Feature

posted 14 Oct 2003 in Volume 8 Issue 6

Studies in ageing: A new Elderly Client Adviser series in conjunction with the Sheffield Institute for Studies on Ageing (SISA)

ECA is pleased to acknowledge the assistance of SISA in helping to meet the long demand from ECA readers for broader coverage of medico-legal issues related to older clients. Professor Tony Warnes, Director of SISA, is editor of the premier UK social gerontological journal, Ageing & Society, and a past chair of the British Society of Gerontology. He explains what is happening in the world of ageing studies and describes SISA’s activities and its enthusiasm for liaison with ECA. If readers think that the legal environment for elder care is complex, then Tony’s explanation of the current research environment, with its many entities, appears to be even more of a labyrinth. It is anticipated that future articles will cover such issues as raising the quality of care in residential and nursing homes, tackling age discrimination in access to health and social services, and extending end-of-life care principles to patients of all ages and health conditions. Given the high level of recognition of the proposed authors in their fields, ECA readers will eagerly await publication. In the meantime, readers should find the details below a useful source of information and contacts, which may assist in dealing with social policy and client-related issues.

An introduction to the work of SISA

This article heralds a series in Elderly Client Adviser on aspects of ageing and old age from authors affiliated with the Sheffield Institute for Studies on Ageing at the University of Sheffield. The overall aim of the series is to provide up-to-date and accessible summaries of current knowledge on various aspects of the care and support of older people. As many ECA authors have remarked, readers will benefit from enhanced knowledge and awareness in these fields. While the series will touch on some socio-legal aspects familiar to ECA readers, other aspects will be much less familiar.

The University of Sheffield has one of the largest concentrations of “gerontology” researchers in the country, and exceptional expertise in, for example, bone metabolism, clinical elderly care, health-services research, long-term care, palliative care and social policies. These and other contributions were recently recognised with the award to the University of a Queen’s Anniversary Prize, for contributions to “raising the quality of life of older people” (The Times, 19 February 2003).

As in all large universities with a medical school, its multiple sites and the scale of the institution is a challenge for the development of multi-disciplinary gerontology. While much of the research is in the School of Medicine, Sociological Studies and the School of Nursing and Midwifery, there are gerontology researchers in 16 departments. Co-ordination and integration are assiduously pursued. The Sheffield Institute for Studies on Ageing (SISA) was established in 1993 with two arms: an inter-disciplinary core group led by Tony Warnes, and a cross-faculty federation of research gerontologists. The core group’s research expertise extends from clinical medicine to ethnographic research.

Gerontology research at the University of Sheffield

There are nearly 100 researchers in gerontology in the University, and their work groups under five main headings:

Gerontological policy and practice: principles, priorities and reform;
Older people’s changing circumstances: resources, aspirations, expectations, problems and needs;
Biomedical and disease processes;
Health and social services: organisation, delivery and outcomes;
Improving the quality-of-life of older people.

Policy and practice reform

For more that two decades, Alan Walker, professor of social policy, and his colleagues, have been conducting policy-related research in the field of ageing, including pioneering work on the social construction of old age, the caring relationship, employers’ practices towards older workers, and the experiences of older people with learning disabilities and their family carers. Much has had a comparative European dimension, and Alan chaired the European Commission’s “Observatory on Ageing and Older People” in the early 1990s.

Alan Walker and Catherine Hennessy (Deputy) direct the UK Economic and Social Research Council (ESRC) “Growing Older” programme, which has injected some £3.5m into British research in gerontology over the past three years. It comprises 24 projects, which have brought together most of the UK’s leading social gerontologists, and will complete its work in 2004 – details of the GO Programme can be found at http://www.shef.ac.uk/uni/projects/gop/index.htm. They also direct the UK “National Collaboration on Ageing Research” (NCAR) – a joint venture among four of the UK research councils to boost inter-disciplinary research. NCAR is holding a series of national scientific workshops to develop research priorities and collaboration – details can be found at http://www.shef.ac.uk/ukncar/.

Alan Walker leads a European Union Fifth Research Framework project to co-ordinate research on ageing. It is expected that the project will lead to the creation of “ageing” as a research priority area. Details of the European Forum on Population Ageing Research can be found at http://www.shef.ac.uk/ageingresearch.

Since November 2000, Ian Philp, professor of health care of elderly people, has been seconded from the University part-time to the Department of Health as national director for older people’s services, the older people’s “czar”, to finalise and implement the National Service Framework for Older People’s Services (details on http://www.doh.gov.uk/nsf/olderpeople.htm).

