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Age and Ageing 2019; 0: 1–4 © The Author(s) 2019.

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COMMENTARY

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Growing research in geriatric medicine
MILES D. WITHAM1,2,3, HELEN C. ROBERTS4,5, JOHN GLADMAN6,7,8, DAVID J. STOTT9, AVAN AIHIE SAYER1,2,3,
THE EXTENDED WORKING GROUP* FROM THE NIHR NEWCASTLE BIOMEDICAL RESEARCH CENTRE MEETING
1
AGE Research Group, Institute of Neuroscience, Newcastle University, Newcastle upon Tyne, UK
2
NIHR Newcastle Biomedical Research Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust and Newcastle
University, Newcastle upon Tyne, UK
3
Newcastle University Institute for Ageing, Newcastle upon Tyne, UK
4
Academic Geriatric Medicine and CLAHRC Wessex, University of Southampton, Southampton, UK
5
Southampton BRC, University Hospital Southampton NHS Foundation Trust, Southampton, UK
6
School of Medicine, University of Nottingham, Nottingham, UK
7
CLAHRC East Midlands, Nottingham, UK
8
Nottingham BRC, Nottingham, UK
9
Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
Address correspondence to: Avan Aihie Sayer, NIHR Newcastle Biomedical Research Centre, 3rd floor, Biomedical Research
Building, Campus for Ageing and Vitality, Newcastle NE4 5PL, UK. Tel: 0191 208 1148; Email: avan.sayer@newcastle.ac.uk

Abstract
Academic geriatric medicine activity lags behind the scale of clinical activity in the specialty. A meeting of UK academic ger-
iatricians was convened in March 2018 to consider causes and solutions to this problem. The meeting highlighted a lack of
research-active clinicians, a perception that research is not central to the practice of geriatric medicine and a failure to trans-
late discovery science to clinical studies. Solutions proposed included better support for early-career clinical researchers,
schemes to encourage non-University clinicians to be research-active, wider collaboration with organ specialists to broaden
the funding envelope, and the need to co-produce research programmes with end-users. Solutions to grow academic geriat-
ric medicine are essential if we are to provide the best care for the growing older population.

Keywords
translational research, academic geriatric medicine, capacity building, older people

Key points
• The volume of geriatric medicine research lags behind the volume of clinical activity
• Culture, a lack of research capacity, and failure to translate research into practice all contribute to this
• Solutions include new funding, supporting academic trainees, involving non-academic clinicians, and ensuring research is
usable

Caring for older people is now the predominant activity of in this area which is holding back much-needed innovation.
health systems in high-income countries, and will soon A number of initiatives have aimed to redress the balance—
become the predominant activity in many lower and middle in Europe for example the Increasing Participation of the
income countries [1]. At present, there is a mismatch Elderly in Clinical Trials (PREDICT) consortium studied the
between the scale of healthcare need for older people and participation of older people in clinical trials and proposed
the relatively modest amount of research funding and activity ways of boosting recruitment [2]. In the UK in 2017–2018,

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M. D. Witham et al.

over 22,000 older people were recruited to studies on the infrastructure support for clinical ageing research deliv-
National Institute of Health Research (NIHR) Clinical ery. Involvement in research by early-career staff across
Research Network portfolio, but only 7,000 were recruited to all professions would develop a larger group representa-

