APPENDIX 4: NOTE OF THE SEMINAR
Present
Lord Drayson
Baroness Emerton
Baroness Hilton of Eggardon
Lord May of Oxford
Lord Mitchell
Baroness Murphy
Lord Oxburgh
Lord Soulsby of Swaffham Prior
Lord Sutherland of Houndwood (Chairman)
Lord Turnberg
Baroness Walmsley
Michael Collon (Clerk)
Dr Jonathan Radcliffe (Specialist Assistant)
Chairman
Professor Tom Kirkwood (Professor of Medicine, University
of Newcastle, Specialist Adviser to the Sub-Committee)
Participants
Dr Alison Austin (Assistant Director, Office of Science and
Technology, OST)
Steve Brown (BT - Martlesham Heath)
Professor Roger Coleman (Professor of Inclusive Design and Co-director
of the Helen Hamlyn Research Centre at the Royal College of Art)
Professor David Cope (Parliamentary Office for Science and Technology)
Professor Peter Crome (President-elect, British Geriatrics Society)
Dr Deborah Dunn-Walters (British Society for Research on Ageing,
BSRA)
Dr Diana Dunstan (Medical Research Council, MRC)
Doug Emery (Innovation Fellow, University of Sheffield)
Sir John Grimley Evans (Emeritus Professor of Clinical Geratology,
Oxford University)
Dr James Goodwin (Head of Research, Help the Aged)
Ms Shabnam Khan (Economic and Social Research Council, ESRC)
Professor Steve Jackson (The Gurdon Institute, Cambridge University)
Professor Peter Lansley (Reading University)
Dr Lorna Layward (Research Manager, Help the Aged)
Mrs Mary Manning (Executive Director, Academy of Medical Sciences)
Dr Brian Merry (Liverpool University)
Dr Colin Miles (Biotechnology and Biological Sciences Research
Council, BBSRC)
Ms Elizabeth Mills (former director, Research into Ageing)
Dr Helen Munn (Academy of Medical Sciences)
Dr Kedar Pandya (Engineering and Physical Sciences Research Council,
EPSRC)
Professor Linda Partridge (University College London)
Martin Rumsey (Office of Science and Technology, OST)
Dr Jacob Sweiry (Wellcome Trust Science Funding Division)
Professor Alan Walker (Professor of Social Policy, University
of Sheffield)
1. Professor Kirkwood opened the seminar, speaking
on the timeliness of the inquiry, with an overview of ageing research
in the UK.
2. A number of factors combined to make this an appropriate
time for the inquiry: demographic changes, scientific progress,
economic factors such as the cost of pensions and health care,
rising expectations, and growing opportunities in an ageing world
for exploiting the UK science base in age-related research.
3. The proportion of the global population aged 65
and over in 1900 was 1% (UK 5%); in 2000 it was 7% (UK 16%); and
by 2050 it was estimated to be 20%, a figure the UK would reach
in 2020. . Life expectancy continued to increase by about two
years per decade. Translating this rate of increase into the immediate
context, it meant that by the end of the seminar, for each hour
of our life spans that would be used for this purpose, 12 minutes
could be "recouped" through the ongoing increase in
life expectancy.
4. From studies in Sweden, where statistics had been
kept since 1860, it was clear that the maximum life-span, far
from reaching a plateau, was accelerating.
5. Life expectancy was influenced by a number of
factors. Genetic heritability accounted for about 25% of the differences
between individuals. The ageing process was not genetically programmed,
but was caused by an accumulation of cellular defects resulting
from random molecular damage, with genes influencing cellular
repair. Other factors affecting ageing were nutrition, lifestyle
and environment. These were influenced by socio-economic factors,
as could be seen from variations in life span recorded by different
local authorities.
6. An important question concerned the relationship
between intrinsic ageing and the development of age-related diseases
such as osteoporosis, osteoarthritis and dementia.
7. A great deal of research was being carried out
in the UK, sponsored mainly by charities, by the research councils,
and by the EU. This was still fragmented, but some efforts at
co-ordination had been undertaken by the Funders Forum for Research
on Ageing, and recently by the National Collaboration on Ageing
Research, which had been sponsored by several of the research
councils. The challenges were that much of the science was new
and poorly understood. There was a lack of clarity in the objectives,
and in particular in the relationship between ageing and disease.
8. An example was established by Jeanne Calment,
the longest-living person (122 years), who enjoyed good health
through most of her life span. She retained a mischievous sense
of humour as, in her words to a journalist in her later years,
"I only ever had one wrinkle, and I am sitting on it".
9. Professor Steve Jackson discussed the biological
determinants of ageing and longevity. He addressed what ageing
was; why and how we aged; whether we could slow down or prevent
ageing; and if so, whether this would be a good thing for society.
