Mobility in Aging Initiative

Priorities for Research and Research-advancing Activities identified through Consultations

Executive Summary
Introduction
Recommendations

Conclusion
Contact

Executive Summary

The CIHR Institute of Aging recently completed a series of consultations to inform the strategic directions of the Mobility in Aging Initiative. The consultations built on the Institute's history of interest in this area, and began with the 2002 Mobility Consensus Conference. Since 2002, various communities across research disciplines and sectors have provided their perspectives on priorities for research and activities to advance research into action.

As consultations unfolded, a set of guiding principles for the Mobility in Aging Initiative emerged. Specifically, it was recommended that research and research-related approaches should consider:

  • individuals in their real environments;
  • diversity of aged populations;
  • diversity of environments;
  • connecting researchers and users; and
  • bridging disciplines and sectors.

The consultations also brought forward priority research areas, listed below. It is important to note that while priority research areas were identified, there was an acknowledgement that the field of Mobility in Aging research is still developing, and that new knowledge is critical to advancing the understanding of the biological, psychosocial and environmental factors in Mobility in Aging. That being said, the recommended areas of priority for research fell into the following categories:

  • Understanding and defining mobility in aging: trajectory of mobility status in health and disease, and from function to impairment
  • Maintaining and restoring mobility in aging: impact of behavior, prevention, intervention and health system models
  • Measures, tools, and technologies in research, assessment and mobility aids
  • Supportive designs for mobility in aging: housing, communities, and transportation

In addition, the consultations identified challenges for the uptake and application of research into action (or knowledge translation) in Mobility in Aging. The consultations suggested that these challenges are primarily due to a lack of a common language and measures exacerbated by the diversity of seniors, stakeholders, and end-users of research. While these could be addressed in part by connecting researchers, users, disciplines and sectors, the consultations emphasized immediate needs, such as:

  • achieving consensus on standardized terminology, protocols, methods and tools/measures for mobility status;
  • studying and evaluating interventions and their effectiveness, especially with respect to falls prevention strategies; and
  • studying barriers, not only to the translation of research evidence to practitioners, but also to the implementation of best practices.

Finally, to address the above research priorities and knowledge translation challenges, various mechanisms (i.e., research funding programs and research-related activities) were recommended. These mechanisms spanned the research to action process, and included training, research projects, intervention research, syntheses and workshops. Team and integrated approaches underpinned many of the recommended mechanisms. These recommendations will be reviewed by the Institute Advisory Board of the Institute of Aging and will inform future directions of the Institute's Mobility in Aging Initiative.

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Introduction

In the context of the CIHR Institute of Aging Mobility in Aging Initiative, the term "mobility" encompasses not only participation in society (e.g., ability to drive and having accessible public transportation) and physical activity of older adults, but also the performance of specific maneuvers such as walking or climbing stairs and the carrying out of instrumental activities of daily living.

The long-term goal of the CIHR Institute of Aging Mobility in Aging Initiative is to address knowledge needs (through research) and knowledge to action barriers (through knowledge translation) within the range of intrinsic and extrinsic challenges (from biological to environmental) associated with mobility of older Canadians.

The CIHR Institute of Aging conducted a number of consultations to inform strategic directions within its Mobility in Aging Initiative (reports on the consultations are in separate Appendices and available upon request):

  • Appendix A: Ontario Rehabilitation Research Advisory Network (2006/04; 50 participants)
  • Appendix B: Canadian Geriatrics Society (2006/04; 70 participants)
  • Appendix C: Muscles: From Molecules to Mobility Workshop (2006/06; 50 participants)
  • Appendix D: University of Western Ontario: Mobility in Aging Research Network (Aging, Rehabilitation & Geriatric Care Program & Centre for Aging and Physical Activity) (2006/06; 40 participants)
  • Appendix E: University of Manitoba: Team on Safe Mobility Stakeholder meeting (2006/10; 40 participants)
  • Appendix F: National Roundtable on Mobility in Aging (2006/09; 35 participants)
  • Appendix G: Regional Seniors' Workshops on Research (2004-2006; over 300 participants)
  • Appendix H: Mobility Consensus Conference (2002/10; 50 participants)

Issues and challenges in Mobility in Aging have been a long-standing interest of the CIHR Institute of Aging. Mobility in Aging was identified as a priority in national consultations on aging research conducted to inform the initial strategic directions of the Institute. The importance of Mobility in Aging was further emphasized at a Mobility Consensus Conference in 2002, which outlined key research areas. Later consultations confirmed 2002 input, and added the input of a broader base of researchers and users1.

Through these eight consultations, various communities across research disciplines and sectors provided their perspectives on priorities for research and for activities to advance research into action. This document provides an overview of all consultations and presents the recommendations on research and research-related activities that surfaced most often in the different discussions and breakout groups. There has been an attempt to collate and synthesize the information as much as possible.

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Recommendations

Overarching Issues
A number of key observations recurred numerous times across the various consultations. These are presented as a preamble to the recommendations for research and for research to action activities.

