Memorandum by The Royal Society of Edinburgh
THE SCIENTIFIC ASPECTS OF AGEING
1. The Royal Society of Edinburgh (RSE)
is pleased to respond to the House of Lords Science and Technology
Sub-Committee Inquiry into the Scientific Aspects of Ageing. This
response has been compiled by the General Secretary, Professor
Andrew Miller and the Research Officer, Dr Marc Rands, with the
assistance of a number of Fellows with considerable experience
in this area.
2. Biology, genetics and lifestyle all influence
how a person ages, and a greater understanding of how these factors
influence "healthy" ageing will allow us to begin to
elucidate the aetiology of age-related disease. In this context,
the Royal Society of Edinburgh is undertaking a range of activities
in this area with the support of the Lloyds TSB Foundation for
Scotland, and is supporting research and scholarly activities
aimed at improving the quality of life of Scotland's ageing population.
3. The specific areas of the call for evidence
are now addressed below:
THE BIOLOGICAL
PROCESSES OF
AGEING
What are promising avenues for research? How will
such research benefit older people and delay the onset of long-term
illnesses and disabilities?
Ageing Brain
4. The ageing brain is one of the most important
avenues for research on the biological processes of ageing. Cognitive
functions, like aspects of memory, reasoning, speed of mental
processing, and executive functioning, tend to decline as people
grow older. This applies even in people who do not have dementia
or Mild Cognitive Impairment. Cognitive decline, including pathological
and non-pathological aspects, is a major cause of lost independence
for older people, a major factor in lowering quality of life,
and is a huge financial burden on families and society.
5. NHS Scotland's Source Document "Risk
Factors for Dementia and Cognitive Decline," issued in October
2003, and the USA's National Research Council report in 2000 on
"The Aging Mind: Opportunities in Cognitive Research"
identified neural health, cognition in context, and structure
of the ageing mind as key areas for research on the ageing brain.
6. In particular, not enough is known about
the phenotype of cognitive ageing. For example, which mental processes
deteriorate, when they do so, the brain basis of this change,
and how the deterioration of mental processes correlate. Too little
is also known about why some people's functions deteriorate while
others remain intact or even improve. Too little is known about
the biological basis for the correlation between age-related change
in cognition with age-related changes in functions such as the
senses, grip strength, and lung function. Similarly, more needs
to be known about whether cognitive decline is related to illnesses,
either overt or subclinical pathology.
7. In addressing these issues, there are
now new ways to image the brain's white matter, which allows hypotheses
about cortical disconnection to be studied in relation to age-related
cognitive change and to follow up ideas about oxidative damage
as a basis for cognitive ageing. The genetic basis for cognitive
ageing is also now possible with large-scale, fast-throughput
genotyping, and telomere length can be studied as a correlate
of cognitive ageing. There are, however, too few studies of endophenotypes
of cognitive ageing, using experimental and psychophysical measures
that can translate cognition into basic processes.
Gene-exercise interactions on bone health
8. Another important aspect that has changed
over the last few decades is our increasingly sedentary lifestyle
and the impact that this has had on "healthy" ageing.
This is of particular importance in the musculoskeletal system.
As we age it is inevitable that we lose bone strength and the
outward manifestation of this age-related decline is frailty,
falls and fractures as a result of osteoporosis. It is estimated
that one in three women and one in 12 men over the age of 50 will
suffer an osteoporotic fracture with the resulting cost to the
NHS and government of £1.7 billion per annum.
9. Physical activity has been shown to be
an essential factor in bone health and the skeletal benefits of
exercise can be demonstrated throughout our life cycle. Exercise
can positively affect peak bone mass in children and adolescents,
has been shown to help maintain or even modestly increase bone
density in adulthood and can assist in minimizing age related
bone loss in older adults. While the skeleton responds positively
to mechanical loading by increasing bone mass and strength (functional
adaptation) this response declines with age in both sexes. Not
only is the loss of functional adaptation of bone a major aspect
of the ageing process it is also highly variable between individuals
suggesting a genetic contribution to the response. In fact understanding
the interaction and the influence of environmental factors such
as exercise on gene expression and function is one of the key
areas that should be highlighted in our research effort. Understanding
the cellular, biochemical and molecular basis of gene-exercise
interactions is, therefore, essential to improving bone health
and performance through exercise.
10. Despite the general belief in the importance
of exercise to our health, the molecular and cellular structures/systems
that contribute to the mechanostat in cells, particularly in the
musculoskeletal system, remain unclear. This information would
contribute to the design of pharmacological interventions to load
related diseases or preventative strategies in health programmes
and to our understanding of the mechanisms behind alteration of
the sensitivity of this system during ageing and disease such
as osteoporosis, osteoarthritis and Pagets disease. An understanding
of the basic mechanism of the response to mechanical stimulation
is also fundamental for repair and regenerative medicine. One
area of research which has been highlighted in the Foresight Health
Care 2020 report is tissue engineering with the long-term aim
to treat age-related degenerative disease disorders. The development
of engineered tissues ex vivo for transplantation will
fail if we do not understand the components of the ageing process
in vivo that lead to an impairment of the mechanosensor
mechanism and hence disease in the elderly. We should, therefore,
aim to increase the understanding of mechanically responsive cells
using techniques at the interface between biology and engineering.
