Funded Research

Spread across four broad subject areas, grants are concentrated in: (1) Social Relationships, Living Arrangements, and Family; (2) The Social Context of Aging; (3) Health Care Research; and (4) Biobehavioral Pathways. A discussion of our pilot projects follows a description of these major areas of research grant activity.

Social Relationships, Living Arrangements, and Family
Individuals live in many overlapping social worlds. The most immediate of these is the household--the collectivity formed by persons sharing a dwelling. In middle through early old ages, people live in quite diverse households. A sizeable minority of older persons lives alone. Epidemiological and prospective studies have identified social isolation as a major risk factor for psychological disturbances and for broad-based morbidity and mortality, but the behavioral, psychological, and biological mechanisms responsible for the epidemiological relationship between social isolation and health are not well understood.

John Cacioppo’s Program Project, Social Isolation, Loneliness, Health, and the Aging Process, comprises three projects, each focused on a different level of the process through which loneliness and social isolation are produced and through which they affect health among older adults. Project 1 (Cacioppo, PI) uses a longitudinal design in older adults to examine the temporal stability of loneliness, the predictors of the experience of loneliness, and the physiological (e.g., autonomic) and behavioral (e.g., health behaviors, sleep) effects associated with loneliness. Project 2 (Waite, PI) uses data from the Health and Retirement Survey and linked Medicare claims data to examine the origins and consequences of loneliness and stress in the social environment. Project 3 (McClintock, PI) is an animal model of vulnerability to social isolation and disruption as an individual trait, identifying the specific hormonal and immunological sequelae that increase risk for infectious and malignant disease during aging. Ronald Thisted (Health Studies) directs the Statistical Core of this Program Project.

Several active projects at Chicago focus on social relationships, living arrangements, and family. A new project, headed by a research team that includes a demographer, two physicians, a sociologist, and a statistician (Waite, Levinson, Lindau, Laumann, and O’Muircheartaigh), The National Social Life, Health, and Aging Project, will explore health and well-being in American men and women age 57 to 84. The centerpiece of the project is a longitudinal, nationally representative in-home survey of 3,000 non-institutionalized people, and it builds directly on three ongoing projects: Chinese Health and Family Behavior (Parish and Laumann), The Social Underpinnings of Risky Sexual Behavior (Laumann), and Socio-Cultural Effects of Aging and Gender on Sexual Dysfunction (Laumann).

Finally, Gary S. Becker has submitted an R01 application to NIH for a project on the connection between below-replacement fertility, economic growth, and population change, especially the increase in the proportion of the population that is aged. Donald J. Bogue just successfully competed for supplemental funds through the Center on Aging for a small grant to experiment with making forecasts for the future size and socioeconomic status of live-alone and family-less elderly persons, sub-classified by sex, race-ethnicity, sex, age, and socioeconomic status. And we have two researchers who have written and been awarded independent postdoctoral fellowships through the Center on Aging, Cynthia Peters and Lianne Kurina. Peters’ project uses the Health and Retirement Study to examine predictors of mild cognitive impairment and cognitive decline, with a focus on social networks. She is funded by NIA. Kurina’s project uses the Health and Retirement Study to examine predictors of depression, especially spousal depressive symptoms and family characteristics. This project is funded by NIMH. Both Peters and Kurina are mentored by Linda Waite.

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The Social Context of Aging--Socioeconomic Status, Race and Ethnicity, and Communities
A long research tradition has focused on social characteristics, such as gender and race, as risk factors for health decline in old age. While much research has addressed this area, there are still gaps in basic knowledge of the demography of aging in some groups, in particular the relatively new and rapidly growing immigrant populations. Diane Lauderdale’s study Death Rates and Death Data for Asian American Elderly analyzes the mortality experience of Asian American elderly, avoiding the problem of combining numerator data for death rates from death certificates with denominator data from the decennial census by using a single data source with consistent ethnic identification for both numerator and denominator (Social Security files). This project further asks whether death rates, cause of death, and death certificate data quality vary by Asian ethnic group and by nativity. To carry out this project, distinctive surname and given name lists were empirically developed; these lists have had wide application during the past three years in data sources lacking ethnic information (or with incomplete information), such as cancer registries and voter roles.

