1. Ageing as a cross-cutting theme Dr Miles D Witham Clinical Reader in Ageing and Health

2. Ageing – why bother?  Core business of the NHS  Growth area…  Current healthcare systems not equipped to deal with ageing populations and their attendant issues  Underdeveloped evidence base  Lot of ill-conceived ‘innovation’  Very little evaluation

3. Healthy ageing – why bother?  Dramatic increases in longevity over last century  Debatable as to whether this is accompanied by increase in healthy life expectancy  So plenty of work still to do here!  ‘adding life to years’ – common, but still useful adage

4. Christensen K et al. Lancet. 2009; 374: 1196–1208

5. Crimmins EL et al. J Gerontol B Psychol Sci Soc Sci. 2011; 66B(1): 75–86.

6. Why focus on ageing as a College?  Impact  Natural home for collaborative working  Some strengths in this area already  Historically under-resourced area of endeavour (but this is changing)

7. FuturAGE roadmap FuturAGE report 2011

8. So what’s wrong with ageing research at the moment?  Basic science in ageing is divorced from clinical practice  Social science (gerontology) is also divorced from clinical practice  Clinical practice lacks an evidence base relevant to older people  Clinical research is often small-scale, single centre, lacking critical mass and lacking the right multidisciplinary ingredients  Lack of ‘follow through’ from discovery, intervention development, testing to implementation and dissemination

9. The evidence mismatch  Most clinical studies look at young people with single diseases  Older people typically have multiple diseases, and are taking multiple drugs  They lack homeostatic reserve, are highly prone to decompensation, and have multiple functional impairments (the state of frailty)  Older people are highly heterogeneous

10.  So evidence accumulated in younger people may not apply to older people  This leads either to: - Inappropriate use of interventions in older people that may be either useless or harmful - Ignoring potentially efficacious interventions in older people because practitioners don’t think the evidence applies to their patient

11. Health care systems  All this is delivered in healthcare systems set up for: -Single diseases -Episodic care -And increasingly…Mobile, articulate, IT- savvy people Which is not very useful for older people!

12. So how do we change this?  We need more of: a)Interventions that target underlying pathological processes common to multiple disorders b)Studies that deliver evidence that is relevant to older, frail people with multimorbidity c)Healthcare delivery systems designed for (and by!) older people, which are flexible enough to deal with the heterogeneity of age

13.  We need less of: -Single organ studies -Highly selected populations And also less of: -Small pieces of disjointed work -Small, isolated teams

14. Where could we target?  Multiple points in the lifecourse: -In utero -Childhood -Young adulthood -Healthy ageing -Ameliorating disease and decline -End of life care Danger of an embarrassment of riches…

15. What would an effective research strategy look like?  Multidisciplinary – just like good clinical care  Involve older people in priority setting and design  Spectrum of methodological expertise:  Qualitative  Systematic reviews  Basic science  Epidemiology  Complex intervention development  Trials  Implementation science  Focus – no point starting a line of enquiry unless you are going to take it through to definitive trials and implementation

16. The UK picture  Historically, lack of join up between basic science, gerontology and clinical geriatric medicine  Lack of capacity in clinical geriatric medicine  Multidisciplinary work is common  Lot of observational work  Few small trials  Very few large trials

17.  Lack of critical mass until recently  Some good work, but lacking multicentre / UK-wide approach  Dundee: small trials  Edinburgh: delirium and dementia  Bradford, Notts: Health services research  Southampton, Cambridge: Epidemiology  Newcastle: Basic science, epidemiology

18. Local expertise  Ageing and Health  Oxidative stress (CVDM)  Trials (TCTU)  Epidemiology (DEBU)  Qualitative expertise (SNM)  Some systematic review expertise (scattered)  Implementation science (SISCC) – early stages

19. Examples from A+H  Health and Social care data integration: -Team from A+H, Clin Pharm, DEBU, HIC, SCPHRP -Now ESRC / Scottish Govt funded PhD (cosupervised by A+H / SNM / PHS / Napier)  Adherence in older HF patients: -Team from A+H, SNM, Health psychology (from Galway) -CSO-funded PhD

20.  Physical activity in older people -Team from A+H, DEBU (PACS cohort); newer collaborations with SNM (PhD on care home physical activity); Computing and Design (BeSIDE project)  Pharmaceutical interventions to improve physical function in older people -Teams from A+H, Clin Pharm, Imaging, IMAR, Health economics (Aberdeen), trials (TCTU and HSRU Aberdeen) -Multicentre trials (BiCARB, LACE); -Single centre trials (PREFACE, SPIROA, ALFIE)

21. Pitfalls of cross-cutting themes 1)Getting Ageing and Health to do all the work 2)Tacking the word ‘Ageing’ onto work in a superficial way 3)Chasing grant calls with the word Ageing in them, rather than pursuing a coherent programme of work 4)Keeping the same structures and expecting cross-cutting work to magically happen

22. Conclusion  Ageing is a natural home for interdisciplinary, cross-cutting research  There is a lot of work that needs to be done  The funding and structures nationally are improving  UoD has several inherent strengths in this area  A joined-up, focussed approach may be the best way to develop critical mass in selected areas  Local examples of collaboration give a good basis for future growth