Title: Exploring the bidirectional influence between awareness of age-related change and health outcomes in the second half of life
Funder: Economic and Social Research Council

Abstract: This fellowship aims to expand my PhD research (09-17 to 04-21) and maximise its impact. This will be achieved through high impact publications, engagement with academic and non-academic audiences, and international networking. I will also prepare new funding proposals to support me in becoming an independent Early Career Researcher in the fields of health and ageing. This fellowship has four overarching aims, with specific objectives within each aim, as follows: 1. Produce two publications to enhance track record and expand the evidence based on awareness of age-related changes (AARC) in the UK. As part of my PhD I planned to collect baseline and one-year follow-up data on a questionnaire assessing AARC through the UK PROTECT (Platform for Research Online to Investigate Cognition and Genetics in Ageing) study. Due to the COVID-19 pandemic, data collection for the UK PROTECT study was delayed and only the baseline data were available for my PhD. As the longitudinal dataset has now become available, I plan to explore, for the first time, the bidirectional associations of AARC with subjective and objective indicators of cognitive, mental, and physical health, and the mediating role of physical activity (Paper 1). I will also explore the mediating role of AARC in the associations of cognitive decline with depression and anxiety (Paper 2). Findings will provide evidence of whether promoting awareness of positive changes and providing help to deal with age-related losses could promote cognitive, mental, and physical health in the older population. 2. Engage with a range of audiences to communicate research findings. To maximise the impact of my research and to strengthen my communication skills I plan to: a) Present at the annual conference of the Australian Association of Gerontology and organise a symposium and present at the annual conference of the British Society of Gerontology. b) Deliver four seminars while visiting international labs (see point 3). c) Deliver a talk for the Centre for Dementia (University of Nottingham). d) Deliver at least one guest lecture within the Medicine and/or Psychology MSc programs at the University of Nottingham. e) Gain experience in writing blogs by contributing to "Dementia day to day" led by the Institute of Mental Health at the University of Nottingham f) Work with non-governmental organisations that represent older people (such as Age UK and Independent Age), to fully understand the mechanisms that drive AARC and their impact on older people, communicate my research, and learn from this constituency in a spirit of knowledge exchange. Joint work to communicate my research (from Point 1) will result in a public event and in the preparation of accessible summaries and an animated video. 3. Build networks by undertaking research visits to internationally leading research organisations. The fellowship would allow the unique opportunity to strengthen my ongoing collaborations and develop new ones. I aim to undertake four international visits of one week each to: a) Prof Anstey; a member of my PhD supervisory committee and director of the Ageing Futures Institute at the University of New South Wales (Australia). b) Prof Windsor (Flinders University, Australia) who is researching AARC in relation to novel outcomes such as life engagement. c) Dr Kaspar (University of Cologne, Germany) who developed the short version of the AARC questionnaire I used in my PhD research. d) Prof Wahl (Heidelberg University, Germany) who is one of the two originators of the AARC construct which has been the focus of my PhD research and is the focus of research in this application. 4. Identifying and applying for funding. I will identify funding sources relevant to my topic area and career stage and prepare at least one funding proposal to expand my program of work in older age health. A possible funding proposal could be the ESRC New Investigator Grant.

Lay abstract: Our society tends to view older people (i.e., those aged > 65 years) as being frail, sad, and forgetful. However, this is not the reality for many. Older aged people can experience both positive and negative changes. Examples of positive changes are increased free time to spend with friends or increased knowledge. Examples of negative changes are reduced energy and poorer memory. To capture the positive (gains) and negative (losses) changes an individual may experience as they age, a questionnaire assessing Awareness of Age Related Changes (AARC) was created. It asks about the gains and losses people perceive from mid-life to older age in five domains including cognition, mood, physical health, social relations, and lifestyle. My PhD documented for the first time levels of AARC gains and AARC losses among UK residents aged 50 + years. On average, people reported higher AARC gains than AARC losses and the losses they experienced mostly related to reduced energy and having to abandon physically demanding activities such as running. However, one's experience of age-related changes is unique, and each person can report different degrees of AARC gains and AARC losses. For example, healthier people reported higher AARC gains and lower AARC losses, compared to those in poorer health. Hence, my PhD contributed to ageing research by showing that asking people about the age-related changes they experience may help to identify those struggling the most while ageing. However, we do not know what is the causal relationship between AARC and one's health. For example, those people that find it increasingly harder to remember things, experience new illnesses, or have low mood as they age, may notice these negative changes in their daily life and, consequently, report lower AARC gains and higher AARC losses. Alternatively, those who think that losses are an inevitable part of ageing, also tend to believe they have little control over their health and, consequently, are less likely to make the effort to follow a healthy lifestyle. Due to lack of engagement in healthy behaviours, such as physical activity, those who believe that losses are intrinsic in older age may experience poorer health over time and report higher AARC losses and lower AARC gains. Finally, it may be that the occurrence of losses in one health domain shapes individuals' perception of their ageing which in turn influences other aspects of their health. For instance, memory difficulties may lead to perceived AARC losses which may then trigger poor mood. This fellowship aims to start addressing the link between AARC and health. This is important for informing the development of new strategies for promoting health in mid to old age. For example, if we were to find that those people whose cognitive abilities have been decreasing report higher AARC losses, asking people to complete the AARC questionnaire would help to detect those at higher risk of further cognitive decline. Such individuals could be enrolled in cognitive training and other programs aimed at delaying further cognitive impairment. Another example, if we were to find that those who report higher AARC losses experience poorer future health and, that this is somewhat due to them not engaging in healthy behaviours, assessing AARC would help to identify those who would benefit most from programs promoting positive views of older age, positive self-perceptions of ageing, greater self-efficacy, and a healthy lifestyle. I aspire to lead an independent, world renowned program of work in the fields of health and ageing. This fellowship would be the first step toward achieving this goal. It would enable me to extend my PhD research and strengthen the empirical basis for future fellowship applications focused on developing new interventions for promoting more positive self-perceptions of ageing and health in the older population. It would also maximise the dissemination of my work and help widen my network of collaborators.

Research activity codes: 2.3 PSYCHOLOGICAL, SOCIAL AND ECONOMIC FACTORS
Health categories: GENERIC HEALTH RELEVANCE