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studies primarily categorised under Ageing; the number of tive of those delivering care who are familiar with
clinical studies primarily categorised under Ageing on the research processes such as recruiting to clinical trials; a
NIHR portfolio [3] is 29% and 16% of the number for spin-off benefit would be enhanced awareness of, and
respiratory medicine and cardiovascular medicine respectively. skills to interpret, research evidence. Support networks
Why might this be, and what can we do about it? These have been successful in supporting clinicians to engage
questions were considered by a group of UK research-active with research in some disease areas, such as stroke,
geriatricians in March 2018, gathered under the auspices of the Parkinson’s, dementia, and osteoporosis—and in deliver-
NIHR Newcastle Biomedical Research Centre, UK—which has ing focussed training for clinicians to support research
a particular focus on ageing and long-term conditions. Invited activity. The challenge is to ensure that ageing syndromes
senior investigators, trainees and PhD candidates met for an and a wider range of disease areas are represented.
intensive one-day meeting, and this commentary describes some Funding is necessary either to support research time dir-
potential solutions generated by the group. ectly, or to allow cover for research time by others.
Although mechanisms in the UK do exist to allow funds
to ‘follow the participant’, service pressures often make it
What Are the Problems? difficult to release time even when funds allow. In health-
care systems where private practice or clinician-level billing
The first problem is one of capacity. There are few research- are prevalent, funding is essential to make research activity
active clinicians compared to the volume of clinical activity; an attractive and viable alternative to service delivery.
this shortage is evident for academic nurses and allied
healthcare professionals (AHPs) in the field as well as doc- (b) Developing early-career researchers:
tors. Research work in geriatric medicine is vital for patients The decision to specialise in geriatric medicine is made
and society, but may not always translate into the metrics by relatively late compared to some specialities [4, 5].
which universities value and appoint staff, such as reports in Academics focussing on ageing and the care of older peo-
journals with a high impact factor. Lack of visibility may ple are in competition with these other specialities—for
contribute to academically inclined trainees not perceiving fellowships, awards and university tenure. Furthermore,
geriatric medicine as a research-active specialty to pursue, they do not typically have access to the considerable fund-
and consequently diverting into other specialities. ing resources of, for example, the major cardiovascular
The second problem is one of culture. There is a per- health and oncology research charities for early-career sup-
ception amongst some clinicians that geriatric medicine is port. Any successful approach to building capacity there-
not a speciality that needs to do research – a view perhaps fore has to start early. The pipeline of trained investigators
driven by the problems outlined above. Research is too could be strengthened by enhancing the visibility of the
often seen as distant from practice, findings are not effect- speciality in undergraduate medical, nursing and AHP
ively disseminated or embedded into teaching or care, and education; offering undergraduate research projects rele-
the research agenda is not always perceived to align with vant to ageing, and providing research training for very
the priorities of patients, policymakers or clinicians. early-career practitioners. The resulting candidates would
The third problem is a failure of translation. Much age- have better awareness and experience, and be competitive
ing research is done in discovery science, but with few clini- for higher research training at PhD level. Expanding the
cians directly involved this work has had little impact on numbers of PhD posts relevant to translational ageing
patient care to date. Similarly, at practice level, geriatric research is necessary, but is unlikely to be sufficient.
medicine is constantly innovating and developing new mod- The transition from PhD to independent researcher
els of service, yet little rigorous evaluation takes place. remains a major challenge in many scientific disciplines
Much of the research that is conducted lacks the scale or [6]. Good mentorship for academics at this career stage
impact to influence practice. is critical to drive successful intermediate fellowship bids;
What then might the solutions be? The meeting con- models such as the establishment of an Ageing Academy
sidered four major areas of activity, which we outline below: or School for Ageing Research may be required to deliver
this support. Representation of geriatric medicine on
(a) Involving clinicians in research: selection panels is also necessary to provide relevant
Clinical research at scale requires recruitment at multiple expertise for funding decisions, taking into account the
sites, many of which may not be affiliated to universities. often highly complex mechanisms and pathways involved
Hence we need to ensure that all clinicians can be active in ageing biology and common geriatric syndromes.
in research; such an approach is also likely to facilitate
implementation of findings. In the UK, the NIHR CRN (c) Getting research into clinical practice:
Ageing Speciality Group and parallel structures in the Bridging the ‘know-do’ gap [7, 8] is essential if research
devolved nations assist this process by providing benefits are to reach patients. Choosing appropriate

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Academic geriatric medicine

research questions is important, and the James Lind work accessing NIA funds via partnering with US colleagues,
Alliance on priority-setting for research is an excellent even with current budgetary pressures [13].
model for this [9]; the alliance has recently published the In summary, growing research in geriatric medicine and

