Project a. Epigenetic alterations in cellular ageing

Supervisor: Dr Louise Reynard

Epigenetic alterations are a primary hallmark of cellular ageing, with many common age-related diseases such as cancer, diabetes and osteoarthritis characterised by abnormal epigenetic signatures. This project aims to understand the role of DNA methylation, an epigenetic regulator of gene expression, in musculoskeletal ageing and multi-morbidity. CRISPR-Cas9 genomic and epigenomic editing of cartilage and bone cells will be used to determine the effect of DNA methylation on ELOVL2 and FHL2 gene expression and investigate the function of these genes in cellular ageing. This project offers an opportunity for a student to work at the forefront of ageing research. 

Project b. Developing novel methods to characterise clusters of MLTCs and their antecedents

Supervisors: Professor Miles Witham and colleagues

MLTCs in older people appear to cluster more than would be expected by chance. Understanding how different conditions associate is important to understand underlying risk factors and mechanisms for groups of conditions. Working with the ADMISSION collaborative, this studentship will apply advanced statistical techniques to large cohorts (e.g. UK BioBank) and electronic hospital datasets, to characterise how groups of conditions associate and change over time. A range of novel clustering methods will be developed and implemented, including directed clustering of risk factors, mechanisms, and outcomes.

Project a. Unravelling inequalities between multimorbidity and polypharmacy in older people using big data 

Supervisors: Professors Adam Todd, Fiona Matthews, Dr Charlotte Richardson

As older people gain more health conditions (multimorbidity), they also gain more medication (polypharmacy). This medication can help manage the different health conditions, or it may complicate the health trajectory and cause adverse effects. It is well known that both multimorbidity and polypharmacy are common in older people. It is also well documented that certain groups of older people experience unfair and avoidable differences (inequalities) in terms of their multimorbidity and polypharmacy. These differences have changed over time, but as yet, no one has explored the interplay between the multimorbidity and polypharmacy, or considered whether the same groups of people experience the same inequalities. 

This PhD proposal represents a unique opportunity to combine expertise in the disciplines of ageing, epidemiology, pharmacy, and inequalities, with experience of advanced quantitative skills that are widely sort after. The student will be affiliated with the multidisciplinary AI MULTIPLY consortium and will get the opportunity to use new data that has only recently been obtained, enabling new understanding to be achieved across the whole PhD. There is also opportunity for the student to spend some time in Sydney, Australia, to analyse data from another healthcare system, as well as access specialist training in quantitative methods.

Project b. Unravelling the complexity of inequalities in hospital care for people living with multiple long-term conditions: a mixed-methods approach

Supervisors: Professors Rachel Cooper, Miles Witham, Thomas Scharf, Dr Sue Bellass

One in four adults are living with multiple long-term conditions (MLTC) and this rises to more than 2 in 3 adults aged 65 and over.  MLTC have adverse impacts on healthy life expectancy and lead to greater health and social care needs for older adults and so represent a global challenge for our ageing population that urgently needs addressing.

MLTC present specific challenges within hospitals. Patients living with MLTC often stay in hospital for longer and their recovery may be slower. However, the way that care is delivered in hospital is not ideal; in a system that was designed for the treatment of single conditions, the care of patients with MLTC can be unsatisfactory, inefficient and costly and may not be equitable. 

This project presents an exciting opportunity for a student keen to develop their qualitative and quantitative research skills to undertake a mixed-methods project that tackles key challenges of MLTC.  The project, aligned to the ADMISSION research collaborative, will involve the study of inequalities in the quality of hospital care for patients with MLTC. The ultimate aim of this work will be to inform strategies that effectively and equitably improve hospital care for people living with MLTC.

Project a. Future needs in new care environments

Supervisors: Dr Gemma Spiers and colleagues

As populations age, it is crucial to anticipate older people’s health and care needs. Understanding what sorts of needs people have at different stages of ageing will help to identify when support should be delivered to prolong independence. This doctoral research will take this important step and provide the necessary evidence to develop timely health and social care support for older people. Using existing cohort data and predictive modelling techniques, the work offers an exciting opportunity to forecast the health needs of ageing populations. Specifically, this work will explore how these needs differ across care settings, such as homes and assisted living dwellings. The methods would ideally suit candidates looking to enhance their skills in statistical approaches.

With a focus on diverse settings of care, the project offers a novel perspective and will enable the student to establish a leading research role in the field. Candidates will be supported to develop links with stakeholders across health and social care to maximise the impact of their work.

