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Invited EditorialAgeing research directions for Australiaajag_566 1..3
‘Ageing Well Ageing Productively’ in the contextof Australian ageing researchThe increasing life expectancy of Australia’s population,coupled with decreasing fertility rates, led inevitably toincreasing population proportions aged 65+ and 80+ andmajor issues for health and aged care policy-makers, practi-tioners and researchers. The Australian Government hastaken the lead in ageing and aged care issues over the lastdecades, specifically in developing the research evidence baserequired to effectively inform positive policy and practiceoutcomes. The increased attention to ageing can be seen inthe Treasury’s release of three Intergenerational Reports(2002, 2007, 2010), the Australian Research Council (ARC)/National Health and Medical Research Council (NHMRC)Research Network in Ageing Well (2005 to 2010), the ARCCentre of Excellence in Population Ageing Research, and theAgeing Well, Ageing Productively (AWAP) Research GrantsProgram and the Productivity Commission Report of 28/6/11‘Caring for Older Australians’, which addresses some of theissues raised in the Health Reform.
The AWAP Research Grants Program provides a goodexample of the Commonwealth Government’s influence onageing research. In 2002, the Prime Minister’s Science, Engi-neering and Innovation Council (PMSEIC) introduced a setof National Research Priorities. These priorities included‘Promoting and Maintaining Good Health’, under which‘Ageing Well, Ageing Productively’ was the focus for researchto enable better social, medical and population health strat-egies and improve the mental and physical capacities of olderpeople. In response, the NHMRC and the ARC collaboratedto develop the AWAP Research Grants Program. The aim ofthe AWAP Research Grants Program was to foster multidis-ciplinary and collaborative research, and develop an authori-tative evidence base to effectively inform policy and practice.Ten million dollars was set aside for research grants tosupport the Program. In 2004, the NHMRC and the ARCcalled for submissions to advise and refine research themes toensure broad stakeholder engagement in developing aresearch agenda. Researchers were then invited to submitgrant applications in 2005, and in July 2006, the then Min-ister for Ageing, the Hon Santo Santoro MP, announced thesix successful grant recipients:
• Working Longer: Policy Reforms and Practice Innova-tions (Chief Investigator: Professor John Piggott).
• Predictors of Ageing Well in the Australian LongitudinalStudy on Women’s Health and the Perth Health in MenStudy (Chief Investigator: Professor Annette Dobson).
• Gene – environment interaction in healthy brain ageingand age related neurodegeneration (Chief Investigator:Professor Perminder Sachdev).
• Using health outcome data from pooled LongitudinalStudies of Ageing to develop statistical and microsimu-lation models to determine how to best compress mor-bidity and optimise healthy and productive ageing(Chief Investigator: Professor Kaarin Anstey).
• The development and evaluation of management strate-gies designed to address poly-morbidity in older people:Implications for health policy planning, practitionersand patients (Chief Investigator: Professor AndrewGilbert).
• Examining a core assumption of policy and services forolder Indigenous Australians (Chief Investigator: Profes-sor John Condon).
The Australian Government then funded the AustralianAssociation of Gerontology (AAG) to produce a publicationto showcase the latest evidence in ageing research, with aparticular emphasis on research funded through the AgeingWell Ageing Productively (AWAP) research grants and theAustralian Longitudinal Study of Women’s Health, and oncontributions to policy and practice outcomes benefitingolder Australians in their everyday lives. The result is thisspecial supplementary edition of the Australasian Journal onAgeing entitled Ageing Well in Australia.
The AWAP research addresses, implicitly and sometimesexplicitly, broader issues for Australia, for example decliningproductivity rates and innovation. The 2009 the AustralianGovernment report Powering Ideas: An Innovation Agendafor the 21st Century outlined seven national innovation pri-orities to focus the production, diffusion and applicationof new knowledge. The innovation priorities complementAustralia’s national research priorities and encourage highquality research, collaboration and improvement of policydevelopment and service delivery through innovation. AgeingWell in Australia is the first publication of its kind intended tomake information available to inform policies that supportageing well, and to provide a valuable resource for policy-makers, nurses, practitioners and researchers, as well asothers working in the ageing and aged care sector.
