Understanding the well-being of older, community-dwelling Americans

NSHAP receives $20 million grant to continue vital research into the health and welfare of older Americans.

Earlier this year, Linda Waite, the Lucy Flower Professor in Urban Sociology in the Department of Comparative Human Development, received exciting news. The National Social Life, Health, and Aging Project (NSHAP), over which she is the principal investigator, was awarded a $20 million grant from the National Institute on Aging (NIA) to support a fourth wave of research into the lives of older Americans. “It was 100 percent of what we asked for,” marvels Waite. “That never happens.”

The funding is testament to the value of data emerging from NSHAP, a longitudinal, population-based study of health and social factors of Americans 59 years old and older. Principal investigators at the University of Chicago conducted the first wave of NSHAP in 2005 through NORC, the university’s independent, non-partisan research institution. Since then, two more waves have been conducted, with the next wave set to launch in 2019. All of the data is publicly availableat the NSHAP website.

Many of the interviews have tracked the same cohort of individuals through all three iterations of the research, producing valuable insights into the evolution of their behavior and abilities over time. “The data explores social participation and how that changes with age,” Waite says, noting that policy makers, health providers, and individual researchers regularly reference the NSHAP results in policies and studies of health and relationships among older people.

Sex and marriage

The research gets a lot of publicity for its insights into relationships and sexuality among older adults. “We have found that a lot of people have active sex lives through the age of 80,” says Waite, whose research interests focus on the link between biology, psychology and the social world. The data also shows that having an active sex life – or not – doesn’t affect whether couples rate their relationship as positive or negative, she says.

NSHAP results have been cited in dozens of studies and articles on the sex lives of older people, including a 2007 piece in the New England Journal of Medicine highlighting the frequency of sexual activity among older Americans; and a 2014 article in the Journals of Gerontology on the prevalence of bacterial vaginosis and candida among postmenopausal women.

However the research goes well beyond sexuality. Through thousands of interviews, bio measure collections, and self-administered questionnaires, the research delves into the complex interactions between physical health and illness, medication use, cognitive function, emotional health, sensory function, health behaviors, social connectedness, and relationship quality. “We are capturing information on things that no one has ever collected before,” Waite says. From tracking sleep and communication patterns among couples to find links between social and health outcomes, to studying the impact of pollution on olfactory declines and mobility issues, the broad reach and collaborative nature of this research has huge implications for understanding health and wellness trends in older Americans.

Alzheimer’s and sense of smell

One of the most valuable elements of the study is its interdisciplinary approach, says Dr. Jayant Pinto MD, an NSHAP investigator and otolaryngologist who studies sino-nasal and other airway disorders at UChicago Medical Center. Pinto became involved with NSHAP in 2010 because he was interested in olfactory issues in older patients. He asked Waite if he could participate in the next wave of research, and she welcomed him to the team. “I was impressed that she would take in a junior researcher,” he says.

Pinto is now one of a group of researchers using NSHAP to study sensory function and aging and its links to other social and medical issues. The team also includes experts in psychology, sociology, geriatrics, internal medicine, mobility, environmental issues, and public policy. “The depth and breadth of the people involved is remarkable,” Pinto says. “It’s unusual compared to research conducted elsewhere.”

Pinto’s work on NSHAP focuses on the sense of smell and how it declines with age. He is partnering with other researchers studying frailty, mobility, and community trends to find connections between sensory decline and physical activity in an effort to determine whether it is predictive of five year health outcomes.

Professor of Sociology Kate Cagney, who directs the Population Research Center, is one of those researchers. Cagney’s role in NSHAP is to provide context to the social and biological survey measures by introducing relevant external data (e.g., the census) related to the economy, the housing market, and other global trends. Like Pinto, she believes the multidisciplinary nature of NSHAP is part of what makes the study so exciting. “One of the things I love about UChicago is the curiosity to work at the margins,” she says. “Reaching across the disciplines in order to see another perspective is very much part of the UChicago way.”

In past waves of the study, for example, she combined NSHAP results and census data in a paper to examine the increase of depressive symptomology during the foreclosure crisis; and she is currently working with Pinto to study the impact of neighborhoods on olfactory issues. Their combined research suggests that African Americans are more likely to have olfactory declines than their white counterparts, and that neighborhood context may play a role. “It’s fascinating research, especially when you consider how close the olfactory bulb is to the brain,” Cagney says.

The fourth wave

The sensory data captured in past waves also suggests that olfactory declines may be a leading indicator of dementia and the onset of Alzheimer’s Disease among aging adults. As part of the study, participants were asked to identify five scents. Looking at sensory declines over time, Pinto found that within five years, virtually all of the subjects who were unable to identify any of the scents had been diagnosed with dementia; and nearly 80 percent of those who could identify one or two had dementia. “Testing sense of smell could help identify people at risk of developing dementia,” he says.

These results are one of the reasons the current wave of research won its full funding, says Waite. The grant was approved through NIA which is distributing significant funds to support the National Plan to Address Alzheimer’s Disease objectives. 

Now the NSHAP team is considering how to use the funding to generate the most valuable and comprehensive data from this fourth wave of research. Getting full funding means they can leverage cutting edge cognitive and clinical measurement tools, along with behavioral interviews, and longitudinal reviews of past NSHAP data to generate new insights, Waite says. “It is going to make a big difference."