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Targeted Call for Research - public call for research priorities in Aboriginal and Torres Strait Islander health

Personal Details
First Name: 
Last Name: 
Specific Questions
1. What is the research priority (a significant research knowledge gap or unmet need) you are nominating? How would a TCR in this area greatly advance our understanding of this issue? (200 word maximum): 
The number of older Aboriginal and Torres Strait Islanders (referred to as Indigenous Elders hereafter) is projected to treble by 2026, but gaps remain in how to optimise their health outcomes, well being and quality of life. Indigenous Elders play key roles in the health of their communities, by maintaining cultural rights and responsibilities; caregiving for extended families and providing community leadership. Recent Australian research has demonstrated higher rates of dementia, frailty, falls, stroke and brain injury, in this population. Preventive measures could delay the onset of these conditions if implemented in a timely manner. A Targeted call for research on Ageing Well for Indigenous Elders would generate much needed research in the following areas: (i) Indigenous meanings of ageing well; (ii) best practice health service pathways to optimise ageing, commencing in primary care; (iii) determine and manage factors throughout the lifespan (from early - late life) that optimise ageing well; and iv) determine Indigenous indicators for well-being in older age. The complexity of factors that impact on Indigenous ageing, that include the constellation of geography, language, culture, poorer health literacy, social economic disadvantage, requires different solutions to that which comes from most aged care research.
2. What are the relevant Australian Government Priorities, and/or Ministerially-agreed State and Territory health research priorities linked to your nominated priority? (200 word maximum): 
Dementia is the Ninth National Health Priority for Australia, a major health problem with profound consequences for the health and quality of life for those with the condition and their family and friends. In addition factors contributing to Ageing Well are closely aligned with many of the other National Health Priorities, including cardiovascular disease, injury (head injury, falls), diabetes, obesity, mental health and arthritis, that all contribute to conditions commonly seen in older people, such as falls, poor vision, frailty, depression and anxiety, and chronic pain. This TCR is in line with the National Aboriginal and Torres Strait Islander Health Plan of 2013 -23 (NATSIHP) stating for the first time the key priority that older Indigenous Australians “should be able to live out their lives as active, healthy, culturally secure and as comfortable as possible”. The Implementation Plan for the NATSIHP 2013-2023 has set the optimisation of screening in primary care as a national priority, currently only achieving 30% completion. The newly established primary health networks (PHNs) have performance indicators to reduce preventable hospital admissions with a focus on four pillars (Aged Care, Indigenous Health, Mental Health & Population Health), all would be addressed in optimising Indigenous Ageing Well.
3. How would a TCR in this area contribute to Aboriginal and Torres Strait Islander health and improve health outcomes for the individual and/or community? (200 word maximum): 
To optimise Ageing Well, a life cycle approach is required that builds on existing health programs. Research has shown that exposure to adverse early life events can predict mid-life health risks (e.g., smoking, obesity, depression) which may contribute to late-life cognitive decline and dementia and frailty. First, understanding the gaps in the health pathway for Indigenous Elders across the lifespan, from primary care to residential and palliative care, is required to generate meaningful pathways for health and other service providers to communicate messages, and improve health literacy to optimise ageing well. Second, refining and testing health service pathways to support better care for older Indigenous people at both primary care level and within community service delivery models including rehabilitation, are needed to deliver culturally responsive assessment and management of Indigenous Elders within their context of community. Finally, developing and implementing best practice guidelines and training programs to provide health care professionals with evidence-based information about health risk in Indigenous people and culturally-appropriate treatment options. These guidelines can enhance capacity for health and community care workforce to optimise delivery of best practice. By improving practice of health care professionals, guidelines can also improve health outcomes for Indigenous people.
4. How will the TCR reduce the burden of disease on the health system and Australian economy? (200 word maximum): 
Currently Indigenous people have lower use of carer and residential services despite higher levels of disabilities, and account for 21% of preventable hospital admissions including in older people. There is currently limited evidence and poorly developed systems to optimise older Indigenous people’s assessment and management within primary health care. Improving this component of care is essential as Indigenous older people overwhelmingly will prefer to remain in their community and primary health care underpins the linkages to and between other essential contributors within the health system and types of care, including hospital and residential care. There is also the potential to avoid costly, futile and inappropriate care, and correspondingly an opportunity to enhance outcomes including satisfaction with care and improve quality of life of older people and their carers through better understanding of their conditions, appropriate discussions of Advance Care Planning, and early identification of health problems at a time when they are more likely to be amenable to simpler interventions. In addition, development of culturally appropriate health related quality of life tools can facilitate methods for inclusion of cost effectiveness measures linked with meaningful outcomes for Indigenous elders and their families, within current health and community systems.
5. Are there any reports or findings that support your nomination for the suggested topic? (200 word maximum): 
The Department of Health, Implementation Plan for the National Aboriginal and Torres Strait Islander Health Plan 2013–2023, describe a number of strategies for optimising well being and health of older Indigenous people. These include that older Indigenous peoples, their families and carers have access to culturally appropriate home based and residential care and are supported to maintain their independence, good health, and social and cultural connections. In addition, health and aged care providers should have the capability and skills to meet the health needs of Indigenous Elders, and that local elders and senior community members champion culturally appropriate health and wellbeing choices. The Australia New Zealand Society of Geriatric Medicine, has released a position statement to support further research into the needs of older Indigenous Australians to improve the equity in screening and management of conditions of the aged, and access to culturally appropriate and meaningful care . This TCR is supported by the following researchers : [REDACTED]

Page reviewed: 30 August, 2018