This burden is even greater in rural areas, where 31.4% of older adults report chronic pain, compared to 20.5% in large metropolitan areas7. These physical challenges intersect with social factors. Isolation and loneliness increase the risk of dementia and other serious health problems8. Pitt Public Health in Action
At the University of Pittsburgh School of Public Health, the mission to promote healthful aging is more than a vision—it's an active, ongoing commitment. Through a robust portfolio of research, education, and community engagement, Pitt Public Health is tackling the multifaceted challenges of aging head-on. The following studies exemplify how faculty and students are advancing science across the continuum, from basic biology to population-level interventions—to improve the lives of older adults.
Basic Research in Aging
Neurodevelopmental and Neurodegenerative Effects of Environmental Determinants
"Pitt Public Health has allowed me to build a collaborative, diverse, and dedicated team that permits us to work across different disciplines, which is crucial for breakthroughs.
Alone I can do so little, but together I have hope for a future of diverse Alzheimer's disease treatments," said Nicholas Fitz, PhD, principal investigator and faculty member in the Department of Environmental and Occupational Health.
As an example of basic science, Fitz's research focuses on determining how exogenous environmental factors induce complex pathophysiological mechanisms in different types of neuroglial cells through genomic changes, altering healthy brain aging, neuroglia bioenergetics and neuroinflammation. Environmental arsenic (As) is at the top of the list of toxic substances threatening human health and can easily enter and accumulate in the brain. Low-level As in water as been associated with poor global cognition in children and adults an induces epigenetic changes.
Specifically, Fitz will determine how As exposure in water impacts: (1) epigenetic and transcriptional alterations of distinct neural populations (neurons, microglia, astrocytes) during aging; (2) glial response to AD-related neurodegeneration; (3) changes in bioenergetics and lipid transport in preclinical models.
Preliminary results suggest that at a low-level of As, the body limits the normal functions of astrocytes and microglia, special brain cells that regulate normal functions of astrocytes and microglia, special brain cells that regulate normal brain functioning. The changes in these cells as a result of exposure to As look similar to those observed in AD. According to Fitz, this research is very innovative because it will identify changes down to the single-cell level to help discover how exposures to toxic substances might increase our risk for AD or other neurodegenerative diseases. By defining these processes, we can subsequently determine how our results can drive therapeutic breakthroughs or novel biomarker discovery for a personalized medicine approach.
Environmental arsenic (As) is at the top of the list of toxic substances threatening human health and can easily enter and accumulate in the brain.
Clinical Research in Aging
Non-Fracture Fall Injuries and Long-Term Geriatric Consequences in Older Women and Men from a Cross-Cohort Study
Aging is accompanied by changes in the musculoskeletal system, including loss in muscle and bone. Through surprisingly, longitudinal studies that examine muscle mass and function with age-related changes in bone loss are rare. Osteoporosis occurs with age as a consequence of bone loss, and is a skeletal disorder characterized by low bone strength and higher risk of fracture. Low bone mineral density (BMD) is a risk factor for fracture in both men and women and is predictive of fracture throughout old age. However, most fractures occur in individuals without osteoporosis and current approaches to measure BMD, such as dual-energy x-ray absorptiometry (DXA), are insufficient to accurately determine the risk of fractures at older age. This study is using a novel way to measure volumetric BMD (vBMD), bone microarchitecture, and strength to more accurately predict the risk of fractures.
Muscle and bone are interrelated tissues, though how they impact each other in aging is unclear. The "mechanostat theory" proposes that bone adapts its
morphology and strength to long-term loads exerted by muscle contraction. However, the interaction between muscle and bone is much more complex than portrayed by the mechanostat theory. Muscle and bone have been shown to function as secretory endocrine organs to regulate each other in bidirectional muscle-bone signaling.
For example, myokines are produced and released by muscle fibers and communicate with muscle and bone. To date, many findings from the basic science of muscle signaling to bone have not yet been extended to human populations. Our goal is to build on early studies in aging populations to provide more robust evidence of muscle-bone crosstalk in contributing to bone density, microarchitecture and strength, as these are predictors of fracture.
"This project will establish for the first time the novel muscle predictors for longitudinal changes in volumetric BMD, bone microarchitecture and strength," said Elsa Strotmeyer, PhD, MPH, who co-leads this study with Jane Cauley, DrPH. >>See Skeleton Keys for a closer look at Cauley's career "These bone parameters predict future fractures and, therefore, our findings have potential implications for fracture prevention targeting muscle measures that may potentially improve bone health."
This project will establish for the first time the novel muscle predictors for longitudinal changes in volumetric BMD, bone microarchitecture and strength."
Elsa Strotmeyer
Population Research in Aging
The Study of Women's Health Across the Nation (SWAN): The Impact of Midlife and the Menopause Transition on Health and Functioning in Early Old Age
Early old age (ages 66-75 years) is a pivotal time of transition into old age, when adverse changes in health and functioning begin to accumulate. Prevention or delay of adverse outcomes is particularly relevant to women because women have a higher life expectancy than men (81.2 versus 76.3 years) and experience a disproportionate burden of chronic conditions and disability in late adulthood, including a higher prevalence of depression, Alzheimer's disease, cardiovascular disease, greater risk of falls and fractures, and greater need for assistance with activities. SWAN, a 20-year aging health study, rigorously assessed menopause timing, symptoms and patterns of hormone changes across midlife, a critical period for women's health.
