Transcript Me Leon Flicker Professor of Geriatric Medicine University

Leon Flicker
Professor of Geriatric Medicine
UWA
Synthesising Session
A Presentation for the National
Symposium on Ageing Research
September 2003
Context (Bias) (Conflict of Interest) of
This Ageing Researcher
 Male
 Medical
Practitioner
 Non-social
(asocial?) scientist
Why Do We Do Research?
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Curiosity, Investigator driven research
We do research because we are driven to do it – we like
finding answers to the questions that interest us.
The wider community helps us by providing us with
– 1) Interesting questions
– 2) Resources to answer these questions
We, the researchers are in a privileged position, to be able
to follow our ideas rather than dwell on our careers.
We should remember that ageing research is
comparatively hopelessly under funded (as demonstrated
by David Le Couteur).
We do not need more ageing research in just one narrow
discipline, we need more of everything, from genes to
geography, spanning all major interests of human
endeavour.
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To compete???
In 16 years as a researcher, despite having collaborated
with molecular biologists, statisticians, nurses, allied health
people, epidemiologists, psychologists, economists,
sociologists, never needed a GAMS number because the
ARC does not fund medicos.
In the modern world, if you are competing for scarce
research funding and you arbitrarily exclude a skill set you
become less competitive. Eg if you want to do dependency,
health cost, X, Y, projections wouldn’t they be improved
by some quantification of potential loss or gains based on
realistic projections of the changing rates of diseases in
older people?
In today’s world it is not the discipline that people bring to
a research team, it is a skill set useful to answer a question.
(pointed out by John Braithwaite) The questions
dominates the assembly of the team not vice versa. If you
can’t assemble the appropriate team, which now is
frequently multidisciplinary, it would be a waste of the
taxpayers’ money to fund you. Same for infrastructure
BUILDING AUSTRALIA’S AGEING
RESEARCH CAPACITY: A FORUM
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The speakers will explore the challenge of harnessing
resources within a changing national research environment
with a view to building a policy-relevant research agenda
and fostering stakeholder alliances.
We did not fucus on this – who are the stakeholders of the
research besides the researchers themselves and what are
their roles?? Pat Reeve did point out that she thought that
Australians, possibly older Australians want to have a
more directed role in determining this.
Foster stakeholder alliances? How??? There must be
mutual benefit, some will actually want specific questions
answered, researchers won’t necessarily appreciate being
enthused to answer a question brought to their attention
and then asked to organise the funding to answer the
question, or explore the area……
BUILDING AUSTRALIA’S AGEING
RESEARCH CAPACITY: A FORUM
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The Forum will focus on ideas and opportunities to build
the quality, relevance, and scale of research to meet the
evidence needs of an ageing Australia. The consultation
paper Australian Ageing Research Agenda 2003 will
provide background context and information for the
session.
Unfortunately , although we did have some criticism of this
paper there were few ideas – It was left open as to whether
we need a few more big studies, or a lot of little ones. Who
will decide this? How do we organise rigorous peer review?
(Like democracy the 2nd worse system……..)
If we use the NHMRC or ARC or both how do we ensure
equity but still maintain the ability to prioritise?
LINKING RESEARCH, POLICY AND
PRACTICE
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LINKING RESEARCH, POLICY AND PRACTICE
Professor Marmot will provide an International
perspective, addressing broad questions relating to
appropriate agenda setting and funding structures in
multi-disciplinary research fields, the implications for
research regarding ageing as a process from birth to death,
and the potential use of research to understand the broad
social and environmental processes of ageing. Particular
emphasis will be given to questions about the mechanisms
used in other countries to address these issues.
Marmot
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Translating research evidence (from health inequalities)
into policy – Why?
– Practical
– Strategic
– Moral
Same for Ageing
The advantage of interdisciplinary research is that you
don’t have to be at the frontiers – The Frontier is that you
are using a separate skill set TOGETHER
You just cannot tell funding bodies that you are doing this.
Nice to be able to compare longitudinal studies done in
different countries, increases the variation in exposures
and outcomes, and allow evaluation of service system eg
the homogenous NHS– My only worry is who has
identified the gaps in our current crop of longitudinal
studies and could we address the issues by adding to the
current ones?
PRIORITIES AND CHALLENGES
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Speakers will reflect on the priorities and challenges in
developing and delivering an Australian Ageing Research
Agenda. In particular, speakers will explore the
impediments to, and catalysts for, successful development
of responsive and policy-relevant ageing research and the
necessary mechanisms to facilitate stakeholder
engagement.
David le Couteur pointed out that although ageing is
indeed a whole of life phenomenon someone at some stage
should pay some attention to the research needs of older
people.
The evidence for efficacy for health care interventions in
older people is severely deficient.
Ageing practitioner researchers are different.
Requires researchers to have a primary focus on ageing
PRIORITIES AND CHALLENGES
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Hal Kendig
– Individual and population ageing
– Older people focused
– Biopsychosocial approach
What sort of research
– What do older people want?
– What can produce the maximum impact?
Barriers to use of research
– Imposition of Political imperatives
– Lack of timelines
– Academic publications unavailable
– Researchers misunderstand policy processes
Please refer to previous documents
THE RESEARCHER PERSPECTIVE
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Researchers will explore issues and challenges in
developing and delivering an Australian Ageing Research
Agenda; in particular, by providing insights into how we
might develop a more mutually beneficial collaboration
between researchers, policy makers’ and practitioners in
building the evidence base for an ageing Australia.
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John Braithwaite gave examples from regulatory research
- Practice led model which required
– Seek out master (and others) practitioners
– Get some good ideas
– Refine practice
– Evaluate (with RCTs)
– Dissmeinate
» BOTTOM UP NOT TOP DOWN
THE RESEARCHER PERSPECTIVE
Rhonda Nay
How do we research “care”
What sort of care? Personal, health care, rehabilitation?
They all need addressing. Current care may not be
good……..
What about the research about workforce issues in providing
this care?
What is the research about educational needs?
What do we do if the care provided is found to be
inadequate.
THE RESEARCHER PERSPECTIVE
Tony Broe explained that human ageing
– Very serious
– Very rapid
– Very recent
– Poorly understood
– Extremely complex
– Multifactorial
How can ageing research contribute to the general
Australian research agenda?
Can investigator driven, hypothesis testing ageing research
assist aged policy/services?
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THE RESEARCHER PERSPECTIVE
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Peter McDonald
– Demography beehive but heading for a coffin
– Concern re dismissal of social sciences from the
national priorities
Question from the floor (John McNeil) increasing trouble
and expense accessing routine databases – making it
harder to do any research