Healthy Aging: Optimizing Physical and Mental Functioning Across the Aging Continuum -- Cycle 3 2021

This Targeted PCORI Funding Announcement seeks to fund high-quality, comparative effectiveness research (CER) projects that focus on optimizing physical and mental functioning for community-dwelling older adults and their caregivers.

Research Initiative Highlights 

By 2060, the number of Americans over 65 is projected to reach around 95 million, making up almost a quarter of the US population. The number of people of color among the older adult population is also projected to increase significantly. Many older adults live with multiple chronic conditions with a disproportionately greater burden experienced by people of color. Most older adults, including those with multiple chronic conditions, prefer to stay in their homes and communities for as long as they can, a concept referred to as “aging in place.” Family members or close friends often serve as the primary caregiver to older adults and play a critical role in helping them age in place by directly addressing their care needs and helping them navigate a fragmented healthcare system. As the needs of older adults become more complex, the caregiving role also intensifies, often resulting in a detrimental impact on caregiver well-being. Currently, the healthcare system is not well-equipped to address these complex care needs of the rapidly growing and diverse older adult population in the United States.

The Healthy Aging Targeted PFA will solicit applications for CER studies that focus on different phases of the aging continuum and aim to achieve one or more of the following four goals:

• Maintaining function and independence
• Facilitating chronic disease management
• Supporting individuals with significant functional impairment  
• Reducing caregiving burden and improving quality of life

The different phases of the aging continuum include on the one end, the healthiest older adults who have no chronic conditions, followed by those who may have one or two well-managed conditions. Their main goal is to maintain function and independence. Next on the continuum are older adults with chronic or multiple chronic conditions whose primary health focus is to manage them and slow or reverse progression, followed by those with significant functional impairment (physical and/or cognitive), who are at higher risk for adverse events, require more support, and are likely to have higher healthcare utilization and expenditures. Finally, at the other end of the continuum are seriously ill older adults who may need end-of-life care. Applications may focus on populations in different phases of the aging continuum except for those at the two extremes, i.e., the healthiest of older adults with no chronic health condition and those who require end-of-life care.

Applications focused on the needs of underserved, underrepresented, or historically excluded populations will be encouraged. Interventions may be delivered in primary and specialty care clinics as well as in home and community-based settings (e.g., assisted living, senior housing and retirement communities, adult day care programs). Applications evaluating interventions delivered primarily in institutional settings such as hospitals and nursing homes will be considered nonresponsive to the funding announcement. Applicants will be strongly encouraged to propose individual, or cluster randomized controlled trials, however, well-specified natural experiments will also be considered. Applicants will be asked to pay special attention to issues of intervention implementation with an aim of facilitating widespread uptake of findings after completion of the study. Toward that end, hybrid type I and hybrid type II designs may also be considered appropriate. Applicants will be asked to propose well-justified outcomes that are clinically meaningful and considered important by patients and/or their caregivers and can be impacted upon by interventions evaluated in CER studies of a maximum duration of five years