payment System to see
  whether it was true the system was forcing
  Medicare beneficiaries to be discharged "quicker
  and sicker.

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Aging Research in the U.S.
21
National Institute on Aging (NIA)

• The National Institute on Aging (NIA), one of the
  25 institutes and centers of the National
  Institutes of Health, leads a broad scientific
  effort to understand the nature of aging and to
  extend the healthy, active years of life.
• In 1974, Congress granted authority to form the
  National Institute on Aging to provide leadership
  in aging research, training, health information
  dissemination, and other programs relevant to
  aging and older people.
• Subsequent amendments to this legislation
  designated the NIA as the primary federal agency
  on Alzheimers disease research.

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National Institute on Aging (NIA)

• The NIAs mission is to improve the health and
  well-being of older Americans through research,
  and specifically to
• Support and conduct high quality research
  on    -aging processes    -age-related
  diseases    -special problems and needs of the
  aged
• Train and develop highly skilled research
  scientists from all population groups
• Develop and maintain state-of-the-art resources
  to accelerate research progress
• Disseminate information and communicate with the
  public and interested groups on health and
  research advances and on new directions for
  research.

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National Institute on Aging (NIA)

• NIA sponsors research on aging through extramural
  and intramural programs.
• The extramural program funds research and
  training at universities, hospitals, medical
  centers, and other public and private
  organizations nationwide.
• The intramural program conducts basic and
  clinical research in Baltimore, MD, and on the
  NIH campus in Bethesda, MD.

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Aging Research Supported by NIA

• BiologyResearch on the biochemical, genetic, and
  physiological mechanisms of aging and the onset
  of age-related disease.
• Neuroscience and NeuropsychologyResearch on the
  structure and function of the aging nervous
  system, including the brain-behavior
  relationship.
• Behavioral and Social ResearchResearch on the
  behavioral changes related to aging and the
  impact of older people on society.
• Geriatrics and Clinical Gerontology
  ProgramResearch on age-related diseases,
  degenerative conditions, and disabilities.

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National Advisory Council on Aging (NACA)

• The National Advisory Council on Aging (NACA)
  advises the Secretary of DHHS, the Assistant
  Secretary for Health, the Director of the
  National Institutes of Health, and the Director
  of the National Institute on Aging (NIA) in its
  mission to lead a broad scientific effort to
  understand the nature of aging and to extend the
  healthy, active years of life.
• The Council meets three times a year to consider
  applications for research and training and to
  recommend funding for those applications that
  show promise of making valuable contributions in
  the field of aging research, and also makes
  recommendations to the Director of NIA regarding
  research conducted at the Institute.

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NIA Funding Collaboration

• In fiscal year 2000, the NIA funded basic and
  clinical scientists through an estimated 1,400
  research grants and 55 research contracts to
  universities and other research centers,
  supporting investigators throughout the U.S. and
  in selected international locations.
• Investigators also apply for training grants and
  individual fellowships.
• The NIA collaborates with every major NIH
  component and leads research efforts that span
  several federal agencies. The NIA is the lead
  federal agency for research on Alzheimer's
  disease and aging demography.
• The NIA also chairs the Interagency Ad Hoc
  Committee on Research on Aging and the
  Interagency Forum on Aging Related Statistics.
• The NIA collaborates with other organizations to
  advance knowledge of aging and leverage
  resources.

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NIA Research Planning

• The NIA maintains a year-round scientific
  planning process that draws upon interactions
  with scientists throughout the world, members of
  Congress, the Institute's National Advisory
  Council on Aging (NACA) and other advisory
  committees, constituency groups, and the public.
• The NIA's strategic planning process focuses on a
  5-year planning horizon. The NIA's current
  strategic planning effort covers a 5-year time
  frame from fiscal years 2001 to 2005 and
  addresses goals for research, research training,
  research resources, and dissemination of health
  information.

