Memoranda by Help the Aged
Help the Aged warmly welcomes the opportunity
to provide evidence to the House of Lords Select Committee inquiry
on research on ageing. With the present global demographic trends,
unprecedented numbers of older people are set to face the risks
of disease, dependence and frailty. The issue of research on ageing
is therefore of fundamental importance. We hope that the Committee's
inquiry will serve to raise the national profile of research on
ageing and will promote actions which will lead to practical benefits
in the lives of older people.
Help the Aged is the only charity in the United Kingdom
which dedicates its research portfolio exclusively to ageing.
The charity invests some £2 to £3 million pounds per
year in funding and supporting research. Through its special trust,
Research into Ageing, we provide a range of studentships,
fellowships and programme grants. Our biomedical research is of
the highest quality, being published in leading academic journals
and leading to practical outcomes which directly benefit the lives
of older people. We commission high impact social research to
support our policy base.
In addition to funding, Help the Aged forms strategic
relationships with leading research organisations, such as the
National Collaboration on Ageing Research, the Research Councils
and government departments in order to influence both the magnitude
and direction of research on ageing. Internationally, we have
strong links with the UN, WHO, the International Association of
Gerontology and the International Federation on Ageing, all of
which have strong research interests.
Help the Aged (and Research into Ageing) publish
a wide range of research reports and publications to disseminate
important new findings to the practical benefit of older people.
Help the Aged calls on the government for:
a clear statement making research
on ageing a greater national priority.
a "step-change" in funding
levels for ageing research in the UK on a per capita scale
of that of the USA. The current low order, inconsistent budget
for research on ageing poses a real threat to the well being of
older people. A stable, long-term regime of generous government
funding must provide the basic research infrastructure to which
charitable funding can contribute.
the appointment of a "champion
for ageing research" in a central government department,
such as the Office of Science and Technology, to lead and direct
a national research agenda on ageing.
the development of mechanisms for
building research capacity to invest in the career paths of researchers,
including gerontology and geriatrics.
emphasis to be given to the critical
areas of cellular ageing biology (such as immunosenescence, molecular
genetics, and replicative senescence) which not only provide vital
new knowledge but which present the potential for the improvement
of human health and well-being.
funding of long term research to
determine whether there is a compression or expansion of morbidity
and the biological, and socio-economic impact of these changes.
more research to identify the modifiable
risk factors that contribute to healthy ageing and the effectiveness
of early intervention programmes on healthy ageing. The interplay
of environment with the organism (particularly genetics) must
be the subject of further research.
research to underpin preventative
and treatment strategies of conditions that cause poor quality
of life and dependence.
tackling ageism to improve the public
perception of the benefits of ageing research, to change attitudes
to funding and to improve the involvement of older people in the
research to identify ageing differentials
due to gender and ethnicity.
greater involvement of older people
and service providers in research agenda-setting to improve the
delivery of tangible benefits to the older population from developments
in science and technology.
more research to provide a cost
analysis of the preventative value of assistive technology to
enable people to continue to live in their own homes.
more translational research to ensure
that research results enter into practice.
What are promising avenues for research? How will
such research benefit older people and delay the onset of long-term
illnesses and disabilities? What are the differences between the
sexes, and between different social and ethnic groups in the UK?
The Challenge of an Ageing Population
Britain is an ageing society. The demographic
trends that are taking place in the UK are widely recognised.
For the first time, the number of people in the population aged
over 65 exceeds those under the age of 16, as shown by the results
of the 2002 census. The fastest growing sector of the population
is the over-80s. In the next five years there will be a 10 per
cent increase in this age group.
Globally there are similar trends. The proportion of the global
population aged 65 and over in 1900 was 1 per cent (UK 5 per cent);
in 2000 it was 7 per cent (UK 16 per cent); and by 2050 it is
estimated to be 20 per cent, a figure the UK would reach in 2020.
In Europe, 50 per cent of the population will be over 50 by 2030.
With these demographic trends, unprecedented numbers of older
people are set to face the risks of disease, dependence and frailty.
There are huge implications for the economy, for pension provision
and for the costs of health and social care. The tremendous advances
in biomedical, scientific and social research have improved our
understanding of the ageing process, of age-related disease and
of older people's experience of growing old. However, much remains
to be done.
