IMPAACT protocol puts older adults at the center of screening policy
Rapid population ageing is changing the clinical agenda in real time. In a new protocol published in BMJ Open, the IMPAACT study sets out a structured plan to bring older people into policy decisions on early screening for common health conditions, including cardiovascular disease, diabetes, dementia and frailty.
The design is deliberately participatory rather than purely observational. Older adults living in the community will not only be asked what they think about screening; they will help generate the recommendations that may later shape research, policy and practice. For a field where age-related assumptions can influence who gets assessed, referred, or overlooked, that shift in who holds the microphone matters clinically.
Why screening policy for older adults needs a different process
Population ageing increases the number of people who may benefit from earlier detection of chronic disease, but age alone can also distort clinical judgment. Screening may identify silent disease, yet it can also expose patients to misclassification, overdiagnosis, anxiety, unnecessary follow-up, or missed treatment opportunities when symptoms are attributed to ageing rather than disease. The protocol is built around that tension. It aims to elicit the values and preferences of evidence-informed older people on whether early screening should be prioritized and how it should be implemented.
Four conditions anchor the project because they are common in later life and increasingly prevalent with age. Each has a different clinical profile. Cardiovascular disease and diabetes often move along long preclinical pathways, where earlier detection may alter risk reduction strategies. Dementia raises difficult questions about the meaning of early identification when disease-modifying treatment remains limited. Frailty sits at the intersection of function, vulnerability, and future care needs, and it is often under-recognized until decline becomes obvious in everyday life.
This is where a policy process built around lived experience becomes more than a consultation exercise. It forces a direct confrontation with the trade-offs embedded in screening: what counts as benefit, who defines harm, and how much uncertainty patients are willing to absorb in exchange for possible earlier action.
Four Citizens’ Juries will shape the first phase
The first phase will recruit 80 older people aged 50 years and over to four Citizens’ Juries. Recruitment will be purposive, with explicit attention to people from traditionally hard-to-reach and diverse groups. That detail is important because policy discussions often overrepresent healthier, more connected, and more affluent voices while missing the experiences of people most likely to encounter barriers in real care pathways.
Citizens’ Juries bring a deliberative model to health policy. Participants are given information, hear evidence, deliberate together, and produce recommendations. In this protocol, the method is being used to move beyond opinion polling and into structured judgment. The objective is not simply to measure preference but to develop recommendations that reflect informed community reasoning about screening, age, and risk.
A single sentence captures the clinical consequence: screening policy will be built from older adults’ judgments about real-world benefit and burden, not from assumption alone.
Stakeholder roundtables will test whether the recommendations can survive implementation
The second phase broadens the lens. Forty stakeholders will be purposively recruited for two Policy Roundtables, spanning consumers and carers, health and aged care policymakers, general practitioners, practice nurses, geriatricians, allied health practitioners, pharmaceutical companies, private health insurers, and community and aged care providers.
That mix is not decorative. Screening policy changes only when it can move across multiple systems at once. A recommendation that sounds reasonable in a deliberative jury can stall when it reaches primary care workflows, payer expectations, aged care settings, or public policy constraints. The roundtables are designed to pressure-test the jury findings in those operational settings and identify where alignment is realistic and where conflict is likely.
The use of multiple stakeholder groups also acknowledges a basic fact of clinical implementation: older adults do not experience screening in isolation. Their decisions are shaped by access, trust, continuity of care, insurance structures, and the practical realities of follow-up. A policy that ignores those channels may be elegant on paper and brittle in practice.
Knowledge translation will be co-designed, not appended at the end
The third phase moves from deliberation to dissemination. Two researchers and six purposively recruited consumers will co-design Knowledge Translation resources intended to support implementation in research, policy, and practice.
This is a crucial step because policy influence rarely comes from a journal article alone. A policy brief and lay summary are planned, along with peer-reviewed publications, conference presentations, and seminars. In other words, the project aims to create material that can travel across audiences with very different information needs. Policymakers need concise action-oriented framing. Clinicians need practical implications. Older adults and carers need language that makes the rationale understandable without stripping away uncertainty.
Knowledge translation in this context is not just communication. It is an attempt to reduce the distance between deliberative evidence and institutional action. If the findings are to influence screening decisions, they will need to survive translation across those layers without losing the values that generated them.
The protocol’s limits are built into its design
Because this is a study protocol, no outcome data are available yet. The value of the paper lies in the architecture of the study rather than any clinical effect estimate. Thematic analysis will be applied to documentation and transcripts, so the primary products will be qualitative and interpretive. That makes the project well suited to questions about preference, acceptability, and implementation, but it will not deliver a quantitative answer about which screening policy is best.
The protocol also depends on successful recruitment of older adults from a wide range of backgrounds. If participation skews toward people who already engage readily with health services or policy processes, the recommendations could still miss some of the views most relevant to equitable screening policy. The same risk applies to stakeholder roundtables, where professional voices may dominate if facilitation is weak.
Ethics approval has been secured through the Torrens University Human Research Ethics Committee, and participants will provide written informed consent. The study is therefore positioned to proceed through a formal governance structure while keeping older adults at the center of the policy conversation.
What remains unresolved is not whether older adults should have a voice, but how much influence their deliberations will exert once the recommendations enter research agendas, policy drafting, and clinical practice decisions. The protocol sets up that test directly.