Introducing Cochrane Global Ageing: towards a new era of evidence (2016)

Lawrence Lawry/Science Photo Library By 2020, for the first time in history, there will be more people aged over 65 than under 5.[1] Surely we should celebrate this as one of humanity's greatest achievements? But we all know that living longer does not necessarily mean we have the good health and circumstances to enjoy those extra years. Added to that, in low‐ and middle‐income countries, for example, ageing populations experience other demographic shocks such as the devastation caused by HIV/AIDS and fragile states. So how can Cochrane respond to this in keeping with its strapline: 'Trusted evidence, Informed decisions, Better health'? Topics that deal directly with geriatric disease, conditions, and syndromes were formerly the scope of the Cochrane Health Care of Older People Field. The focus was on evidence concerning health and care of older adults in the following domains: delirium and dementia; incontinence; immobility; falls and fractures; sensory impairment; rehabilitation; caregiver support; and systems and structures of care. Many would perhaps disagree with this medical model, endorsing instead that attention should be focussed on allowing people to lead active and healthy lives in later age, highlighting older people's productivity and contributions to family and society as a whole.[2] Respecting everyone's fundamental right to the enjoyment of the highest attainable standard of physical and mental health, irrespective of age has been endorsed by the United Nations for over a quarter of a century.[3] We know, for example, that older people are underrepresented in clinical trials.[4, 5] Two recent events enabled us to consider how the health and care of ageing populations is addressed within Cochrane. The first was the publication of Cochrane's Strategy to 2020.[6] The second was the World Health Organization's (WHO) Global Strategy and Plan of Action on Ageing and Health, adopted in May 2016.[7] The WHO has been responding to global population ageing through a number of key initiatives. The WHO Global Network of Age‐friendly Cities and Communities was established in 2010 to connect cities, communities, and organizations worldwide with the common vision of making their community a great place in which to grow old.[8] Key publications include the Knowledge Translation Framework for Ageing and Health (2012) and the World Report on Ageing and Health (2015).[9, 10] Furthermore, Goal 3 of the United Nations 2030 Agenda for Sustainable Development is "Ensure healthy lives and promoting well‐being for all at all ages".[11] This year, the theme of the United Nations International Day of Older Persons (1 October 2016) is "take a stand against ageism".[12] This prompted us to ask: to what extent do ageist attitudes impact on research in general and Cochrane Reviews in particular? A search of titles in the Cochrane Library (as of 7 September 2016) for Cochrane Reviews related to ageing resulted in only 45 reviews and 14 protocols from 9530 records (less than 1%). Incidentally, the term "ageing" did not elicit any hits. Is this evidence that ageism is present in our organization and policy practices? Or, does it indicate a problem of indexing and evolving terminology, making evidence difficult to find? Clearly we will need to look at this more closely. Our response has been to create Cochrane Global Ageing (globalageing.cochrane.org), a natural evolution of Cochrane Health Care of Older People. Its aim is to promote the quality, dissemination, accessibility, applicability and impact of Cochrane Reviews towards optimizing the health and wellbeing of older people everywhere.[13] Our mission is to connect people within and outside Cochrane and facilitate sharing of knowledge and experiences related to global ageing and health that are relevant and accessible to consumers, review editors, authors, specialists, policy makers, educators, commissioners, and funders. Our international advisory board includes leading experts, thought leaders, and critical friends to act as informed advisors and advocates on issues of importance to Cochrane Global Ageing as it develops and expands its international scope and efforts, and strives to meet its mission and objectives. To ensure our activity is focussed, we need to clearly define our scope. The description of the scope will help to delineate the way in which global ageing is conceptualized and activities are prioritized. We will achieve this by conducting a broad stakeholder engagement and prioritization exercise to identify the important and burning questions with respect to ageing. We will then map these priorities to existing or planned Cochrane Reviews to identify knowledge gaps where new reviews are needed. Our call to action is to identify and produce systematic reviews that are age‐appropriate, embrace the multidisciplinary nature of ageing, and are accessible to all. For example, the implications for research, practice/policy sections of our reviews could be a useful way of promoting this. There is a wealth of talent and passion within Cochrane. We would like to see that harnessed and expressed by linking Cochrane Global Ageing with complementary initiatives both within and external to Cochrane. This has already begun. We are working closely with the WHO, and we were invited to speak at a meeting in Geneva, Switzerland, on 30 September 2016 to celebrate the UN International Day of Older Persons, with the launch of Cochrane Global Ageing on 1 October. Cochrane Global Ageing will also hold a special session at the Cochrane Colloquium in October 2016 in Seoul, South Korea (colloquium.cochrane.org). We invite attendees of the Colloquium to join the session and support our call to action. We look forward to hearing from those of you who would like to be involved. Expect to hear more from us very soon.