What are promising areas for research? How will
such research benefit older people and delay the onset of long-term
illnesses and disabilities?
There are four areas, in our estimation, which are
of particular concern. They are: the biology of ageing, the determinants
and status of healthy ageing; age-related disease and its prevention;
and the effectiveness of treatments for older people.
Biology of Ageing
Ageing is a summary term for a set of processes
that predisposes us to deterioration of health and ultimately
death with the passage of time. It can be thought of as a group
of processes (including physiological, genetic and environmental)
that contribute to increasing risk of frailty, disability, morbidity
and mortality. The challenge for the science of ageing is to identify
such processes and develop preventative and treatment strategies
to delay the morbidity and ultimately mortality that occurs with
the passage of time.
As good health is vital for older people to live
full and active lives, it is essential to know more about the
general biological principles underlying the ageing of cells,
organs and organisms. There are many promising areas of research
within this area: teasing out the mechanisms of the increase in
longevity and health expectancy and translating such mechanisms
into interventions; understanding the gender differences that
exist in response to caloric restriction, and the role of the
insulin-IGF1 axis. The genetics of long-lived and short-lived
species is also important to determine the contribution of "longevity"
genes. Promising avenues of cellular and organ ageing research
include immunosenescence (the failure of the immune system to
respond effectively to infection with age) causing the death of
around 4-5,000 older deaths each year from influenza (up to 20,000
in a `flu epidemic) and many more deaths from subsequent conditions
such as pneumonia. Studies on replicative senescence have the
potential to bring clinical benefits in the future with strategies
to block senescence and prevent oxidative damage. It is recommended
that emphasis is given to the critical areas of cellular biology
(such as immunosenescence, molecular genetics, and replicative
senescence) which not only provide vital new knowledge but which
present the potential for the improvement of human health and
Life expectancy for UK citizens has been steadily
increasing (approximately three months was added to life expectancy
for each year of the last century) and while health expectancy
(the number of years living in good health) has also been increasing,
it is not clear to what extent the added years are experienced
in good health.
There is a clear need for good reliable data to determine whether
there is a compression or expansion of morbidity with the changing
demographics and the biological, economic and social impact of
The science of ageing should be viewed as being wider
than purely cellular changes, but viewed holistically as the wider
factors contribute to morbidity and mortality. Lifestyle and environment
contributes around 75 per cent of a person's chance of healthy
ageing and longevity. The major indicator for health expectancies
and life expectancy is socio-economic class with the greatest
impact seen on health expectancies.
These inequalities in quality of life have been know for some
time and should be urgently tackled at a political level. It is
vital that these differences are explored further with longitudinal
population studies and the environmental factors contributing
healthy ageing identified and put into practice. Some of the modifiable
risk factors are known: diet, exercise, smoking and can be the
target of further governmental health promotion initiatives. These
initiatives should take account of the data on health promotion
in pregnancy, adolescence and throughout adulthoodageing
is not just about changes in middle age and beyond, many ageing
processes start much early in life (bone loss starts in the third
decade) and foetal health can contribute to these processes. More
research is required to identify the modifiable risk factors that
contribute to healthy ageing and the effectiveness of early intervention
programmes on healthy ageing. The interplay of environment with
the organism (particularly genetics) must be the subject of further
Preventing dependency, a key government issue,
not only depends upon minimising the risk factors and understanding
of the basic biological processes, but also on research delivering
on the understanding of age-related conditions, the development
of effective treatment strategies and specific preventative measures.
Some of the major causes of death (heart disease, cancer, and
lung disease) are relatively well funded; others are not, notably
stroke. The day to day health concerns of many older people are
often focused on the non-disease issuestheir feet, eyes,
ears and teethas well as the more general frailty associated
with ageing such as muscle wasting and poor balance causing poor
mobility, loss of independence and an increased susceptibility
to falls. Major causes of dependency and poor quality of life
eg sensory loss, bone and joint degeneration, cognitive decline,
muscle wasting, falls, and incontinence are relatively poorly
funded and require substantial investment.
Incontinence is a case in point where there is a
small research base within the UK, poor understanding of the biological
process, little in the way of effective treatment and research
funding in response mode competitive manner is rarely available.
