Mobility in Aging Initiative

National Forum on Mobility in Aging:
Mobilizing Researchers and Stakeholders

September 27-28, 2007
Ottawa

Plenary Presentations - Day One
Building Mobility in Aging Research to Action Teams and Programs
Common Language and Measures of Mobility in Aging
Advancing Research to Action in Mobility in Aging

Proceedings

The National Forum on Mobility in Aging: Mobilizing Researchers and Stakeholders was organized in response to earlier consultations that identified the need to bring together experts from a broad spectrum of disciplines and sectors to generate research and knowledge translation addressing critical deficits in mobility in aging. Hosted by the CIHR Institute of Aging, the Forum was held in Ottawa on September 27 and 28, 2007, advancing the Institute's Mobility in Aging Initiative. The program is attached as Annex A.

The forum was designed to provide participants the opportunity to:

Gain an understanding and appreciation of how different disciplines and sectors approach research to action issues in Mobility in Aging.
Share best practices and realities in crossing disciplines and in researcher-stakeholder collaborations aimed at mobilizing research to action.
Provide guidance on future useful partnered activities and funding opportunities under the Mobility in Aging Initiative.

Participants representing a range of perspectives, expertise, and experience were invited from different health professions; voluntary, non-governmental and private organizations; levels of government; and research disciplines. The list of participants is attached as Annex B.

Opening Remarks

Dr. Anne Martin-Matthews, Scientific Director, CIHR Institute of Aging, welcomed participants and reviewed the objectives of the forum. She also provided an overview of the Canadian Institutes of Health Research and the Institute of Aging, its mandate and initiatives. The goal of the Mobility in Aging Initiative, 'to address research and knowledge translation needs within the range of intrinsic and extrinsic challenges (from biological to environmental) associated with Mobility in Aging' was a key point of this presentation.

1. Plenary Presentations - Day One

The objectives of the first morning's presentations were to bring participants to a common level of understanding on both the state of research in Mobility in Aging and the broader concepts of knowledge translation. Presentations highlights are provided below. The full presentation texts are available upon request from the Institute of Aging at aging@interchange.ubc.ca.

The Mobility in Aging Initiative
To provide background on the Mobility in Aging initiative, Dr. Linda Mealing, Assistant Director, CIHR Institute of Aging, spoke on " Mobility in Aging Strategic Initiative: What we've heard; Where we're headed; Who's on board". This information is summarized on the Mobility in Aging Initiative website.

Current and Emerging Research Themes and Approaches
Dr. Geoff Fernie, VP Research, Toronto Rehabilitation Institute, provided an overview of the Mobility in Aging landscape in Canada from the perspective of an expert in the field and his experience on scientific review committees. He reminded participants what the customer (the older adult) desires, which is "to be able to continue to get around independently and to stay living in their own home".

Issues in Mobility in Aging range from carer-assisted mobility indoors to independent mobility in challenging environments. These issues are stimulating various research advances in risk assessment, orthotics, wheelchair design, stair safety, public transport, and street design.

Among emerging areas in Mobility in Aging, Dr. Fernie noted how advances in neuroscience and cell biology are increasing our understanding of neuro-motor control and opening avenues for new technological aids and therapies. Our aging and changing society is additionally calling for research in mobility for persons with cognitive impairment as well as in bariatric care (e.g., moving the morbidly obese). Finally, Dr. Fernie emphasized the importance of considering the future context in which older persons (from healthy to immobile) may have limited mobility.

Dr. Fernie indicated that to be successful, research projects must include good science, clear objectives, a realistic plan, a track record, and an appropriate research design and sample size. A project will stand out from the ordinary for novelty achieved through crossing boundaries and impact achieved through carefully planned knowledge translation and commercialization activities.

Moving Research to Action Across Disciplines, Professions and Sectors
Ms. Jacqueline Tetroe, Senior Policy Analyst, Knowledge Translation Portfolio, CIHR, spoke on knowledge translation (KT) from its theoretical aspects to its operationalization at CIHR. She described KT activities within the research cycle that are necessary to moving knowledge (or research) into action.

For CIHR, KT entails making users aware of research knowledge and facilitating their use of this knowledge to improve the health of Canadians; essentially closing the gap between what we know and what we do. CIHR also supports the science of KT. Knowledge translation research (KT Science) involves studying the determinants of knowledge use and effective methods of promoting knowledge uptake. KT publications and resources can be found in About Knowledge Translation.

