Memorandum by the Royal Society
BIOLOGICAL PROCESSES
OF AGEING
Ageing is a normal process of functional decline
that is near universal in living organisms. In humans, ageing
is the major risk factor for multiple age-associated diseases,
including cancer, heart disease, neurodegeneration and diabetes.
Genetic research in short-lived simple organisms
such as yeast, nematode worm, fruit fly, mouse has identified
genes that have an important influence on life span as well as
a range of interventions that can delay many of the manifestations
of ageing and thus opens new approaches to prolonging healthy
life. Furthermore, advances in molecular biology, genetics and
genomics are increasingly showing that principles established
in model organisms can be translated across species. This now
leads to unprecedented opportunities to increase our understanding
of the intrinsic ageing process, how it constitutes a risk factor
for multiple diseases and how interventions might improve health
and activity during ageing.
The brain also is a major avenue for research
on the scientific processes of ageing. Cognitive decline, also
known as normal cognitive ageing, results in aspects of memory,
reasoning, speed of mental processing and executive functioning
declining as people grow older. These can lead to a major loss
of independence and quality of life. There is still not enough
known about the phenotype of cognitive ageing: which mental processes
deteriorate, when they do so, the brain basis of this change,
and how the deterioration of mental processes correlate. There
is still the lack of understanding of the biological basis for
the `common cause' hypothesis, the fact that age-related change
in cognition is correlated with age-related changes in functions
such as the senses, grip strength and lung function. In starting
to find answers to these questions new ways have been developed
to image the brain's white matter which allows hypotheses about
cortical disconnection to be studied in relation to age-related
cognitive change. In addition, much work also needs to be done
to follow up ideas about oxidative damage as a basis for cognitive
ageing and the many aspects of the genetic basis for cognitive
ageing.
Stem cell research offers many opportunities
for amelioration of age-associated decline and disease, and UK
is particularly well placed to make progress in this area because
it has one of the strongest regulatory systems in the world.
The UK is well positioned to contribute to and
exploit these opportunities, although the current volume of research
in this area is low compared with the United States. Using a combination
of generic, theoretical and applied science, a balanced approach
to the study of health during the later years of life can be achieved.
APPLICATION OF
RESEARCH IN
TECHNOLOGY AND
DESIGN
Technologies such as artificial joint replacement,
cardiac pacemaking and continence control are applications of
technology that have had and will continue to have an impact on
extending the quality of life. To achieve further advances work
needs to continue on the development of new materials, electronics
and mechanics. These applications should not be considered in
isolation but in conjunction with standard technologies that exist
to support independent living such as communication and mobility
aids; and housing design and modification.
Below is a classification of the kinds of relevant
technology with which the inquiry might be concerned:
— Low technology: Mobility aids (eg,
canes, simple wheelchairs), vision devices (eg, magnifiers, large
print), hearing devices (eg, assistive listening devices) and
cognitive devices (eg, pill organisers).
— High technology: Computer applications,
wireless technology, information technology, pervasive computing,
wearable computers, sensors and home monitoring.
— Transportation: Older driver safety,
the role of high and low technology in enabling mobility later
in life, and alternative (to personal vehicles) transportation
approaches.
— Home modifications and universal
design: The environment, both through retrofitting and new construction
for people as they age.
— Injury prevention: Falls, fire safety,
poisons, pedestrian safety and other issues relating to safe environments
in the home and in the community.
In addition to technologies that support independent
living, consideration should be given to those technologies which,
generally, involve "health care" interventions which
counteract or compensate for the adverse effects of the natural
ageing processes and enhance the quality of life. The overriding
objective being to keep people healthy until they die. These interventions
include:
— Screening for diseases which meet
appropriate criteria.
— Diagnostic technologies, particularly
in relation to cognition and prognosis.
— Therapeutic procedures that extend
quality life.
RESEARCH PRIORITIES
The UK has started to respond to the challenges
presented by the issues of research into ageing through ageing-related
initiatives by several of the UK research councils (BBSRC, EPSRC,
ESRC, MRC). There have been some criticisms of the co-ordination
of research into ageing but we hope that the launch of the National
Collaboration on Ageing Research will start to bring these initiatives
together. The many lines of inquiry in ageing research will require
longer-term support. For example, in cognitive ageing there are
requirements: for longer duration studies on cohorts of subjects,
for organising researchers in large-enough multidisciplinary teams,
and for a more co-ordinated approach to funding. Further consideration
should be given to co-ordination between the work funded by the
Research Councils and the National Health Service effort. This
will go some way to improving the difficult translation of research
from the laboratory to application in clinical practice.
Although we agree that aspects of future funding
of pensions are, rightly, out of remit of this inquiry there are
however economic considerations that the inquiry might need to
embrace. For example, as the capabilities of "health care"
technologies increase, so, generally, do their costs. The escalating
expenditure during the last few weeks and days of life is often
cited. In the case of the elderly, approaches such as the cost
of the QUALY (quality-adjusted life year) will need to be refined
to inform the opinion of society concerning resource allocation.
Should you wish any clarification or expansion
of our views we would be happy to respond to any written queries
and also to provide oral evidence to the Committee.
October 2004
|
