Building interventions to improve quality of life for older people: Dunhill Medical Trust PhD Cohort

Our multidisciplinary PhD projects will focus on improving quality of life for older people through: (i) using person-centred approaches to develop better understanding of older adults’ experience of three important facets of well-being: intergenerational connections, care decisions and health behaviours, and (ii) development and evaluation of novel interventions to improve well-being in each of these three domains.

Throughout we will focus on inclusive recruitment of older adults from urban and rural locations, proactive participant involvement in our research design, and interdisciplinary and multimethod projects which provide rich training opportunities for the PhD students. Each supervisory team will include at least two supervisors from different disciplinary backgrounds.

Project 1 (Supporting intergenerational communication) will tackle a key goal outlined in the current UN Decade of Healthy Aging: addressing age-related social isolation (supervisor team: Louise Phillips, Psychology; Claire Wallace, Sociology; Lorna Philip, Geography).

Intergenerational communication has been argued to play a particularly important role in alleviating social isolation for older people, but societal changes have resulted in more age-segregated communities.

Recent systematic reviews have highlighted that there is currently a knowledge gap in understanding the nature of intergenerational engagement, and how best to facilitate it.

This PhD project will: identify barriers to intergenerational interactions, model processes of intergenerational communication through detailed analysis of dyadic interactions, and engage with stakeholders to develop new methods of supporting intergenerational links.

Focus groups will be used to explore psychological, social and geographical factors which facilitate or impede intergenerational connections, looking at both individual-level characteristics (e.g. gender, education level, ethnicity) and societal-level influences (e.g. urban or rural location, neighbourhood characteristics, family dynamics) and their intersection.

The dynamics of intergenerational communication will be modelled using behavioural techniques to record and analyse dyadic interactions.

We will work with stakeholders to identify methods to encourage intergenerational communication, and evaluate the effectiveness of these methods in improving quality of life for older adults in everyday settings.

Project 2 (Supporting future care decisions) will develop a tool to encourage communication and planning for future care needs for older people (supervisor team: Stephen Makin, Centre for Rural Health; Louise Locock, Health Services Research; Andrew Maclaren, Geography). For an older person to settle into a care home can be a long and distressing process.

This can be experienced more positively if the person needing care and their family are involved in key decisions about care from an early stage.

This project aims to help older people in decision-making about future care choices by developing an intervention to record future wishes and priorities.

Whilst there are generic tools to support decisions about future health decisions, there are no tools which actively involve the care recipient and their family in advance decisions about their wishes on social care before a crisis point has been reached.

This PhD will develop and evaluate a tool to support older people to discuss their wishes about care home admission, and their choice of home, with their families or others who might have to make this decision for them in the future.

The PhD will have a particular focus on older people living in remote and rural areas, where travel distance and potential for dislocation from the home community may be particularly problematic.

It will begin with qualitative interviews with care home residents, families, and professionals about their experience of making care decisions.

Informed by this, the student will work with older people, families and care staff to co-design a tool, and evaluate its use with the target demographic in advance of major care needs.

Project 3 (Supporting health behaviours) will explore the effectiveness of new interventions to support consistent engagement with important health behaviours in old age (supervisory team: Katharina Schnitzspahn, Psychology; Julia Allan, Applied Health Sciences).

Taking medication with each meal or attending doctor’s appointments depends on a specific memory system called prospective memory (remembering to enact intentions).

The majority of older adults’ everyday memory problems are due to prospective memory failures, and the frequency of these memory failures predicts successful adherence to treatment schedules. Also, prospective memory problems relate to poorer well-being.

Improving prospective memory in older adults is therefore an important goal to support health behaviour, functional independence and quality of life.

There has been a surprising lack of research into prospective memory interventions that improve health behaviours and independence in older adults. In this project we will evaluate promising intervention techniques from the literature on memory training.

Working with older adult stakeholder groups, the student will evaluate the feasibility and acceptability of potential interventions to support prospective memory in everyday health behaviours (such as adhering to medication schedules and attending health appointments), as well as evaluating the best possible communication strategies to encourage engagement with the interventions in a diverse range of older adults.

The final phase of the project will be to evaluate the effectiveness of relevant intervention(s) to improve health behaviours and quality of life in older adults.

Supporting health behaviours through this route has the potential to improve functional independence for older adults with complex health needs.

We have identified three important predictors of quality of life for older adults (intergenerational communication, planning for future care, implementing important health behaviours) and designed novel PhD projects which aim to understand the perspectives of older people on these domains and evaluate interventions to improve them.

Each of these projects is very different in focus, but there are common underlying themes of (i) gaining a detailed understanding of the nature of older adults’ quality of life in these domains, (ii) working with stakeholders to identify possible interventions, and (iii) evaluating the effectiveness of the interventions to improve quality of life for diverse samples of older people.

In all projects we will involve older people from diverse communities (considering gender, ethnicity, socioeconomic status), with a particular focus on engaging with those from rural as well as urban locations.

These projects have the potential to directly improve quality of life of older adults through reduced isolation, increased autonomy in care decisions, and better self-management of health conditions.