Ageing and geriatric medicine - Research

The World Health Organisation (WHO) recognises Dementia as a public health priority.  Worldwide, 50 million people have dementia, with nearly 60% living in low- and middle-income countries.  People with dementia are frequently denied the basic rights and freedoms available to others.   The Centre has worked to support improvements in access to diagnostic services, quality of care in hospital, understanding different health outcomes, improved approaches to economic evaluation of dementia care, health policy issues and quality of life for people with cognitive impairment.  

The Centre is involved in a body of work which aims to increase our understanding of aspects related to the diagnosis, treatment, and care of people with cognitive impairment and dementia.  We work with people with cognitive impairment and their care partners as collaborators in this research process.

This work is led by Dr Melinda Martin-Khan and Associate Professor Tracy Comans.

Featured projects include:

Dementia Quality of Life Tool

• The AD-5D tool is an algorithm developed in our centre to derive utility values for economic evaluation. Compared to all other instruments being used in the past, AD-5D is much easier to use due to its short and simple nature, yet dementia-specific and backed by strong clinical research (with the widely used Quality of life – Alzheimer’s Disease as the base instrument). The tool is available with no charge.

Visit UQ espace for access to the tool

Pictographic QoL Tool

• The loss of memory and verbal communication in people with advanced dementia severely affects their ability to self-report their quality of life (QoL). This project aims to develop a pictographic QoL tool that reliably captures the quality of life of people with communication and language barriers.

Visit the Pictographic QoL Tool site

Quality of Care for people with Cognitive Impairment (CI)

• The identification of CI (delirium, Mild Cognitive Impairment, dementia) is poor in hospitals.  The focus of this work is to improve the identification of CI in adults on admission to acute care, and to improve the quality of care (using quality indicators) for patients with CI during the hospital episode of care.

Visit the eQC Project site

Telehealth to support people with Cognitive Impairment

• Specialist clinical services utilised by people with cognitive impairment are often located in metropolitan centres. For people living in rural or remote locations travelling can be difficult, and at times, not desirable. Attention has been given to factors which support the clinical services applicable for people with cognitive impairment.

Visit UQ eSpace for access

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 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 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. 

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. 

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.

The Centre collaborates with experts, clinicians and institutions locally and internationally to develop practice-level quality indicators using a robust methodology which incorporates knowledge of the current scientific literature, expert panel review and comprehensive field work. Across a broad range of clinical setting (Acute care, Emergency Care, Transition Care) suites of indicators have been, or are currently being, developed. They incorporate Structural, Process and Outcome indicators.

The focus is on identifying current variation across sites in a common clinical setting where there is evidence that stakeholders can influence the outcome and impact quality.  This results in meaningful quality indicators, amenable to change, with the potential to impact the health outcomes or experience of the patient.  Where robust international quality indicators already exist (such as residential care), we incorporate indicators as measure of quality when testing an intervention implementation.

This work is led by Dr Melinda Martin-Khan and Professor Len Gray

The Centre has established a special program to promote quality indicator development and implementation: The Research Collaboration for Quality Care

As demand for specialist advice grows, for a patient group that has difficulty with travel, new solutions are required to provide access in a timely, reliable and affordable manner.  Our telegeriatrics program exploits new technologies and the internet to link older people with health professionals.  Strategies include video-consultation, online systems and remote monitoring.  Our work embraces home care, primary care practice, small rural hospitals and residential aged care facilities.  The Centre works in partnership with the CHSR Telehealth Program to advance this work.

Models of remote consultation developed by CRGM have been widely implemented across Queensland, within Queensland Health, and in the private sector. CHSR has established a service entitled "Res-e-Care" to support private sector consultations into Residential Aged Care Facilities and primary care practices.

This work is led by Professor Len Gray and Dr Melinda Martin-Khan.

People with cognitive impairment will be requiring admission to hospital during the COVID-19 pandemic either as a direct result of a COVID-19 infection or from other causes. Adopting innovative approaches will minimise infection risks for patients and health care professionals, but planning for the needs of patients with cognitive impairment can ensure these approaches also minimise the risk of delirium and poor long term outcomes. For more information about the work and to access resources, click this link.

This work is led by Dr Melinda Martin-Khan.

Resources and more information