One of the centerpieces of the Center on Aging at Chicago is the Union Army Project, formally titled Early Indicators of Later Work Levels, Disease, and Death, directed by Robert Fogel. This project recently received its third competitive renewal, with funding in place through 2006. The completed life-cycle Union Army data set is based on 35,570 men out of a randomly drawn sample of 39,616 males who were mustered into the Union Army from 1861 to 1865. Socioeconomic and biomedical histories of the recruits from childhood to death have been created by linking together information from different sources. This Program Project investigates the impact of socioeconomic and biomedical insults during developmental, middle-life, and older ages on the onset of specific chronic diseases at middle and late ages, on the capacity to work during these ages, on the demand for retirement, and on waiting time to death from specific causes. It will chart the way in which these life-cycle interactions have changed with successive cohorts that reached age 65 during the twentieth century, and the way in which these life-cycle interactions have changed for different races and different socioeconomic groups. It examines the impact of familial factors (environmental and genetic elements taken together) on mortality, health in later life, and exceptional longevity, and will estimate what types of public health interventions have been most effective in lowering mortality rates and improving health.

In the current competitive renewal, the Union Army project expands the range of biomedical and socioeconomic factors that can be considered in the life-cycle Union Army data set by linking it to the 1880 census, which provides health information, and by linking it to data on the epidemiological characteristics of cities and of wards in the late 1800s and early 1900s. In the current funding period the project will create two new life-cycle samples, one for black Union Army veterans and one for men rejected for service from the Union Army. These two data sets will permit the researchers to examine populations not represented in the life-cycle Union Army data set; the first sample will permit the detailed consideration of racial differences in the aging process.

Recent conceptualizations of the social processes surrounding health have emphasized the role of social environment in addition to individual demographic characteristics. These frameworks suggest that the development of health problems with age is critically dependent upon interactions between the individual and his or her social surroundings. The capacity of communities to bolster and sustain the well-being of individual residents is particularly salient for older adults; their daily activities are likely dependent on the infrastructure and social resources of their communities, particularly if health is already compromised. Although it has long been believed that the neighborhood one lives in affects one’s health, it has been difficult to delineate why, and under what circumstances, neighborhood context contributes to health. A project just funded by NIA, Neighborhood Context and the Health of Older Adults, headed by Kate Cagney, brings an important new sociological concept, collective efficacy, to bear on the study of neighborhood and the health of older persons. The project addresses the following questions: 1) Are structural features of urban neighborhoods--concentrated poverty, concentrated affluence, residential stability, ethnic heterogeneity, and age structure--associated with the health status of older residents?; 2) Are neighborhood social processes--collective efficacy, social networks, social norms, and physical/social disorder--associated with the health of older residents?; 3) Is the health services infrastructure of the neighborhood associated with the health of older residents?; and 4) Does the health of older residents affect the ability of the community to sustain social networks and develop collective efficacy? This project combines perspectives from sociology and health services research; it bridges these disciplines to formulate research that addresses a set of questions vital to both fields and to aging-related health and social policy.

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Health Care Research
The organization, costs, and quality of medical care all influence health trajectories and health outcomes for the elderly. Marshall Chin’s projects Improving Diabetes Care Collaboratively in the Community and Outcomes, Incentives, and Improvements in Collaboratives seek to improve and evaluate the quality of chronic disease management for the indigent elderly served by federally funded health centers, and thus reduce health disparities. David Meltzer’s project A Multi-Center Trial of Academic Hospitalists measures and analyzes the effects of hospitalists (physicians specializing in inpatient care) on quality of care, costs, and medical education among the general medicine services of six academic medical centers. Naoko Muramatsu’s project State Long Term Care Policies and Elderly Well-Being investigates how trajectories of long term care use and well-being among elderly persons vary as a function of state level policies and across cohorts.