Successful knowledge translation recognizes the importance of all stakeholders (researchers and research-users¹) in its processes. Ms. Tetroe explained that research-users can and should be involved at various points in the research to action trajectory. Examples of such involvement include:

shaping the research questions and deciding on the methodology;
helping with data collection and tools development;
interpreting the study findings;
crafting the message and disseminating the research results;
moving the results into their everyday business (practice, policy, etc.); and/or
widespread dissemination and application.

2. Building Mobility in Aging Research to Action Teams and Programs

For the remainder of this first day, participants worked in breakout groups; each group focusing on one of the following thematic areas:

Balance and Falls in Seniors
Community Mobility and Participation in Society
Driving for Safety and Independence
Maintaining Function in Aging, Frailty and Other Conditions
Supportive Designs in Home and Care Settings

2.a Opportunities and Challenges in Collaborative Research
Within each group, representatives from different disciplines and sectors were asked to discuss their roles, contributions, and motivation, as well as challenges and opportunities in participating in collaborative research. Members were asked to propose solutions to challenges identified and to describe what success would look like. Group discussion highlights were then presented to all participants.

The varying perspectives of the participants emphasized both the importance and the challenge of collaborating with persons from diverse disciplines and sectors. While participants were similar in their desire to work towards the common good, there were differences in their perceptions of the research to action process and the ways in which they could contribute to it.

Valuing Collaborative Research: Non-researchers
For non-researchers, being part of a collaborative program would be valued because it would give them an opportunity to:

influence research questions and research design to increase the likelihood of creating knowledge that meets their needs;
open links to their own networks (professionals, patients, practitioners, etc.) as well as access to their own data and/or real-world settings to evaluate program outcomes in domains such as long-term care facilities, community centres, policy fora, and the service industry;
be privy to immediate access to different experts, credible evidence and best practices and tools to support their own practice, policies, programs, product designs, and business cases (e.g., advocating within their own organization); and
be involved in a program that could have societal and/or financial impact.

Valuing Collaborative Research: Researchers
Academics (researchers and research trainees) viewed collaborative programs as an opportunity to:

work with research-users/stakeholders on a ongoing basis to get insights on appropriate and useful research questions and to improve research focus and design;
undertake cutting-edge research responding to real-world needs and see their research lead to real-world solutions (policies, programs, products, etc.);
be connected to a collaborative program recognized for its mission; and
be linked to other disciplines/sectors and expand their personal scope of thinking.

The details from the separate discussions of the breakout groups are summarized below into best practices for participants' use in their future collaborative endeavours.

2.b Best Practices for Collaborative Programs in Mobility in Aging

Designing Collaborative Programs of Research
In designing collaborative programs, the key message was to start early. Engaging relevant researchers and research-users/stakeholders must be commenced early in the collaboration process as it takes time to build relationships and trust, and to develop common goals. Additional recommendations include:

Lay the ground work for the collaborative program: conduct required environmental scans, literature reviews, identify needs, gaps and opportunities, and identify a core of relevant researchers and research-users/stakeholders to contribute to and validate ground work.
Identify and manage challenges: bring opposing parties on board, identify stumbling blocks early on and adapt solutions. Achieve consensus up-front before proceeding with goal setting and research.
Manage expectations: make it clear that teams are not permanent. They should come together to solve a tangible problem, dissolve and reform perhaps differently to tackle new evolving issues.
Seek and capture the unique contributions of each member: engage each member in a meaningful way. Coordinate available experience and expertise in working towards a common goal that is innovative, valued and understood by all.
Select a strong and capable leader: build on a leader with a track record of success.
Communicate transparently: communication is key and will improve research focus and design. It must be undertaken at the onset of the collaboration with ground rules related to: avoiding hidden agendas and managing collaborative program priorities together with individual members' priorities. Mutual understanding is needed with respect to definitions and common language.
Train the next generation: include students and trainees. Training of highly qualified personnel is essential to increase capacity not only in generating knowledge, but also in its uptake and application.
Resource the team appropriately: ensure that the team's goals and size are in line with available financial, administrative and other support. A project coordinator and/or knowledge broker is essential.
Size does matter: focus efforts and size to maximize success. A large network may be difficult to manage, and the idea of teams within teams was put forward.
Identify and secure study participants: prepare for possible difficulty in finding study participants as there is a fear of unwanted news (e.g., diagnosis of disease or losing the right to drive).
Table 1 identifies recommended team members for Mobility in Aging collaborations.