The task now is to keep older people’s issues, and the National Service Framework standards (including the near revolutionary target of ending age-discrimination in health and social services for older people) to the forefront of the Department of Health and NHS agenda. The harmful effects of age discrimination has been noted in ECA over many years and I am certain readers will fully support this initiative.

Older people’s changing needs

The patient or client perspective and understanding older people’s preferences and opinions pervades SISA’s research, most overtly in projects on long-term care, palliative care, sexual health, homeless people’s services and housing choices.

Dr Lorna Warren’s Older Women’s Lives and Voices project, which arose through her involvement in the Better Government for Older People Programme, has been supported by the ESRC Growing Older Programme and now has a European dimension. With colleagues in 12 European countries, she is investigating the living conditions and problems faced by older women in Europe.

I co-ordinate a European Science Foundation - Scientific Network on the wellbeing and needs of older migrants, which is integrating the findings of surveys in seven countries. I am also preparing a report on this topic for the Council of Europe, an intergovernmental organisation, which aims to protect human rights, pluralist democracy and the rule of law; to promote awareness and encourage the development of Europe’s cultural identity and diversity; to seek solutions to problems facing European society (discrimination against minorities, xenophobia, intolerance, environmental protection, human cloning, Aids, drugs, organised crime, etc.); and to help consolidate democratic stability in Europe by backing political, legislative and constitutional reform (for more details visit http://www.coe.int/DefaultEN.asp).

I continue to work closely with the Regional Ageing Population Panel (now chaired by Jill Manthorpe of King’s College London). The panel of representatives from statutory and voluntary agencies was established in connection with the Department of Trade and Industry’s Ageing Population Foresight Panel of 1999-2000, itself a response to the government’s concern that the country’s responses to population ageing were being inadequately researched. An information booklet for policy makers and the general public: Older People in Yorkshire and the Humber, was recently published (available from Age Concern Rotherham, email: co@acr-yorks.freeserve.co.uk). While strictly geared to reflect the region, many of its points will be relevant nationwide.

Biomedical research

Sheffield’s Schools of Medicine and Biological Sciences have many five-star research departments, as established in the 2001 Higher Education Funding Councils’ Research Assessment Exercise, and found: “Almost without exception, the research output was of national or international quality.”

An unequivocally gerontological field is osteoporosis research (and clinical treatment), led by Professor Richard Eastell. A leading scientific journal in the field, Osteoporosis International, recently commissioned the US-based Institute for Scientific Information to rank the world’s leading osteoporosis research centres, and it found the University of Sheffield to be the fourth most frequently cited institution. Current research grants total £4.9m and support 45 researchers.

SISA related research was the first to show: (i) that intestinal calcium (a key component of bone) absorption does not decline with age; (ii) that bone turnover increases with ageing, not decreases, as had been formerly believed; (iii) that most of the bone loss in osteoporosis occurs during the night and could be prevented by a late evening calcium supplement; (iv) that a regular milk supplement increases bone density in teenage girls – a valuable safeguard against the possibility of osteoporosis occurring in later life. Major new lines of research are new approaches to the identification of vertebral fractures, the use of ultrasound for the early identification of women at risk for osteoporosis, and the use of biochemical markers of bone turnover for monitoring treatment response.

Improving health and social services for older people

Ian Philp’s service development research is in “single assessment”, particularly for primary care and community-health applications. He has developed the “easy care” instrument, partly through a sequence of EU-funded studies that have supported trials in 12 European countries. The research has also led to the development of an assessment instrument for carers’ needs, the COPE Index. Ian is now embarking on comparative research with Professor Bob Kane at the University of Minnesota.

Many other University of Sheffield researchers contribute to this field. Pam Enderby, professor of community rehabilitation and dean of the Faculty of Medicine, has a special interest in community rehabilitation. She has developed the holistic Therapy Outcome Measures instrument (TOMS), to monitor changes in a patient’s disease, activity level, social participation and well-being. It has been widely adopted in the UK and abroad. Pam is also leading the South Yorkshire NHS Workforce Development Confederation bid, supported by an NHS Learning Contract, and is a partner in the EU supported Ortho-Logo-Paedia Project, on IT support for the home-based rehabilitation of older people with speech disorders.

Nurse education is crucial to the improvement of older people’s services. Researchers in the School of Nursing and Midwifery recently completed a major study on the effectiveness of nurse training to meet the needs of older people and their carers. Anthony Smith, chief executive of the ENB, commented: “The board is delighted to be able to publish the report, which will be of major significance to practitioners, education providers and commissioners, service managers, and students of health and social care. The rich research evidence ... extends beyond the nursing profession and will be of relevance to many agencies involved in the care of older people and their families.”