The consultations emphasized that, in relation to Mobility and Aging, the individual cannot be separated from his/her environment, and that the diversity of individuals and the diversity of environments significantly add to the complexity of research design, conduct, application and uptake by users. The consultations also emphasized that, while aging is a dynamic process and elderly persons often live with multiple conditions, the approaches to research and treatment are "siloed". Multi-disciplinary, multi-sectoral and horizontal approaches were identified as a priority need, as well as the need to address barriers to such approaches. Additional details on these overarching issues follow:

  • Diverse aged populations include, e.g., different ages (young-older to oldest old), varying status of health, disease and conditions, and different behaviors.
  • Diverse environments include, e.g., different cultures, care settings, socioeconomic statuses, geographic locations and communities.
  • Silos in research and treatment are pervasive. Research is usually disease focused and/or area focused (motor control, cardio-respiratory rehabilitation, musculoskeletal rehabilitation), but in reality, older adults most often have co-morbidities, which treatment silos may not be able to address fully.
  • Researcher-User disconnect: there is a real need for collaboration within and across organizations, disciplines, specialties, and stakeholders to breakdown silos in research and address lack of cross-sectoral interactions.

Discussions on these overarching issues generated the following set of guiding principles for the Mobility in Aging Initiative. The consultations recommended that research approaches consider:

  • individuals in their real environments;
  • diversity of aged populations;
  • diversity of environments;
  • connecting researchers and users; and
  • bridging disciplines and sectors

A final observation stemming from the consultations is that "Mobility" as such is typically not perceived as the central research question, Rather it has been often seen as a secondary outcome measure of other diseases or conditions. CIHR has been asked, through its Mobility in Aging Initiative, to promote the concept of looking at mobility limitations as a "syndrome" or a common final pathway, in contrast to it being the outcome of other diseases or conditions.

Knowledge Creation Opportunities
There was general agreement that the field of Mobility in Aging research is still developing and that new knowledge is critical to advancing the understanding of biological, psychosocial and environmental factors in Mobility in Aging. This assertion supports the current five eligible areas of inquiry of the Mobility in Aging Initiative, namely:

  • biological and physiological factors;
  • behavioral and psychosocial factors;
  • biomedical, clinical and technological innovations;
  • prevention, rehabilitation and management; and
  • environmental factors - social, economic, policy and physical.

The consultations identified a number of priority research areas, which have been synthesized as much as possible into priority thematic areas. These recommended areas are closely related to one or more of the current five areas of inquiry (above), and demonstrate the importance of spanning the areas of inquiry. Recommended priority areas and their scope are as follows:

  • Understanding and defining mobility in aging
    • Muscle atrophy, disuse and deconditioning.
    • The trajectory of mobility status in aging and in the aged. What are normal age-associated changes?  What is indicative of disease and/or conditions? How do mobility impairment and disability evolve?
  • Maintaining and restoring mobility in aging: prevention, intervention and health systems
    • Activity and other interventions in Aging, Frailty and other age-related conditions affecting mobility: who, how, where, when, and evaluation models for existing and novel interventions.
    • Barriers within the health system, including access and navigation, lack of information, coordination and continuity of care, attitudes and myths. Where does the health system fail/breakdown in supporting seniors to enhance mobility and health? Challenges for vulnerable aged populations (dementia, frailty, co-morbidities).
    • Psychosocial factors affecting motivation and adaptation in mobility in aging: attitude, culture, self-perceived notion of health, stigma, fear, and adherence.
  • Measures, tools, and technologies in research, assessment and mobility aids:
    • Outcome measures and assessment tools, devices, and equipment for research and interventions in the field and/or reflecting " real world" environments.
    • Measurement tools and indicators/predictors of mobility status, including generalizable vs. tailored tools.
    • Affordable and usable assistive devices and technologies: from design to application and from biomechanical to psychological implications.
  • Supportive designs for mobility in aging: housing, communities, and transportation
    • Relationship between supportive designs, mobility and health for seniors.
    • Societal barriers to supportive designs for mobility in aging: cultures, systems, economics, and policy.
    • Programs, tools and vehicle designs for transportation safety for seniors, including training, abilities and driving assessment, and considerations for vulnerable aged populations (dementia, frailty, co-morbidities).

Knowledge Translation Opportunities
Knowledge translation and exchange challenges were identified in all consultations. Mutildisciplinary, mulitsectoral and horizontal approaches, as well as the barriers to such approaches, were often raised as a priority in the context of health research. There was a general consensus that there is a significant need to engage end-users of research and to increase collaboration within and across organizations, disciplines, specialties, and stakeholders, in order to breakdown silos in research and address lack of cross-sectoral interactions (researchers, governments, consumer groups, etc).

Challenges across research disciplines that hamper exchange and transfer of knowledge within and across research communities were also noted. According to the consultations, there is a need to increase researcher understanding of other relevant fields of research (such as, biomedical, clinical, health services), other terminologies, settings and aging issues.

