Director of the NIHR Newcastle Biomedical Research Centre and Professor of Geriatric Medicine, Avan Sayer, and Professor of Trials for Older People, Miles Witham, gave evidence to the House of Lords’ Science and Technology Committee on 22nd and 29th October, as part of their ‘Ageing: Science, Technology and Healthy Living Inquiry’.

Over the past three weeks, the House of Lords Science & Technology Committee has been hearing evidence from experts as part of its inquiry – Ageing: Science, Technology and Healthy Living. This House of Lords Science & Technology Committee inquiry was set up to investigate how approaches from science and technology could be used to increase health span, to mitigate some of the negative effects of ageing, and to support older people living with poor health.

Accelerating the conversion of lab-based research into practical and meaningful benefits for people

Avan Sayer, Director of the NIHR Newcastle Biomedical Research Centre and Professor of Geriatric Medicine, gave evidence to the committee on Tuesday 22nd October. Asked what steps or policies the Government should take to achieve its aim to ensure that people can enjoy at least five extra healthy, independent years by 2035, while at the same time narrowing the gap between the rich and the poor, Professor Sayer suggested three areas for immediate Government focus:

1. Developing a suite of interventions that could happen at an individual or a population level in a more systematic and comprehensive way than has been delivered to-date, focusing not just on those in later life, but throughout the life-course where it has been shown that changes to diet and exercise in particular earlier on can have a lasting impact on health in old age. Particularly, that these interventions could take the form of self-directed changes for those who are more advantaged and then the promotion and delivery of directed interventions to the least advantaged.
2. Increasing resource to help bridge the gulf between the “beautiful science going on in animal organisms and in cell lines” and the delivery of treatments that directly benefit patients, the public and the health and care system.
3. Encouraging more collaboration between research/academia and business/industry specifically in this area. Professor Sayer highlighted the pioneering work of the National Innovation Centre for Ageing, which was set up in Newcastle in 2014, expressly to bring together companies, the NHS, academia and members of the public to look at how societal and personal problems resulting from ageing can be solved through technology.

Professor Sayer also spoke about the importance of translational ageing research – the need to convert lab-based research in to tangible and practical benefits for patients, the public and the NHS. This includes the need to train the next generation of academic geriatricians and linked disciplines – echoing our focus here in the NIHR Newcastle BRC – where we have long-recognised that the UK does not have enough research-active clinicians and academics working in the field of ageing and long-term conditions and have invested significantly in the development of a custom approach to training the next generation and filling the skills gap. This approach is already seeing an impact, with 75% of Newcastle BRC-funded students choosing to stay in the field of ageing and long-term conditions and with more than 100 researchers and clinicians (including doctors and dentists, nurses, midwives and allied health professionals) receiving training in this area over the past 15 years.

Structural issues within the NHS and the regulatory framework around clinical trials and new treatments that need to be addressed

Whilst giving his evidence to the committee on 29th October, Miles Witham, Professor of Trials for Older People and Deputy Theme Lead for Ageing Syndromes in the NIHR Newcastle BRC, agreed with comments made by the new Chief Medical Officer, Professor Chris Whitty, who expressed concern that the NHS is not structurally able to deal with patients with multiple conditions (multimorbidity).

“Historically the NHS was designed, or has evolved, to deal with single problems in single-organ systems. It has evolved to deal with episodic care. It is less good and less well designed to deal with chronic care. It is particularly poorly equipped to deal with multiple problems affecting a single person.”

Professor Witham highlighted how this configuration of our health and care system leads to a number of unintended consequences, including:

1. polypharmacy (where patients are prescribed different medications for different conditions, each of which has side effects and the potential to negatively interact with each other)
2. competing and often contradictory guidelines for appropriate care for different conditions
3. the time burden on patients having to attend multiple appointments in different clinics, remember medications, and undertake multiple, different self-care behaviours at a time when they aren’t well

Professor Witham also discussed the need for Government to invest in the right infrastructure and training to bring more older people in to clinical trials effectively and efficiently as well as to create a regulatory enviornment that facilitates this work and that allows companies to get marketing authorisations for medicines with multiple benefits. He highlighted that the NIHR is aware of these issues and has been trying to accelerate bringing more older people into trials, but that the fact that Professor Witham’s post (Professor of Trials for Older People) at Newcastle is the only one of its type in the country, suggests that we need to pay more attention to this issue specifically.

References and other coverage:

• Ageing: Science, Technology and Healthy Living (House of Lords Inquiry)
• ‘Elderly people being ‘poisoned’ by medication, say drug experts’, The Guardian, 29th October 2019