Mike Nolan (deputy dean (research) of the School of Nursing and Midwifery and chair in gerontological nursing), Gordon Grant (professor of cognitive disability, School of Nursing), Dr Sue Davies (senior lecturer in nursing) and others, have a substantial programme of research on the quality of long-term care for frail older people. Their work emphasises not only the quality-of-life and satisfaction of residents and care recipients, but also the partnership between formal and informal carers, and the importance of improving carers’ satisfaction and conditions. With Dr Kevin McKee (senior lecturer, SISA) and myself, the team is about to start an extended evaluation of the Age Care Awards, a training scheme for all staff of residential care and nursing homes.

Many of Sheffield’s gerontologists have strong advisory links and some management and practice responsibilities with local health and social service agencies and non-governmental organisations. Professor Stuart Parker took up the inaugural chair in geriatric medicine at Barnsley District General Hospital NGH Trust, where he joined Dr Salah Gariballa, clinical senior lecturer. Stuart’s principal research interest is the organisation of clinical services, and with partners in Leicester and Birmingham he is a lead investigator in the Department of Health funded project, Intermediate Care: A National Evaluation. Salah Gariballa researches malnutrition in older people.

Another rapidly growing and exciting field, pursued by Professor Sam Ahmzedai (head of palliative medicine and director of the Trent Palliative Care Centre), Dr Jane Seymour (TPCC), Professor Sheila Payne (School of Nursing) and Dr Merryn Gott (lecturer, SISA), is into the extension of end-of-life care principles to a wide range of terminal conditions and to many older people who experience a protracted death. Another rapidly developing field, led by Dr Merryn Gott, is sexual health in later life. An initial focus has been the role of sexual relations in the well being of long-established marriages and sexual unions, but the team is also initiating studies into the rising incidence of sexually-transmitted diseases among older people. The team has exceptional skills in conducting in-depth qualitative interviews on sensitive subjects with older people.

Among more specialised fields of research with high practice and policy impacts has been Dr Maureen Crane’s (research fellow, SISA) work on older homeless people’s unmet needs. She was involved in the establishment of the first British homeless hostel specifically for older people, and her work directly informs the practice and service-development priorities of major non-statutory provider organisations. With myself, she is now undertaking, with ESRC support, a comparative three-nation study of the causes of homelessness in later life. In 2002, we were honoured by winning the Tony Dennison prize for the best research report on homelessness.

Quality-of-life (QoL) research

The “dimensioning” and measurement of QoL is another common theme in much Sheffield gerontology research. Kevin McKee and Dr Chris Parker (lecturer, SISA) are our specialist methodologists, but the substantive issues have been a prime concern of Mike Nolan, Alan Walker, Sue Davies and Pam Enderby. All have made important contributions, the most distinctive arguably being with colleagues in the School of Architectural Studies on the QoL impacts of the internal design and space use of residential and care homes. Dr Doug Emery of the School of Nursing and Midwifery pursues innovative research on applications to support and contribute to the care of older people and their informal carers.

New initiatives

The award of the Queen’s Anniversary Prize (QAP) is the latest fillip to the progress of gerontology in the University, and we are delighted by this recognition of “innovation and excellence” in our contributions across theory, policy and practice. Just prior to the award, the University decided to allocate some £0.85m for a building extension specifically dedicated to gerontology research and designed to catalyse new cross-disciplinary working among social scientists, health-services researchers and clinical (medicine, nursing and therapies) scientists. Research teams, led by Ian Philp, and myself will move from the Northern General Hospital in the north of the City to work alongside the team in Sociological Studies.

I end with a quotation from Merryn Gott that was included in the QAP bid: “I’ve found the University to provide the ideal environment within which to develop an innovative, multidisciplinary research programme in the field of ageing. Working with international experts on the social, clinical and biological aspects of ageing has stimulated me to develop my own research portfolio and helped attract significant funding, and the sheer number and range of staff and students has enabled me to work in a collaborative way that has brought significant benefits in research funding – and helped me more fully to understand the complex needs of older people.”

I do hope that by engaging with ECA editorial staff and its diverse readership we can help to break down the existing barriers to understanding the problems that arise from ageing and those that persist among the caring professions involved.

Professor Warnes can be contacted at: a.warnes@sheffield.ac.uk. For more details of the University’s research programmes, visit http://www.shef.ac.uk/sisa.