australian ageing research agenda priorities and challenges david le couteur professor of geriatric...
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Australian Ageing Research Agenda
Priorities and Challenges
David Le Couteur
Professor of Geriatric Medicine
Centre for Education and Research on Ageing
University of Sydney
UNITED NATIONShttp://www.un.org/esa/socdev/ageing/ageimpl.htm
Demographers note a demographic revolution, wherein
the proportions of the young and the old will undergo a
historic crossover...This portrait of change in the world's
population parallels the magnitude of the industrial
revolution - traditionally considered the most significant
social and economic breakthrough in the history of
humankind since the Neolithic period.
Old age is the main risk
factor for disease and
disability after 28 yrs
(Harman 2001)
1 in 5 hospital days are
> 80yrs
Age (years)
<44 45-64 65-74 >75
Pre
va
len
ce
of
dia
be
tes
pe
r 1
00
0
0
20
40
60
80
100
20-34 35-44 45-54 55-64 65-74 75+
Pe
rce
nt
of
po
pu
lati
on
wit
h h
igh
blo
od
pre
ss
ure
0
20
40
60
800-19 20-49 50-74 75+
All c
an
ce
r m
ort
ality
ra
te
0
250
500
750
1000
1250
1500
1750
2000
Evidence for healthcare
– little evidence for efficacy
• >4% of RCT are older people
– efficacy often absent
– adverse outcomes greater
Future $$ predictions
• Baby boomers graduate to retirement in 2011
• Intergenerational Report, costs associated with
ageing will amount to $84 billion within 40 years
• Health care - $15.5 billion
• Pharmaceuticals - $46.5 billion
• Aged care and pensions - $22 billion
Evidence for health policy (AHR, Lowe & Kasap, 2002)
“New ways of doing things in health care are usually
introduced with little or no scientific evaluation …
Political and economic imperatives, often seeming to be
based on little other than the whim of State or
Commonwealth ministers results in management
directives to rationalize reformulate and change tried
and tested systems...”
Where is ageing research in Australia?
• NATIONAL RESEARCH PRIORITY AREAS
• 17 areas covering defence, environment, technology and health
• “Ageing well, ageing productively”
NHMRC Scoping Study(CERA, NARI consortium)
• designated ageing/geriatric research poorly funded
• minor NHMRC representation
• productive in terms of publications
• performed by “non-ageing” researchers
number of applications in 2000
0 50 100 150 200 250
NH
MR
C f
un
din
g (
$)
0
2000000
4000000
6000000
8000000
continuing grantscompeting grants
ger
iatr
ics
and
ger
on
tolo
gy
imm
un
olo
gy neu
rosc
ien
ces
can
cer
end
ocr
ino
log
y
gas
tro
-hep
ato
log
y
NHMRC Project Grants 2000
Includes 8 grants on dementia
Pu
blic
ati
on
s s
up
po
rte
d b
y N
HM
RC
by IS
I c
ate
go
ry
0
200
400
600
800
1000
1200
NHMRC Australian Biomedical Research1998 Butler, Biglia and Bourke
Geriatrics was the lowest of all categories
A B C D E F GTo
tal n
um
be
r o
f A
ust
ralia
n p
ub
licat
ion
s 1
996
-200
0
0
1000
2000
3000
4000
5000
6000
AGEINGA: AGING OR AGEING OR SENESCENCE OR ELDERLY OR OLDER PEOPLE NOT NEONATE NOT INFANTB: GERIATRIC OR GERONTOLOGY OR ELDERLYC: DEMENTIA OR ALZHEIMERS DISEASE
DISEASED: CANCER OR NEOPLASIA OR CARCINOMAE: IMMUNOLOGY OR IMMUNODEFICIENCY OR HIV OR ALLERGYF: HEART OR BLOOD PRESSURE OR CARDIAC OR CARDIOVASCULARG: BRAIN OR NERVE OR NEURON OR NEUROLOGY OR NEUROSCIENCE
AUSTRALIA = AUSTRALIA OR SYDNEY OR MELBOURNE OR BRISBANEOR PERTH OR ADELAIDE OR CANBERRA
PubMed citations1996-2000
Survey of Australian ageing researchers
• N=79
• average age 45
• 42% research degree
• 49% hospitals, 25% university, 20% institute
• 61% medical, 25% science, 14% other
The conclusions of the report
• Ageing research
– primary focus on ageing
– multidisciplinary
– interface with health
care
• Infrastructure needs
– career development
– ageing animals
– longitudinal studies
Ageing research will succeed if
• targeted funding and seeding
– area of extraordinary need vs current orphan
status
• primary focus on ageing
– not disease, gene or methodology
• multidisciplinary
– ageing is complex therefore solutions will be
multifaceted