Meltzer’s project Cost-Effectiveness of Prostate Cancer determines the effectiveness, costs, and cost-effectiveness of prostate cancer screening and treatment using an innovative model that captures a range of important aspects of the disease that have been neglected by previous cost-effectiveness analyses, and assesses how the effects and cost-effectiveness of screening and treatment at different ages will be altered by the declines in mortality from other causes of death that are expected to occur over the next several decades. David Meltzer and Elbert Huang's project on self-selection and cost-effectiveness in diabetes examines how patient choice in the context of heterogeneous preferences affects the cost-effectiveness of treatments for diabetes.

For older patients, communication with providers is a key determinant of satisfaction with care and of outcomes. Marshall Chin’s project Treatment Preferences of Older Patients with Diabetes assesses older patients' preferences regarding the aggressiveness of their diabetes treatment and determines the concordance between their preferences and physicians' preferences regarding the aggressiveness of diabetes care, as well as with actual treatment style. Wendy Levinson’s project Informed Decision Making in Older Patients and Surgeons observes and analyzes communication skills of practicing orthopedic surgeons during routine office visits with their elderly patients, surgeons’ attitudes toward older patients, participatory decision-making, and fear of litigation.

Public and private medical insurance are also key determinants of health for older persons. Edward Lawlor’s new book, Redesigning the Medicare Contract: Politics, Markets, and Agency (2003), argues that most debates on Medicare reform have focused on the wrong issues, not recognizing realities such as the vulnerability of beneficiaries, the complexity of the program itself, and geographical variation in services and financing. He argues that we consider the agency of the program--the informational, organizational, and incentive elements that assure Medicare provides the most appropriate, high-quality care possible. A number of economists at Chicago attempt to understand theoretically and measure empirically the larger institutional or market context. Townsend is focusing in particular on the role of family in providing insurance and credit to its members, that is, help in times of stress and help with small business and other investments. More theoretically related work is that of Pierre-André Chiappori on French life and automobile insurance markets, scrutinizing empirically whether there is adverse selection in insurance markets among a menu of contracts over and above the measured variables which insurance companies have available to them. It is often said that formal, “outside” institutions like insurance companies do not have the information about their clients to which family members and kinship groups have access. It is thus surprising if the choice of insurance contracts by individuals can be predicted by information to which insurance companies do have access. Helen Levy examines the economic consequences for individuals of being uninsured.

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Biobehavioral Pathways
An important new research area at the University of Chicago is the study of the psychological and physiological mechanisms that may underlie the strong associations between social and economic factors and health outcomes. Multidisciplinary teams are key to developing innovative projects in this area. The University of Chicago is well situated to carry out research in this area not only because of a strong interdisciplinary tradition but also quite simply because it is a compact urban campus, where demographers and social, biomedical, and behavioral scientists are all within a few minutes walk of each other. These projects include state-of-the-art assessments in the lab of biobehavioral processes as well as biomarker data that can be collected in the home. We briefly describe our three major NIA-funded efforts in this area, which include two program projects and a new national survey.

Cacioppo’s program project on loneliness includes several biological measures of specific pre-disease pathways. These include cardiovascular measures (e.g. blood pressure, cholesterol, homocysteine, total peripheral resistance, and cardiac output), measures of pulmonary function, stress hormones (e.g. urinary cortisol and catecholamines), immune function (e.g. EBV), and HPA activity (e.g. salivary cortisol).

