DOI: 10.1111/ajag.12095
Advancing Research, Education, Practice and Advocacy in Ageing Advances in gerontology research and education: Perspectives from the Australian Association of Gerontology Population ageing is a key issue in Australia and the world. As we celebrate the 30th anniversary of the Australasian Journal on Ageing, it is worth reflecting on the history of ageing research and education in Australia from the perspective of the Australian Association of Gerontology (AAG). The AAG has provided information about ageing since its formation in 1964, to help policy-makers, researchers, service providers and older adults make informed choices about ageing well. Today, with over 800 members as well as divisions established in every state and territory, the AAG represents gerontologists on a variety of government advisory panels and working groups, and brokers a broad range of news, education, evidence and opinions with an emphasis on research translation. Within the context of an ageing population, new research questions are being asked and researchers are crossing disciplinary boundaries to explore novel approaches to studying ageing. As the leading professional body supporting ageing research, the AAG believes that building a robust evidence base is an essential foundation upon which to develop ageing and aged care policies and reforms. Ageing of our society should be a cause for celebration and an extension of opportunities; and knowledge derived from research and experience must be put into practice to maximise its benefit. This paper presents a brief history of ageing research and education in Australia, an analysis of current educational opportunities and gaps and future directions for gerontological research and education, framed alongside the growth and development of the AAG as a prominent organisation in the communication and application of knowledge to age well.
Advances in gerontology research and education Australia’s interest in ageing research goes way back to the pragmatic trials of Dick Gibson and Grace Parberry in developing geriatric care in Newcastle and the founding of the National Ageing Research Institute in Victoria in 1975, to the establishment of some of the earliest longitudinal studies of ageing, including the Dubbo Study which commenced in 1988 [1], and the Australian Longitudinal Study on Ageing established by Gary Andrews in 1992 (which continues today under the leadership of Mary Luszcz) [2]. More studies followed including the Blue Mountains Eye Study [3] and the Australian Longitudinal Study on Women’s Health [4]. In 2004, the Australian Institute of Health and Welfare produced a report that included 21 longitudinal studies of ageing around Australia [5]. 40
In 2007, the Ageing Well Ageing Productively (AWAP) grants program funded the Dynamic Analyses to Optimise Ageing (DYNOPTA) study [6] to pool data from several of these longitudinal studies. To date, analysis of these pooled data has focussed on four key areas (dementia and cognition, mental health, sensory impairment, and mobility/ activity limitations), with other domains including socioeconomic and behavioural risk factors studied as either risk or protective factors. A summary of findings from this effort was published in a special ‘Ageing Well’ edition of the Australasian Journal on Ageing in October 2011, along with interim findings from other AWAP-funded projects. The AWAP grants program was a joint collaboration between the National Health and Medical Research Council (NHMRC) and the Australian Research Council (ARC) that aimed to foster research into ageing, which crosses sectors, research disciplines and institutions, to develop an authoritative evidence base to underpin more effective and wellinformed policy and practice. In addition to the DYNOPTA project, five other projects were funded that investigated predictors of ageing well, management strategies to address poly-morbidity in older people, gene–environment interaction in healthy brain ageing and neurodegeneration, policy and practice around older age employment, and policy and services for older Indigenous Australians. An obvious gap in most of the existing longitudinal studies of ageing is the lack of information on older Indigenous people. In the DYNOPTA study, for example, only 297 Indigenous participants were identified in the pooled dataset, representing 0.7% of men and 0.5% of women in the weighted sample, compared with 0.8% of both sexes in the Australian population [7]. The New South Wales ‘45 and Up’ study is one general population study that does have numbers of Indigenous people for detailed analyses. However, even where sufficient data about Indigenous Australians are available from studies of the wider population, careful consideration must be given to the analysis and representation of these data [8]. Some specific studies involving older Aboriginal Australians have been conducted including in the Kimberly region [9], and Tony Broe’s Koori Growing Old Well Study1. AAG supports indigenous people and their research partners through the Aboriginal and Torres Strait Islander Ageing 1
For further information on the Koori Growing Old Well Study, visit http://www.neura.edu.au/research/projects/koori-growing-old -well-study Australasian Journal on Ageing, Vol 32 Supplement 2 October 2013, 40–45 © 2013 ACOTA
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Committee, which held its inaugural meeting at the Australian Association of Gerontology Annual National Conference in Melbourne in November 2004.
year, National Research Priorities were announced with ‘Ageing Well, Ageing Productively’ identified as a national research goal.
There have been several efforts to capture and coordinate Australia’s efforts in ageing research. In 2001, the NHMRC commissioned a ‘Scoping study on ageing research’ [10]. This study involved a survey of 79 Australian ageing researchers. Among the many findings of the study was that ageing researchers tended to be young, with an average age of 45 and many (58%) did not have a research degree. The report also identified that ageing research in Australia concentrated on the multidisciplinary interface between ageing and health care across 17 areas including environment, technology and healthy and productive ageing. The report also called for targeted funding to allow researchers to work together and to build areas of strength.
In 2003, the Australian Government released its Framework for an Australian Ageing Research Agenda. Building on symposia and fora identifying key areas for research, the Framework identified six key policy issues of imminent importance requiring thorough research: • Maintaining economic growth in the face of an ageing workforce and reduction in the supply of younger workers. • Achieving adequate, sustainable retirement income over lengthening periods of retirement. • Developing positive images of ageing and supporting continued social participation. • Developing age-friendly infrastructure and built environment. • Achieving healthy ageing to maintain health and independence. • Providing accessible, appropriate, high-quality health and aged care.