In regards to what would make a difference in the knowledge translation of Mobility in Aging research and evidence, the consultations identified the following target areas:

  • Study and evaluate interventions and their effectiveness, especially with respect to falls prevention and care strategies.
  • Study barriers, not only to the translation of research evidence to practitioners, but also to the implementation of best practices.
  • Achieve consensus on standardized terminology, protocols, methods and tools/measures for mobility status.
  • Blend bodies of knowledge, and study how best to do this.
  • Support collaboration between clinicians and researchers across continuum of care, including social science expertise.
  • Increase public awareness, especially early in life.
  • See also knowledge creation opportunities above, the research outcomes will need to be synthesized, communicated and applied.

Research and Research-related Mechanisms
The term "Mechanisms" refers to research funding programs or other activities by which could be supported that above identified knowledge creation and knowledge translation priorities within the Mobility in Aging Initiative. The mechanisms recommended across the consultations include:

  • Review/Synthesis
    • of existing information (e.g., mobility issues for different chronic conditions)
    • of current literature on a number of Mobility in Aging topics
    • through national surveys on mobility (broadly defined)
  • Research Capacity building
    • training and supporting new researchers
    • supporting new "re-tooled" researchers
    • clinician-scientists for rehabilitation
    • attract New investigators to area (e.g., career transition, experience in another field)
    • enable researchers to spend time working alongside government, learning about the setting of policy and informing policy makers about issues related to mobility, disability and health
  • Operating grants
    • on the understanding of the biological, clinical, psychosocial and environmental determinants of Mobility in Aging.
    • for pre-experimental designs, often the starting place for rehabilitation research.
    • projects (not necessarily hypothesis-driven) to develop new assistive technologies.
    • see also: knowledge creation opportunities above.
  • Demonstration projects/Case studies
    • on different cultural groups and diverse groups
    • on integration of exercise professionals, kinesiologists and other relevant professionals into health care teams
  • Team grants
    • to encourage multi-sector partnerships and engagement (e.g., bridging health care providers from different disciplines and professions; and, engage various groups such as provincial health authorities, practioners, urban planners, policy makers)
    • to support interdisciplinary approaches with appropriate funding level and duration (success in Mobility in Aging will require large, long-term, and longitudinal approaches)
    • to improve transportation for mobility-impaired Canadians in rural and urban settings through funding teams based on models such as Community Alliances in Health Research
  • Community Building activities
    • infrastructure or events (workshops, think tanks, Champions) that facilitate and enable research collaboration and networking across pillars (biomedical, clinical, health systems and population health) and across sectors (researchers, patients, public, community, practioner, policy, housing, transport, etc.)
    • workshops on specific issues and related knowledge translation results, with all relevant stakeholders to take action on next steps
  • Consensus conferences
    • to develop screening tools and relevant standards of practice
    • to achieve consensus on standardized terminology, protocols, methods and tools/measures
  • Knowledge Translation grants
    • to develop knowledge translation and exchange tools that are easy to implement for practitioners
    • best strategies for knowledge translation to inform users and prescribers of developments in assistive technology
    • increase funding level and duration of support in order to increase technology transfer
    • to study and evaluate interventions and their effectiveness
    • see also: knowledge translation opportunities above for thematic areas
  • Inventory/Database resource
    • providing easy access to information on research results, including a database on interventions

Messages to the CIHR Institute of Aging

  • CIHR peer review committees need to be comfortable with mixed qualitative and quantitative methods.
  • CIHR peer review committees need education re: looking beyond acute care issues.
  • In relation to the aging workforce, the Workplace Safety and Insurance Board does not cover all workers and CIHR funding is absent in this area.
  • The results of health services research should inform research funders/decision makers, not only clinicians.
  • Cross-cutting research often falls between the funding agency cracks, especially in technologies for Mobility in Aging.
  • CIHR should promote the concept of Mobility limitations as a "syndrome" or a common final pathway in contrast to being disease-based.

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Conclusion

The following key areas have been identified by various research and user communities for consideration by the CIHR Institute of Aging:

  • Understanding and defining mobility in aging: trajectory of mobility status in health and disease, and from function to impairment.
  • Maintaining and restoring mobility in aging: impact of behavior, prevention, intervention and health system models.
  • Measures, tools, and technologies in research, assessment and mobility aids.
  • Supportive designs for mobility in aging: housing, communities, and transportation
  • Study and evaluate interventions and their effectiveness, e.g., falls prevention/care strategies.
  • Study barriers, not only to the translation of research evidence to practitioners, but also to the implementation of best practices.
  • Achieve consensus on standardized terminology, protocols, methods and tools/measures for mobility status.

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Contact

For questions about the Mobility in Aging Initiative and the consultations, please contact:

Linda Mealing
Assistant Director-Ottawa
CIHR Corporate Headquarters
Telephone: 613-952-4537
Fax: 613-954-1800
Email: Lmealing@cihr-irsc.gc.ca

  1. The term “users” in general includes, but is not limited to, health practitioners, health institution administrators, public policy decision makers, front line educators, the media, health charities, persons living with diseases/conditions, consumers, family members and caregivers, the private sector and the general public. [ return ]
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