The British Geriatrics Society welcomes the decision of the House of Lords Select Committee on Science and Technology to hold an Inquiry into the Scientific Aspects of Ageing. Both of the areas of investigation have direct relevance to the core work of the Society - the promotion of the health of older people. The study of the biological processes of ageing will lead to a greater understanding of the mechanisms of ageing thus unlocking potential areas for therapeutic advance in the prevention and treatment of diseases of later life. Technology and design have the potential to revolutionise diagnosis and therapy and, by enabling improvements in the built environment, improve the quality of life of older people, particularly those whose independence is threatened by physical or mental health disabilities.
Earlier this year the Academic and Research Committee of the Society published a research strategy. This submission has been developed from that Strategy and from the work that has flowed from it.

BGS Academic and Research Strategy
A thriving research culture in ageing and clinical geriatric medicine is of key importance to the future care of older patients. Academic medicine in general and academic geriatric medicine in particular are experiencing difficult times for a variety of reasons not least the squeeze in higher education funding and the rush to attempt to enhance research assessment ratings for the next research assessment exercise. The focus of the NHS on short term targets and continuing under funding of research by the NHS (<1% total expenditure) has also contributed to increased difficulties in maintaining active research programmes in geriatric medicine in many universities. It is only necessary to look at the evidence base underlying those medical specialties without significant academic activity to understand the likely long term detrimental effects of a loss of research activity within the specialty. In keeping with many other specialties, there are vacant chairs of geriatrics (e.g. Birmingham, Liverpool, London and Oxford) and senior lectureship posts in geriatric medicine. There is a trend to disestablish academic departments. Whilst loss of departments in itself is not a problem, loss of posts in academic geriatric medicine will have far reaching negative effects on both teaching and research and in providing role models for the researchers of tomorrow. Cross disciplinary institutes of ageing research have been established (e.g. Newcastle, Keele). These provide an ideal opportunity for clinical, basic and social scientists to work collaboratively. Chairs in Geriatric Medicine have also been established in some of the new Medical Schools (e.g. Warwick, Keele, Brighton/Sussex and Leeds/Bradford). However, given the huge clinical challenge posed by the health care needs of older people, the Society believes that there is a convincing case that academic geriatric medicine should be represented in all medical schools.

Identification and support of potential independent researchers
It is crucial that the "supply" of young researchers is increased and that they are supported. The Society believes that research experience within Specialist Registrar training should be seen as the 'norm' and not the exception. Without being directly exposed to a research environment it is impossible to identify, with any certainty, those that will flourish and become the future leaders of academic geriatric medicine. The Society is contributing towards this through: research methodology workshops established jointly with Help the Aged/Research into Ageing; successful "Meet the Researchers" sessions are held at the Society's national meetings; success in research by SpRs is being spotlighted in the Society's Newsletter.; BGS funds are used to provide start-up grants for registrars and to fund travel expenses to visit centres of research excellence; the Dhole bequest to the Society is being used to fund two training fellowships annually (jointly funded with Help the Aged/ Research into Ageing).

These initiatives complement the training fellowships offered by the MRC and medical charities. Targeting of this type of award for "ageing" researchers rather than those involved in "disease-specific" research may be one way of giving a message to younger researchers and to the Heads of Medical Schools that the study of ageing is a priority area.

Identification of Evidence Gaps
One consistent obstacle to effective clinical practice is the paucity of robust evidence on the effectiveness of therapeutic interventions in the oldest old (those aged 80 and over). This section of the population is the one growing the fastest and yet it has been systematically excluded from clinical trials either because of specific age restrictions or because the presence of co-morbid conditions or concomitant medication are exclusion criteria. In the absence of evidence the production of clinical guidelines and the involvement of the patient in decision-making is made more difficult. The risk in clinical practice is in balancing the use of treatments that may be at best ineffective and at worst potentially dangerous with adopting an ageist and nihilistic approach to disease in later life.

The Society is working with its Special Interest Groups in identifying clinical areas where there are evidence gaps. These are then being fed into the Health Technology Assessment process. This process is not yet completed but both delirium and frailty are common, important conditions with major adverse outcomes that seem ideal for cross-disciplinary study involving basic scientists, clinicians and social scientists and which have potential for the beneficial application of new technologies.

Other potential areas identified by this process include: Primary prevention of disease in the very old; Pulmonary rehabilitation in later life; Management of anxiety and depression associated with physical illness; management of chronic disease in care homes; complementary therapies in later life; development of strategies for enhancing the quality of prescribing to older patients at home, in hospitals and in care homes.

An important general area for development is the promotion of clinical trials that include the oldest old. These individuals are going to make up the majority of patients that present to geriatricians in the next 10-20 years.

External Links
The Society seeks to strengthen its links with other research-focussed organisations. It was instrumental in establishing the European Union Geriatric Medicine Society which has as one of its aims the bringing together of researchers from the enlarging community. There are also good links with the American Geriatrics Society. In the UK, close collaboration exists with Research into Ageing with two members of the BGS Academic and Research Committee serving on the formers Research Advisory Committee.

Status of Academic Geriatric Medicine
A review of the status of Geriatric Medicine was undertaken in 2002. It concludes that the major deficit in academic Geriatric Medicine now is in the infrastructure. There is not a large body of senior lecturers committed to an academic career, pursuing research of a high standard and preparing themselves to be the academic leaders of the profession in the future. Hence when chairs become vacant, there are often no suitable applicants and sometimes no applicants at all. Research activity in academic geriatric medicine is under-performing. It is notable that a significant number of research reports on areas relevant to geriatric medicine are published by researchers working in other fields. Geriatric medicine is the single biggest medical specialty and is broadening the scope of its activities. The opportunities for research in ageing, age related disease and the care of elderly people are enormous and increasingly research funders are keen to support such research. It is essential that the specialty has a strong teaching and research base and that the brightest young doctors in the specialty are attracted to academic careers.

Conclusions
The Research Assessment Exercise with its financial implications for research performance has caused Universities to appoint only those with who have strong research records and research potential. There is a comparative lack of appropriate research training opportunities and infrastructure in Geriatric Medicine and it will need a culture change on all sides if this is to change.

It is recognised that smaller specialties such as geriatric medicine, if they do not build up very large research teams of their own will have to collaborate with others and to some extent risk losing their identity as geriatric medicine departments. Solutions will vary from institution to institution and might include inter-disciplinary groupings focussing on ageing or groups investigating the specific problems of older people within a disease-specific department.

It is likely that proposals to shorten the period of training before physicians can reach specialist status will further dilute exposure to research. The establishment of specific training opportunities through fellowship schemes may to some extent counter-balance this.

The threat to existing academic geriatric medicine groupings in teaching hospitals gives a signal that medicine of later life is less important and will deny exposure of geriatric medicine researchers to medical students and to young doctors in the formative stage of their career.

The BGS is striving to develop the status and standing of research from its own resources and by partnership with like-minded organisations. The role of the research establishment in this process is also of crucial importance.