In another effort, the Australian Ageing Research Directory was designed to provide ready access to current and ongoing research with six editions produced between 1997 and 2000, with the 2000 edition including 731 project entries from 202 research organisations and involving 1192 different principal or co-researchers. The Directory was replaced with Ageing Research Online http://www.aro.gov.au/. Then, in 2005, the ARC/NHMRC Research Network on Ageing Well developed a literature database of ageing research conducted in Australia or by Australians between 1999 and 2005. Extensive searching of electronic databases, websites, checking of reference lists and a survey of Network members, identified 2176 citations (research publications and grants) across four theme areas (healthy ageing, productivity and economic participation, independent living and social participation, and population research strategies). The majority of these citations were in the areas of healthy ageing and independent living, with few citations in the productivity and population themes. The healthy ageing theme included research into ways individuals can maintain well-being, how social environments promote ageing well, management of age-related conditions, and rehabilitation and prevention of decline among people with a degree of frailty. The independent living theme addressed personal, social and environmental factors affecting independence and participation. The productivity theme included older workers, retirement, volunteering, consumption, savings and assets management, and supportive care for older people. The population theme included population dynamics, life expectancy and longitudinal studies. Ageing Research Online and the Ageing Well database illustrate the range of topics that can be considered relevant to ageing research and the potential breadth of the Australian research agenda. Several attempts have been made to delineate this research agenda and set priorities. In 2002, the same year that the International Research Agenda on Ageing for the 21st Century was announced, the National Strategy for an Ageing Australia [11] identified the importance of an ageing research agenda in Australia. Later that Australasian Journal on Ageing, Vol 32 Supplement 2 October 2013, 40–45 © 2013 ACOTA
Alongside the growth in interest in ageing research, there have also been several efforts to build and support Australia’s ageing research capacity. The Building Ageing Research Capacity (BARC) project was a collaborative venture between the Australian Institute of Health and Welfare and the Office for an Ageing Australia. The project began in 2002, and aimed to enhance collaboration and coordination between Australian researchers and policy-makers and thereby improve the quality and quantity of the evidence base available to inform policy. A main outcome of the BARC project was the development of a framework for an Australian Ageing Research Agenda, released in 2003. Following on from BARC, the ARC/NHMRC Research Network in Ageing Well was funded by the Commonwealth as part of the Australian Government’s Research Network Grants Program. The aims of this program were to enhance the scale and focus of national research activity, stimulate innovation and support researchers to connect with others. The Networks were designed to identify and address areas of strength, opportunity or need where increased research effort would make a significant contribution to national outcomes. Following the cessation of the Network, AAG has worked to continue links between researchers through the identification of AAG-collaborating research centres. There are currently 20 collaborating research centres ranging in specialty from dementia to spirituality, which work to create an avenue for communicating policy, research and opinion within the context of an ageing population. Underpinning the use of research is gerontology training and education. Even among people who work with older people, strong biases and stereotypes exist that colour their expectations of ageing, of the people they work with, and of what 41
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can be achieved with older people. There is a need to promote a deeper and more comprehensive understanding of the process of ageing and how this process impacts across populations and on health and service needs. The promotion of such understanding has been a fundamental goal of AAG and is reflected in the educational and training activities of our members. At the most direct level, AAG’s role in education to date has been through organising conferences and seminars where researchers, educators, policy-makers, planners and providers can interact to share latest research findings and their potential impacts and to understand emerging issues in ageing that may require further research and action. In 1990, Anna Howe published a paper that traced the origins and contributions of gerontological education in Australia and reviewed the topics of research published by journals (notably AJA since 1982) and at AAG conferences since 1969 [12]. At that time, medicine and health care accounted for more than 70% of all items, and 50% of journal articles. Notably there was an absence of papers on psychology of ageing, and few nursing studies. Over time, more conference papers on demography and social policy analysis were published, and dementia appeared as a ‘recent health topic entrant’. Housing, retirement and residential care had ‘intermittent representation’. In contrast, more recent AAG conferences have evolved to have a greater emphasis on social, psychological and environmental issues (including a feature topic on housing in 2010), and greater participation by nursing, allied health and social scientists. In terms of formal education, the AAG has promoted the many gerontology courses across Australia through prizes and through promotion of these programs in the AAG Guide to Gerontological Education. Courses included in the guide span a wide range of fields, from community medicine to nursing, from gero-psychology to aged care management and from undergraduate to postgraduate levels. The range of courses also reflects the multidisciplinary nature of gerontology with courses offered from schools of medicine, health sciences, nursing, psychology, sociology and social work, environmental and life sciences, and theology. However, while formal tertiary courses are available across Australia, there was also a perceived need for a more generally accessible short course on ageing that would allow a broader audience to develop a more sophisticated understanding of the effects of ageing at individual, community and population levels. To meet this need, the Department of Health and Ageing funded the development of a supplemental course, which bridged gerontology and public health and was broadly available to many people working with older people, either as an online short course or as a unit within an existing program. This course was designed to provide a population view of ageing, its health impacts and potential policy and service responses. Development of the course was informed by focus groups and interviews to explore the 42
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educational needs, knowledge gaps and perceptions of current issues relevant to population ageing. The findings helped inform the main themes of the modules, as well as scenarios, exercises and assignments included therein. The content of the course was developed by a national faculty of 21 gerontologists from a variety of disciplinary backgrounds. A pilot program was delivered in 2005, and since then, the course has been delivered and adapted through online short courses and used in gerontology curricula around Australia. The course has been undertaken by postgraduate students as well as people who work in aged care, health services, government and commercial settings. One particular impact of the course has been the ability to challenge people about their thinking about ageing, and how this affects their attitudes and approaches to older people.