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NIA Strategic Research Goals 2001-2005

• Goal A Improve Health and Quality of Life of
  Older People
• Subgoal 1 Prevent or Reduce Age-Related
  Diseases, Disorders, and Disability
• Subgoal 2 Maintain Health and Function
• Subgoal 3 Enhance Older Adults' Societal Roles
  and Interpersonal Support, and Reduce Social
  Isolation
• Goal B Understand Healthy Aging Processes
• Subgoal 1 Unlock the Secrets of Aging, Health,
  and Longevity
• Subgoal 2 Maintain and Enhance Brain Function,
  Cognition, and Other Behaviors

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NIA Strategic Research Goals 2001-2005

• Goal C Reduce Health Disparities Among Older
  Persons and Populations
• Subgoal 1 Increase Active Life Expectancy and
  Improve Health Status for Older Minority
  Individuals
• Subgoal 2 Understand Health Differences
  Associated with Race, Ethnicity, Gender,
  Environment, Socioeconomic Status, Geography, and
  Culture
• Subgoal 3 Monitor Health, Economic Status, and
  Life Quality of Elders and Inform Policy
• Goal D Enhance Resources to Support High Quality
  Research
• Subgoal 1 Train and Attract a Diverse Workforce
  of New, Mid-career, and Senior Researchers
  Necessary for Research on Aging
• Subgoal 2 Develop and Sustain a Diverse NIA
  Workforce and a Professional Environment that
  Supports and Encourages Excellence
• Subgoal 3 Disseminate Accurate and Compelling
  Information to the Public, Scientific Community,
  and Health Care Professionals
• Subgoal 4 Develop and Distribute Research
  Resources

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Research highlights

• NIA supports networks of centers that focus on
  specific topics, including demography and the
  basic biology of aging.
• There are currently 29 NIA-supported Alzheimers
  Disease Centers (ADCs).
• Another type of Center, the Edward R. Roybal
  Centers for Research on Applied Gerontology,
  translates behavioral and social research
  findings into practical outcomes for older
  adults.
• The NIA also supports a variety of clinical
  trials, frequently in collaboration with one or
  more NIH Institutes or other organizations.
• For example, NIA is currently supporting 25 AD
  clinical trials, seven of which are large-scale
  prevention studies.
• A major clinical trial in which NIA-supported
  researchers took part is the Diabetes Prevention
  Program, a multi-institutional study that was
  initiated by the National Institute on Diabetes
  and Digestive and Kidney Diseases. The
  researchers found that people who are at high
  risk for diabetes can sharply reduce their risk
  by adopting a low-fat diet and moderate exercise
  regimen. This effect was most pronounced among
  study participants age 60 and over. Treatment
  with the drug metformin (Glucophage) also
  reduced diabetes risk among study participants,
  but for unknown reasons was less effective among
  older participants.

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Research highlights

• Recent findings in C. elegans, a tiny worm that
  is frequently used for genetic studies, are
  providing important insights about fat regulation
  and storage that may lead to improved
  understanding of overweight and obesity in
  humans.
• Another recent basic discovery, this one in mice,
  may have profound implications on the field of
  reproductive biology. Since the 1950s, scientists
  have believed that women are born with all the
  oocytes (eggs) they will ever have, and that
  these eggs die off as a woman ages, with
  fertility diminishing and, at menopause,
  disappearing as a result. However, NIH-supported
  researchers recently found that oocyte-containing
  follicles continue to develop in the ovaries of
  adult mice. If this finding is confirmed and
  extended to humans -- it could lead not only to
  new treatments for premature ovarian failure
  (which affects some 250,000 American women under
  age 40, according to the National Institute of
  Child Health and Human Development), but also to
  interventions to delay menopause and extend
  fertility.

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Research HighlightsBehavioral and Social
Research

• BSR has identified seven major areas to be
  emphasized over the next several years. These
  areas have been selected because
• (a) they represent new and important perspectives
  or emphases that have not been adequately
  highlighted in the past,
• (b) they are areas that have a potential for
  major scientific advancement, or
• (c) they have important implications for policy,
  and for the future well-being of older persons in
  the United States.
• These special initiatives are
• Health Disparities
• Aging Minds
• Increasing Health Expectancy
• Health, Work and Retirement
• Interventions and Behavior Change
• Genetics, Behavior and the Social Environment
• The Burden of Illness and the Efficiency of
  Health Systems

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Research programs BSR

• Principles Cutting Across BSR Research Programs
• Aging from Birth to Death -- Life Course
  Perspectives
• Bio-behavioral Linkages and Collaboration With
  Other NIA Programs
• Integration and Synthesis - Multi-level
  Interactions Among Psychological, Physiological,
  Social and Cultural Levels
• Development of Improved Methodologies and
  Measurement
• Translation and Application of Findings