10. Ageing consisted of a loss of vigour; in skin,
a loss of the subcutaneous fat cell layer leading to loss of suppleness
and wrinkling; connective tissue changes; greying hair and loss
of hair; impairment of the senses; osteoporosis; and cardiovascular
and neurological degeneration. The underlying changes were cellular
damage leading to impaired cell function; accumulated tissue and
organ damage leading to dysfunction; and the loss of ability for
tissue renewal.
11. Longevity, while influenced by the environment,
was pre-ordained by genes. Identical twins tended to have similar
life-spans. There were startling differences between species:
people lived seven times longer than cats, which lived five times
longer than mice, which in turn lived 25 times longer than fruit-flies.
But selections for longer-lived laboratory animals revealed that
certain mutations could dramatically increase life-span without
apparent detrimental effects.
12. The rate of ageing was not fixed. The reason
we had not evolved to live longer was that evolution acted to
maximise reproductive success, so that there was little selective
pressure to retain genes which might allow an individual to live
significantly longer than its reproductive phase. On the contrary,
evolution would select genetic factors which increased reproductive
fitness even though this might cause accelerated ageing.
13. Oxidative stress was a major factor causing ageing,
and a major target for oxidative damage was DNA. Laboratory animals
selected to live longer were more resistant to oxidative stress.
The reason calorie restriction enhanced the life-span of many
organisms was related to its effects on oxidative metabolism and
stress-resistance.
14. Most human cells could divide only a limited
number of times, and when they reached the end of their replication
capacity, they entered into senescence. There was evidence that
cell senescence also took place during the ageing of a person.
Telomeres in cells provided a cell-division clock: when they became
too short, senescence was induced. There were strong links to
DNA damage. Another link to DNA damage was Werner's syndrome,
an autosomal recessive disorder which led to death in the fourth
to sixth decade of life.
15. In principle, it was possible that damaged DNA
could be better repaired, rates of cell death reduced, and hence
ageing slowed down, using drugs, but this led to the questions
whether extending human life-span was desirable for the individual
or for society.
16. Ageing research was not an isolated discipline,
but was closely connected to research into diseases such as Alzheimer's,
Parkinson's, cancer and cardiovascular diseases.
17. Sir John Grimley Evans spoke about the impacts
of ageing on human health, and the prospects for science-based
intervention.
18. Biologically, ageing was characterised by a loss
of adaptability manifested in age-specific mortality rates. Between
birth and age 10, mortality rates decreased with age, but from
age 11 onwards they increased. For effective prevention of late-life
disability ageing had to be seen as a life-long process, with
some determinants of late life trajectory acting in childhood
and in utero. Biological ageing was the result of interaction
between intrinsic (genetic) and extrinsic (environmental and lifestyle)
factors, but was modulated by non-ageing effects: selective survival,
cohort effects such as education, and the differential challenge
exemplified in the many aspects of cultural ageism.
19. Science wanted to know why ageing came about,
but there were two sorts of questions relating to causes and to
mechanisms. Epidemiology sought causes, but needed biological,
physiological and social sciences to elucidate mechanisms. In
coping with human ills it was possible to remove causes or to
interrupt mechanisms. Neither approach was generally better than
the other.
20. In the UK, medical, social and biological geratology
had followed separate traditions; the time had come to try in
particular to bring medical and biological developments closer
together. The impediments included different career structures
and funding sources, and difficulties in extrapolating from the
short-lived animals studied by biologists to the human being.
Developments in molecular biology had now made such extrapolation
more reliable. The focus of biologists on longevity contrasted
with the medical concern with disability. There was a need for
greater complementarity between the work of the three traditions
of geratology.
21. There was a divergence between projected rates
of disability and the rates found in practice. In a US study of
the period 1982 to 2001, it had been expected that the numbers
of people over age 65 who were disabled would increase steadily
over time as life expectancy was lengthened. In fact, in the US
there were now 2 million fewer older people with disability
than would have been expected if disability rates of 1982 had
continued. The trend was "live longer, die faster".
22. There was thus encouraging evidence that the
present pattern of age-associated disability could be improved.
Age-associated loss of adaptability meant that the older one was
when first suffering potentially disabling disease (such as heart
attack or stroke), the more likely one was to die rather than
linger with disability. This was the principle of "postponement
as prevention". Disability arose when there was an "ecological
gap" between what an individual needed or reasonably wished
to do and what his or her environment required for this to be
achieved. Technological approaches could improve a person's range
of function and reduce the demands of the environment. There were
problems associated with the development and deployment of technological
approaches to the prevention and management of disability. Areas
of particular need included technologies to help people with cognitive
impairment and those suffering trauma or undergoing surgery.