Identifying current gaps in research and education In October 2011, the AAG, together with the NHMRC, held a workshop entitled ‘Progressing Australia’s Research Agenda in Ageing Well’. The workshop included a broad range of senior stakeholders from government, consumer advocacy groups and the university sector. The purpose of the workshop was threefold: • To inform the development of a national ageing research agenda. • To consider options for increasing capacity in ageing research. • To suggest mechanisms for better enabling the translation of ageing research. The workshop included a broad range of issues from biological ageing, geriatrics and neurosciences, through to psychosocial ageing and the spectrum of issues for government policies and programmes. Delegates also recommended that a national ageing research agenda needs to focus on collaborative, multidisciplinary research that can be applied in policy and practice, both domestically and internationally, as well as striking the right balance between observational, intervention and translational research in order to address research priorities effectively. Participants at the workshop were also concerned with the lack of targeted funding for ageing research and inadequate support for emerging and mid-career researchers, leading to a smaller ageing research workforce at a time when the tertiary sector will be impacted by the impending retirement of senior ‘baby-boomer’ academics. Thus, building capacity in ageing research is an important consideration in parallel with developing a national ageing research agenda. The findings from the workshop reinforced the AAG’s messages in submissions delivered to the Productivity Commission’s inquiry on Caring for Older Australians. As stated in the AAG’s initial submission2 to the Commission: 2
For a copy of the AAG’s submission to the Productivity CommisAustralasian Journal on Ageing, Vol 32 Supplement 2 October 2013, 40–45 © 2013 ACOTA
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Ageing is a major issue for the full range of research supported by the ARC and NHMRC and there are few aspects of medical, scientific or social research that will not impact upon or be affected by the ageing of the Australian population. Unlike much traditional health and scientific research, ageing research does not apply a single issue, reductionist research model. Gerontological enquiry recognises the complexity of ageing and the multi-factorial causality of age-related health and decline. Ageing research demands a cross-disciplinary approach, building capacity in medical, psycho-social, nursing, allied health, environmental and technological areas . . . Furthermore, there is an urgent need to build Australia’s capacity in ageing research. A strong research and development focus, supporting skill development and career opportunities for researchers will be a national resource in addressing an ageing population over the coming decades. For successful research outcomes it will be necessary to harness all the existing expertise as well as promoting the development of additional expertise. Following on from the Productivity Commission’s report on Caring for Older Australians and the NHMRC/AAG report on Progressing Australia’s Research Agenda on Ageing Well, the Minister’s Advisory Panel on the Economic Potential of Senior Australians recommended to the Government that ‘The federal government establish an ongoing process for developing and maintaining the currency of a broad based national ageing research agenda and for targeting funding to identified priorities’ [13]. In response, the Government acknowledged that the AAG is working to develop a research agenda on ageing well as part of its Healthy Ageing Project under the Aged and Community Services Improvement and Healthy Ageing Grant [14].3 Additionally, in further support of research, the Government has committed $12.7 million over 7 years to fund the ARC Centre of Excellence in Population Ageing Research. The ARC Centre of Excellence was established to explore issues associated with population ageing, inform private and public sector policy, and yield outcomes that improve the well-being of older people and their social and economic environment. Demand for education and training in gerontology has been increasing rapidly in both higher education and vocational education and training (VET). For example, in 2007, there were six Masters courses in gerontology, geriatrics, aged care or a related field on offer at universities around Australia [15]; by 2012, this had swelled to 17 Masters courses in gerontology and related fields. In January 2012, the AAG further undertook a gap analysis examining the educational needs of the ageing and aged care sion’s Inquiry on Caring for Older Australians, see http://www.pc .gov.au/__data/assets/pdf_file/0016/100366/sub083.pdf 3 The AAG is due to deliver its report on a research agenda on ageing well in 2015. Australasian Journal on Ageing, Vol 32 Supplement 2 October 2013, 40–45 © 2013 ACOTA
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sector by identifying areas associated with health conditions, body functions/structure, environmental factors, personal factors and activity participation, where dysfunction would likely lead to the involvement of aged and community care service providers in the life of an older person. The educational opportunities available to support service providers to achieve positive outcomes were then identified.4 The list was developed through online searches and, although it was not exhaustive, it was considered sufficient to identify any significant gaps in available educational opportunities. For the purpose of this paper, ‘educational gaps’ are characterised as areas of knowledge and/or skill development where: • Educational opportunities are available, but these opportunities are limited in comparison to the number of potential learners (e.g. programs with broad applicability but restricted entry). • Evidence exists that the quality of available education is lower than sector, or employer requirements. • Geographical limitations in access exist in relation to particular areas of education (e.g. a well-subscribed face-to-face course is only available to learners in one location). • Irregularity of educational program delivery means that consistent development of the knowledge or skills acquired through attendance at the program is not possible (e.g. a 2-day course which is delivered only once a year based on the availability of a single expert presenter). • No appropriate programs are available in the area. The gap analysis identified a range of needs in education in the ageing and aged care sector. While areas such as dementia, falls and wound care were well covered in higher education and VET sector education, other more niche subject areas were neglected. Areas identified as missing from education programs, or with only limited attention, included sensory functions (vision, hearing, olfaction), community participation (volunteering, recreation), employment and training, sexuality and sexual health, use of prescription medicines, and elder abuse. Other areas were addressed by high quality education programs, but were incapable of meeting potential demand. These included education programs on physiology and the biology of ageing, psychological function, hypertensive disease, depression and anxiety, nutrition and obesity, driving and transport, and spirituality and ageing. Identifying the gaps in research and education, while important, is a preliminary step in terms of action; the next stage is to address the gaps and fund appropriate research and education programs, as well as build capacity in gerontology to 4
The list of educational programs in gerontology in Australia is available at http://www.aag.asn.au/education 43
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ensure that it is able to meet the needs of students, practitioners and policy-makers in the future, with the aim of improving the lives of older Australians.