Van Cauter’s program project Alterations of Circadian Timing in Sleep and Aging uses a multi-disciplinary approach, combining epidemiology, clinical research, in vivo studies in laboratory rodents, and molecular genetic analyses to test whether chronic partial sleep loss has adverse effects on biomarkers of aging and increases the risk of obesity and diabetes. Persons in the U.S. are subjectively reporting fewer and fewer hours of sleep since 1980, and Van Cauter’s previous work has shown in the sleep lab that there are metabolic and immunologic consequences of reduced sleep hours. Project 1 (led by Lauderdale) is an epidemiologic project which adds in-home wrist actigraphy (a non-intrusive objective measurement of sleep duration and fragmentation) to an on-going NHLBI-funded cardiovascular cohort (CARDIA cohort participants at the Northwestern University site) to examine both the social and economic determinants of sleep quantity and also whether sleep quantity predicts weight gain and diabetic risk over the course of five years. Other projects in the program project carry out complimentary analyses in the sleep lab, intensively monitoring how controlled sleep duration affects appetite and metabolic function. In another project, Extended Work Schedule and Health: Role of Sleep Loss, Van Cauter examines in the sleep lab whether reduced sleep hours and circadian maladaptation, typically experienced by persons with extended and shift work hours, affect glucose tolerance, neuroendocrine profiles, cardiovascular function, and neurobehavioral parameters.

NSHAP (National Social Life, Health, and Aging Project) is an in-home survey of 3,000 persons aged 57 to 84 that will collect biomarkers of health and physiological functioning to better characterize the health of survey participants, as described in detail in Social Relationships, Living Arrangements, and Family above. In addition, McClintock proposes an ancillary (pilot funded) study to NSHAP which would be the first assessment of olfactory function carried out in a demographic survey. Olfactory deficits are among the early manifestations of depression, cognitive decline, and Alzheimer disease. This data collection would allow the analysis of how smell and sensitivity to a human pheromone are associated with aging, sexuality, and health in a population-based sample.

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Pilot Projects
We regard the pilot project program as the most important single function of the Center on Aging. The availability of funds for projects that are just beginning to take shape, available quickly, and requiring a short proposal, has attracted outstanding researchers, both new and established, to aging topics by lowering the start-up costs. The program has been a strongly positive factor in the growth of research on aging at Chicago. This program has had a high demand for funding, an innovative and exciting list of projects, and a very high rate of submission of grant applications. The number of funded projects that has grown out of the pilot project program, even at this point, is quite impressive. From 1999-2003, we awarded 19 pilot projects to 22 different researchers. There have been 16 grant submissions during the past four years which drew on pilot data (some of the pilot data were collected during the prior funding cycle). Eleven have been funded (10 by NIH) and five are pending, in revision, or in preparation.

Some of the pilot projects also served as small-scale studies, yielding presentations and publications, in addition to providing pilot and feasibility evidence for subsequent grant proposals for larger endeavors. There have been at least a dozen journal publications (some in press) that drew on work carried out in the pilot projects. There have also been a few books: Nicholas Christakis’s Death Foretold, S. Jay Olshansky and Bruce Carnes’s The Quest for Immortality: Science at the Frontiers of Aging (2001), and Sarah Harper’s The Family in an Ageing Society (2003).

Note also that a number of the current funded projects (and projects which were supporting research during the past four years but are now completed) were supported by pilot projects from the Center on Aging during the first five-year funding cycle (1994-1999). These include the Waite/Hughes project in the Cacioppo P01 (The Social Environment, Loneliness, Stress, and Health), Cagney’s completed project, supported by the R03, Education, Wealth, and Cognitive Decline in Later Life, Tomas Philipson’s completed project, supported by R01 Old Age Longevity and the Market for Long Term Care, and Leonid Gavrilov’s K02, The Biodemography of Human Longevity.

It is also important to point out that some pilot projects lead to successful applications that moved with an investigator to another institution. These include an R01 that Nicholas Christakis, now at Harvard Medical School and a collaborator on the Waite/Hughes project, developed using pilot project funds from the Center on Aging, Olshansky’s K02 on The Biodemography of Aging, and Carnes’s K02 on The Biodemography of Genetic Diseases. Although these researchers are no longer at the University of Chicago, they continue to work in the demography and economics of aging on projects begun here with pilot projects from the Center on Aging. All these researchers maintain active collaborations with colleagues at Chicago. In addition, both Mark Duggan (now at Maryland) and Tom DeLeire (now at the Kennedy School) received funding for proposals submitted from pilot work.

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