Without special initiatives of ring-fenced funds (such as that
initiated by Research into Ageing in 2000) little change can be
expected to help the six million people in the UK with this disabling
and distressing condition.
Research is desperately needed to underpin preventative
and treatment strategies of conditions that cause poor quality
of life and dependence.
Treatments for older people
Research opportunities do exist and are emerging
to treat degenerative and debilitating conditions eg tissue engineering
using stem cells and genetic engineering for the treatment of
degenerative conditions, hormones in osteoporosis and cognitive
decline. Major advances in biomedical, social, physical and behavioural
research have improved health and functioning, and continue to
reduce rates of disease for older people, although this impact
has been uneven across the older population.10 The representation
of older people in pharmaceutical trials has improved with the
new European Directive.
but there is still little funding available for the evaluation
of clinical outcomes in trials involving interventions and treatment
of older people.
Ageism affects attitudes to research on ageing at
all levels. It influences both priorities and decision making
in terms of funding and investment. Attitudes such as "incontinence
and hearing loss are a normal part of ageing" are commonly
experienced. Research activity is therefore low, the body of knowledge
relatively poor, and hard fought for research funds hard to find.
This vicious cycle needs to be broken. Similarly, the level of
public awareness of the benefits of research on ageing, other
than that in relation to specific diseases, appears to be poor.
This particularly applies to research on healthy ageing which
may not only prolong life but will improve its quality in the
later years and have impact on public expenditure. Finally, there
is a notable absence of the meaningful involvement of older people
themselves in research, particularly in technology.
Ageism must be tackled to improve the public perception of the
benefits of ageing research, to change attitudes to funding and
to improve the involvement of older people in the research process.
What are the differences between the sexes, and
between social and ethnic groups in the UK?
Gender differences have been identified in relation
to response to caloric restriction
and in immunescenesence.
Ethnic differences clearly exist with demonstrable differences
in longevity between countries.
The degree to which such ethnic differences can be attributable
to genetic, socio-economic, nutritional, cultural or environmental
factors is difficult to tease out,
but clearly all have a role to play. Help the Aged has well developed
programmes working with the different ethnic communities and recognises
the importance of inclusivity in this area. The scope for progress
in identifying ageing differentials due to gender and ethnicity
is large and warrants further investigation within identified
priority areas of biological ageing.
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
Assistive technology (AT) has been defined very
broadly as "any product or service designed to enable independence
for disabled and older people".
With this in mind, it covers an extensive variety of aids, adaptations
and supportive technologies including the following:
Mobility aids, eg powered wheelchairs,
Aids to daily living, eg accessible
baths, showers or toilets.
Environmental control systems, eg
infra-red controls to allow the user to operate household equipment
such as radios, TVs, light switches.
Communication equipment, including
accessible telephone equipment or videophones used for telemedicine.
Security devices, eg community alarms
to warn carers or other care services if anything is untoward.
Smart Homes providing electronic
or computer-controlled integration of assistive devices within
Beyond this, a range of more basic
yet vital technologies aimed at assisting people to undertake
activities of daily living. These include such aids as "jam-jar
openers" and "stocking aids".
Priorities and gaps in research
Through the EQUAL programme the EPSRC has been the
key government funder of research relating to design and AT over
the past few years.
Within this successful programme there has been a real commitment
to engage with users in delivering research which meets their
needsa progressive policy which should be developed upon.
Undertaking an assessment of research gaps and priorities
would seem of little value unless there is greater and more transparent
engagement with both older people in determining their priorites
for technologies to support independence and those agencies responsible
for providing and commissioning such technology. It remains the
case that older people may not know what is available and those
seeking to meet their needs don't always know what is wanted.
This is a real issue in that consumer demand must be one of the
necessary elements of a successful introduction of services which
should in turn inform the research agenda. Two key organisations,
emPOWER and FAST (Foundation for Assistive Technology), are working
to achieve a proactive approach to user involvement in this are.
Help the Aged would greatly urge a more transparent process for
agenda setting which begins from the perspective of older people.
Greater involvement of older people and service providers
in research agenda-setting is recommended to improve the delivery
of tangible benefits to the older population from developments
Barriers to transferring research into policy
The translation of research into practice and policy
remains a pressing concern. In their recent report,
the Audit Commission conclude that, in general, AT services in
the UK are underdeveloped. As a result, new designs and technologies
are not being transferred into practice. There may be a number
of reasons for this.