"Uncovering the sources of the female-centric burden of disease and disability is critical to improving quality of life and well-being in older Americans,"
says Maria Mori Brooks, PhD, principal investigator of SWAN.
SWAN has documented accelerated increases in total and low-density lipoproteins cholesterol, subclinical atherosclerosis, vascular stiffness, fat mass, inflammation, risk of depressive symptoms and accelerated declines in bone mineral density and lean mass around the time of the final menstrual period. This suggests a distinct role of menopause beyond that of aging alone. 
Health and function in older age are influenced by multiple factors. For example, persistent insomnia was also associated with risk of cardiovascular events. In SWAN, fewer than 25% of midlife women meet ideal cardiovascular health standards, with poor glucose control, elevated blood pressure and nicotine exposure driving much of the risk. SWAN created a risk score demonstrating that depression, obesity, smoking, cardiovascular risk factors and osteoarthritis predicted greater decline in physical function in midlife and early old age. Greater physical activity and fewer sleep problems in midlife were associated with better psychological well-being in later life. Inflammation was associated with bone density decline and prediabetes with fracture risk.
Findings from SWAN have led to a paradigm shift in our understanding of the aging process and a recognition that midlife, and particularly the menopause transition, is a period of unique changes in health risks across multiple health and functioning domains. SWAN research has identified antecedents of major adverse health outcomes in older women and has informed the design of interventions that avoid or delay their onset to maximize independence and well-being in old age.
The Study of Muscle and Physical Performance in African Caribbeans: Tobago Muscle Health Study
This population-based study is led by Iva Miljkovic, MD, PhD. >>See Studying Age, Sustaining Lives for more information about the study From metabolic benefits to maintaining physical and cognitive function, muscle plays a fundamental role in all these important aspects of healthy aging. Decline in muscle with aging is a significant clinical and public health problem that leads to increased disability, chronic diseases such as type 2 diabetes, institutionalization, health care costs, lower quality of life, loss of independence and premature mortality in an aging population. A growing body of evidence suggests that factors underpinning muscle quality, in particular skeletal muscle adiposity, rather than muscle mass, may play a significant role in risk for poor cardiometabolic and musculoskeletal health. However, long-term changes in muscle adiposity and muscle strength from middle age to older adulthood are unknown and may inform the age at which we should target prevention efforts.
Over the past 20 years, we have been studying a large cohort of African Caribbean men from the island of Tobago, the Tobago Health Study, in whom we have extensive measures of lifestyle habits, family and medical history, muscle and body composition, and biospecimens. We previously found that despite the fact that African Caribbean men have more lean mass (estimated muscle mass), their muscle is weaker, with higher levels of adipose tissue infiltration than observed in U.S. adults.
We also found that maintaining high serum vitamin D levels seems to be very important for maintaining the optimal muscle health in older African Caribbean men. One of our study findings to date is that aging-related changes in skeletal muscle adiposity, but not muscle mass, are important for future walking ability. We reported for the first time that greater adiposity in the muscles of the legs (both the calf and thigh), but not the muscles in the abdomen, is strongly associated with poor physical performance. Our findings also suggest that type 2 diabetes affects muscle quality, and that there may be a bidirectional link between Type 2 diabetes and muscle adiposity.
"As the number of older people around the world continues to increase, prevention efforts beginning in middle-age and targeting muscle adioposity, not just muscle mass, may help prevent health declines and promote healthy aging," said Miljkovic.
"What we learn in the Tobago study informs how we can promote healthy aging in the U.S. and in other parts of the world."
Highlights of other active research in aging across the science continuum are presented in Box 1. These projects reflect a prevention-oriented approach that not only addresses risk factors for aging-related diseases, such as Alzheimer's and related dementias (ADRD), but also promotes physical, cognitive and social well-being.
Box 1. Active Research in Aging
| Department | Principal Investigator | Title |
| Epidemiology | Dubowitz, Tamara | Longitudinal Examination of Neighborhood Disadvantage, Cognitive Aging and Alzheimer's Disease Risk in Disinvested, African American Neighborhoods |
| Epidemiology | Sekikawa, Akira | Arterial Stiffness, Cognition and Equol (ACE) |
| Epidemiology | Cauley, Jane Ann | Sleep, Falls and Fractures in Men and Women: Role of Nocturnal Hypoxia |
| Environmental and Occupational Health | Lefterov, Iliya | ncRNAs in Plasma EVs of AD Patients and Their Discriminatory Power as Biomarkers |
| Epidemiology | Strotmeyer, Elsa S.; Cauley, Jane Ann | Muscle Quantity, Quality, Function and Biomarker Associations with Longitudinal Preservation of Bone Microarchitecture and Bone Strength in Older Adults |
| Environmental and Occupational Health | Koldamova, Radosveta | The Interplay between Tau and ncRNAs—Genomic and Epigenomic Clues to Early AD Pathogenesis |
| Epidemiology | Strotmeyer, Elsa S. | Non-Fracture Fall Injuries and Long-Term Geriatric Consequences in Older Women and Men from a Cross Cohort Study |
| Epidemiology | Rosano, Caterina | Neural and Energetic Drivers of Performance and Perceived Fatigability in Older Adults |
| Environmental and Occupational Health | Fitz, Nicholas | Neurodevelopmental and Neurodegenerative Effects of Environmental Determinants: Altering Neural Cellular Populations Impacting Homeostatic Functions and Inflammatory Response |
A Focused Curriculum
Preparing the next generation of public health scientists and professionals focused on healthy aging and well-being
The School of Public Health incorporates topics in aging across graduate and undergraduate programs through coursework, experiential learning and community engagement.
