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Exploring the Many Facets of Research in Late-Life Issues
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Introduction

Canadians are living longer, but in many cases they face complex health challenges, usually in the form of multiple chronic diseases. These complex health conditions in seniors, which are often poorly studied and characterized, represent a challenge for professionals in identifying optimal treatments or options. This concern was clearly expressed during the "Speaking of Aging Tour" that the Canadian Institutes of Health Research (CIHR) Institute of Aging undertook in 2012. The goal of this consultation was to identify gaps in knowledge and where new research was most needed as well as transfer of existing knowledge to best care practices health services organisations. Information was gathered through a process of web consultation (with 840 respondents) followed by a series of in-person consultations carried out in 16 cities across nine provinces, gathering the feedback and opinions of more than 600 stakeholders. Attendees included researchers, health professionals, policy makers, industry representatives, and representatives of seniors associations. These stakeholders identified the research needed to address the challenges faced by the aging community of Canada and allowed to propose the Institute of Aging 2013–18 Strategic Plan (http://www.cihrirsc.gc.ca/e/documents/IA_Strategic_Plan_En_v5jul13.pdf).

One of the most commonly cited and important challenges identified in the "Speaking of Aging Tour" concerned the late-life portion of the life course trajectory. The expression late-life refers to more than the period that is commonly referred to as end-of-life (see Insert 1); the latter is the object of much research reported in the literature. Late-life is a broader concept used to describe the later stages of life that lead to the end-of-life in the life course trajectory. Throughout this late-life period, individuals and their support systems are often confronted with numerous health and social issues that have an impact on their well-being and contribute to their frailty (Bergman et al., 2007; Clegg, Young, Iliffe, Rikkert, & Rockwood, 2013).

Late-life care options are little understood and poorly studied. It is important, however, to gain insight into these to integrate end-of-life care practices into treatment choices such that seniors benefit from an optimal quality of life in the latter stages of their life course trajectory. Complicating the determination of what is an optimal quality of life in this population is the current lack of clarity on which health care outcomes are most relevant in late-life. Moreover, a limitation of currently described health care outcomes is that they have been often formulated without involving those living with such complex health conditions (Upshur, Kuluski, & Tracy, 2014).

An additional challenge is how to provide appropriate support to health care professionals and caregivers advising those at late-life who are deciding on which treatment options to pursue, including when to consider and receive palliative and end-of-life care. A person-centred approach, rather than the traditional "best practice" approach to treatment decisions, is an important element of this support.

Boxed Text.

Insert 1

The issues surrounding late-life were incorporated within the CIHR Institute of Aging 2013-18 Strategic Plan: Living Longer, Living Better (http://www.cihr-irsc.gc.ca/e/documents/IA_Strategic_Plan_En_v5jul13.pdf).

Within Priority 4 of the Plan ("Health Care and Services that Combine and Integrate Continuity, Innovation and Efficiency"), one of the main issues identified is the availability and the need for evidence to support late-life issues and care decisions – including their ethical and legal dimensions – for the person, the family, health professionals, and policy makers.

The importance of providing older people with high-quality late-life, palliative, and end-of-life care makes it imperative to take concrete steps in this area. It is essential to derive better approaches (models and programs) – for supporting families, clinicians, care-givers, and clinicians – that take late-life and end-of-life issues into consideration in an inclusive environment that facilitates informed decisions. Unfortunately, many of these issues concern care and treatment options which are associated with high degrees of uncertainty regarding potential benefits, harms, and so on.

Additionally, the questions regarding late-life issues are included in the Strategic Plan’s Priority 5 ("Ensuring the Conditions for a Positive Impact on Older People’s Health and...



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