The lack of integration and collaboration between
agencies to deliver AT and the lack of professional training on
and awareness of new technologies among service providers, including
GPs, are certainly major obstacles.
Further, the question of budgets also complicates the picturethose
agencies in the position to provide AT are not necessarily those
that will benefit from them. For instance, Housing departments
can use "housing supporting community alarms" but social
services or health will reap the benefit. In addition, the capital
costs relating to AT are not as much an issue as the revenue costs
associated with providing staff who can deliver and train users
to make use of AT.
Installation and user training of AT can be labour
intensive and maybe off-putting for service providers with limited
budgets. However, it is arguable that the longer term benefits
of reduced interaction with the clients themselves should outweigh
these costs. The Assistive Technology Forum argue that "a
vicious circle exists where arguments for investment are undermined
by a lack of evidence and effective evidence cannot be produced
due to a lack of robust infrastructure".
One of the problems is that devices are seldom offered as part
of a support package with staff included. Successfully demonstrating
the benefits of such technology is therefore problematic.
Whilst cost benefit analysis has taken place with
some forms of assistive technology,28 more research is needed
to provide a cost analysis of its preventative value, in enabling
older people to continue to live in their own homes. Generally,
more translational research is required to ensure that research
filters into practice.
Beyond this, there is a real need to ensure that
older people are offered proper training and choice when accessing
AT without which older people may be reluctant to make use of
such technology. The shortage of Occupational Therapists and other
health professionals with knowledge of AT creates delays in providing
support to older people and is likely to reduce the time available
to therapists to work with clients in providing appropriate AT.29,
A Joseph Rowntree Foundation study
found that "Age . . . [is] one of the strongest predictors
of someone's interest in living in a smart home". The
most interested were aged 15-34the "ambivalent"
were more likely to include older people and the "uninterested"
were most likely to be aged 55 and over. Older people were the
group most concerned about potential technical problems with the
systems. Certainly the stigma of "disability" associated
with the need to use special equipment
affects uptake of AT. Mainstreaming its benefits would seem to
be vital in attempting to remove this stigma.
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? Is there sufficient research capability in the UK?
Is the research being used to inform policy?
Between 2002 and 2004, Help the Aged played
a leading role in the joint IAG/UN initiative "Research Agenda
for the 21st Century". This initiative started with the Valencia
Forum in 2002 and was followed by expert workshops in each of
the four UN Regions (Cape Town, Barcelona, Santiago and Tokyo).
An international comparison across the four UN Regions reveals
three common strategic problems with ageing research which are
applicable to the UK. They are: low relative investment; fragmentation
and lack of capacity; and absence of strategic direction.
In terms of investment, the total Research and
Development budget (all sectors) for the UK (2002-03) amounted
to £18,817 million; government expenditure £2,841 million
and accumulated research on ageing to less than £200 million,
about 1 per cent of the total. Government funding for ageing research
is principally in vested via four of the Research Councils. None
of the Councils spends more than 5 per cent of their budget on
ageing research. For example, in 2002-03, the EPSRC's total budget
was £436.2 million with the "EQUAL" Programme worth
£9 million, 0.7 per cent of the total. Not only so but the
dedicated spend on ageing by the Research Councils appears to
In the 2002 Spending Review,
Government priorities were Genomics (£110 million); eScience
(£98 million); and Basic Technology (£44 million). Ageing
research was not identified as a priority and this holds true
for the Spending Review 2004.
Ageing research was not mentioned in the Vision for UK Science,
no research achievements in ageing science were mentioned and
ageing research was not one of the six priority areas for Multidisciplinary
The principal government departments with research
budgets for ageing are the Department of Health (DH) and the Department
of Work and Pensions (DWP). Help the Aged estimates that in 2002-03
on-going projects were worth £20.45 million (DH) and £3.57
million (DWP) with an annual expenditure of £4.80 million
and £1.23 million respectively. These are relatively small
Charitable spending on ageing research for on-going
projects in any one year resides at about £125 million (£124.26
in 2002-03). However, two important caveats must be made. It is
very difficult to portion out the costs of research because much
expenditure is age-related and is not necessarily categorised
as "ageing research". For example, the AMRC does not
categorise its research expenditure by "age" but many
of its members, eg British Heart Foundation, Alzheimer's Society,
etc fund research which is clearly age-related. Secondly, the
high impact of charitable funding, which is often variable and
insecure, depends on sustainable, high order, reliable central
funding on which the UK research infrastructure is dependent.