Table 1. Relevant stakeholders for mobility in aging collaborative programs

Architects
Assistive devices representatives
Associations representing consumers
Biologists
Caregivers and family members
City and urban planners
Clinical researchers
Communication / Knowledge Translation experts
Engineers (transportation, automotive, biomedical)
Decision-makers at the federal, provincial, municipal, and health organization level
Front-line health care professionals: e.g., physicians, clinicians, geriatricians, physiotherapists, occupational therapists, nurses, nutritionists, dieticians, psychologists
Geomatic experts
Health Service providers (public and private)

Health Services researchers
Housing experts and builders
Human rights groups
Insurance industry
Intellectual property specialists
Law enforcement experts, Canadian Bar Association
Older adults (especially those facing mobility challenges)
Organizations legislating building codes
Potential users/consumers
Professional associations and groups (e.g., Canadian Automobiles Association, Canadian Home Builders Association)
Public Health researchers
Research trainees
Researchers
Rural Populations Study participants (research subjects)
Transportation agencies (national and provincial)

Setting goals for the collaborative team

Collaborative research succeeds when realistic goals and timelines are established through an early focus on feasibility as well as functional and usable outcomes. Additional considerations include:

Identify short-term objectives: set immediate, tangible objectives for timely impacts that are relevant to the targeted end-user (e.g., clinician, policy maker). Although this may prove to be a challenge - as research takes time - governments largely seek short-term objectives. Consider a balance between short, medium and long-term objectives.
Define roles and responsibilities: each member should be selected for an essential role that is well defined and for which there is accountability and responsibility for a subset of agreed-upon deliverables within a set time frame.
Account for diversity of individuals: in selecting target groups for program outcomes, consider cultural sensitivity, the healthy and keeping them mobile, and the variability in the older population: frail, mobility impaired, oldest-old, etc.
Be relevant in different environments: consider how Mobility in Aging differs in different environments, such as urban versus rural, real Canadian climate versus laboratory setting, or a private home versus an institutional setting. Exploit mechanisms by which these differences are best assessed. In cases of differing practices or legislations in different settings or jurisdictions, consider obtaining evidence in jurisdictions where an approach already works, then involve all jurisdictions in finding a common solution, adapting the solution to local circumstances.
Identify real receptor(s) for program outcomes: there must be an interested party who has a need for and will use the results of the collaborative program. Secure political will/drive in support of the program. Include influential people as part of your team.
Establish a Communication Plan: develop key messages to targeted audiences. Communication strategies are essential not only to exchange the information among the multi-disciplinary team members, but also to disseminate the information to the public (including stakeholders in remote areas) and to achieve social marketing. It is beneficial to engage the public through the media. Emphasize social value as well as economic benefits.
Establish a Knowledge Translation Plan: the multi-stakeholder input into both the design of the collaborative program and the diversity of team members, is a key starting point for successful KT.
Establish a Commercialization/Marketability Plan: feedback from users/ consumers/ clients/ potential investors /technology transfer experts must be collected and taken into consideration. Consider market surveys and engaging designers in the process in order to turn ideas into marketable products.

Planning for and measuring success of the collaborative program

In designing a collaborative program, it is important to report on progress and more so to measure success. An evaluation framework is essential for monitoring project progress towards desired outcomes. Keeping in mind that indicators must link to program objectives, participants identified the following indicators as important in an evaluation framework:

Evidence of uptake and application: e.g. a new or improved approach (program, product, policy, legislation, and/or practice) has been accepted and is being offered and used in the community. It is accessible, is sustainable, and/or has been successfully transferred to other jurisdictions nationally or internationally;
Evidence of sustainability: e.g. the collaborative program has secured further financial support by attracting new partners or grants for follow-up work and training;
Evidence of improved outcomes for individuals or populations: improvements in mobility outcomes measures, decreased accidents (falls, injuries), increased functional independence, improved safety, increased quality of life, user satisfaction, health economics data, and social value of the approach;
Evidence of change in behaviour and awareness: e.g., alignment of federal and provincial priorities in Mobility in Aging and a shared understanding of these by researchers and research-users; and an increase in the use of evidence in decision making;
Evidence of recognition: e.g., the collaborative program is recognized as an important information and expertise resource nationally and/or internationally. It has publications in peer reviewed journals and accessible best practices and information for its relevant target audiences (researchers, research-users, and stakeholders).