Future directions When considering the future of gerontology research and education, it is largely a case of ‘Back to the Future’. No new challenges face us today except that we have better access to information and faster and more efficient methods of communication than ever before, so expectations are higher. We now need to be fully committed to and have expertise in consumer engagement, interdisciplinary approaches, national and international collaboration, two-way translation of research and the fast-changing technological world. At the same time, we need to continually advocate for and help set the ageing research agenda as well as the resources to conduct research and research translation. Building on our past and capitalising on the present, the AAG seems generally well placed to meet these challenges. It is becoming increasingly important to governments to include consumers in all aspects of research [16], from setting the research agenda, advising on engagement of participants and developing recommendations to disseminating the findings. The AAG has a long history of engaging directly with older people as members, advisors, researchers, educators and active participants governing the Association. The AAG also has the opportunity, through our collaborating research centres, to collectively build a comprehensive and dynamic picture of the needs and aspirations of successive cohorts of older Australians through separate consultations and research endeavours. Although not new, it is becoming increasingly important for researchers to take an interdisciplinary approach to enquiry. While it is important for researchers to have a sound grounding in their own discipline, research should be driven by questions that are important to society and by ideas, rather than academic disciplines [17]. Nowhere is this more pertinent than in the field of gerontology. It is encouraging to see this approach being developed at school (with the International Baccalaureate being increasingly offered at government schools) and at an undergraduate level, with generic undergraduate degrees being offered at some universities. Students with a broad and interdisciplinary education are more likely to understand and value the contributions that can be made from a range of disciplines, essential in gerontology. An excellent example of this was presented by Paul Pholeros in his inspirational plenary address at the 2012 AAG conference on the benefits to Aboriginal health of a simple, cost-effective housing program that engaged the local community. The AAG is uniquely interdisciplinary – members are drawn from all health disciplines, policymakers, and people with expertise in housing, finances and the built environment, just to name a few. Future research and education in gerontology will continue to benefit from cross disciplinary enquiry. 44
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Collaboration in research and education is also not new but is becoming increasingly important. Governments and philanthropists who fund research increasingly expect to see programs of research that represent a partnership between consumers, policy-makers, researchers and practitioners. Not only does research have to be grounded in peer-reviewed literature but researchers are expected to know about unpublished research in their area of enquiry nationally and internationally, consumer views, current practice and government policy and policy directions. This represents a huge challenge for gerontologists, as the field is so broad and dynamic. However, again, the AAG provides many opportunities for developing and maintaining collaborative partnerships. Not only does the AAG auspice the 20 Australian collaborating research centres, it is also linked regionally and internationally via the International Association of Gerontology and Geriatrics with researchers, practitioners and policy-makers on the international stage. Translation of research into policy and practice is being increasingly developed and understood. The AAG has promoted translational research for some years, including having a special interest group to promote translational research and research funding in gerontology. More recently, the NHMRC has established a Translational Research Faculty, suggesting that they also see research translation as important. However, translational research means many things to many people. In gerontology, we usually mean the translation of research findings into policy and practice: for example, fall prevention guidelines being disseminated to and taken up by hospital clinicians. However, the future of translational research is a two-way exchange, where clinicians are not seen as empty vessels waiting to be filled with knowledge by the experts, but as practice experts who have questions that they want answered and knowledge of the practice setting and the barriers and facilitators for implementation of research evidence. This is important not only for the future on gerontology research, particularly the identification of research questions, but also for education. Future education in gerontology should take an adult learning approach, treat the audience as experts and provide opportunities for exchange of knowledge. Some of the many challenges that we face in developing education and professional development in gerontology are: • The breadth and diversity of content – we need expertise in physical and mental health, across the continuum from prevention to palliative care, best practice models of care, housing, income security, care management, care relationships and health systems. • The breadth and diversity of personnel working in the area – from those working in policy development to residential care. • Lack of an agreed conceptual framework. • Need for specialist (such as neurologists, music therapists) and generalist (gerontologists and allied health assistants) disciplines. Australasian Journal on Ageing, Vol 32 Supplement 2 October 2013, 40–45 © 2013 ACOTA
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• Need to focus on process issues, such as care coordination, interdisciplinary teamwork as well as content issues such as wound care and fall prevention. • Diversity in the workforce, including educational levels (from VET graduates to professors), roles, values and philosophies and cultural understandings of ageing. • Need for broad community education to address ageism.
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Ideally, future education and professional development opportunities would address all these challenges. Educational opportunities in gerontology should be offered at every level within the existing education system in order to equip all working in the area with the knowledge and skills they need, be they specialists in gerontological nursing, aged care policy, service providers or personal carers. However, this is probably not a realistic goal in the short term. A more realistic approach would be to focus our energies on the areas that older people are most likely to come into contact with and where there is currently an identified need. In gerontology, the workforce that has the most contact with older people includes general practitioners, acute and subacute nursing and allied health staff, community care workers, and personal carers (both in residential and community care settings).
Conclusion As an interdisciplinary, independent professional association, the AAG has a long history of leading and facilitating gerontology research and education. The Association has been engaged in research, research agenda setting, education and policy and has the capacity to continue to contribute to the vision of healthy ageing, both within Australia and internationally. Future AAG efforts will continue to build upon strong relationships already held with industry, research and government so that insights gained into ageing can continue to be translated into benefits for the whole community.
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References 1 2 3 4
All these challenges come on top of broader challenges in education and professional development, such as reaching rural and remote workers, selecting the appropriate pedagogy for the target audience, and translation of evidence into teaching and practice.
