Memorandum submitted by AgeNet
INTRODUCTION
1. AgeNet is an initiative sponsored and
funded by the Medical Research Council, BUPA, Research into Ageing,
SmithKline Beecham and Westminster Health Care. Funding is also
received from the Office of Science and Technology's Foresight
Challenge. AgeNet's purpose is to stimulate multidisciplinary
and multisector research partnerships which will have beneficial
outcomes for the health and quality of life of older people.
2. Over the initial three year phase of
activity, starting in April 1997, AgeNet will have arranged some
20 multidisciplinary workshop meetings, developed databases, and
established a website where information on its activities can
be found (www.agenet.ac.uk). AgeNet is in touch with over 1,000
researchers and others interested in ageing, and in age-associated
conditions and issues, across the whole range of relevant scientific
and professional disciplines. The responses to the Committee's
questions that follow are intended to reflect the views of this
community as assessed by the Director of AgeNet. They are not
intended to reflect the views of the sponsors of AgeNet, some
of whom have been invited to submit evidence by the Committee.
Summary
3. Public support for ageing research in
the UK is fragmented and arguably insufficient, given the challenge
of the ageing population. The EQUAL initiative has made a start
in stimulating relevant new research activity. However, under
present arrangements there can be no assurance that the scale
and balance of effort is appropriate, nor is there vision and
leadership. There would be a good case for developing the EQUAL
initiative, under the auspices of the Office of Science and Technology,
to constitute a mechanism for taking a Government-wide view of
research strategy relevant to population ageing.
AgeNet's involvement in the EQUAL initiative
4. AgeNet has kept in close touch with the
four Research Councils that are active in support of research
on ageing and age-associated conditions and issues, with a view
to participating in joint activities. Joint activities within
the EQUAL initiative are outlined in the Annex. These Research
Councils, and the Office of Science and Technology (OST), have
been represented on AgeNet's Management Committee.
How well has EQUAL gained the support and participation
of the most appropriate organisations and individuals?
5. OST's EQUAL initiative in effect comprises
the research programmes formulated in response to the initiative
by the Engineering & Physical Sciences Research Council (EPSRC,
whose programme is also designated EQUAL), the Biotechnology
& Biological Sciences Research Council (BBSRC; Science
of Ageing—SAGE), the Medical Research Council (MRC;
LINK Integrated Approaches to Healthy Ageing), and the
Economic and Social Research Council (ESRC: Growing Older).
Beyond this, EQUAL has virtually no profile in the research community
and hence no support as such.
6. The significant new programmes of the
EPSRC, BBSRC and ESRC have made a start in drawing the attention
of the wider scientific community to the research agenda that
follows from the prospect of population ageing over the coming
half century.
7. The BBSRC and ESRC programmes each employed
a single call for proposals, and each runs for about three years
with the component projects (32 and 24 respectively) commencing
at about the same time. There is no reason to suppose that the
selection process did not pick the best proposals from amongst
those submitted. However, programmes operated in this way tend
to disfavour proposals from new research collaborations crossing
disciplinary boundaries, particularly when there is a relatively
short interval between the announcement of the call for proposals
and the deadline for submissions.
8. In contrast, the approach adopted by
the EPSRC features scoping workshops leading to annual calls for
proposals, with each topic repeated in successive years; encouragement
for one-year feasibility studies as well as standard grants; deliberate
effort to employ referees and Panel members from a wide background;
and obligatory involvement of organisations that can represent
the interests of the ultimate users of the innovation. This approach
is well designed to foster new multidisciplinary research partnerships,
which is particularly desirable given the broad range of disciplines
and professions relevant to the ageing process.
9. The MRC supports a wide range of research
relevant to ageing and age-associated disease, and has introduced
new funding schemes that promote multidisciplinary research. Although
the health of older people is one of 11 topics identified by the
Health Departments as a research priority for the MRC, research
proposals in this area have to compete with the generality of
proposals for the funding available. In these circumstances, it
is hard to judge to what extent the MRC's programme of research
relevant to the EQUAL initiative has gained the support and participation
of the most appropriate organisations and individuals.
10. It is noteworthy that the four Research
Councils have adopted three distinct responses to the EQUAL initiative,
consistent with their differing approaches to research support
generally. It would be worthwhile commissioning a comparative
evaluation at an appropriate time to see if lessons could be learned
about relative effectiveness.
Has the initiative identified and supported the
most appropriate research areas for confronting the challenges
of an ageing population?
11. The challenges of an ageing population
follow from the projected increase in the numbers of older people
over the next half century, together with the desire to improve
their health and quality of life beyond present levels. The purpose
of research is to generate the knowledge necessary (a) to intervene
effectively in the processes which start with biological ageing,
lead on to age-associated impairment of function and thence disability,
and result in loss of social capability and thence dependence;
and (b) to promote active, successful ageing. The research agenda
may be outlined as follows:
— biology of ageing, an area of great
current interest and activity. The BBSRC's SAGE programme is contributing;
— age-associated disease, where the
paradigm is the world-wide effort in academia and industry to
understand the basis of Alzheimer's disease at molecular level
and thence to devise rational, effective therapeutic interventions.