Day Two Activities

3. Common Language and Measures of Mobility in Aging

One key recommendation that came out of the 2006 Mobility in Aging consultations, was the need for consensus on mobility measures and their definitions, valid outcomes of mobility research, and an understanding of the role of such metrics across populations, settings and professions. These agreements would make easier communication among different stakeholder groups in the pursuit of new knowledge and its application to practice, products, programs and policy.

Participants at this 2007 Forum reiterated that the lack of a common language/definition created difficulties in a variety of domains, including comparison of research outcomes. Mobility in Aging should be approached as a continuum: from staying healthy to diminishing mobility to being immobile. Language and measurement tools are needed that are generalizable and standard, and reach beyond "Aging" and "Health".

At this forum, the Institute of Aging wished to explore ways to address the lack of a "common language/definition" for Mobility in Aging.

In the context of a simulation exercise on what should inform a Planning Committee, the participants were asked to consider the "common language/definition" issue from their individual perspectives, its impact, and possible solutions. The following is a summary of recommended actions and ideas from the different breakout groups.

Groundwork to document the issue
It was recommended that the "common language/definition" issue be documented through environmental scans, reviews, surveys as well as successful case studies. Environmental scans may identify relevant models in other jurisdictions (provinces, countries) and/or non-health sectors (e.g., urban planning). A literature review followed by synthesis would ensure credibility of foundational information, and provide benchmark data. While surveys of different organizations and groups would reveal the "lexicons" of different disciplines, sectors and populations, and identify needs and opportunities for standardization.

Clarifying the nature and scope of the definition and expected outcome
In their deliberations, participants explored what an ideal outcome or solution to the "common language/definition" issue would look like. The participants proposed that a framework or conceptual model would be more useful than a rigid definition. A useful framework would have a generic component applicable across different scenarios (accounting for the diversity of stakeholders, individuals and environments) and a flexible component permitting adaptation to specific scenarios. Such a flexible approach to a framework or conceptual model would also facilitate promotion and marketability.

Any development would require clear guidance and decisions as to what should be considered under the "common language/definition" or framework for Mobility in Aging: from the micro to the macro level, from biological to public health. Also decisions on focus would be required. Such decisions should consider: individual centric versus environment centric and/or traditional treatment (disease-based) approach versus prevention (e.g., healthy weights versus obesity).

A useful definition or framework should approach "Mobility in Aging" both as a continuum and as multifactorial. It should also be forward-looking and take into account future mobility issues, e.g. mobility restrictions resulting from the obesity pandemic.

Implementation considerations
Participants noted that the success of any chosen definition or framework would need to be measured, emphasizing the requirement for performance measures and benchmarks at the outset. Health economic impact data and influence on policies were identified as important measures. In the case where common tools and measures would be agreed upon, validation research would likely be required and need support.

For the successful adoption of the chosen definition or framework, marketing will be key. Marketing activities could include establishing a translational research network, publishing case studies and training modules, and efforts to involve the public and media. The "Man in Motion" was suggested as a successful marketing strategy to emulate and the public was identified as a key target for awareness.

It was recommended that the composition of a Planning Committee (or other type of steering committee to guide the Institute of Aging) should include representatives from stakeholder groups identified in Table 1. The meaningful inclusion of immobile seniors was emphasized. The use of regional/local subcommittees was proposed so as to increase the likelihood of local action.

In the context of the above recommendations, a workshop format (i.e., collecting information and input and developing standardized tools, etc), would meet desired objectives. Workshop design should consider:

Targeting different disciplines and sectors separately and then in combination;
Targeting different themes (e.g. cognitive impairment; social, physical, and economic environments);
Bringing together existing teams to determine how they could work together towards a common definition or framework and promote standardization; and,
Using relevant venues such as long-term care facilities and seniors' community centres.