Undergraduate Bachelor of Science in Public Health students explore aging through a life course perspective in foundational courses and engage in service activities like virtual conversations with seniors, Meals on Wheels, and age-friendly initiatives, with some translating these experiences into capstone projects focused on age-friendly health systems. Volunteer efforts such as "Epi Gives Back" further strengthen intergenerational connections and promote healthy aging through community-based outreach.
Graduate students are offered advanced courses on aging, such as the Department of Epidemiology's three-course "Epidemiology of Aging" series and the Department of Health Policy and Management's "Current Topics in Aging, Disability, and Long-term Services and Supports Policy" course. Graduate students' practicums include activities such as implementing wellness activities in long-term care facilities, supporting suicide prevention interventions for older adults and analyzing fall-related health outcomes to inform public health strategies.
A Sustained Commitment
Assuring the next generation of aging research scholars
A cornerstone of Pitt Public Health's commitment to aging research and education is the National Institute on Aging (NIA)-funded Epidemiology of Aging T32 Training Program (NIH/NIA T32 AG000181), which Strotmeyer directs.
Established in 1989, this program is one of the longest-standing aging-focused training grants in the country and has supported over 75 trainees to date. It exemplifies the school's dedication to cultivating future leaders in aging science through rigorous interdisciplinary training.
The program supports three predoctoral and two postdoctoral trainees annually, offering a tailored curriculum that blends epidemiologic and statistical methods with cutting-edge biological and physiological approaches.
"Our trainees don't just learn—they lead," said Strotmeyer. "They design ancillary studies,
contribute to national research efforts and present their findings at major conferences like the Gerontological Society of America, the American College of Sports Medicine and the American Society for Bone and Mineral Research."
The program's faculty, including Anne Newman, MD, MPH, Nancy Glynn, PhD, and Cauley bring decades of leadership and innovation to the table, mentoring students in both research and professional development.
The T32 program is more than a training grant—it's a launchpad for careers that shape the future of aging research. By embedding trainees in high-impact studies and fostering a collaborative, multidisciplinary environment, Pitt Public Health ensures that the next generation of scientists is equipped to tackle the complex challenges of aging with precision and purpose.
"We advance our portfolio of research, education and practice through the pillars of precision public health by predicting who is at highest risk, so we prepare by tailoring the right intervention to the right population at the right population at the right time and, ultimately, prevent potential adverse health outcomes," said Lichtveld.
"Innovation is accelerated by leveraging artificial intelligence to facilitate the integration of disparate databases to bolster discovery and advance resilience in our aging communities and their families locally and globally.
To do so, we need a sustained commitment to invest in further expanding our public health aging research portfolio and growing a robust cadre of emerging scholars in aging science and practice."
References
- Chetty R, Stepner M, Abraham S, et al. The Association Between Income and Life Expectancy in the United States, 2001-2014. Jama. Apr 26 2016;315(16):1750-66. doi:10.1001/jama.2016.4226
- 2019-2023 American Community Survey 5-Year Estimates, Table B19013: Median Household Income.: U.S. Census Bureau; 2023.
- United States Mortality Rates and Life Expectancy by
County, Race, and Ethnicity 2000-2019. Institute for
Health Metrics and Evaluation (IHME). - County Health Rankings & Roadmaps 2025. University of Wisconsin Population Health Institute; 2025.
- 2025 Alzheimer’s disease facts and figures. Alzheimer’s & Dementia: the journal of the Alzheimer’s Association. 2025;21(4)doi:10.1002/alz.70235
- Kakara R BG, Burns E, Stevens M. Nonfatal and Fatal Falls among Adults Aged ≥65 Years—United States, 2020-2021. Vol. 72. 2023:938–943. MMWR and Morbidity and Mortality Weekly Report.
- Lucas JW, Sohi, Inderbir. Chronic Pain and High-impact Chronic Pain in U.S. Adults, 2023. 2024. NCHS Data Briefs. https://dx.doi.org/10.15620/cdc/169630
- Social Isolation and Loneliness in Older Adults: Opportunities for the Health Care System. The National Academies Press; 2020:316.
- 2021 Profile of Older Americans. Administration for Community Living; 2022.