23. In discussion of these topics a number
of points were raised.
24. Lord Turnberg asked about the relation between
genes and environment. Matters such as status in society and marital
status affected longevity. Sir John Grimley Evans agreed
that there was a relationship, but it was complex. It was clear
from US studies that education was highly significant. It gave
the ability to earn more and to control the pace of working; educated
persons were better able to respond to progress in scientific
knowledge, and to balance present pleasure against future happiness.
25. Lord Sutherland asked why it was necessary to
make a distinction between ageing and disease, and wondered if
this was caused only by the structure of research. Professor Kirkwood
said that there was agreement on the need for research to combat
disease, but not on the need for research to combat ageing, as
had become clear when Alzheimer's was classified as a disease.
It was more difficult to raise funding for research into ageing.
Dr Goodwin agreed that the pragmatic distinction did affect fundraising
from donors and the general public. Dr Dunstan said that the MRC
was concerned only with the quality of research.
26. There was general agreement on the lack of dialogue
between medical and biological researchers. It occurred in all
areas, but was pronounced in gerontology. Lord Oxburgh pointed
out that the design of the Norman Foster building at Imperial
College encouraged interaction between the disciplines.
27. Professor Lansley thought it was easier for researchers
to focus on diseases. Professor Partridge said that attempts were
made to focus on basic biology (diet and health) rather than specific
diseases. The increased understanding of biological interventions
had led to an explosion of research. Dr Dunn-Walters said that
the three research societies had carved up the research territory
and moved further apart. The BSRA welcomed medical researchers,
but they were not keen to join. Medical and biological researchers
were pulled apart by the imperatives of their jobs.
28. Professor Peter Lansley introduced the topic
of better environments for healthy ageing.
29. The EPSRC supported the EQUAL Initiative, aimed
at Extending the Quality of Life. It was concerned with creating
better home environments (adapting buildings for older people);
creating better hospital environments (using colour coding to
facilitate use by older people, and colour and lighting to promote
recovery and well-being); creating better urban environments (e.g.
by designing dementia friendly streets); and creating better consumer
products.
30. The EQUAL Initiative had started in 1997, since
when it had spent £8.6m funding 48 research teams in 33 universities.
It was multidisciplinary, bringing together scientists concerned
with the physical sciences, design and engineering with those
involved with social, health and medical research. They designed
new technologies for use in existing homes, in shops, and in transport,
and promoted new approaches for designing better environments
and products. These reduced the effects of physical impairment,
vision and hearing loss, dementia and other cognitive impairment.
31. There was practical evidence of the value of
this research, which was designed to be close to the end user
rather than an academic talking shop. Of the contacts of the EQUAL
Network, which supported dissemination of the findings from the
EQUAL Initiative, only one third were researchers; one third were
professionals and practitioners, the remainder older and disabled
people. In the words on one of these, "Leading-edge of research
meets sharp-end of practice tempered by the realities of ageing
and disability".
32. Lately however support for research had been
tailing off. There was little political support, and it was not
even clear which government department had responsibility.
33. Steve Brown looked at design and assistive technology
for older people.
34. Telecare was the use of information and communication
technology (ICT) to support independent living for older, frail
and disabled people. The existing first generation telecare systems
were community alarm systems, such as pull-cords and pendants
linked to auto-dialling phones. The technology was proven; it
was low cost, and used by all local authorities. It was non-invasive,
requiring the client to initiate an alarm and alert a remote carer.
35. The second generation consisted of emerging telecare
systems; "smart systems" incorporating "smart sensors".
These were capable of alerting a carer when the client was disabled,
and could incorporate safety and security applications, but they
were still based on response to an alarm, though in this case
an alarm created by the system rather than the client. They were
invasive, monitoring people in their own homes. They were currently
being trialled by local authorities.
36. Finally, future third generation telecare systems
involved highly complex data processing and novel sensors, designed
not to react to events but to prevent them occurring. They were
still at the design stage, but with some early trials. They were
designed to be used in conjunction with first and second stage
telecare.
37. Professor Alan Walker explained the work of the
Research Councils.
38. Four of the Research Councils (MRC, ESRC, EPSRC,
BBSRC) all sponsored major research programmes or portfolios relevant
to ageing. One of the most important of these was the ESRC Growing
Older programme, launched in 1999 and the largest social sciences
research programme on ageing ever mounted in the UK.
39. In 2001 these four Research Councils set up the
UK National Collaboration on Ageing Research (NCAR) to stimulate
inter-disciplinary research and develop a new cross-Council approach
to ageing research. A broader overview of ageing research was
maintained by the Funders Forum for Research on Ageing, which
brought together the four Research Councils, six leading charities,
the OST and the Department of Health. The NCAR was responsible
for creating the European Forum on Population Ageing Research.
