Memorandum by The Stroke Association
The Stroke Association has been the major funder
of research into all aspects of stroke illness and its care including
prevention. The Association has a major concern for the prevention
of disability through the primary prevention of strokes and transient
ischaemic attacks (TIAs), improvements in the early management
of stroke illness (the creation of stroke units) and the effective
rehabilitation both immediately after the acute episode and in
the longer term. The Association is concerned to assist patients
achieve independence through adjustment to disability and effective
rehabilitation. The case is compelling:
— Suffering a stroke increases the
chances of disability more markedly than any other condition.
— Stroke is a more powerful cause of
disability than musculo-skeletal and other chronic disorders.
— Stroke has a greater disability impact
than other chronic diseases.
— Stroke causes a greater range of
disabilities than any other condition.
— A quarter of a million people suffer
with long-term severe disability due to stroke in the UK.
The conclusions from the research conducted
for the Association informs the care of all older people with
disability[1]
and for this reason and because stroke services are covered by
standard 5 of the National Service Framework for Older People
it has been appropriate for the Stroke Association to serve as
a member of the Funders' Forum.
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?
Derek Wanless has focussed on the importance
of life style factors in the development and progress of chronic
illness. Older people stand to be major beneficiaries of the change
in emphasis that Wanless recommends. Whereas the benefits have
been identified effective strategies for bringing about these
benefits have not been defined.
The report from the Academy of Medical Sciences
"Restoring neurological function: putting the neurosciences
to work in neurorehabilitation" prepared by Professors Ray
Tallis and Richard Frackowiak identifies the opportunities which
research in to rehabilitation presents.
— Differences between the sexes, and
between different social and ethnic groups in the UK.
Although there is a social gradient for stroke
as for coronary heart disease this is not presently afforded a
high priority. On the other hand Professor Hugh Markus (St George's
Hospital, research supported by the Stroke Association) reporting
on his research concludes: "Individuals of African and African
Caribbean descent living in the United Kingdom and the United
States have a markedly increased risk of stroke compared with
white individuals. In a recent population stroke registry study
in London, UK, African Caribbeans had a doubling of stroke incidence
compared with that of whites. This increased incidence remains
after adjustment for cardiovascular risk factors and socioeconomic
status. The reasons for this increase in stroke risk are uncertain,
although the increase in risk could be related to differences
in the prevalence of cardiovascular risk factors or susceptibility
to them, reduced access to or utilization of medical care, uncontrolled
for socioeconomic factors (including associated environmental
factors), and/or differing genetic predispositions."
Professor Markus's study reached the conclusion that—more
advanced deleterious changes in the wall of the carotid arteries
(atheroma) occur in UK African Caribbeans even after controlling
for conventional risk factors. There are highly significant ethnic
differences in the distribution of many potential cerebrovascular
candidate genes. Although those examined did not explain the ethnic
differences in extent of damage to the carotid arteries, other
genetic predispositions or environmental exposures could account
for these differences[2].
— How effectively is research co-ordinated
in the public, private and charitable sectors (including internationally)?
— Have the correct priorities been
identified? Are there any gaps in research?
The Funders' Forum for Research in Ageing and
Older People has identified priorities for research in its field
and gaps. The list is included here because it is relevant but
it will have been discussed in greater detail in a submission
from the MRC.
— the psychology of ageing, disability
and dependence;
— the economic and social implications,
behaviour and aspirations of an ageing population;
— technologies and design to help people
maintain independence and autonomy and their effects on older
people;
— technologies for the detection, prediction,
diagnosis and treatment of age related disease, and the effects
of these technologies on older people;
— the molecular and cellular changes
associated with basic biological processes of cell death, senescence
and physiological ageing;
— the causes of, and influences on
age related diseases and disability;
— prevention of breakdown in health
and loss of independence in old age and of specific diseases and
conditions which cause these;
— treatment of disease and breakdown
in health in older people;
— rehabilitation strategies to improve
and maintain function and restore independence; and
— the delivery of effective and efficient
health and social care for old and frail people.
DISCUSSION OF
THESE TOPICS
IN THE
FFRAOP BUSINESS PLANNING
GROUP LED
TO THESE
CONCLUSIONS: (SEPTEMBER
2003)
"High quality research in basic sciences
in relation to ageing, and research in the epidemiology, causes,
prevention and treatment of disease in old age should continue
to be supported. Research which is of particular relevance to
ageing should be identified and categorised.
What is relatively sparse is multi-disciplinary
research into the causes, prevention, and rehabilitation of multi-factorial
breakdown of independence in old age. Research in ageing and older
people requires a new strategy."
CO-ORDINATION
Research has depended upon support from a number
of relatively small medical research charities faced with a set
of research priorities, which has inhibited collaboration on more
ambitious research.
The Research Councils point to a considerable
amount of research funded by them which is taking place in many
of the common diseases of adults as well as older people. They
point to a considerable amount of basic research being undertaken
in the biological, social and behavioural sciences, some of which
may be specifically directed at ageing and some of the rest will
have implications for ageing. Close examination of the previous
research strategies suggests that the issues specific to the needs
of older people have been neglected.
THESE ARE
VERY SIMILAR
TO THE
RECOMMENDATIONS PROPOSED
BY THE
NHS STRATEGIC REVIEW
ON AGEING
AND AGE-ASSOCIATED
DISABILITY, WHICH
REPORTED IN
JUNE 1999. PROGRESS
HAS BEEN
VERY DISAPPOINTING
— Is there sufficient research capability
in the UK?
— Is the research being used to inform
policy?
DEFINITELY NOT
. . .
The Stroke Association has placed a high priority
upon the building of the research capacity in physiotherapy, occupational
therapy, speech and language therapy and nursing. It has offered
a small number of research bursaries annually for 10 years. The
Association welcomes recent initiatives made by the DoH.
THE APPLICATION
OF RESEARCH
IN TECHNOLOGY
AND DESIGN
TO IMPROVE
THE QUALITY
OF LIFE
OF OLDER
PEOPLE, INCLUDING:
— Existing technologies which could
be used to a greater extent to benefit older people.
— The development of new technologies.
Research in this area consists of pilot projects
and the design of exciting prototypes only. Funding is required
to expand these pilot studies into extensive trials.
September 2004
1 Adamson J, Beswick A, Ebrahim S. Stroke and Disability.
Journal of Cardiovascular Diseases. In press. Back
2
Markus H, Kapozsta Z, Ditrich R, Wolfe C, Ali N, Powell J, Mendell
M, Cullinane M. Increased Common Carotid Intima-Media Thickness
in UK African Caribbeans and its Relation to Chronic Inflammation
and Vascular Candidate Gene Polmorphisms. Stroke 2001; 32: 2465-2471. Back
| 
