Submission into Dementia, Ageing and Aged Care Mission Roadmap

The Old Colonists’ Association of Victoria commends the Federal Government for its draft Dementia, Ageing and Aged Care Mission Roadmap. We also welcome the fact that the roadmap will help the government prioritise funding for dementia and aged care research.

We commend the main aim of the Mission which is to support older Australians to maintain their health and quality of life as they age, to live independently for longer, and to access quality care when they need it.

Is the Mission Statement appropriate for the vision and goals of the Mission?

Mission Statement: Through health and medical research, the Dementia, Ageing and Aged Care Mission aims to improve the quality of life for people as they age. 

We believe the mission statement could be strengthened by changing the aim to “enable healthy ageing”, to how healthy ageing is defined by the World Health Organisation (WHO). WHO defines healthy ageing as the process of developing and maintaining the functional ability that enables wellbeing in older age (https://www.who.int/ageing/healthy-ageing/en/).

This would be a definable and measurable mission statement.  

Is the Vision statement appropriate for the investment being made towards the Mission?

Vision: Healthy ageing will enable older people to contribute socially, culturally and economically to the wider community and reduce the cost burden of disease by delaying the onset of symptoms, particularly those associated with more resource intensive health and aged care services.

The proposed vision statement does not fully capture the scope and mission statement as it is focussed on delaying the onset of symptoms and directly connects this as the only factor in enabling older people contributions socially, culturally and economically to the community. The vision should be reworded to separate the two sentiments and to include improving aged care and quality of life for older people.

Do the goals appropriately capture the aim of the Mission?

Goals:

• Address the issues of ageism and its impacts on quality of care and quality of life for older people.
• Increase the number of years a person could expect to live in optimal health as they age.
• Deliver care and services that are of high quality, takes a human rights based approach and supports an individual’s wellbeing.
• Slow the progression of cognitive decline.
• Achieve timely diagnosis of dementia.
• These outcomes would be facilitated through the following elements:
  • Develop innovative care models, interventions and technologies to improve health and wellbeing.
  • Inform health and aged care system change to deliver improved quality of life and care.
  • Retain and build research capacity, excellence and collaboration on these topics that is integrated into care settings across the health and aged care sector.

The goals of the Mission could be strengthened by:

• Modifying the wording of Goal 1 to specify key issues of ageism that should be addressed as follows “Address the issues of ageism and their impact on quality of care and quality of life for older people. Key issues of ageism include attitudes and beliefs, behavioural discrimination and policies and practices.”
• Refining the goals for dementia research. Goals 4 and 5 are very specific compared to the others and could be broadened to include understanding causes and risk factors of dementia as well as ways to prevent cognitive decline.
• The fifth goal should be expanded to acknowledge that diagnosis of dementia without appropriate intervention may not be beneficial.
• Adding an additional goal “Provide accurate, up to date, centralised information on ageing, health, dementia and treatments for an ageing population.”
• Adding an additional goal of “Research policy and practice of dementia-friendly communities” which would address issues emerging from Goal 1.

Are there key barriers in the Australian research context that should be considered in framing these guiding principles to maximise the success of their achievement? 

• Focus on single disease research rather than research on the ‘whole’ older person encompassing the complexity of clinical and social issues they face.This notes in particular the recent policy development by GPs of the importance of ‘social prescribing’ to combat loneliness, anxiety and other social issues affecting older people
• Insufficient recognition of the legitimacy, validity and rigour of implementation and evidence-based science, co-design methods, participatory action research and other methods that should be used in translational research.
• Systematic exclusion of groups of people from research including people with low English proficiency and people with cognitive impairment.
• Challenges associated with engaging people living with dementia and their family carers in research
• Ageism, reflected in the idea that research related to older people is a less valuable investment than that relating to younger people.

Are there other principles that should guide the Mission’s research that you feel are missing from the draft Roadmap? 

In your view, do the six funding priorities and sub-questions identify the top priorities during the life of the Mission? 

From the viewpoint of a retirement and aged care community, the six priorities identify the top priority areas, however, we recommend that there should be additional sub-points that will address important gaps in understanding, policy and practice for dementia, ageing and aged care.

Priority 1

This priority is essential as it is the only one of six priorities that addresses dementia specifically and should be broadened to include research that considers and innovative directions and new paradigms of causes of dementia. This priority should include research into:

• development of drugs and new interventions for dementia, as well as underlying causes and risk factors in older people.
• Hearing loss which has been reported by the Lancet Commission as the largest potentially modifiable risk factor in mid-life for dementia
• Dementia friendly, as opposed to dementia specific communities
• Fall prevention

It should be noted that given that there is no treatment currently available, early diagnosis of dementia needs to be supported by evidence of benefit in diagnosing the condition early.

Priority 2

This priority is essential to the mission as ageism is an issue that affects health of older people in many ways. This priority should include environmental and community aspects of how to address ageism, including how to engage in intergenerational discussions on ageism and promote public awareness on the issues.

Priority 3

We support research into developing and maintaining purpose as a high priority for the mission.

Priority 4

We support the focus on healthy ageing starting earlier in life (middle-age). This priority should include an emphasis on prevention and support for translational research in this field. There are distinct challenges for older populations with declining immunity that should be prioritised, including low efficacy of vaccines and low coverage of vaccines in the population.

This priority should include research into implementation of evidence-based interventions for older people that can improve health outcomes. For example, exercise has been shown to reduce risk of falls, cardiovascular conditions, and improve mental health.

Priority 5

This priority addresses issues raised by many of our residents who are concerned about the prevention of falls which can result in fractures and disability and are a serious threat to the quality of life and independence of older people. There is a need for research into the mechanisms of falls to design more effective ways to treat falls.

Priority 6

Health of the frailest of the frail in Aged Care Facilities should be a major priority of the Mission. This priority represents an opportunity to take up the challenges and recommendations highlighted by the current Royal Commission into Aged Care Quality and Safety through high quality research into aged care provision. It is also an opportunity to ensure aged care is visible and integrated into the local community and broader society.

Are there any specific areas of research that you would prefer to see funded under any of the priorities? 

Investments should include research that:

• Includes diverse communities such as culturally and linguistically diverse (CALD) communities (30% older Australians are from CALD background) and the needs of Aboriginal and Torres Strait Islander communities.
• Has a focus to advance health and care as well as science on implementation. This includes diverse approaches combining arts, design, technology and clinical interventions.
• Takes a systems-based approach that includes older people, their families and communities.
• Considers multi-morbidity and medication management for older people. Many older people have 5-10 conditions simultaneously which presents challenges for choosing treatment options as each condition cannot be treated separately. Most (95%) people over 65yo are on at least 1 medication and two thirds are taking five or more medications. Management (and reduction) of medications for older people as well as how to effectively manage multiple conditions is essential to healthy ageing.

What should be the high priorities for the Mission? 

• Prevention and care, not just cure, to enable older people to contribute socially, culturally and economically to the wider community.
• Improving health and aged care systems to promote the health and wellbeing of older people.
• Realistic and practical implementation in daily life
• Research that considers new examples into underlying causes of dementia
• Research that is inclusive of diverse communities