It was also leading ERA-AGE, a European Union initiative coordinating
research into ageing in nine EU countries. UK research, while
behind the US in terms of coordination and strategic thinking,
was the leader in Europe.
40. "New Dynamics of Ageing" was a cross-Research
Council initiative launched in 2004, and the largest UK programme
of interdisciplinary research on ageing to date. Among its aims
were to ensure that science fed into policy and practice, to cross
the boundaries of disciplines, and to bring young scientists into
the topic. It was looking at ageing across the whole lifespan,
and not just among older people.
41. In summary, the Research Councils working in
partnership were coordinating different scientific approaches,
stimulating inter-disciplinary research, leading Europe, increasing
investment in research, and bridging the gap between research
and policy.
42. Dr James Goodwin discussed research by charities.
43. Help the Aged was a leading member of the Association
of Medical Research Charities (AMRC) which brought together 112
members to provide guidance on research governance, ethics, policies
and processes. In 2002/03 £660m had been spent on biomedical
research, £578m by the top five members. A very large proportion
of this involved research into diseases which were prevalent among
the elderly. There were an increasing number of applications for
funding, 19 out of 20 of which had to be refused. However there
were only six charities in the Funders Forum on Ageing Research,
four of which supported ageing research in science and technology
areas.
44. An international comparison across the four UN
regions revealed three strategic problems applicable to the UK:
low relative investment; fragmentation and lack of capacity; and
absence of strategic direction. The European Union approach was
particularly disappointing; ageing research was a low priority.
In 2002 expenditure on research into ageing in the UK was considerably
higher than in the whole of the rest of the EU. The EU Sixth Framework
Programme made only limited reference to ageing as a priority.
In the USA, by contrast, the National Institute of Aging combined
high order strategic organisation with enviable levels of funding;
this paradigm should be considered by the Committee.
45. In summary, there were a number of matters the
Committee should consider. There were numerous biomedical charities
with age-related disease well represented, but few entirely dedicated
to ageing research. The comparative expenditure on ageing was
moderate, but quality assurance mechanisms ensured that it had
a high impact. The priorities went beyond funding: charities were
well placed to work with Government to increase funding levels,
improve strategic direction, and maximise the benefits of new
research.
46. In subsequent discussion the following
points were made.
47. Professor Kirkwood stressed that an issue for
the Committee would be how far an inquiry into scientific aspects
of ageing could extend into questions of disability. Professor
Coleman thought disability was largely created by the impact of
the environment on ageing. Lord Sutherland said that the Committee
should concentrate on how different contexts affected disability.
48. Professor Lansley said that the EQUAL Initiative
provided strong evidence of the return of investment in the new
technologies. A cost/benefit analysis must involve economists
and business schools. Professor Kirkwood instanced the large benefits
derived by the NHS from a minimal investment in ensuring that
the elderly were provided with walking sticks of the right length.
49. In relation to third generation assistive technology,
Lord Oxburgh asked why individuals were reluctant to wear devices.
Mr Brown said the reason was not known; there had been no research
into what older people wanted.
50. Professor Kirkwood suggested that there was a
need to look at the differences between the sexes, and between
different social and ethnic groups. Dr Sweiry, agreeing, said
that the Biobank Project, funded jointly by the Wellcome Trust,
the MRC and the Department of Health, would provide enormous quantities
of data to assist in uncovering genetic and environmental factors
affecting ageing and leading to diseases prevalent among the elderly.
Professor Walker agreed with Baroness Walmsley that there was
not enough research into the cultural aspects of ageing. However
there was a huge database, and the ESRC was a significant investor,
for example through the Growing Older programme.
51. Discussion turned to the direction and funding
of research. Lord Sutherland said that the Treasury regarded young
people as producers, but the elderly only as consumers, which
might be a reason why research tended to focus on infants and
the young. He asked how effective it was to attempt to drive research
strategies by targeted calls for grant applications in particular
areas. Professor Partridge explained that the National Institute
for Aging in Washington DC regularly invited research proposals
on specific topics. Lord May thought there was scope for programmes
calling for responses in particular areas provided these were
chosen by people with the right attitudes.
52. Professor Kirkwood wondered why the Department
of Health was not represented at the seminar, and whether they
were put off by the word "scientific" in the title of
the inquiry. Lord Sutherland thought that there was a radical
divide in the Department between research and its application.
For them the vital question seemed to be, not whether research
would reduce expenditure generally, but whose budget was affected?
Was the benefit going to accrue to the body whose budget bore
the cost of the research?
53. Lord Sutherland concluded by thanking all those
who had attended the seminar, and in particular those who had
made presentations, for their contributions to a very valuable
debate. It would be of great assistance in focusing the work of
the inquiry.
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