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Research Highlights

• Books on Aging and Health by the U.S. National
  Academies published by the National Academies
  Press.
• 1. The Aging Mind Opportunities in Cognitive
  Research2. Assessing Knowledge of Retirement
  Behavior3. Assessing Policies for Retirement
  Income Needs for Data, Research, and Models4.
  Between Zeus and the Salmon The Biodemography of
  Longevity 5. Cells and Surveys Should
  Biological Measures Be Included in Social Science
  Research?6. Demography of Aging7. Elder
  Mistreatment Abuse, Neglect, and Exploitation in
  an Aging America8. Forecasting Survival, Health,
  and Disability
• 9. Improving Access to and Confidentiality of
  Research Data 10. Improving Data on Americas
  Aging Population 11. New Horizons in Health An
  Integrative Approach12. Preparing for an Aging
  World The Case for Cross-National Research13.
  Racial and Ethnic Differences in the Health of
  Older Americans14. Trends in Disability at Older
  Ages

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Toward internationally harmonized study on aging
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Why harmonize?

• Aging is one of the greatest social and economic
  challenges of the 21st century in the world.
• The projected growth in the numbers and
  proportions of the worlds older population pose
  array of challenges to policy makers.
• Many countries are now in the early stages of
  adapting to their changing population age
  structures.
• Since current and perspective policy responses
  are likely to differ among countries, a number of
  natural experiments are, or shortly will be,
  under way, enabling countries to learn from each
  others experience.

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Why harmonize?

• Therefore,
• major scientific and policy gains would be
  possible if a number of countries could be
  induced to embark on data design and collection
  activities.
• Advantages would arise from the confluence of
  several factors
• the differential rates of population aging
  throughout the world provide a unique opportunity
  for countries to learn from each others
  experiences
• the concomitant economic and social changes that
  are occurring differently throughout the world.

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Why harmonize?

• To benefit from the possibility of exploiting
  institutional differences to understand the
  effects of policy measures,
• data collection efforts in different countries
  must be harmonized
• in the sense that conceptually comparable
  information is collected, and
• procedures (e.g., for sampling and quality
  control) are synchronized to the extent possible.
• However,
• the harmonization does not imply that survey
  protocols need to be identical in all countries.

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Internationally harmonized Health and Retirement
Study
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Health and Retirement Study (HRS)

• This multi-disciplinary study began in 1990,
  including subject matters of
• demographics,
• health,
• family structure,
• job history,
• cognition,
• housing,
• income, and
• net worth.

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Health and Retirement Study (HRS)

• HRS is intended to provide data for researchers,
  policy analysts, and program planners
• who are making major policy decisions that
  affect retirement, health insurance, saving and
  economic well-being.

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HRS Study design

• National panel study
• Initial sample of over 12,600 persons in 7,600
  households
• Over-samples of Hispanics, Blacks, and Florida
  residents
• Baseline
• in-home, face-to-face in 1992 for the 1931-41
  birth cohort (and their spouses, if married,
  regardless of age) and
• in 1998 for newly added 1924-1930 and 1942-47
  birth cohorts
• Follow-ups by telephone every second year, with
  proxy interviews after death

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HRS Questionnaire topics

• Health and cognitive conditions and status
• Retirement plans and perspectives
• Attitudes, preferences, expectations, and
  subjective probabilities
• Family structure and transfers
• Employment status and job history
• Job demands and requirements
• Disability
• Demographic background
• Housing
• Income and net worth
• Health insurance and pension plans
• Experimental modules

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International Harmonization of HRS

• With the goal of collecting data that are
  strictly comparable to allow cross-country
  research, the following three harmonized projects
  have begun
• The Mexican Health and Aging Study (MHAS)
• The English Longitudinal Study of Aging (ELSA)
• The Survey of Health, Ageing and Retirement in
  Europe (SHARE)

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HRS in Asia

• Currently, there is a lack of comparable data in
  Asia.
• There is a critical need to collect the
  harmonized HRS in Asia.
• An initiative on HRS in Korea

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• Thank You!!