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Simons L, McCallum J, Simons J et al. The Dubbo Study: An Australian prospective community study of the health of elderly. Australian and New Zealand Journal of Medicine 1990; 20: 783–789. Andrews G, Cheok F, Carr S. The Australian Longitudinal Study of Ageing. Australian Journal on Ageing 1989; 8: 31–35. Mitchell P, Cumming R, Attebo K, Attebo K, Panchapakesan J. Prevalence of cataract in Australia: The Blue Mountains Eye Study. Ophthalmology 1997; 104: 581–588. Brown W, Bryson L, Byles J et al. Women's Health Australia: Establishment of the Australian Longitudinal Study on Women's Health. Journal of Women's Health 1996; 5: 467–447. Logie H, Hogan R, Peut A. Longitudinal Studies of Ageing: Implications for Future Studies. Australian Institute of Health and Welfare, Catalogue No. AGE 42. Canberra: AIHW, 2004. Anstey K, Bielak A, Birrell C, Byles J, Burns R, Kiely K, DYNOPTA Investigators. Understanding ageing in older Australians: The contribution of the DYNOPTA project to the evidence base and policy. Australasian Journal on Ageing 2011; 30: 24–31. Anstey K, Kiely K, Booth H et al. Indigenous Australians are underrepresented in longitudinal ageing studies. Australian and New Zealand Journal of Public Health 2011; 35: 331–336. Arkles R, Jackson-Pulver L, Robertson H, Draper B, Chalkley S, Broe G. Ageing, Cognition and Dementia in Australian Aboriginal and Torres Strait Islander Peoples. Sydney: Neuroscience Research Australia and Muru Marri Indigenous Health Unit, University of New South Wales, 2010. Smith K, Flicker L, Dwyer A et al. Factors associated with dementia in Aboriginal Australians. Australian and New Zealand Journal of Psychiatry 2010; 44: 888–893. LeCouteur D. Scoping study on ageing research. Prepared by a National Consortium auspiced by the Centre for Education on Research and Ageing (CERA) and the National Ageing Research Institute (NARI), 2001. Commonwealth Department of Health and Aged Care, National. Strategy for An Ageing Australia: An Older Australia, Challenges and Opportunities for All. Canberra: Commonwealth of Australia, 2002. Howe A. Gerontology in Australia: The development of the discipline. Educational Gerontology 1990; 16: 125–149. Advisory Panel of the Economic Potential of Senior Australians. Realising the Economic Potential of Senior Australians: Turning Grey into Gold. Canberra: Commonwealth of Australia, 2011. Australian Government. Government Response to the Final Report of the Advisory Panel of the Economic Potential of Senior Australians. Canberra: Commonwealth of Australia, 2012. Russell C, Mahoney M, Hughes I, Kendig H. Postgraduate education in gerontology in the Asia-Oceania region. Gerontology and Geriatrics Education 2007; 27: 99–111. National Health and Medical Research Council. A Model Framework for Consumer and Community Participation in Health and Medical Research. Canberra: Commonwealth of Australia, 2005. Rathjen P. The ideas man. The University of Melbourne Voice 2009 (Jun. 8); 5 (3). [Cited 29 July 2013] Available from URL: http://archive .uninews.unimelb.edu.au/news/5832/index.html
Tony Coles, Julie Byles, Briony Dow and Meredith Tavener Australian Association of Gerontology, Melbourne, Victoria, Australia
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Advancing Research, Education, Practice and Advocacy in Ageing Advances in gerontology research and education: Perspectives from the Australian Association of Gerontology Population ageing is a key issue in Australia and the world. As we celebrate the 30th anniversary of the Australasian Journal on Ageing, it is worth reflecting on the history of ageing research and education in Australia from the perspective of the Australian Association of Gerontology (AAG). The AAG has provided information about ageing since its formation in 1964, to help policy-makers, researchers, service providers and older adults make informed choices about ageing well. Today, with over 800 members as well as divisions established in every state and territory, the AAG represents gerontologists on a variety of government advisory panels and working groups, and brokers a broad range of news, education, evidence and opinions with an emphasis on research translation. Within the context of an ageing population, new research questions are being asked and researchers are crossing disciplinary boundaries to explore novel approaches to studying ageing. As the leading professional body supporting ageing research, the AAG believes that building a robust evidence base is an essential foundation upon which to develop ageing and aged care policies and reforms. Ageing of our society should be a cause for celebration and an extension of opportunities; and knowledge derived from research and experience must be put into practice to maximise its benefit. This paper presents a brief history of ageing research and education in Australia, an analysis of current educational opportunities and gaps and future directions for gerontological research and education, framed alongside the growth and development of the AAG as a prominent organisation in the communication and application of knowledge to age well.
Advances in gerontology research and education Australia’s interest in ageing research goes way back to the pragmatic trials of Dick Gibson and Grace Parberry in developing geriatric care in Newcastle and the founding of the National Ageing Research Institute in Victoria in 1975, to the establishment of some of the earliest longitudinal studies of ageing, including the Dubbo Study which commenced in 1988 [1], and the Australian Longitudinal Study on Ageing established by Gary Andrews in 1992 (which continues today under the leadership of Mary Luszcz) [2]. More studies followed including the Blue Mountains Eye Study [3] and the Australian Longitudinal Study on Women’s Health [4]. In 2004, the Australian Institute of Health and Welfare produced a report that included 21 longitudinal studies of ageing around Australia [5]. 40
In 2007, the Ageing Well Ageing Productively (AWAP) grants program funded the Dynamic Analyses to Optimise Ageing (DYNOPTA) study [6] to pool data from several of these longitudinal studies. To date, analysis of these pooled data has focussed on four key areas (dementia and cognition, mental health, sensory impairment, and mobility/ activity limitations), with other domains including socioeconomic and behavioural risk factors studied as either risk or protective factors. A summary of findings from this effort was published in a special ‘Ageing Well’ edition of the Australasian Journal on Ageing in October 2011, along with interim findings from other AWAP-funded projects. The AWAP grants program was a joint collaboration between the National Health and Medical Research Council (NHMRC) and the Australian Research Council (ARC) that aimed to foster research into ageing, which crosses sectors, research disciplines and institutions, to develop an authoritative evidence base to underpin more effective and wellinformed policy and practice. In addition to the DYNOPTA project, five other projects were funded that investigated predictors of ageing well, management strategies to address poly-morbidity in older people, gene–environment interaction in healthy brain ageing and neurodegeneration, policy and practice around older age employment, and policy and services for older Indigenous Australians. An obvious gap in most of the existing longitudinal studies of ageing is the lack of information on older Indigenous people. In the DYNOPTA study, for example, only 297 Indigenous participants were identified in the pooled dataset, representing 0.7% of men and 0.5% of women in the weighted sample, compared with 0.8% of both sexes in the Australian population [7]. The New South Wales ‘45 and Up’ study is one general population study that does have numbers of Indigenous people for detailed analyses. However, even where sufficient data about Indigenous Australians are available from studies of the wider population, careful consideration must be given to the analysis and representation of these data [8]. Some specific studies involving older Aboriginal Australians have been conducted including in the Kimberly region [9], and Tony Broe’s Koori Growing Old Well Study1. AAG supports indigenous people and their research partners through the Aboriginal and Torres Strait Islander Ageing 1
For further information on the Koori Growing Old Well Study, visit http://www.neura.edu.au/research/projects/koori-growing-old -well-study Australasian Journal on Ageing, Vol 32 Supplement 2 October 2013, 40–45 © 2013 ACOTA
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Committee, which held its inaugural meeting at the Australian Association of Gerontology Annual National Conference in Melbourne in November 2004.
year, National Research Priorities were announced with ‘Ageing Well, Ageing Productively’ identified as a national research goal.
