Gathering evidence – investing in research now will offer cost savings in a stretched economy
Dr Carly Welch is a Consultant Geriatrician at Guy's and St Thomas' NHS Foundation Trust and Adjunct Clinical Senior Lecturer at King's College London. She was previous Chair of both the BGS Trainees Council and the Geriatric Medicine Research Collaborative. She completed her PhD on the topic of "Acute sarcopenia: the last remaining acute organ insufficiency" at the University of Birmingham in 2022. She tweets @CarlyWelch_42
Older people have historically been excluded from research trials, and research funding has been disproportionately directed towards clinical research for individual conditions, rather than promoting the health and wellbeing of older adults. This means that health and social care interventions are often implemented based on hypothesised benefit, rather than national evidence. The last decade has seen increasing pressures on health and social care services, as government funding has not matched the increased demands of a vulnerable ageing population, who are often at greatest risk of harms from hospitalisation.
To ensure we are making best use of funds that are available, we need to ensure that some investment is directed towards research, and that research is conducted in a way that is in itself cost-effective. I have set out recommendations below for how this can be achieved:
- We must urgently make use of routinely collected electronic healthcare data utilising models that remove effects of bias from evaluation of services on a local scale. The use of computational learning models on large anonymised datasets will enable identification of factors that predict outcomes on an individual scale, but also demonstrate how complex interactions can affect the success of individual services. Linkage of datasets across health and social care is vital to identify effective strategies to prevent delayed transfers of care or multiple unnecessary transfers of care.
- We must promote collaboration on a much wider scale and reduce incentives that promote siloed working through competition between centres. Academics, clinicians, and key stakeholders with interests in improving healthcare of older adults should work together with the common aim of conducting research with early translation into clinical practice.
- Clinicians working on the “shop floor” of healthcare services should be encouraged to conduct research that can be embedded into clinical practice in a cost-neutral and meaningful way. The Geriatric Medicine Research Collaborative, and the ongoing Frailty and Outcomes Research in Clinical Environments: probable Sarcopenia, geriatric Evaluation, and Events (FORCE:SEE) study are examples of such models. The FORCE:SEE study will enable enhanced understanding from real world models of factors that are predictive of readmission and quality of life following hospitalisation – outcomes that we know matter to older people themselves. We urge you to consider enrolling your site in this study if you have not done so already!
- Whilst there is great need for further clinical trials involving older people, we also need to be pragmatic in using an approach that does not lead to significant delays to improvements in healthcare. Where appropriate, research that utilises an implementation science approach should be encouraged, with ongoing analysis on effectiveness post-intervention so that this can be tailored and scaled up rapidly on a sustainable national scale.
- Research should not be delayed by long timelines between idea generation and funding generation. The timelines of many major funding organisations can lead to a delay of more than one year from application to contract agreement. New models of accelerated funding such as the Wellcome LEAP programme offer the opportunity to prevent such unnecessary delays.
- The process of obtaining ethical approvals can also be extensive and drawn out. Where national approvals for research are in place, individual sites should strive to streamline local Research and Development approvals to prevent unnecessary delays.
- In the longer term, there is a need for research that strives to improve healthspan, including the prevention of frailty, cognitive impairment, and disability with age. There is an urgent need for research that helps develop treatments for underlying biological processes of age-related conditions, rather than developing treatments for single organ disease. This approach has potential to reduce rates of hospitalisation, social care needs, and polypharmacy amongst older people in the years to come.