Other age-associated diseases which have an equally big impact
on quality of life receive less attention, however, for instance
osteoarthritis and loss of vision through macular degeneration;
— "frailty", shorthand for
all those chronic conditions of older people which are not capable
of consideration as a single pathology and which require long-term
care and complex interventions (including rehabilitation). There
is increasing concern on the part of geriatricians, gerontological
nurses and practitioners of the various therapy disciplines to
move towards evidence-based practice underpinned by methodologically
sound research findings. It is not clear that we are devoting
enough effort here;
— healthy ageing, the phenomenon whereby
many people manage to avoid ill-health in old age (at least until
close to death), requires close study to identify the determinants
of healthy ageing and the interventions—both medical and
social—best designed to promote this. The research agenda
needs to be developed;
— health services research relevant
to the needs of older people is now beginning to be recognised
as important in relation to the cost-effective employment of the
40 per cent of NHS expenditure that is incurred on behalf of those
over the age of 65. It is very welcome that the MRC's new Health
Services Research Collaboration has chosen to focus on the chronic
health problems of older people;
— modifying the physical environment,
to reduce the handicap experienced by people with disabilities.
The EPSRC's EQUAL research programme has made a start in addressing
the possibilities;
— modifying the social environment
to foster well-being and to lessen the loss of capability that
is experienced in old age, whether on account of physical or mental
disability, or poverty or loneliness. The ESRC's Growing Older
programme bears on this.
12. There is at least some coverage of the
elements of this research agenda from the programmes comprising
the EQUAL initiative. However, there seems to have been no attempt
systematically to consider the balance of effort.
13. Balance of research effort has to take
into account the needs of society for the new knowledge generated
by research, both to advance basic understanding and to underpin
innovative practice. It also has to take account of potential
scientific fruitfulness, since there is a well justified reluctance
to throw resources at a problem, however important and interesting,
before the concepts and tools are in place to allow progress.
However, it is arguable that with the enormous advances currently
being made in our understanding of the genome and of cell structure
generally, and in our ability to elucidate metabolic pathways
and control processes, we might feel less constrained than hitherto
in targeting the chronic diseases of old age which have the biggest
adverse impact on quality of life.
Is research in this area receiving sufficient
Government funding?
14. As well as the balance of effort, discussed
above, there is the overall scale of effort to consider. In general
terms, ageing research has been something of a Cinderella, at
least until the developments in funding programmes outlined above.
The medical research charities have generally funded work on the
diseases of early and mid-life, with the notable exceptions of
Research into Ageing, a small but expanding source of funding,
and the new PPP Medical Healthcare Trust which has recently initiated
a funding programme. Beyond the medical research charities, the
Nuffield Foundation last year commenced a programme to support
relevant social sciences research, but otherwise there is little
dedicated support for research on ageing issues.
15. It is understood that the National Health
Service is reviewing its support of research relevant to the needs
of an ageing population. The outcome could be significant in the
context of judgements about the sufficiency of Government funding
of research in this area.
16. Given the magnitude of the projected
demographic trend of population ageing, the burden of chronic
age-associated disease, the need to develop new societal roles
in the increasingly long period that follows mid-life, and the
developments in the underpinning science that will allow progress
to be made, there is a strong prima facie case for considering
additional Government funding for research.
17. There is also a good case for directing
specific support to aspects of ageing research which present particular
institutional difficulties. Studying the process of human ageing
requires that subjects be followed over considerable periods of
time in what are known as longitudinal studies. Such studies require
more commitment and administrative support than does the generality
of biomedical or social science research. Analogous studies with
animal models require the maintenance of colonies of rodents,
for instance, to substantially greater ages than would be normal
for non-ageing research—incurring substantially greater
costs.
What should be the priority areas of research
for the EQUAL initiative?
18. In principle, the scope of the EQUAL
initiative covers the full range of research on ageing and age-associated
conditions and issues. This is the only viewpoint within Government
which has such a synoptic perspective, since there is no Government
Department which has lead responsibility for ageing or for the
research requirements for policy development (unlike the position
for nearly all other areas of policy-relevant research).
19. It is noteworthy that some counties
manage the public support of ageing research substantially through
the aegis of a lead institution. The US National Institute on
Ageing is a notable example. The arrangements in the Netherlands
and in the European Union under the Fifth Framework Programme
are others. Such arrangements naturally facilitate a strategy
approach to research programme development, unlike the position
in the UK.
20. The priorities, scale and balance of
research on ageing in the UK should reflect national needs and
scientific potential, not administrative mechanisms and institutional
boundaries for the publicly funded support of research. Under
present arrangements, there is no assurance that this is the case.
Nor is there any source of vision and leadership.
21. There would therefore be a good case
for developing the EQUAL initiative, under the auspices of the
OST, to constitute a mechanism for taking a Government-wide view
of research strategy relevant to population ageing. This mechanism
would address research priorities, as these evolve over time,
and the scale and balance of research effort. The mechanism should
be able to address research needs within single disciplines as
well as the multidisciplinary approaches that are becoming increasingly
important in improving the quality of life of older people. The
means whereby research findings are translated into practice ought
also to be considered.
22. AgeNet, as the one organisation whose
remit covers all aspects of ageing research, stands ready to play
its part in future developments.
January 2000
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