There have been several efforts to capture and coordinate Australia’s efforts in ageing research. In 2001, the NHMRC commissioned a ‘Scoping study on ageing research’ [10]. This study involved a survey of 79 Australian ageing researchers. Among the many findings of the study was that ageing researchers tended to be young, with an average age of 45 and many (58%) did not have a research degree. The report also identified that ageing research in Australia concentrated on the multidisciplinary interface between ageing and health care across 17 areas including environment, technology and healthy and productive ageing. The report also called for targeted funding to allow researchers to work together and to build areas of strength.
In 2003, the Australian Government released its Framework for an Australian Ageing Research Agenda. Building on symposia and fora identifying key areas for research, the Framework identified six key policy issues of imminent importance requiring thorough research: • Maintaining economic growth in the face of an ageing workforce and reduction in the supply of younger workers. • Achieving adequate, sustainable retirement income over lengthening periods of retirement. • Developing positive images of ageing and supporting continued social participation. • Developing age-friendly infrastructure and built environment. • Achieving healthy ageing to maintain health and independence. • Providing accessible, appropriate, high-quality health and aged care.
In another effort, the Australian Ageing Research Directory was designed to provide ready access to current and ongoing research with six editions produced between 1997 and 2000, with the 2000 edition including 731 project entries from 202 research organisations and involving 1192 different principal or co-researchers. The Directory was replaced with Ageing Research Online http://www.aro.gov.au/. Then, in 2005, the ARC/NHMRC Research Network on Ageing Well developed a literature database of ageing research conducted in Australia or by Australians between 1999 and 2005. Extensive searching of electronic databases, websites, checking of reference lists and a survey of Network members, identified 2176 citations (research publications and grants) across four theme areas (healthy ageing, productivity and economic participation, independent living and social participation, and population research strategies). The majority of these citations were in the areas of healthy ageing and independent living, with few citations in the productivity and population themes. The healthy ageing theme included research into ways individuals can maintain well-being, how social environments promote ageing well, management of age-related conditions, and rehabilitation and prevention of decline among people with a degree of frailty. The independent living theme addressed personal, social and environmental factors affecting independence and participation. The productivity theme included older workers, retirement, volunteering, consumption, savings and assets management, and supportive care for older people. The population theme included population dynamics, life expectancy and longitudinal studies. Ageing Research Online and the Ageing Well database illustrate the range of topics that can be considered relevant to ageing research and the potential breadth of the Australian research agenda. Several attempts have been made to delineate this research agenda and set priorities. In 2002, the same year that the International Research Agenda on Ageing for the 21st Century was announced, the National Strategy for an Ageing Australia [11] identified the importance of an ageing research agenda in Australia. Later that Australasian Journal on Ageing, Vol 32 Supplement 2 October 2013, 40–45 © 2013 ACOTA
Alongside the growth in interest in ageing research, there have also been several efforts to build and support Australia’s ageing research capacity. The Building Ageing Research Capacity (BARC) project was a collaborative venture between the Australian Institute of Health and Welfare and the Office for an Ageing Australia. The project began in 2002, and aimed to enhance collaboration and coordination between Australian researchers and policy-makers and thereby improve the quality and quantity of the evidence base available to inform policy. A main outcome of the BARC project was the development of a framework for an Australian Ageing Research Agenda, released in 2003. Following on from BARC, the ARC/NHMRC Research Network in Ageing Well was funded by the Commonwealth as part of the Australian Government’s Research Network Grants Program. The aims of this program were to enhance the scale and focus of national research activity, stimulate innovation and support researchers to connect with others. The Networks were designed to identify and address areas of strength, opportunity or need where increased research effort would make a significant contribution to national outcomes. Following the cessation of the Network, AAG has worked to continue links between researchers through the identification of AAG-collaborating research centres. There are currently 20 collaborating research centres ranging in specialty from dementia to spirituality, which work to create an avenue for communicating policy, research and opinion within the context of an ageing population. Underpinning the use of research is gerontology training and education. Even among people who work with older people, strong biases and stereotypes exist that colour their expectations of ageing, of the people they work with, and of what 41
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can be achieved with older people. There is a need to promote a deeper and more comprehensive understanding of the process of ageing and how this process impacts across populations and on health and service needs. The promotion of such understanding has been a fundamental goal of AAG and is reflected in the educational and training activities of our members. At the most direct level, AAG’s role in education to date has been through organising conferences and seminars where researchers, educators, policy-makers, planners and providers can interact to share latest research findings and their potential impacts and to understand emerging issues in ageing that may require further research and action. In 1990, Anna Howe published a paper that traced the origins and contributions of gerontological education in Australia and reviewed the topics of research published by journals (notably AJA since 1982) and at AAG conferences since 1969 [12]. At that time, medicine and health care accounted for more than 70% of all items, and 50% of journal articles. Notably there was an absence of papers on psychology of ageing, and few nursing studies. Over time, more conference papers on demography and social policy analysis were published, and dementia appeared as a ‘recent health topic entrant’. Housing, retirement and residential care had ‘intermittent representation’. In contrast, more recent AAG conferences have evolved to have a greater emphasis on social, psychological and environmental issues (including a feature topic on housing in 2010), and greater participation by nursing, allied health and social scientists. In terms of formal education, the AAG has promoted the many gerontology courses across Australia through prizes and through promotion of these programs in the AAG Guide to Gerontological Education. Courses included in the guide span a wide range of fields, from community medicine to nursing, from gero-psychology to aged care management and from undergraduate to postgraduate levels. The range of courses also reflects the multidisciplinary nature of gerontology with courses offered from schools of medicine, health sciences, nursing, psychology, sociology and social work, environmental and life sciences, and theology. However, while formal tertiary courses are available across Australia, there was also a perceived need for a more generally accessible short course on ageing that would allow a broader audience to develop a more sophisticated understanding of the effects of ageing at individual, community and population levels. To meet this need, the Department of Health and Ageing funded the development of a supplemental course, which bridged gerontology and public health and was broadly available to many people working with older people, either as an online short course or as a unit within an existing program. This course was designed to provide a population view of ageing, its health impacts and potential policy and service responses. Development of the course was informed by focus groups and interviews to explore the 42
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educational needs, knowledge gaps and perceptions of current issues relevant to population ageing. The findings helped inform the main themes of the modules, as well as scenarios, exercises and assignments included therein. The content of the course was developed by a national faculty of 21 gerontologists from a variety of disciplinary backgrounds. A pilot program was delivered in 2005, and since then, the course has been delivered and adapted through online short courses and used in gerontology curricula around Australia. The course has been undertaken by postgraduate students as well as people who work in aged care, health services, government and commercial settings. One particular impact of the course has been the ability to challenge people about their thinking about ageing, and how this affects their attitudes and approaches to older people.
