Special report: Improving research in aged care

Aged care providers and the research community are working together to bolster the research undertaken in the sector and to ensure latest findings are translated into practice at the coalface. 

In an environment where aged services are expected to do more with less, to meet an ever-increasing demand for services, and to continually innovate and improve, evidence-based practice and policy will be increasingly important.

This reality will refocus minds on the need to create a robust research culture in aged care, by nurturing research on ageing issues, by ensuring research findings become practice at the coalface, by improving linkages between researchers and the sector, and by aged services influencing the research agenda and how it is funded.

Background

In her first column in Australian Ageing Agenda as president of the Australian Association of Gerontology (AAG), Dr Briony Dow tackled the issue of research in aged care, and said the imperative was knowledge exchange; greater collaboration between researchers, providers and older people.

“Researchers bring research evidence and knowledge of research methods; service providers bring knowledge of the practice context; and consumers bring their knowledge and experience of the issues,” she wrote in the January-February 2014 issue.

Barbara Squires, head of research and advocacy at IRT, takes that concept further and describes a circle which, along with research and practice, includes policy and education/dissemination. All four are equally virtuous and interrelated points on the circle.

Partnerships

A central issue, says Squires, is the contribution of frontline aged care staff to the design and development of research. “This would help ensure the research is of good quality and practical, because researchers can’t be expected to understand all the nuances of real life at the coalface.”

Echoing this, Professor Jeni Warburton, who holds the John Richards Chair of Rural Aged Care Research at LaTrobe University, highlights the dual strengths researchers and practitioners bring to the table.

“Both researchers and practitioners are needed to work collaboratively to create and foster a robust research culture that builds appropriate evidence that can then feed into practice development,” she says.

“It is essential in this context to look at research as a process; clarify roles, recognise different expectations, and then communicate effectively within the team.”

Researching in realities

A common complaint is that research is conducted at a distance from the sector and is not informed by the policy and practice realities of aged care; the proverbial academics in their ivory towers.

“One of the banes of my life is researchers who come with a really detailed plan about how they’re going to do their research; it’s very elegantly designed with the control group, the sample size and so forth, but the problem is it’s completely impractical,” says Squires.

A surprisingly large number of researchers have not “caught up with the times” and very often think of residential aged care as it was a decade ago, she says.

“They assume you can still go into low level facility or hostel and find people who will happily volunteer for research intervention. What they don’t realise is that group of more active, cognitively intact but slightly frail older people are not in residential care any longer, they’re in their own homes receiving community care.

“Researchers haven’t caught up with the fact that people in residential care are primarily there because they have fairly advanced dementia, or they are at the palliative end, or they’re extremely frail.”

When researchers learn of this reality they also discover that the new paradigm is a more challenging one in which to conduct research, given it is more resource intensive to survey individuals in their own homes, as opposed to as a group in a facility.

For Ian Hardy, CEO of Helping Hand Aged Care, the essence of the challenge is to embed research “in the reality of the sector and the reality of the lives of our clients.”

As Australian Ageing Agenda reported, last October Hardy was appointed inaugural chairman of a strategic review panel to advise the trustees of the J.O. & J.R. Wicking Trust where to allocate their $4 million in annual research and innovation grants.

Through that work Hardy and his panel members are considering the broader issues of research dissemination and collaborations in aged care.

Fundamentally, all research initiatives have to be grounded in the reality of the older person’s experience and the way in which the provider sector and policy supports that. That has to be starting point, he says.

Translation into practice

From there, Hardy says, translation of research into practice is made easier because all the stakeholders – researchers, providers, clients and, perhaps, policy makers – have a common understanding of the intent and methodology behind the research.

Interestingly, Squires notes the knowledge translation challenge may be greater in community care, as residential care, driven by the accreditation process, has long been focussed on ‘quality improvement’ and ensuring processes are up to date.

“People in residential care are fairly good at that; you have things like the Joanna Briggs evidence-based guidelines. In community care there is very little of that out there.”

To address this, IRT produced a ‘research to practice guide’ for community care workers during a recent project with Alzheimer’s Australia NSW. Such guides could play an important role in getting latest research findings out to community care workers and helping them apply it in their daily work, Squires believes.