Some highlights in the special issueA review of the AWAP research program, as evidenced in thisspecial issue, shows that considerable innovative work hasbeen done on genetics, meta-analysis of longitudinal studies,risk factors for healthy ageing, multiple illnesses in later life,economics of work in later life (not in this issue) and, last butby no means least, ageing of Indigenous Australians.
The continuing influence and uses of a number of longitudi-nal studies of ageing done in Australia can be seen in three of
DOI: 10.1111/j.1741-6612.2011.00566.x
1Australasian Journal on Ageing, Vol 30 Supplement 2, October 2011, 1–3© 2011 The AuthorAustralasian Journal on Ageing © 2011 ACOTA
the papers reported here. First, the Anstey et al. project (page24) is the first major pooling and analysis of Australianlongitudinal studies done in Australia, combining data frommore than 50, 000 older people from across Australia. Thishas been innovative in a number of other ways because newmethods have had to be developed to complete these analy-ses. It provides estimates of disease and disability in theoldest-old and allows for evaluation of current health andsocial policy areas including on alcohol. Further work isbeing done on the health and morbidity of the baby-boomercohort. Next, the Dobson et al. project (page 13) focuses onbody mass index, physical activity, alcohol and smokingevidence across two studies to examine how well currentnational guidelines accord with specific evidence for olderpeople and with particular regard to gender. They find thatthese guidelines could be better attuned to the evidence ofrisks for older people, for example, by recommendingalcohol-free days each week. They make a case for age-related recommendations, particularly for physical activitywhich, like other areas of health advice, needs further goodquality research for support. Finally, the Byles et al. project(page 6) reports on exciting work from three cohorts ofwomen born 1921–26, 1946–51 and 1973–78 who weresurveyed every three years from 1996. The factors associatedwith survival included not being underweight, maintainingphysical activity, not smoking but drinking moderately, andhaving better self-reported health. The good news from theoldest cohort is that about two-thirds of survivors main-tained high physical functioning. The bad news from theyoungest cohort is the high prevalence of overweight andobesity for those around 20 years of age at the start of thestudy. All is not necessarily well for future healthy ageing‘down under’ and that is one of the challenges for futurehealth promotion efforts and for health care planning.
Next, we are all aware of the promise (and promises!) ofgenetics and health for the future. In the Sachdev et al. project(page 17) using the Australian Twin Registry, we have researchthat reflects the growing importance of genetics to the under-standing of healthy ageing. There is much still to be under-stood about the observed heritability of hypertension, asthmaand cognitive function, shown in their work and subject totheir forthcoming second wave. The future promise in suchwork is for opportunities to intervene and hopefully preventchronic disease upstream rather than mitigating problemsassociated with disease after they have occurred.
Into this mix we have the Gilbert et al. project (page 32) whichis focused on improving care and health outcomes for olderpeople with multiple chronic health problems, and not just anarrow focus on one disease which characterises the approachof our current system. Some 65% of older people have two ormore chronic conditions, and current clinical guidelines donot specifically address this complexity. This is importantbecause of the potential for ‘treatment conflicts’ betweendiseases which can cause further harm to older people. TheGilbert et al. paper argues a compelling case for multidisci-
plinary, coordinated care as the route to improving the healthcare of older Australians. This has already been translated intoVeteran’s Affairs and National Medicines policy and practice.This study is an example of the future of Australian research ina world where ageing is ‘in the mainstream’. The emphasis ontranslatable findings and practical questions does indicate astyle of research that can compete in the mainstream andattract the attention of policy-makers and practitioners whoare looking for advice they can use.
