Department of Health
and Human Services (HHS)
and Human Services (HHS)
July 21,202
PA-20-183 - NIH Research Project Grant (Parent R01 Clinical Trial Required)
PA-20-184 - NIH Research Project Grant (Parent R01 Basic Experimental Studies with Humans Required)
PA-20-185 - NIH Research Project Grant (Parent R01 Clinical Trial Not Allowed)
PA-20-194 - NIH NIH Exploratory/Developmental Research Grant Program (Parent R21 Clinical Trial Required)
PA-20-195 - NIH NIH Exploratory/Developmental Research Grant Program (Parent R21 Clinical Trial Not Allowed)
PA-20-196 - NIH Exploratory/Developmental Research Grant Program (Parent R21 Basic Experimental Studies with Humans Required)
National Institute on Aging (NIA)
This Notice of Special Interest (NOSI) underscores NIA’s continued commitment to research that seeks to better characterize the affective, cognitive, social, and motivational parameters of impaired and intact decision making in adults who are aging normally, as well as in individuals with mild cognitive impairment (MCI), Alzheimer’s disease (AD), and AD-related dementias (ADRD). Research is sought that characterizes the extent to which behavioral, psychological, and neural processes involved in decision making are differentially impacted in normal aging, MCI, and AD/ADRD. Investigations that target the influence of social factors on decision making or other factors that render older adults (with or without cognitive impairment) vulnerable to financial exploitation and other forms of mistreatment and abuse are of particular interest. This NOSI also encourages preclinical and applied research on decision making that may facilitate the design of decision-supportive interventions for midlife and older adults with and without MCI and AD/ADRD. Specific opportunities include the development of decision-support interventions to leverage cognitive, emotional, social, and motivational strengths of these populations; tools to assess decisional capacities; strategies for simplifying choices and offering better defaults; and the promotion of timely adoption of optimal delegation practices (e.g., power of attorney, living wills, etc.). The use of animal models to explore the neural basis of affective, cognitive, social, and motivational parameters as they relate to age-related changes in decision making is also invited.
Background
Longer life expectancy requires longer maintenance of decision-making capacities in older adults across multiple settings to support health and independence in old age. Older adults face complex decisions about health care, finances, illness management, and planning for end-of-life care, among other everyday challenges. To understand how aging affects decision making, it is necessary to understand the psychological processes and neurobiological substrates involved, including social and emotional motivations and interactions with cognitive and emotional processes.
When decision-making capacities are compromised, either as a function of normal aging or in MCI and AD/ADRD, individuals may become vulnerable to self-harm, exploitation, and abuse. There is evidence that financial exploitation is the most prevalent form of elder mistreatment in the U.S., potentially due to decision-making deficits that render elders especially vulnerable. Healthcare decisions, healthcare management, and risks and harms to health and well-being can also be impacted by vulnerabilities in decision making. Cognitive impairments associated with MCI and AD/ADRD may exacerbate this risk. Notably, assessment of deficits in managing finances and medications is recommended as a core component of a simple clinical screening tool for dementia risk, based on findings that deficits in this domain are strongly predictive of dementia diagnosis in several large, ongoing cohort studies.
Research has demonstrated age-related changes in various aspects of decision making—ranging from decision making under risk or ambiguity to inter-temporal choice, value-based learning, and use of heuristics—with implications for health and well-being outcomes. There is evidence that as cognitive flexibility decreases, older individuals may increasingly draw on expertise, learned heuristics, and emotional maturity for decision making. There has been no systematic attempt to assess whether these shifts in capacity enhance or undermine decision making in aging, whether they are differentially impacted in normal aging and in the early stages of MCI or AD/ADRD, or how MCI and AD/ADRD-specific cognitive, psychological, or neuropathological changes over the progression of the disease interact with other age-related changes in brain and behavior.
Older age is also associated with shifts in social goals and changes in social relationships and contexts, both of which may impact the extent to which interpersonal processes--such as coercion, trust, competition, generativity, and empathy--influence decisions in health and financial domains. The social and institutional contexts within which individuals make decisions can become more complex over the life course. For example, older adults increasingly need to interact with health insurance companies, multiple medical providers, and financial institutions. New types of decisions may require expanded cognitive capacities at a time when those capacities are declining. This may also require new strategies to adapt to these cognitive changes to aid in decision making in this increasingly complex environment.
Despite these needs, our understanding of how these changes impact decision making in normal aging, MCI, and/or AD/ADRD remains limited. Individuals with MCI and/or AD/ADRD may have difficulty separating valid advice from potentially exploitative encounters with peers, family members, the media, professional advisors, or service providers when making decisions. Moreover, sociodemographic factors may moderate these influences, with differences in wealth, education, and occupational status exerting powerful influences on both the ability to make sound choices and on the array of choices available. Finally, there is also increasing recognition of the need for improved measurement of the core behavioral and economic phenotypes that account for individual variation in decision making and choice behaviors over the life span, and the extent to which these represent risk or protective factors for normal neurocognitive aging, MCI, and/or AD/ADRD.
Objectives
The goal of this NOSI is to stimulate fundamental (e.g., basic) and translational research on decision making in normal aging, MCI, and/or AD/ADRD.
Fundamental and translational research projects should aim to identify or refine our understanding of mechanisms or processes in decision making in midlife or older age. These may be studied at the neurobiological, psychological, behavioral, interpersonal, social, institutional, and/or population level.
Fundamental research studies can focus on human populations and/or make use of appropriate animal models to interrogate the social, behavioral, psychological, and/or neurobiological mechanisms that lead to changes in decision-making capabilities over the lifespan.
This initiative also encourages the application of research on these fundamental processes to the design of decision-support interventions. For translational projects involving adults at midlife and older age, with or without MCI or AD/ADRD, this initiative provides a vehicle for submitting intervention studies at all phases and stages (Stage Model for Behavioral Intervention Development). Interventional approaches should be in line with the mechanisms-focused approach outlined in the NIH Stage Model and encouraged by the NIH Common Fund's Science of Behavior Change (SOBC) program.
Applicants are encouraged to study decision-making processes in diverse populations and to consider the impact on later life decision-making abilities of life histories that may differ by gender, race, educational background, or socioeconomic status.
Application and Submission Information
This notice applies to due dates on or after October 5, 2020 and subsequent receipt dates through January 8, 2022.
Submit applications for this initiative using one of the following funding opportunity announcements (FOAs) or any reissues of these announcement through the expiration date of this notice
All instructions in the SF424 (R&R) Application Guide and the funding opportunity announcement used for submission must be followed, with the following additions:
For funding consideration, applicants must include “NOT-AG-20-039” (without quotation marks) in the Agency Routing Identifier field (box 4B) of the SF424 R&R form. Applications without this information in box 4B will not be considered for this initiative.
Applications nonresponsive to terms of this NOSI will not be considered for the NOSI initiative.
Scientific/Research Contact(s)
Luke Stoeckel, Ph.D.
National Institute on Aging (NIA)
Telephone: 202-570-9388
Email: luke.stoeckel@nih.gov
Molly V. Wagster, Ph.D.
National Institute on Aging (NIA)
Telephone: 301-594-7768
Email: wagsterm@nia.nih.gov