PSYCHOSOCIAL GERIATRICS RESEARCH:  HEALTH BEHAVIORS AND AGING

NIH GUIDE, Volume 22, Number 11, March 19, 1993



PA NUMBER:  PA-93-064



P.T. 34



Keywords:

  Aging/Gerontology 

  Behavioral/Social Studies/Service 

  Disease Prevention+ 

  Health Promotion 

  Treatment, Medical+ 



The National Institute on Aging



PURPOSE



The National Institute on Aging (NIA) invites qualified researchers to

submit applications for research and research training on those

health-related behaviors and attitudes of older adults, their families,

and significant others, that can affect health and functioning as

people grow older.  Studies are sought that extend scientific

understanding of how older adults' health behaviors and attitudes

develop under varying social conditions; how they relate to health

promotion and disease prevention, care and treatment of disease,

rehabilitation or death; and how they can be modified as relevant new

scientific knowledge is developed.



HEALTHY PEOPLE 2000



The Public Health Service (PHS) is committed to achieving the health

promotion and disease prevention objectives of "Healthy People 2000,"

a PHS-led national activity for setting priority areas.  This Program

Announcement (PA), Psychosocial Geriatrics Research:  Health Behaviors

and Aging, is related to the priority area of aged-related objectives

for older adults.  Potential applicants may obtain a copy of "Healthy

People 2000" (Full Report:  Stock No. 017-001-00474-0) or "Healthy

People 2000" (Summary Report:  Stock No. 017-001-00473-1) through the

Superintendent of Documents, Government Printing Office, Washington, DC

20402-9325 (telephone 202-783-3238).



ELIGIBILITY REQUIREMENTS



Applications may be submitted by foreign and domestic, for-profit and

non-profit organizations, public and private, such as universities,

colleges, hospitals, laboratories, units of State and local

governments, and eligible agencies of the Federal government.

Applications from minority individuals and women are encouraged.

Foreign institutions may apply for National Research Service Training

Awards (F32, F33) only if the applicant is a U.S. citizen or resident

alien. Applicants for K04, F32, and F33 awards must be U.S. citizens or

resident aliens.  Foreign institutions are not eligible for First

Independent Research Support and Transition (FIRST) (R29) awards.



MECHANISMS OF SUPPORT



The mechanisms of support for this program are:



o  Research grant (R01):  the anticipated average award (direct costs)

is $150,000 per year.

o  FIRST (R29) award

o  Conference grant (R13)

o  Research Career Development Award (K04)

o  Fellowships (F32, F33)



Deadlines for applications are as follows:



F-series grants:                            Apr 5, Aug 5, and Dec 5

New R and K-series grants:                  Feb 1, Jun 1, and Oct 1

Competing continuation and revised grants:  Mar 1, Jul 1, and Nov 1



RESEARCH OBJECTIVES



A variety of studies in the United States and other countries have

demonstrated the importance of social and behavioral factors in the

causes, prevention, diagnosis, treatment, and recovery from illness in

later life, as well as in the maintenance of health over the life

course.  An often quoted report from the Surgeon General states that

society will achieve its health goals primarily through changes in

behavior.  To specify such a global statement, research is needed in

several areas such as:  (1) the identification and distribution of

psychosocial risk factors (e.g., psychosocial epidemiology), (2) the

development, maintenance, and change of health-related behaviors, (3)

the basic biobehavioral mechanisms, (4) the behavioral and social

interventions to prevent and treat illness or to promote health, and

(5) the effects of health upon behavior.



Psychosocial geriatrics research addresses these issues by undertaking

the development and integration of social/behavioral and biomedical

science knowledge relevant to health promotion and the prevention and

treatment of disease in the middle and later years.  The pathways

linking health and behavior are of special concern, including the

sociocultural environment (e.g., health and social policies),

psychosocial mediators (e.g., reactions to illness, sense of control,

stress, coping) and physiological mediators (e.g, neuroendocrine or

immune functioning).



Research on the full range of health and illness behaviors are relevant

to this announcement. Health behaviors include self care, informal or

lay care, and formal care taken to improve health and functioning of

people as they grow older.  Illness behaviors are concerned with how

older individuals monitor their bodily functioning; how they define and

interpret symptoms perceived as abnormal; whether they consult with

non-professionals, relatives, and friends; whether they take or fail to

take remedial action, utilize formal health-care systems, or comply

with prescribed regimens; and how they approach death.



