APPENDIX 15
Memorandum submitted by Research into
Ageing
INTRODUCTION
Research into Ageing is the national medical
research charity dedicated to improving the health and quality
of life of elderly people through the initiation, funding and
support of medical research relevant to the conditions that affect
them. Since its foundation in 1976, Research into Ageing has committed
around £7 million to over 200 research projects at universities
and hospitals throughout the UK, seeking prevention or treatment
of the extensive range of diseases and disabilities that become
more common in later life.
Research into Ageing has been involved in the
EQUAL initiative from an early stage, and was invited to submit
evidence to the Science and Technology Committee inquiry into
this initiative.
THE AGEING
OF THE
POPULATION
The United Kingdom, in common with other developed
countries, has experienced the ageing of its population throughout
the twentieth century. A fall in mortality has combined with a
long-term downward trend in fertility to create a decline in the
proportion of the population made up of young people, while the
proportion of older people has risen. The Government Actuary's
National Population projections (1996) show that the total population
of the UK is expected to continue to grow during the first two
decades of the next century. The current population of 58 million
is expected to increase to 61 million by 2020 and then decrease
slightly to 57 million by 2050. During this same period, expectation
of life at birth is projected to increase from 73.9 years for
males and 79.2 for females in 1994, to 77.7 and 82.6 respectively
by 2020 and to 78.9 and 83.8 by 2050. The size of the very old
section of the population is projected to rise the most rapidly
with numbers of those aged over 75 estimated to increase from
the current figure of 4 million to 5 million by 2020 and 8 million
by 2050. By the middle of the next century the number of people
aged over 75 will have doubled while the population over age 90
will have more than tripled.
Current debate focuses on whether rates of morbidity
and disability will decline in parallel with rates of mortality
or whether this decline will be faster or slower. Some individuals
argue that the ageing of the population will be accompanied by
a pandemic of generative diseases and chronic mental disorders
as surgical and medical interventions enable the survival of people
with significant long-term health needs. On the other hand, Fries
(1980) argues that life expectancy is unlikely to increase much
beyond present levels and that the adoption of healthier lifestyles
and scientific advances will result in the compression of morbidity
into an increasingly brief period before death. In between these
two positions, Manton (1982) argues that there is no evidence
that we have reached, or will soon reach, a mortality "ceiling".
He believes that life expectancy will continue to increase but
that the balance between mortality and morbidity will be maintained.
The challenges posed by this rapid ageing of
the population and associated disabilities are not only medical
and social, but extend to the research community as a whole.
LEVELS OF
DEPENDENCY—LONG
TERM CARE
COSTS
The report of the Royal Commission on Long Term
Care highlighted the enormous range within which future costs
of long term care are likely to fall. The cost of £11.1 billion
in 1995 (64 per cent public; 36 per cent private) is likely to
increase to £14.7 billion in 2021; £19.9 billion in
2021; £28 billion in 2031 and £45.3 billion in 2051.
The biggest influence on these costs is the level of physical
and mental impairment which might be anticipated at the end of
life. A reduction of, say, 50 per cent—from 10 years to
5 years years of long term care—would have a dramatic impact
on these projected costs. Prevention of dependency should, therefore,
form a major part of the Government's investment in research and
development.
The factors which influence dependency are not
always obvious. for example, the absence of teeth leads to poor
nutrition which, in turn, leads to ill health and frailty. Loss
of flexibility and dexterity can lead to a failure to cut toenails,
which, in turn, can lead to loss of mobility and pain. More importantly,
however, it is often not the most expensive interventions or drug
treatments which will lead in due course to a major reduction
in the cost of care, but simple low-tech solutions which enable
an individual to remain for longer in their own home.
The Continuing Care Conference, in its evidence
to the Royal Commission, highlighted the need for "the compression
of morbidity to be an explicit policy objective across all departments
of government. To achieve this, priority should be given to research
. . . into preventive strategies and rehabilitation."
EQUAL
To what extent has Research into Ageing been involved?
When it was launched in July 1995, the EQUAL
initiative was heralded as addressing the science and technology
challenges of an ageing population. Research into Ageing was involved
at a number of levels with Research Councils as they worked up
their own responses to the call. The Director of the charity was
invited to the first EQUAL seminar as well as preliminary meetings
of EPSRC, ESRC and BBSRC. Other key advisers to the charity were
also involved at an early stage of the initiative.
The Director encouraged the Director General
of Research Councils at that time to consider appointing an EQUAL
co-ordinator at a high level to encourage and facilitate the development
of Research Council activity. It is unfortunate that this has
not been done since such an appointment would have helped the
OST to evaluate the impact and effectiveness of EQUAL.
Has the initiative identified and supported the
most appropriate research areas?
The EQUAL initiative has certainly stimulated
research across a wide front. This has been important in identifying
and supporting a range of new and existing research areas. It
is perhaps too early to evaluate whether or not it has stimulated
the most appropriate research areas but, clearly, much appropriate
research has been funded.
There is however a question about whether the
initiative has simply "heated up the economy" of ageing
research, thus raising the expectations of the scientific community,
with no real hope of the Research Councils building on the new
communities that have resulted.
To what extent has EQUAL stimulated research in
new areas?
EQUAL has stimulated research in several new
areas across the field, particularly via a range of Research Council
initiatives. It has also raised the profile of the field, thereby
encouraging established researchers to turn their attention to
the problems covered by EQUAL.
Is research in this area receiving sufficient
Government funding?
There has been a reasonable level of research
funding from the BBSRC "SAGE" initiative; the EPSRC
"EQUAL" initiative; and the ESRC designated programme.
This has drawn new researchers into the field of ageing research
and provided training opportunities for them. The MRC has not
funded a specific programme or call for research on an EQUAL theme,
so it is difficult to judge whether they are funding research
in ageing to a greater, lesser or similar level than they were
prior to the summer of 1995. As research in this area develops,
through the success of EQUAL, there will be need for significantly
increased funding.
In summary, therefore, the initiative has made
an important start in addressing a major challenge for our society,
but it is only a start!
FUTURE OF
EQUAL
From Research into Ageing's perspective, the
most important result of EQUAL has been to help reinforce our
message that research is vitally important if we are to see an
improvement in quality of later life for our society. This is
the message which the charity has been delivering for 24 years
and will continue to do so.
A number of key officers of Research Councils
have expressed the view that ring-fencing money leads to lower
quality research proposals. Having observed the ageing programmes
for BBSRC and EPSRC, this does not appear to be the case for ageing
research.
EQUAL should be continued. It should be continued
in order to encourage the Research Councils to build on their
notable achievements to date. But it should be continued with
a central mechanism for managing a ring-fenced research budget
to be distributed across a wide range of disciplines aimed at
reducing dependency in later life. This should also do as much
as possible to promote research that spans traditional disciplinary
boundaries.
REFERENCES:
Manton KG; Changing concepts of morbidity and
mortality in the elderly population. Millbank Mem Fund Quart 1982
60(2): 183-244.
Fries JF; Aging, natural death and the compression
of morbidity. New Eng J Med 1980; 303(3): 407-428.
Prophet H; Fit for the Future: the prevention
of Dependency in Later Life. Continuing Care Conference, 1998.
National Diet and Nutrition Survey; HMSO. 1998.
21 January 2000
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