Ageing and geriatric medicine - Research
As one of Australia's most successful geriatric medicine research organisations, our centre has a strong multi-disciplinary focus and conducts research across multiple program areas.
Frailty
Older people in hospital are at high risk of adverse outcomes, a vulnerability commonly referred to as frailty.
In community-dwelling older people, frailty status can be measured precisely with an index of deficits. As people age, they accumulate problems across multiple systems (e.g. medical comorbidities, functional impairments, cognitive decline and loss of vision and hearing). By applying a well-defined methodology, these problems can be coded as deficits, summed and divided by the total number of potential problems to derive a frailty index (FI) score. As a continuous variable (rather than dichotomous frail vs not frail), the FI provides a precise, individualised summary of risk status. Though it has been validated in tens of thousands of community-dwellers, the FI has been criticised as too unwieldy for the busy inpatient setting. One of our current projects is to derive an FI from information that is already routinely collected for the interRAI Acute Care instrument. Integration of frailty quantification into an existing assessment system, which serves other clinical and administrative purposes, could optimise clinical utility and minimise costs, without losing fidelity. This would assist clinicians to identify vulnerable older inpatients, improving their care in the acute setting.
Other ongoing projects include Frailty ADD: Improving Hospital Outcomes for Frail Patients Across Different Disciplines, the measurement of frailty in patients with chronic kidney disease, the stratification of risk for older people needing elective or emergency surgery, investigation of sex differences in frailty and the role of assets in mitigation of risk. Students undertaking research higher degrees are affiliated to each of these sub-themes.
This work is led by Associate Professor Ruth Hubbard.
Implementation science
Implementation Science is as research discipline which seeks to systematically close the gap between 'what we know' (research) and 'what we do' (practice) by studying the methods and strategies that facilitate the uptake of evidence-based practice and research into regular use by practitioners and policymakers.
Our team uses implementation science theories, models and frameworks to optimise the implementation of ageing and frailty research findings into practice. We do this by conducting hybrid implementation-effectiveness trials to concurrently study not only 'if' interventions work, but 'how' and 'why' they work, and in 'which contexts' to inform future implementation and spread, as well as qualitative inquiry to test and develop theories about implementation and sustainability.
We support other research teams to integrate implementation science into their research programs, and contribute to programs that train and mentor researchers and health professionals about implementation science and knowledge translation. An example of this capacity building that we have contributed to is Queensland Health’s Allied Health Translating Research into Practice initiative.
This work is led by Dr Adrienne Young.
Malnutrition
Nutrition plays a critical role in ageing, by promoting health ageing and preventing age-related chronic diseases and inflammation, and in delaying progression of frailty. Decline in nutritional intake and the subsequent development of malnutrition is common in older age across community, hospital and residential aged care settings.
Our team leads research to improve malnutrition management in the acute and sub-acute hospital setting, by developing and implementing multi-component nutrition and mealtime interventions to address barriers at the individual, ward and system levels. We approach this using co-design principles to ensure that those with lived and professional experience can contribute equally to the process. We also develop and validate methods to measure nutrition and mealtime processes and outcomes.
This work is led by Dr Adrienne Young.
Optimising prescribing
Ageing is associated with the development of chronic illness, and the implementation of guidelines for the management of these conditions has resulted in an increase in the cost and number of prescribed medications. There is increasing concern that the prescription of multiple medications for older people can cause significant harm.
Pharmacokinetic and pharmacodynamics changes with chronological age increase the risk of adverse drug events. In older people, polypharmacy, commonly defined as the concurrent use of five or more medications per day, is associated with falls, functional decline, and mortality. On the other hand, medications can be of considerable value to older people — improving quality of life through symptom control, preventing cerebrovascular morbidity, and reducing cardiovascular mortality.
Our team within the Ageing & Geriatrics Research unit investigates the effect of inappropriate medication use on outcomes in older people and how this can be improved. Our understanding of frailty provides a unique and innovative perspective to these studies. We hypothesise that frail older people may be more vulnerable to the adverse effects of drugs whereas those who are fitter may gain more benefit.
This work is led by Professor Ruth Hubbard.