The description below was taken from the R01 version of this FOA.
This FOA invites applications for basic research to better characterize the affective, cognitive, social, and motivational parameters of impaired and intact decision making in both normal aging and Alzheimer’s disease (AD). The FOA also invites applications to apply basic research on the processes involved in decision-making to the design of decision-supportive interventions for midlife and older adults with and without AD. Applications should demonstrate either relevance for aging or for age differences or age-related changes in these processes. Aging-relevant applications can address issues of importance to the well-being and health of either mid-life or older adults, and can include data spanning the entire life course.
Longer life expectancy requires longer maintenance of sound decision making from older adults in multiple life domains to support health and independence in old age, even as many experience cognitive decline. Older adults face complex decisions about health care and illness management, planning for end-of-life care, and financial planning to support health and well-being in older age, among other every day decisional challenges. To understand how aging affects the ability to make decisions, it is necessary to understand basic psychological processes involved, including the social and emotional motivations for decisions. When these capacities are compromised, either as a function of normal aging – or in the more severe cases of mild cognitive impairment and Alzheimer’s disease – 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. Cognitive impairment associated with AD may exacerbate this risk. Notably, the 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.
For the past decade, NIA has been supporting research integrating perspectives from psychology, neuroscience, and economics to advance the understanding of cognitive, affective and motivational mechanisms associated with age-related changes in decision-making capabilities and connecting those to health and wellbeing outcomes. A picture is emerging of both strengths and vulnerabilities in various aspects of decision making – ranging from decision-making under risk or ambiguity, inter-temporal choice, value-based learning, and use of heuristics – in older adults. There is evidence that as the cognitive flexibility of youth wanes, older individuals may increasingly draw on expertise, learned heuristics, and emotional maturity to tackle decisions. 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 Alzheimer’s disease, or how AD-specific psychological changes over the progression of the disease interact with those associated with normal psychological aging.
Older age is also associated with both shifts in social goals and changes in social relationships and contexts, which may impact the extent to which interpersonal processes, such as coercion, trust, competition, generativity, and empathy, influence decisions in health and financial domains. Yet, our understanding of how these changes impact decision making in both normal aging and AD remains limited. Individuals with cognitive impairment and AD may have difficulty separating true from potentially exploitative advice offered by 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 effects 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 behavior over the life span, and the extent to which these represent risk or protective factors for normal neurocognitive aging and AD.
This initiative aims to fill both basic and translational research gaps on decision-making in aging and AD. Building on advances in research in judgment and decision-making, decision neuroscience of aging, and research on decisional capacity in at risk elders, this initiative seeks to better characterize the affective, cognitive, social, and motivational parameters of impaired and intact decision making in normal aging and Alzheimer’s disease. Basic research projects should aim to identify or refine our understanding of mechanisms or processes (which may be studied at either the neurobiological, psychological, behavioral, interpersonal, social, institutional or population level) in decision-making in midlife or older age. Basic research on decision-making in Alzheimer’s disease should extend our understanding of the operation of these mechanisms or processes in individuals in early stages of AD and/or identify mechanisms or processes uniquely impacted in AD.
This initiative also encourages the application of basic research on these processes to the design of decision-supportive interventions for midlife and older adults with and without AD. For translational projects, this initiative provides a vehicle for submitting intervention studies at all phases and stages (Stage Model for Behavioral Intervention Development). Translational projects are encouraged that have potential to inform the design of programs and practices that will improve the lives of older people and the capacity of institutions to adapt to societal aging.
Applicants are encouraged to study decision-making processes in diverse populations, including a diversity of educational backgrounds, and to consider the impact on later life decision-making abilities of life histories of decision-making that may differ by gender, race or socioeconomic status.
Basic research opportunities include but are not limited to:
(1) Characterization of the extent to which basic behavioral and neural processes involved in decision making are differentially impacted in normal aging and in the early stages of AD.
(2) Research on the influence of social factors on decision-making in aging and in AD, and research on decision making in health domains, both of which are difficult to study in controlled laboratory settings.
(3) Research on the decision-making factors that render older adults with and without AD vulnerable to financial exploitation and other forms of mistreatment and abuse.
(4) Assessment of the validity of performance on laboratory tasks as predictors of real-world decision-making in normal aging and AD, and research linking poor economic decisions with cognitive health outcomes.
(5) Research on how behavioral and economic phenotypes, socioeconomic status, and especially poverty, influence decision making over the life course, and the extent to which these factors confer vulnerability for late life socioeconomic adversity, poor health, cognitive aging health disparities, and AD risk.
(6) Research using normal aging and AD populations to validate and improve key assumptions of theoretical models of decision making over the life course.
Translational opportunities include but are not limited to:
(1) Development of interventions to leverage cognitive, emotional and motivational strengths to facilitate optimal decision-making across the lifecycle and in various stages of AD progression. Applicants should consider the Stage Model for Behavioral Intervention Development when designing interventions.
(2) Development of tools for assessing decisional capacity across a wide range of clinical and non-clinical contexts.
(3) Strategies for simplifying choices and offering better defaults for health and treatment-related decisions for midlife and older adults, including strategies tailored to individuals in various stages of AD progression.
(4) Leveraging understanding of age-related changes in decision making to promote timely adoption of optimal delegation practices, such as power of attorney, living wills, and advance health and financial directives, particularly related to planning for deficits in cognitive aging and AD.
Deadlines: standard dates apply
- R01 – http://grants.nih.gov/grants/guide/pa-files/PAR-16-448.html
- R21 – http://grants.nih.gov/grants/guide/pa-files/PAR-16-449.html
Filed Under: Funding Opportunities