Identifying current gaps in research and education In October 2011, the AAG, together with the NHMRC, held a workshop entitled ‘Progressing Australia’s Research Agenda in Ageing Well’. The workshop included a broad range of senior stakeholders from government, consumer advocacy groups and the university sector. The purpose of the workshop was threefold: • To inform the development of a national ageing research agenda. • To consider options for increasing capacity in ageing research. • To suggest mechanisms for better enabling the translation of ageing research. The workshop included a broad range of issues from biological ageing, geriatrics and neurosciences, through to psychosocial ageing and the spectrum of issues for government policies and programmes. Delegates also recommended that a national ageing research agenda needs to focus on collaborative, multidisciplinary research that can be applied in policy and practice, both domestically and internationally, as well as striking the right balance between observational, intervention and translational research in order to address research priorities effectively. Participants at the workshop were also concerned with the lack of targeted funding for ageing research and inadequate support for emerging and mid-career researchers, leading to a smaller ageing research workforce at a time when the tertiary sector will be impacted by the impending retirement of senior ‘baby-boomer’ academics. Thus, building capacity in ageing research is an important consideration in parallel with developing a national ageing research agenda. The findings from the workshop reinforced the AAG’s messages in submissions delivered to the Productivity Commission’s inquiry on Caring for Older Australians. As stated in the AAG’s initial submission2 to the Commission: 2
For a copy of the AAG’s submission to the Productivity CommisAustralasian Journal on Ageing, Vol 32 Supplement 2 October 2013, 40–45 © 2013 ACOTA
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Ageing is a major issue for the full range of research supported by the ARC and NHMRC and there are few aspects of medical, scientific or social research that will not impact upon or be affected by the ageing of the Australian population. Unlike much traditional health and scientific research, ageing research does not apply a single issue, reductionist research model. Gerontological enquiry recognises the complexity of ageing and the multi-factorial causality of age-related health and decline. Ageing research demands a cross-disciplinary approach, building capacity in medical, psycho-social, nursing, allied health, environmental and technological areas . . . Furthermore, there is an urgent need to build Australia’s capacity in ageing research. A strong research and development focus, supporting skill development and career opportunities for researchers will be a national resource in addressing an ageing population over the coming decades. For successful research outcomes it will be necessary to harness all the existing expertise as well as promoting the development of additional expertise. Following on from the Productivity Commission’s report on Caring for Older Australians and the NHMRC/AAG report on Progressing Australia’s Research Agenda on Ageing Well, the Minister’s Advisory Panel on the Economic Potential of Senior Australians recommended to the Government that ‘The federal government establish an ongoing process for developing and maintaining the currency of a broad based national ageing research agenda and for targeting funding to identified priorities’ [13]. In response, the Government acknowledged that the AAG is working to develop a research agenda on ageing well as part of its Healthy Ageing Project under the Aged and Community Services Improvement and Healthy Ageing Grant [14].3 Additionally, in further support of research, the Government has committed $12.7 million over 7 years to fund the ARC Centre of Excellence in Population Ageing Research. The ARC Centre of Excellence was established to explore issues associated with population ageing, inform private and public sector policy, and yield outcomes that improve the well-being of older people and their social and economic environment. Demand for education and training in gerontology has been increasing rapidly in both higher education and vocational education and training (VET). For example, in 2007, there were six Masters courses in gerontology, geriatrics, aged care or a related field on offer at universities around Australia [15]; by 2012, this had swelled to 17 Masters courses in gerontology and related fields. In January 2012, the AAG further undertook a gap analysis examining the educational needs of the ageing and aged care sion’s Inquiry on Caring for Older Australians, see http://www.pc .gov.au/__data/assets/pdf_file/0016/100366/sub083.pdf 3 The AAG is due to deliver its report on a research agenda on ageing well in 2015. Australasian Journal on Ageing, Vol 32 Supplement 2 October 2013, 40–45 © 2013 ACOTA
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sector by identifying areas associated with health conditions, body functions/structure, environmental factors, personal factors and activity participation, where dysfunction would likely lead to the involvement of aged and community care service providers in the life of an older person. The educational opportunities available to support service providers to achieve positive outcomes were then identified.4 The list was developed through online searches and, although it was not exhaustive, it was considered sufficient to identify any significant gaps in available educational opportunities. For the purpose of this paper, ‘educational gaps’ are characterised as areas of knowledge and/or skill development where: • Educational opportunities are available, but these opportunities are limited in comparison to the number of potential learners (e.g. programs with broad applicability but restricted entry). • Evidence exists that the quality of available education is lower than sector, or employer requirements. • Geographical limitations in access exist in relation to particular areas of education (e.g. a well-subscribed face-to-face course is only available to learners in one location). • Irregularity of educational program delivery means that consistent development of the knowledge or skills acquired through attendance at the program is not possible (e.g. a 2-day course which is delivered only once a year based on the availability of a single expert presenter). • No appropriate programs are available in the area. The gap analysis identified a range of needs in education in the ageing and aged care sector. While areas such as dementia, falls and wound care were well covered in higher education and VET sector education, other more niche subject areas were neglected. Areas identified as missing from education programs, or with only limited attention, included sensory functions (vision, hearing, olfaction), community participation (volunteering, recreation), employment and training, sexuality and sexual health, use of prescription medicines, and elder abuse. Other areas were addressed by high quality education programs, but were incapable of meeting potential demand. These included education programs on physiology and the biology of ageing, psychological function, hypertensive disease, depression and anxiety, nutrition and obesity, driving and transport, and spirituality and ageing. Identifying the gaps in research and education, while important, is a preliminary step in terms of action; the next stage is to address the gaps and fund appropriate research and education programs, as well as build capacity in gerontology to 4
The list of educational programs in gerontology in Australia is available at http://www.aag.asn.au/education 43
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ensure that it is able to meet the needs of students, practitioners and policy-makers in the future, with the aim of improving the lives of older Australians.