11. Large scale population based studies
have provided clues to the likely impact of genetic status on
the development of a number of age related disease of the musculoskeletal
system. However they have largely failed to develop a clear idea
of the genetic lesions involved at the level required to develop
genetic screens to identify members of the population at risk.
There is also need to focus on a functional genetics approach
in order to identify genes with possible impact on the musculoskeletal
health based on their known importance in the function of these
tissues. Only with this information can the most useful data from
the large population genetic studies be extracted.
THE APPLICATION
OF RESEARCH
IN TECHNOLOGY
AND DESIGN
TO IMPROVE
THE QUALITY
OF LIFE
OF OLDER
PEOPLE
Existing technologies which could be used to a
greater extent to benefit older people
12. There are a number of existing technologies
that could be used to a greater extent to benefit older people.
For example, research could be undertaken into a "home hospital"
for the elderly. An elderly person can find it difficult to go
to the doctor or hospital but communication technology is available
whereby he/she can do much by him/herself without directly taking
up doctors' time or hospital facilities. For example, computer
technology developed for the home office could be adapted for
home medical care and with good communication channels a patient
can use a digital thermometer which a doctor can "read",
or carry out blood pressure measurements, and communicate with
the doctor.
13. However, although maintenance of the
elderly in their own homes is often the best option, the likely
rise of IT support mechanisms and surveillance of old people in
their homes (such as that that developed by SECOM in Japan) may
lead to isolation and increasing mental problems. More specialists,
psychologists and psychotherapists, community care workers and
"friends" will, be required to maintain mental health
and physical independence of elderly people.
The development of new technologies
14. As noted above, the loss of bone mass
(10 per cent of loss of strength for each decade of years) with
age is a major concern and leads to osteoporosis and fractures.
New technologies are therefore needed for stimulating bone growth.
New lightweight bio-compatible materials and techniques also need
to be developed for improved implant/bone fittings that can enable
secure extended life for these implants and reduce the need for
revision surgery. In particular, new coating technology for implants
is required, providing greater wear resistance, as well as biocompatibility.
HOW EFFECTIVELY
IS RESEARCH
CO-ORDINATED
IN THE
PUBLIC, PRIVATE
AND CHARITABLE
SECTORS (INCLUDING
INTERNATIONALLY)?
15. There has been a UK response to the
challenge of the scientific aspects of ageing. Most of the research
councils have had ageing-related initiatives, and the National
Collaboration on Ageing Research has begun to bring some of these
together. Ageing-related charities, such as Research into Ageing,
National Osteoporosis Society and Arthritis Research Council,
have also been supportive of research into the biological processes
of ageing.
16. Cognitive ageing will, however, require
longer-term support for cohorts of subjects, organising researchers
in large-enough multidisciplinary teams, and a more co-ordinated
approach to funding and a body such as the USA's National Institute
on Ageing would help matters considerably.
HAVE THE
CORRECT PRIORITIES
BEEN IDENTIFIED?
ARE THERE
ANY GAPS
IN RESEARCH?
17. In addition to the areas identified
above, current research into Alzheimers, Parkinsonism, and like
afflictions will be important, as will continuing research to
find ways of preventing or curing the major degenerative diseases
such as cancer and diabetes. Research over the past 50 years has
also produced useful guidance in respect of diet and exercise
and the avoidance of risk-producing habits such as smoking and
some features of life-style. Some aspects of these, still need
further well-planned research to confirm or modify current beliefs
and there will be a need to examine the psychological barriers
that prevent people following oft-repeated simple advice on healthy
living.
IS THERE
SUFFICIENT RESEARCH
CAPABILITY IN
THE UK?
18. There are current difficulties in maintaining
sufficiently large cohorts of people over time to explore cognitive
ageing. There are some exceptions, such as the MRC's 1946 British
Birth Cohort, which effectively has long-term funding, but some
of the world-class cohorts that this country possesses are run
on short-term grant support. In addition, there would be benefit
in researchers on brain ageing being brought together in larger
groups, a rare example of which has occurred in Newcastle.
IS THE
RESEARCH BEING
USED TO
INFORM POLICY?
19. An ageing population presents a massive
health and financial burden, and research findings are being publicised
and influencing policy, especially given the economic and social
consequences for communities.
ADDITIONAL INFORMATION
20. In responding to this inquiry the RSE
would like to draw attention to the following Royal Society of
Edinburgh responses which are of relevance to this subject: The
Ageing Population (December 1999); EQUAL (Extend Quality
Life) (January 2000) and Healthcare in 2020 (September
2000).
October 2004
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