Project b. End of life and palliative care for people with multiple long-term conditions

Supervisors: Dr Felicity Dewhurst and colleagues

End-of-life and palliative care for older people with multiple long-term conditions requires development to address unmet and poorly served patient needs. Identifying the target patient group and appropriate point of referral/intervention are key challenges. This study will used mixed methods to further our understanding of the palliative care needs of older people with multiple long-term conditions, and how services should respond. This doctoral project will provide an opportunity to develop skills in qualitative and quantitative methods, and contribute to policy and practice in a growing area.

Project c. Assessing mobility in the real world: an inclusive post-diagnostic tool to support older adults across the spectrum of cognition and care

Supervisors: Dr Silvia Del Din, Dr Ríona Mc Ardle, Professors Lynn Rochester and Louise Robinson

Cognitive impairment is often accompanied by other long-term health conditions, and comes with increased risk of falls, frailty and placement in aged care. There is a global need for improved and proactive care of people with cognitive impairment to reduce these risks.

Assessing daily mobility (e.g. walking behaviours/abilities) with digital technology may capture subtle changes in the condition, and flag risk of unwanted events (e.g. poorer walking abilities reflect greater fall risk). To combat social inequalities in care, we must explore the ability of digital assessment of mobility to predict post-diagnostic outcomes in representative CI groups, inclusive of ethnic minorities, and people with lower socio-economic status or living in deprived/rural communities or within aged care.

The aim of this project is to develop novel ways to look at mobility with digital technology, and to understand its ability to predict unwanted events in an inclusive group of people with cognitive impairment. This project will utilise data from studies which assessed mobility in people with cognitive impairment using wearable devices for a seven-day period in the real world. A multidisciplinary supervisory team (psychology, engineering, movement science, primary care) will support you to develop a foundation for a post-diagnostic tool to support care.

Project a. How can social care data be used to promote equitable outcomes in later life for people with multiple long-term conditions?

Supervisors: Professor Barbara Hanratty and colleagues

Ensuring that people with multiple long-term conditions access the health and social they need is critical. Yet not everyone gets the help they need to live well, and there are growing health inequalities between the richest and poorest. Currently, there is little evidence about how to ensure health and wellbeing outcomes are equitable for people with multiple long-term conditions.

This doctoral research offers an exciting opportunity to work closely with a local Integrated Care System to address this critical gap in evidence. Specifically, the work will explore how data from domiciliary social care providers can be used to promote equitable wellbeing and health outcomes for people with multiple long-term conditions. This novel research will suit candidates with an interest in developing metrics at the intersection of social care and health inequalities. Candidates will be embedded in an existing cross-university research team and supported to work closely with key stakeholders, to ensure their work has real world impact.

Project b. Understanding and mapping trajectories of functional decline in older people

Supervisors: Dr Andrew Kingston and colleagues

Older people lose the ability to perform tasks that maintain independence (such as bathing and eating) in a predictable order. Yet, this ordered loss of capability with daily activities is seldom used to develop understanding of care needs at individual or population level. Using longitudinal studies of ageing, and the property of loss in daily activities, this project will help us to detect and track functional decline through daily activities; expose inequalities and provide insights into how to support older people to live independently for longer. This project will provide an opportunity to work with leaders in the field, to develop skills in epidemiological analyses, and address some of the most important questions in ageing research. 

Project c. Digital technologies to displace and reduce future needs for health and social care: An ethnographic study of community interventions

Supervisors: Dr Jenny Liddle and colleagues

Inequalities in health and social connections in later life can result from cumulative advantage or disadvantage in circumstances and experiences over the life course. Chronological age can also be a barrier to treatment for physical and mental health conditions, and access to health care differs for people living in disadvantaged versus affluent areas. The consequences of these inequalities can be compounded in later life by factors such as reduced income in retirement and the impact of multiple long-term conditions. The COVID-19 pandemic had a disproportionate impact on older people, reinforcing inequalities in later life. Physical distancing requirements exacerbated loneliness and isolation and led to delays in accessing health and care services. The pandemic also resulted in rapid digitalisation of services, potentially increasing inequalities further by disadvantaging those older people without the ability, skills, knowledge or resources to participate digitally within society (digital citizenship). This studentship will use ethnographic methods to critically explore the role of community groups in both promoting digital citizenship, and in using digital technologies to support wellbeing. The potential impact of such technology-related innovation will be investigated, focusing on how older people living with multiple long term conditions interact with and use health and social care resources.