Future directions When considering the future of gerontology research and education, it is largely a case of ‘Back to the Future’. No new challenges face us today except that we have better access to information and faster and more efficient methods of communication than ever before, so expectations are higher. We now need to be fully committed to and have expertise in consumer engagement, interdisciplinary approaches, national and international collaboration, two-way translation of research and the fast-changing technological world. At the same time, we need to continually advocate for and help set the ageing research agenda as well as the resources to conduct research and research translation. Building on our past and capitalising on the present, the AAG seems generally well placed to meet these challenges. It is becoming increasingly important to governments to include consumers in all aspects of research [16], from setting the research agenda, advising on engagement of participants and developing recommendations to disseminating the findings. The AAG has a long history of engaging directly with older people as members, advisors, researchers, educators and active participants governing the Association. The AAG also has the opportunity, through our collaborating research centres, to collectively build a comprehensive and dynamic picture of the needs and aspirations of successive cohorts of older Australians through separate consultations and research endeavours. Although not new, it is becoming increasingly important for researchers to take an interdisciplinary approach to enquiry. While it is important for researchers to have a sound grounding in their own discipline, research should be driven by questions that are important to society and by ideas, rather than academic disciplines [17]. Nowhere is this more pertinent than in the field of gerontology. It is encouraging to see this approach being developed at school (with the International Baccalaureate being increasingly offered at government schools) and at an undergraduate level, with generic undergraduate degrees being offered at some universities. Students with a broad and interdisciplinary education are more likely to understand and value the contributions that can be made from a range of disciplines, essential in gerontology. An excellent example of this was presented by Paul Pholeros in his inspirational plenary address at the 2012 AAG conference on the benefits to Aboriginal health of a simple, cost-effective housing program that engaged the local community. The AAG is uniquely interdisciplinary – members are drawn from all health disciplines, policymakers, and people with expertise in housing, finances and the built environment, just to name a few. Future research and education in gerontology will continue to benefit from cross disciplinary enquiry. 44
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Collaboration in research and education is also not new but is becoming increasingly important. Governments and philanthropists who fund research increasingly expect to see programs of research that represent a partnership between consumers, policy-makers, researchers and practitioners. Not only does research have to be grounded in peer-reviewed literature but researchers are expected to know about unpublished research in their area of enquiry nationally and internationally, consumer views, current practice and government policy and policy directions. This represents a huge challenge for gerontologists, as the field is so broad and dynamic. However, again, the AAG provides many opportunities for developing and maintaining collaborative partnerships. Not only does the AAG auspice the 20 Australian collaborating research centres, it is also linked regionally and internationally via the International Association of Gerontology and Geriatrics with researchers, practitioners and policy-makers on the international stage. Translation of research into policy and practice is being increasingly developed and understood. The AAG has promoted translational research for some years, including having a special interest group to promote translational research and research funding in gerontology. More recently, the NHMRC has established a Translational Research Faculty, suggesting that they also see research translation as important. However, translational research means many things to many people. In gerontology, we usually mean the translation of research findings into policy and practice: for example, fall prevention guidelines being disseminated to and taken up by hospital clinicians. However, the future of translational research is a two-way exchange, where clinicians are not seen as empty vessels waiting to be filled with knowledge by the experts, but as practice experts who have questions that they want answered and knowledge of the practice setting and the barriers and facilitators for implementation of research evidence. This is important not only for the future on gerontology research, particularly the identification of research questions, but also for education. Future education in gerontology should take an adult learning approach, treat the audience as experts and provide opportunities for exchange of knowledge. Some of the many challenges that we face in developing education and professional development in gerontology are: • The breadth and diversity of content – we need expertise in physical and mental health, across the continuum from prevention to palliative care, best practice models of care, housing, income security, care management, care relationships and health systems. • The breadth and diversity of personnel working in the area – from those working in policy development to residential care. • Lack of an agreed conceptual framework. • Need for specialist (such as neurologists, music therapists) and generalist (gerontologists and allied health assistants) disciplines. Australasian Journal on Ageing, Vol 32 Supplement 2 October 2013, 40–45 © 2013 ACOTA
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• Need to focus on process issues, such as care coordination, interdisciplinary teamwork as well as content issues such as wound care and fall prevention. • Diversity in the workforce, including educational levels (from VET graduates to professors), roles, values and philosophies and cultural understandings of ageing. • Need for broad community education to address ageism.
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Ideally, future education and professional development opportunities would address all these challenges. Educational opportunities in gerontology should be offered at every level within the existing education system in order to equip all working in the area with the knowledge and skills they need, be they specialists in gerontological nursing, aged care policy, service providers or personal carers. However, this is probably not a realistic goal in the short term. A more realistic approach would be to focus our energies on the areas that older people are most likely to come into contact with and where there is currently an identified need. In gerontology, the workforce that has the most contact with older people includes general practitioners, acute and subacute nursing and allied health staff, community care workers, and personal carers (both in residential and community care settings).
Conclusion As an interdisciplinary, independent professional association, the AAG has a long history of leading and facilitating gerontology research and education. The Association has been engaged in research, research agenda setting, education and policy and has the capacity to continue to contribute to the vision of healthy ageing, both within Australia and internationally. Future AAG efforts will continue to build upon strong relationships already held with industry, research and government so that insights gained into ageing can continue to be translated into benefits for the whole community.
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References 1 2 3 4
All these challenges come on top of broader challenges in education and professional development, such as reaching rural and remote workers, selecting the appropriate pedagogy for the target audience, and translation of evidence into teaching and practice.
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Tony Coles, Julie Byles, Briony Dow and Meredith Tavener Australian Association of Gerontology, Melbourne, Victoria, Australia
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