Warburton says researchers need to distribute findings back to the sector routinely, so that the implications can ideally be assessed by collaborations with the field.

“However, practitioners also need to bring their skills to bear. Partners from the sector may be needed to assess the implications of the research, as this may not be the researcher’s strength,” she says.

Setting the agenda

Beyond the challenges of designing realistic and relevant research and disseminating its findings, the sector is considering how it can shape the research agenda and influence what areas are funded.

Squires says IRT’s annual competitive grants prioritise those researchers who are addressing questions that are relevant to the big issues. She points to the community care research agenda developed in 2010 by the AAG, the joint Australian Research Council (ARC) and National Health and Medical Research Council (NHMRC) Research Network in Ageing Well, and ACSA.

“The questions it developed looked at community care, mental health care, people living alone, transport, housing. These are not the first questions most researchers tend to go towards, but it’s where the main game is. We are trying to encourage researchers to think seriously about researching this group of older people living in their own homes.”

Squires says that for the same reasons researchers prefer residential aged care, the funders of research tend to favour quantitative “medical type, double blind randomly controlled” studies.

The challenge is helping the government’s funding mechanisms, the NHMRC and the ARC, to understand the complexity of ageing, the importance of multidisciplinary research and the value of qualitative research, she says. “That it doesn’t all have to be microscopes and blood tests.”

This, she argues, is where the relevant stakeholders, which include the AAG, Council on the Ageing, National Seniors and the provider peaks, can advocate and influence.

“We need to keep our voices firmly raised around Australia’s ageing population; these are new issues and they require a new approach to research,” says Squires.

Hardy, meantime, points to the NHMRC partnership centre in cognitive decline as an emerging model of aged services working with researchers and funders to influence the agenda.

Helping Hand is involved in the centre along with Brightwater, HammondCare and Alzheimer’s Australia. The Department of Social Services participates as an observer, bringing the policy perspective.

The partnership centre arose out of a review which encouraged the NHMRC to engage more with key sectors. Six initial partnership centres were proposed, the cognitive decline centre being the first.

“That really will be the way of the future,” Hardy says. “There is now a growing recognition within academia that industry engagement will be the basis of research activity, and we will all be the better for it.”

All-encompassing issue

While the focus of discussion about research in aged care is often on clinical and operational areas, the issue is much more far reaching. Take facility design, for instance.

According to a global survey of 400 architecture practices by Dr Darragh O’Brien, head of the Architectural Research Consultancy (ARC), 60 per cent of the healthcare architects surveyed did not regularly engage with latest research to inform their designs, and just 20 per cent conducted a post-occupancy analysis.

This means that, troublingly, the aged care client and the architect are relying on each other’s expertise and knowledge to guide the design of a project, and neither may be engaging with latest research.

“There is an expectation among the client that architects already understand the role of the environment and the impact it has. What they don’t understand is that most architects do not engage in reviewing research from other fields,” says O’Brien, who founded ARC in 2010 to establish connections between academia, government and industry.

He says the reason many do not review new research is because it is often not readily accessible. “In addition, our study indicates that if clients do not require architects to be familiar with the latest research, then it is less likely to happen.”

O’Brien argues that in order to design environments that effectively support those living with dementia or requiring palliative care, architecture firms, aged care peak bodies, providers and clinicians must be engaged in ongoing research.

“It’s one thing to review work been done in the US or Germany, it’s another thing to understand how it relates to what’s happening in the local context,” he says.

He proposes that large aged care providers establish research programs within their facilities, where residents and staff would volunteer to participate, with studies looking at both environment and operational procedures.

Crucially, O’Brien says the findings would be shared freely among the research stakeholders – providers, architects, policy makers, consumers.

“We argue that in this new environment of consumer directed care the demand for best practice will grow, and the best way to demonstrate your commitment to best practice will be through your engagement in research – individually and as part of an industry movement.”

ARC is currently working on a new journal entitled Evidence-Base Design, the first issue of which will be focus on aged care design.

JOIN THE DISCUSSION: How can we help create a research culture in aged care? Comment below