The following are offered as illustrations of appropriate topics for

research.  Accepted referral guidelines will be followed in assigning

applications to NIA or to other Institutes.  Applications need not,

however, be limited to these issues.



o  Nature and Distribution of Health Behaviors and Attitudes



How do attitudes and behavior change as people age?  How and under what

specific conditions do the health behaviors, attitudes, beliefs, and

knowledge of older people vary by sex, education, race, or ethnic

background?  How do they vary from one type of society to another?  Or

from one cohort to another as society changes?



How are particular health behaviors and attitudes of older people

derived from cultural explanations of symptoms?  From popular

stereotypes of inevitable aging decline?  From their earlier illness

experience?  From their intuitive models of their own bodily

functioning?  From the mass media?



How do social conditions and social relationships at work, in the

family, and in the community influence the development and maintenance

of health behaviors and attitudes as people grow older?



o  Relation between Health Attitudes and Behaviors



How do older people's beliefs about the nature of particular illnesses

affect the preventive behaviors in which they engage?  How do self

assessments of their health affect their behavioral functioning in

activities of daily life?



How and to what extent can awareness of healthful practices be

converted into sustained health behaviors?



How do older people's use of self care and reliance on family or

significant others increase or reduce their demand for formal health

care services?



o  Linkages between Health Behaviors and Attitudes and Health-related

Outcomes



What psychological mechanisms (e.g., self-esteem, sense of personal

control, forms of coping) link particular health behaviors and

attitudes to functional health or disease outcomes in old age?



What biological mechanisms and age-related changes (e.g., in neural,

immunological, endocrine, and other physiological systems) link

particular health behaviors and attitudes to functioning health or

disease outcomes in old age?



What social and behavioral interventions can increase older people's

health promoting attitudes and behaviors and improve their health and

functioning?



o  Methodological issues



What measures of health behaviors and attitudes can be devised to

improve predictions of health outcomes of older patients?  How well do

behavioral measures, as compared with conventional biological

indicators, predict health outcomes?  How can measures of health

quality of life be adapted for use in cognitively or physically ill

older populations?



How can multivariate methods of longitudinal and cohort analysis be

used to study age-related changes and stabilities in health attitudes

and behaviors as they relate to health outcomes?



How can methods currently used in other areas of behavioral research

(e.g., in communications research or operant conditioning) be adapted

for modifying older people's health behaviors and attitudes?



STUDY POPULATIONS



SPECIAL INSTRUCTIONS TO APPLICANTS REGARDING IMPLEMENTATION OF NIH

POLICIES CONCERNING INCLUSION OF WOMEN AND MINORITIES IN CLINICAL

RESEARCH STUDY POPULATIONS



NIH policy is that applicants for NIH clinical research grants and

cooperative agreements are required to include minorities and women in

study populations so that research findings can be of benefit to all

persons at risk of the disease, disorder or condition under study;

special emphasis must be placed on the need for inclusion of minorities

and women in studies of diseases, disorders and conditions which

disproportionately affect them.  This policy is intended to apply to

males and females of all ages.  If women or minorities are excluded or

inadequately represented in clinical research, particularly in proposed

population-based studies, a clear compelling rationale must be

provided.



The composition of the proposed study population must be described in

terms of gender and racial/ethnic group.  In addition, gender and

racial/ethnic issues should be addressed in developing a research

design and sample size appropriate for the scientific objectives of the

study.  This information must be included in the form PHS 398 in

Sections 1-4 of the Research Plan AND summarized in Section 5, Human

Subjects.  Applicants are urged to assess carefully the feasibility of

including the broadest possible representation of minority groups.

However, NIH recognizes that it may not be feasible or appropriate in

all research projects to include representation of the full array of

United States racial/ethnic minority populations (i.e., Native

Americans (including American Indians or Alaskan Natives),

Asian/Pacific Islanders, Blacks, Hispanics).  The rationale for studies

on single minority population groups must be provided.



For the purpose of this policy, clinical research is defined as human

biomedical and behavioral studies of etiology, epidemiology, prevention

(and preventive strategies), diagnosis, or treatment of diseases,

disorders or conditions, including but not limited to clinical trials.



The usual NIH policies concerning research on human subjects also

apply.  Basic research or clinical studies in which human tissues

cannot be identified or linked to individuals are excluded.  However,

every effort should be made to include human tissues from women and

racial/ethnic minorities when it is important to apply the results of

the study broadly, and this should be addressed by applicants.



For foreign awards, the policy on inclusion of women applies fully;

since the definition of minority differs in other countries, the

applicant must discuss the relevance of research involving foreign

population groups to the United States' populations, including

minorities.



If the required information is not contained within the application,

the review will be deferred until the information is provided.