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top ten priorities for research for people with multiple interdisciplinary gerontology is an essential component of
conditions [10]. Co-production of research by knowl- improving healthcare for older people. This is now being
edge users and research teams helps to ensure that the prioritised by governments and funders. There has never
results will be relevant to both clinicians and patients. been a more opportune time to demonstrate that as a com-
Embedding assessment of implementation strategies (in munity we can bring academic and clinical activity together
particular areas of implementation failure including cost, to provide better care for our patients. We must be both
training and workflow) is another key component, as is innovative and bold in developing capacity to deliver
the use of linked, routinely collected health and social research into practice—our patients deserve no less.
care data to evaluate interventions in real-world popula-
tions. Co-production can also help with dissemination—
targeting research findings to research users in ways that
Acknowledgements
they find useful. Research users need to be ready to The authors acknowledge the support of NIHR Newcastle
receive and engage with research findings; this can be Biomedical Research Centre in holding the meeting that led
facilitated by delivering research findings that are both to this Commentary. The views contained herein represent
relevant and accessible to practitioners. In the UK the those of the authors and not those of NIHR.
applied healthcare research programmes of several The extended working group* from the NIHR
regional NIHR Collaborations for Leadership in Newcastle Biomedical Research Centre meeting:
Applied Health Research and Care (CLAHRCs) seek to Terry J. Aspray (AGE Research Group, Institute of
address this translational gap. Neuroscience, Newcastle University; NIHR Newcastle
Biomedical Research Centre, Newcastle upon Tyne Hospitals
(d) Expanding the funding envelope
NHS Foundation Trust and Newcastle University), Peter
There is growing awareness of the importance of ageing
Brock (Research and Development, Northumbria Healthcare
and care of older people by funders. European Union
NHS Foundation Trust, North Tyneside Hospital, Rake
funding streams have included a substantial component
Lane, Newcastle upon-Tyne, NE29 8NH), Andrew Clegg
of research which is directly relevant for older people.
(Academic Unit for Elderly Care & Rehabilitation (University
Within the UK, the recent Academy of Medical
of Leeds), Bradford Institute for Health Research), Natalie Cox
Sciences report on multimorbidity [11] presages
(Academic Geriatric Medicine and CLAHRC Wessex,
increased interest from a range of funders in this area.
University of Southampton; Southampton BRC, University
In his 2017 Harveian Oration [12], Professor Chris
Hospital Southampton NHS Foundation Trust, Southampton),
Whitty, Head of NIHR and Chief Scientific Advisor for
Victoria Ewan (Department of Older Person’s Medicine, James
the UK Department of Health and Social Care, spoke
Cook University Hospital, Marton Road, Middlesbrough),
of the urgent need to focus on the health of older peo-
James Frith (Institute of Cellular Medicine, Newcastle
ple, particularly those with multiple conditions, and of
University), Jennifer K. Burton (Geriatric Medicine, Royal
the need to drastically increase the capacity of the
Infirmary of Edinburgh, University of Edinburgh), Thomas
research community to tackle the health problems of old
Jackson (Institute of Inflammation and Ageing, University of
age. If these funding streams are to fully benefit older
Birmingham, Birmingham), Emma Grace Lewis (Institute of
people, academic geriatricians need to drive multidiscip-
Health and Society, Newcastle University; Northumbria
linary, multicentre bids to address key research questions
Healthcare NHS Foundation Trust, North Tyneside General
at scale and pace, as well as providing representation on
Hospital), Steven E. Lim (Academic Geriatric Medicine,
the funding panels that consider such bids.
University of Southampton, University Hospital Southampton
There is also scope to widen our funding sources. In the NHS Trust, Tremona Road, Southampton), Stephen Makin
UK, individual philanthropy is relatively under-used compared (Clinical Lecturer Academic Institute of Cardiovascular and
to the USA and industry is not currently a major funding Medical Sciences, University of Glasgow), Mary Ni Lochlainn
source—although care is needed to ensure high-quality science (Department of Twin Research, Kings College London, St
and to avoid conflicts of interest and intellectual property. As Thomas’ Hospital), Sarah Richardson (Institute of Neuroscience,
instinctive collaborators used to working in multidisciplinary Newcastle University; NIHR Newcastle Biomedical Research
clinical teams, geriatricians are well placed to exploit the cur- Centre, Newcastle upon Tyne Hospitals NHS Foundation Trust
rent interest in interdisciplinary funding, as well as working and Newcastle University; Newcastle University Institute for
with other specialists in accessing funding from organ-specific Ageing), Susan D. Shenkin (Geriatric Medicine, The University
charities. In the US there is a dedicated National Institute on of Edinburgh, Royal Infirmary of Edinburgh, Edinburgh),
Aging (NIA). Opportunities exist for international collaborative Claire J. Steves (Department of Twin Research, Kings College

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M. D. Witham et al.

London, St Thomas’ Hospital), Oliver Todd (Academic Unit for 3. NIHR Clinical Research Network Ageing portfolio. www.crn.
Elderly Care & Rehabilitation (University of Leeds), Bradford nihr.ac.uk/ageing (accessed 3 July 2018).
Institute for Health Research), Ellen Tullo (NIHR Newcastle 4. Fisher JM, Garside MJ, Brock P et al. Why geriatric medi-

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Declaration of Conflicts of Interest: None. 9. Petit-Zeman S, Firkins L, Scadding JW. The James Lind
Declaration of Sources of Funding: The meeting Alliance: tackling research mismatches. Lancet 2010; 376: 667–9.
reported in this commentary was hosted by the NIHR 10. James Lind Alliance. Multiple Conditions in Later Life top 10
Newcastle Biomedical Research Centre, funded by the priorities. http://www.jla.nihr.ac.uk/priority-setting-partnerships/
health-with-multiple-conditions-in-old-age/top-10-priorities.
National Institute for Health Research, UK.
htm (Accessed 6 June 2018).
11. Academy of Medical Sciences. Multimorbidity: a priority for
global health research. April 2018.
12. Whitty CJM. Harveian Oration 2017: triumphs and challenges
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