In spite of the low order of spending, the UK compares
well with Europe which under the 6th Framework Programme (FP6)
does not currently identify ageing as a research theme, though
1,155 million are being spent on combating major
diseases, some of which are age-related. Under FP5 only
190 million was spent directly on ageing research
over four years (1998-2002) through Key Actions 1 and 6.
However, the UK compares poorly with the USA which
through the National Institute of Aging (NIA) combines high order
strategic thinking with enviable levels of funding. NIA has a
budget of $994 million in 2004-05, a rise of 44 per cent over
the last five years ($688 million in 2000-01). Of this sum, at
least $669 million are being spent on Research Project Grants
and a further 9 per cent on Institutional support.
The result is substantial progress in reducing illness and disability
among older people in the USA and large reductions in projected
healthcare costs.37, 
A "step-change" in funding levels for ageing
research in the UK is required on a per capita scale of that of
the USA. Questions must be asked as to why the UK has persisted
with a low order, inconsistent budget for research on ageing which
poses a real threat to the well being of older people. Help the
Aged, with others in the voluntary sector, will play its part
in maintaining funding for research. However, it has to be recognised
that a stable, long-term regime of generous government funding
must provide the basic research infrastructure to which charitable
funding can contribute.
Research capacity building is an issue because
of the generalised problem of the absence of a research career
structure in the Universities and the way they are funded. Charitable
expenditure on research in the universities went from £250
million in 1990-91 to £550 million in 2000-01 and much of
this investment was targeted to support research capacity. At
the present time, such capacity as exists is threatened by the
absence of adequate funding and is tiny in relation to the scale
of the UK problem. Between 2000 and 2004 the demand for funding
at Research into Ageing rose from 100 to 250 applications
per year and with funding levels constant, the rejection rate
consequently rose to 1:31. High rejection rates threaten capacity
and do not augur well for the maintenance and expansion of the
research base. In our current Major Gifts Campaign, 32 proposals
mostly of outstanding international merit, have been submitted.
Each proposal required £10-15 million. Of the total fundable
volume of £450 million, only one proposal will be funded.
The remainder of the proposals are highly likely to be lost to
UK science. Finally, charitable support for capacity building
will not be helped by the government requirement for universities
to move to a "full economic cost" model by 2005, though
the government has provided some £90 million in 2007-08 in
support of the voluntary sector (the Charity Research Support
The development of mechanisms for building research
capacity is necessary to invest in the career paths of researchers,
including providing opportunities for research training in gerontology
There is no central organising body for ageing
research in the UK. Ageing and age-related research is carried
out independently in the universities with little strategic direction.
The National Collaboration of Ageing Research (NCAR) was set up
in 2001 and has been largely successful in promoting a cross-council
model of research which has led to the inauguration of a new programme,
the New Dynamics of Ageing. The Funders Forum on Ageing Research
(FFOAR), a parallel development to NCAR, is a co-operative body
made up of the Research Councils, six major charities and the
Department of Health. It meets once per year to receive reports
from its members and to make recommendations for research and
development. It has advisory powers only and lacks the authority
to direct a national agenda. There is no government department
which takes the strategic lead on research into ageing.
In the USA, the NIA provides a high degree of strategic
direction. It provides substantial funding for four major Extramural
Programs (Biology of Aging; Behavioral and Social Research; Neuroscience
and Neuropsychology of Aging; Geriatrics and Clinical Gerontology),
Intramural Programs at a dedicated gerontology research centre,
Conferences, Workshops & Meetings, Funding & Training
and Scientific Resources.
In view of the profound demographic changes
taking place in the UK, Help the Aged calls on the government
for a clear statement making research on ageing a greater national
There must be the appointment of a "champion
for ageing research" in a central government department,
such as the Office of Science and Technology to lead and direct
a national research agenda on ageing. This appointment must combine
strong leadership with budgetary control and must involve partnership
working with existing bodies, such as NCAR and FFOAR to promote
and co-ordinate research on ageing.
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