Peer reviewers will address specifically whether the research plan in

the application conforms to these policies.  If the representation of

women or minorities in a study design is inadequate to answer the

scientific question(s) addressed AND the justification for the selected

study population is inadequate, it will be considered a scientific

weakness or deficiency in the study design and will be reflected in

assigning the priority score to the application.



All applications for clinical research submitted to NIH are required to

address these policies.  NIH funding components will not award grants

or cooperative agreements that do not comply with these policies.



APPLICATION PROCEDURES



Applicants are to use the research grant application form PHS 398 (rev.

9/91) for research project grants and PHS 416-1 (rev. 10/91) for

Individual Fellowships.  Applications are available at most

institutional offices of sponsored research and from the Office of

Grants Inquiries, Division of Research Grants, National Institutes of

Health, Westwood Building, Room 240, Bethesda, MD 20892, telephone

301-496-7441.  Complete item 2a on the face page of the application

indicating that the application is in response to this announcement and

print (next to the checked box) Psychosocial Geriatrics Research:

Health Behaviors and Aging.



Five legible copies and the original must be mailed when using the PHS

398 application.  The original and two legible copies must be mailed

when using the PHS 416-1 application.  The original and all copies must

be mailed to:



Division of Research Grants

National Institutes of Health

Westwood Building, Room 240

Bethesda, MD  20892**



REVIEW CONSIDERATIONS



Applications will be assigned to the appropriate group for initial

review in accordance with the usual PHS peer review procedures.  The

review criteria are the traditional considerations underlying

scientific merit.  Applications will be reviewed for scientific and

technical merit by an appropriate initial review group; second-level

review will be by the appropriate national advisory council.

Second-level review of individual fellowship applications will be

conducted by the appropriate Institute Executive Group.  Applications

compete on the basis of scientific merit.



AWARD CRITERIA



Applications will compete for available funds with all other approved

applications assigned to the NIA.  The following will be considered in

making funding decisions:



o  Quality of the proposed project as determined by peer review

o  Availability of funds

o  Program balance among research areas of the announcement



INQUIRIES



The opportunity to clarify any issues or questions from potential

applicants is welcome.



Direct inquiries regarding programmatic issues to:



Dr. Marcia G. Ory

Behavioral And Social Research Program

National Institute on Aging

Gateway Building, Room 2C234

Bethesda, MD  20892

Telephone:  (301) 496-3136



Other Interests in This Research Area



Other PHS institutes and agencies are also interested in research

dealing with health-related behaviors and attitudes of older adults,

their families, and significant others, that can affect health and

functioning as people grow older, including the Agency for Health Care

Policy Research, the National Center for Nursing Research, the National

Institute of Mental Health, and the General Clinical Research Centers

Program (GCRC).



The GCRC Program supports inpatient and outpatient research facilities,

along with specially trained research nurses, research dietitians and

other paraprofessionals to host medical research, including research on

behavioral aspects of aging.  Additionally, most GCRCs are equipped

with computerized data management capabilities, as well as with

biostatisticians.  Applicants from institutions that have a GCRC funded

by the NIH National Center for Research Resources may wish to identify

the GCRC as a resource for conducting the proposed research.  If so, a

letter of agreement from either the GCRC program director or Principal

Investigator could be included with the application.



Direct inquiries regarding fiscal matters to:



Ms. Linda Whipp

Grants Management Office

National Institute on Aging

Gateway Building, Room 2N212

Bethesda, MD  20892

Telephone:  (301) 496-1472



AUTHORITY AND REGULATIONS



This program is described in the Catalog of Federal Domestic Assistance

No. 93.866, Aging Research.  Awards are made under authorization of the

Public Health Service Act, Title IV, Part A (Public Law 78-410, as

amended by Public Law 99-158, 42 USC 241 and 285) and administered

under PHS grants policies and Federal Regulations 42 CFR 52 and 45 CFR

Part 74.  This program is not subject to the intergovernmental review

requirements of Executive Order 12372 or Health Systems Agency review.



References



Background readings useful for exploring this area of psychosocial

geriatrics research include the following:



Ory, MG, Abeles, RP, and Lipman, PD. (Eds.) 1992. Aging, Health, and

Behavior. Newbury Park, CA: Sage Publication, Inc.



Riley, MW, Matarazzo, JD, and Baum, A. (Eds.) 1987. Perspectives in

Behavioral Medicine: The Aging Dimension. Hillandale, NJ: Lawrence

Erlbaum.



U. S. Department of Health and Human Services. 1990. Promoting

Health/Preventing Disease: Year 2000 Objectives for the Nation.

Washington, DC: Government Printing Office.



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