Department of Health and Human Services
	Research, Demonstration, and Evaluation Activities FY 2003 Plan and Budget February 2002

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RESEARCH AND DEMONSTRATIONS

(by HHS Strategic Plan Objective)

INCREASE THE PROPORTION OF OLDER AMERICANS WHO STAY ACTIVE AND HEALTHY (OBJECTIVE 2.5)

FY 2003 Priorities

ALZHEIMER’S DISEASE DEMONSTRATION GRANTS (AoA)

Demonstrations: Alzheimer’s disease exacts a heavy toll on its victims, their families, and our health care system. Each year new research helps to sharpen the effectiveness of care for people with Alzheimer’s disease. The Alzheimer’s Disease Demonstration Grant program helps states use this research to demonstrate effective models of care for persons with Alzheimer’s disease.

The Alzheimer’s Disease Demonstration Grant program will examine and demonstrate the effectiveness of four primary components:

• development and operation of State Alzheimer’s disease programs in coordination with organizations that provide diagnostic, treatment, care management, respite care, legal counseling, and education services to individuals with Alzheimer’s disease and related disorders.
• provision of home care, personal care, day care, respite care, and companion services.
• provision of information on Alzheimer’s disease services, assistance, and legal matters.
• improve access to home and community based long-term care services for persons with Alzheimer’s disease and their families.

TRAINING, RESEARCH, AND DISCRETIONARY PROJECTS (AoA)

Demonstration: Aging research and demonstration projects are designed to enhance the capacity of state, local, and tribal governments and non-profit private agencies, organizations, and institutions to develop and improve the quality and effectiveness of services and activities for older individuals. AoA will use these funds to:

• develop and synthesize knowledge about aging from multidisciplinary perspectives.
• establish an information base of data and practical experience.
• examine effective models of planning and practice that will improve or enhance services provided under other provisions of the Older Americans Act.
• evaluate the efficacy, quality, efficiency, and accessibility of programs and services for older individuals.
• develop, implement, and evaluate innovative planning and practice strategies to address the needs, concerns, and capabilities of older individuals.

SUPPORTIVE SERVICES - PERFORMANCE OUTCOMES MEASURES PROJECT (AoA)

Evaluation: In FY 2003, AoA will continue to support the development of performance outcome measures that are required for the ongoing assessment of AoA programs by the Government Performance and Results Act and the Older Americans Act in the following ways:

• AoA has made funding available through cooperative agreements with state units on aging which, along with local agencies, will continue the development and implementation of performance outcome measurement projects. AoA will expand this effort to include agreements with Native American tribal organizations to allow for outcome assessment for those program entities as well.
• AoA, the state agencies, and the area and tribal entities will continue to conduct consumer based outcome assessments in the following program domains: nutritional risk, transportation services, physical and social functioning, emotional well being, home-care satisfaction, caregiver support and satisfaction, and information and assistance services.
• AoA will apply the sampling and interview techniques and the information collection instruments developed for state and local use to repeat national surveys of performance outcome measures to ensure compliance with GPRA and the Older Americans Act.

HEALTH SERVICES RESEARCH (NIH)

Research: In FY 2003, NIH funds will be used to support projects that improve our understanding of diseases and other causes of disability among older persons and that develop and test interventions to prevent disease and disability and prolong the independence of older persons. FY 2003 priorities include:

Research supported by the National Institute on Aging (NIA) will focus on:

• enhancing the effectiveness of health promotion, disease prevention, and rehabilitation aimed at substantially reducing premature mortality and morbidity in the elderly.
• preventing falls that can lead to hip fractures, as well as rehabilitation to prevent long- term disability as a result of fractures and examining the cost-effectiveness of the strategies tested.
• improving geriatric evaluation and management.
• identifying conditions and factors that lead to ill health and disability, especially among racial and ethnic minorities, and developing and testing interventions to improve health and functioning.
• improving the coordination, organization, and delivery of health care services for older people, with emphases on home health care, doctor-patient interactions, and care of patients with Alzheimer's disease.
• developing effective resources and approaches to assist caregivers in postponing or preventing institutionalization of frail older persons.
• developing methods to enhance support of the older person, the family, and medical care personnel as they provide humane and life-affirming services at the end of life.
• improving the efficiency and effectiveness of nursing home care, especially as it affects the well being of Alzheimer's disease patients.
• developing and testing of technologies to increase medication compliance and to monitor the safety of older people living alone.
• developing scientifically-based interventions to facilitate prevention and treatment programs for elder abuse and neglect.

In addition, NIA will support research to:

• examine characteristics of different health care structures and delivery systems and their impact on health and functioning in old age.
• examine economic aspects of older people's access to and use of health care, relationship to health, and comparative cross-national analyses of health care needs and services.
• forecast the need for health services and medical treatments in an aging population and to understand patterns of health care utilization by the elderly population.
• strengthen estimates of the burdens and costs of specific diseases as they impact both older individuals and the health services systems that serve them.
• examine the effects of public subsidies on use of long-term care.
• evaluate alternatives to institutionalization, and develop and compare of different systems for managing home care.

The National Institute of Child Health and Human Development (NICHD) will support research to examine adults with arthritis in order to discern: personal and environmental factors leading to disabilities; barriers that inhibit the involvement of arthritis-disabled persons in their communities; and clues about accommodations that can be promoted to help arthritis-disabled persons take a more active role in their communities, thus, improve the quality of their lives.

(This is also related to objective 2.6 - Increase Independence and Quality of Life of Persons with Long-term Care Needs.)