In our second 'Meet the researcher' post, we talk to Professor Miles Witham, Deputy theme lead for Ageing Syndromes with the NIHR Newcastle Biomedical Research Centre (BRC), as well as Professor of Trials for Older People at Newcastle University.
Alongside these roles, he is National Specialty Lead for the NIHR’s Ageing Clinical Research Network (CRN), is Deputy Editor for Age and Ageing, and has a clinical role with Newcastle upon Tyne Hospitals, working specifically with older adults.
As a medic, I find working with older people intellectually satisfying, but it’s also a particularly rewarding thing to do; older patients are some of the most vulnerable people, and a lot of the time, they need us to advocate for them, and that is still something that drives me now. Getting into ageing research stemmed from that, as very early on I was frustrated by the lack of evidence there was for how best to care for older people. In clinical trials, older people were often neglected, if not deliberately excluded, and therefore severely underrepresented. You can sit on the side-lines and complain about this, or you can get involved.
Much of our current work is about trying to find treatments for frailty and sarcopenia. Sarcopenia is the loss of muscle mass and strength as we get older and that’s important because people who are weaker and have a lower amount of muscle don’t do as well. Sarcopenia is a major contributor to frailty as well, which is a broader syndrome where older people are unable to withstand even a minor illness; even a cold or urine infection causes a disproportionate loss of function. So finding ways to tackle sarcopenia and frailty is really important for improving the health of older people, and reducing their need for healthcare services in the future. At the moment, exercise is one of the few ways we know to prevent sarcopenia and frailty, but not all older people can, or want to exercise. So finding different treatments, or finding better ways to deliver exercise, is a really important thing to do to try and tackle the large burden that sarcopenia and frailty places on older people and the healthcare system.
We get submissions from all sorts of topics - sarcopenia, frailty and multimorbidity, but also on how to manage care for people who are dying, and broader health services research. As well as making sure the science that we publish is of high quality, I look for what is relevant to clinical practice; it’s a really good way of ensuring that the research makes a difference to the care of older people. Age and Ageing focusses on research with clinical relevance, rather than early discovery science, so this fits well.
You can’t assume that because a treatment works in one group, it will also work with older people. It’s only by including older people in trials that you can get the evidence you need to recommend the right treatment. Older people have been excluded from research in the past, but it’s really important to change that; if you don’t do that, the risk is that you either end up with treatments for older people that don’t benefit them, or treatments that are in fact harmful.
It’s critical that we do research where the need is. This is something that Professor Chris Whitty, when he was head of NIHR was keen to promote, and it is still a very important strand of the NIHR’s philosophy; to take research out to where there is greatest patient need, and particularly to make sure that we don’t just include people from wealthy areas of the country. We know that Newcastle and some surrounding areas have really significant pockets of deprivation, and this can be linked to more negative health outcomes for older people, so it’s really important that we do research with those communities, and for those communities.
I am the national specialty lead for NIHR Ageing CRN which exists across England to facilitate the delivery of national clinical research. My role is not only to deliver clinical studies for older people, but also to grow the amount of research that we are able to carry out for, and with older people. COVID has had a big impact on this, but we have rapidly reconfigured the Clinical Research Network to deliver the urgent studies needed to understand more about COVID, test treatments, and to find vaccines. It is really important that the voice of older people is strongly represented in this area; as we know that COVID disproportionately affects older people and those with multiple conditions and frailty.
I have been in service on the front line, in a rehabilitation unit on the outskirts of Newcastle. COVID has meant that we need to change how we work in this area. For example, we’re rehabilitating people in their own rooms as they’re in isolation; we’ve rapidly trained a new set of staff to cover for our colleagues who have been ill. The rehabilitation needs for people with COVID are slightly different; they are very weak, tired and often breathless and still need oxygen, and they’re very prone to complications. At the same time, I have been involved in the response to supporting care homes. We all know from the media that care homes have been particulate badly hit from COVID, and we’re trying as best as we can to support care home staff and residents, to make sure they get access to assessment, equipment and support.
This has all been brought into sharp focus with COVID. Research has really driven our response to how we deal with the virus. Three months ago we didn’t know that much about COVID, but everything that we have learned since has been to the result of rapid research and investigation. So all the things I am involved in give a sense to how that all joins up.
I think that’s a difficult one, especially at the moment, as COVID has thrown all cards up in the air. The pandemic has also presented us with many opportunities to rethink our research and how we design and deliver it. I don’t think there will be a major single breakthrough, as ageing is broad and complex, but what we’re starting to uncover the basic biology of ageing, and we’re beginning to see the benefits of that as new treatment progress towards early clinical trials. Also, we’re used to dealing with single diseases. Older people with multiple diseases get more and more treatments. That’s no longer a tenable way to proceed, so we need to understand the basic biology of ageing and tackle multiple diseases, but by treating common underlying causes.. If we can do that, we can treat multiple conditions of ageing with a smaller number of treatments, reducing side effects and being more likely to improve overall health.
In the ageing syndromes theme we have benefitted from collaboration with a number of other themes, particularly dementia. For example, putting together the cognitive aspects of frailty with the physical aspects of frailty. But we’ve also got colleagues in the neuromuscular theme who are experts in mitochondrial disease and function. It is becoming increasingly clear that mitochondria are important in sarcopenia and frailty, so we’re collaborating with them to better understand and characterise mitochondria in older people’s muscles. We’ll work on designing therapies around this.