Finally, participants cautioned that the lack of an existing common language/definition should not hold up the establishment of collaborations and efforts in research and its application in Mobility in Aging.

4. Advancing Research to Action in Mobility in Aging

Participants were asked for recommendations on how the Institute of Aging might advance the Mobility in Aging Initiative. The Institute was encouraged to continue communicating with researchers, seniors, other stakeholder organizations, and jurisdictions, and providing linkages among these groups. Other suggestions were:

Hold a National Conference on Mobility in Aging in 2008, to showcase keynote speakers from a range of disciplines (biology to clinical to KT) and sectors. To promote KT, experts in communications and marketing should be engaged to report on what they heard.
Establish a Canadian coalition of voluntary/non-governmental, public and private organizations that would support different Mobility in Aging priorities. The coalition could create a framework to determine where each partner fits vis-à-vis each priority and what each could contribute; resulting in unique coalition-led initiatives each involving a sub-set of committed partners (a model exists: Cognitive Impairment in Aging Partnership). The pooling of resources and voices through such a coalition would influence government decision makers. The current situation of many small funding pools and separate lobbying efforts has been largely ineffective.
Provide assistance to non-research organizations in the translation of their needs to researchers. This could be achieved by holding a researcher:research-user workshop on the articulation of research questions from the "bottom-up".
Document the current state of knowledge in the field, which is essential to forward planning. The Mobility in Aging community needs to share and understand as a collective, what is known individually in different silos. This could be achieved through smaller interdisciplinary working groups.
Create a Knowledge Translation network in Mobility in Aging to accelerate the application of research through the networking of researchers and research-users and building KT skills in both the researcher community and research-user community.
Enable match-making of researchers and research-users through a website on which individuals could identify their research plans or information needs, and others could respond and indicate how they can help, what they can contribute, and what services they can provide. Other KT tools recommended were web-based platforms for discussions and/or databases for input and retrieval of literature and evidence that is translated into usable language (a model exists in Ontario, the Alzheimer Knowledge Exchange).
Connect to large provincial service organizations, such as Community Care Access Centres in Ontario, with which to hold roundtables for the sharing of best practices and encouraging evidence-based programming.
Consider ways of engaging and supporting rural service providers who work in small and often remote communities and cannot always tap into the larger picture or know what others across the country are doing.

There were a number of comments on knowledge translation. There is a need for change in the KT system and culture. While researchers need to consider KT and gain or access the required skills, research-users need to be proactive in seeking evidence and learning to identify credible evidence (a model exists in the Government of Alberta's initiative to develop strategic policies based on results). The onus of knowledge translation should not be put exclusively on the researcher. Additionally, there needs to be a recognition system within academia for KT undertakings by researchers.

Closing Remarks and Next Steps

Dr. Anne Martin-Matthews concluded the two-day forum by acknowledging the broad-ranging discussion and outlining the Institute's role in moving forward with the Mobility in Aging Initiative.

The CIHR Institute of Aging is dedicated to advancing research to action in Mobility in Aging through its support not only of research, but also of knowledge translation, partnerships, and capacity building. The Institute will consider the recommendations of this forum to update its plans for activities and funding opportunities under the Mobility in Aging Initiative.

The Institute of Aging will pursue partnerships with new organizations as well as build on existing collaborations. Being a complex issue, Mobility in Aging involves considerations outside of the traditional "health" research areas, such as in architectural design, urban planning, and so on. Collaborations are therefore necessary, starting with the fundamental need to understand as a group what we currently know in our individual disciplines and sectors.

Recognizing the challenges of linking with different government levels, the Institute of Aging is strengthening its relationship to the Federal-Provincial-Territorial Committee Responsible for Seniors, some of them present at this Forum, who are in a position to assist in this endeavour by reporting to their colleagues and jurisdictions and promoting provincial involvement.

Dr. Anne Martin-Matthews thanked all participants for their valuable input and time spent working with the Institute of Aging towards the success of the Mobility in Aging Initiative.

Meeting adjourned at 2:00 p.m.

Research-users: refers to those who could or should use research findings and evidence in their decisions on policies, programs, etc., such as health institution administrators, health care providers (e.g., physicians, nurses, physiotherapists), formal and informal caregivers, social and frontline workers, policy decision makers, the media, health charities, the private sector and the general public.