The final highlight strongly focused on improving healthyageing, we have the Condon et al. project (page 38) focused onplanning for Indigenous Australians. While the AustralianGovernment continues to work on policies to ‘close the gap’on the morbidity and mortality of Indigenous Australians,chronic disease and social disadvantage continue to create lowquality life in later years. This project identifies differentservice use patterns within the Indigenous population andbetween Indigenous and non-Indigenous Australians. Forexample, community-based services are much more importantfor Indigenous Australians than others. Particular groups ofolder Indigenous Australians are under-serviced and theirdiverse needs are not well met by planning across geographicareas and different levels of care. Finding out more about whatworks best in services for Indigenous Australians is central toimproving the quality of their health in old age.
The way forwardAgeing continues to remain high on the list of nationalresearch priorities. The NHMRC 2010–12 Strategic Plan, forexample, explicitly recognises the importance of maintaininghealth as we age, both from a social and economic stand-point. The plan states that the NHMRC ‘will focus onresearch, evidence translation and capacity building in thecare and support of ageing Australians and provide the evi-dence to underpin the most effective services supporting pre-vention of ill-health, improved quality of life and promotionof well-being’ (page 8). Clearly, ageing well research willcontinue to be an important part of Australia’s response topopulation ageing and research will be sought to improvepolicy and practice and by implication Australia’s productiv-ity and innovation rates.
During the last decade ageing shifted from being ‘the hotissue’ of 1990s to a major mainstream issue. This main-streaming of the issue of ageing has important contextualimplications for ageing research in the coming decade. Inparticular, it has to deal on equal terms with other fields withthe key ‘drivers’ of research and funding, for example:
• Ageing research has to become more competitive in a‘mainstream’ research funding environment.
• Scale will become more important for competitivefunding so we need to move away from ‘cottage indus-try’ research while supporting individual development.
• Healthy ageing and its corollaries are now more impor-tant than ‘sick’ ageing.
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• Genomics, epigenetics and related fields will becomemore important parts of the mix of multidisciplinaryresearch.
• Ageing research is usually cross-disciplinary and ‘wholeof government’ which are the research directions of thefuture but both challenging research directions.
• Capacity building in ageing research remains critical sothat we grow our new researchers and infrastructurerather than diminishing them.
• Faster, cheaper and more practical will be the mantra ofthe future for research and translation.
• Teaching nursing homes can provide a base for high-quality, practical research.
• There is new need for disciplined intervention and com-parative effectiveness research and proper researchtranslation.
• There is a need to build a base for learning by doingthrough focused work kept in repositories.
The AWAP investment shows the benefits of a scheme set upto fund multidisciplinary, innovative and big picture ideas inageing research. Having been successfully implemented once,this is a potential model to consider for future, ‘stimulus’funding for ageing research. The key questions are how,without the PMSEIC driver, it would be funded and refo-cused in the new policy environment. Some options toimprove research capacity and support in a ‘steady state’ wayinclude: harnessing the AAG Collaborating Centres todevelop foundations for a more coordinated and large-scaleresearch effort through collaboration; and, engaging in joint
dialogue with governments and research bodies such as theNHMRC and the ARC to develop a comprehensive ageingresearch agenda incorporating all aspects of ageing andaged care. This could be facilitated in various waysthrough outside assistance and potentially involve capacitybuilding grants of various kinds. The aim of such initiativeswould be to strengthen the ageing research community and tospeak with a collective voice on issues facing an ageingAustralia.
While there is still a long way to go in terms of building acomprehensive Australian ageing research agenda, much canbe learned from the success of programs such as the AWAPResearch Grants Program in fostering growth in the ageingresearch evidence base to better inform policies and pro-grams and improve the health and well-being of olderAustralians. Rather than marking the conclusion of theAWAP Project, it is hoped that Ageing Well in Australia willbe a catalyst for new ideas and innovation from which futureresearch and research programs will evolve.
Professor John McCallumHead, Research Translation GroupNational Health and Medical Research CouncilCanberra ACT, Australia
Note: I declare two conflicts of interest as one of the Panelthat recommended the AWAP projects to the Minister and asone of the directors of a longitudinal study on ageing notspecifically mentioned here.
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3Australasian Journal on Ageing, Vol 30 Supplement 2, October 2011, 1–3© 2011 The AuthorAustralasian Journal on Ageing © 2011 ACOTA