Title: How does the environment in and around the home impact social care and health outcomes for older people?
Funder: Health and Care Research Wales (Welsh Government)

Abstract: Background Healthy ageing is extremely important internationally, evidenced by highlight notices from the World Health Organisation, National Institute for Health Research and UK Research and Innovation council. One of the key aspects of healthy ageing is functional ability, which is the capability of an individual to be and do what they have reason to value. The World Health Organisation defines functional ability as the intrinsic capacity (mental and physical health) of the individual, relevant environmental characteristics and the interaction between them. Aims It is our aim to investigate the relationships between environmental characteristics and adverse social care and health outcomes (functional ability) for older people in Wales. Specifically, we will investigate the following characteristics and social care and health outcomes: 1. Walkability and accessibility profile of the home neighbourhood 2. Individual living environment (garden size, greenness around the home, rurality) 3.Home interventions provided by Care&Repair Cymru 4. Seasonal weather trends 5. Personal characteristics such as age, gender, deprivation, living alone and frailty Outcomes: a) Care home admissions b) Falls related hospital admissions c) How a dementia diagnosis impacts (a) and (b). Research Questions These aims form the basis for our research questions: 1. Are more walkable and accessible neighbourhoods protective in relation to falls and care home admissions? 2. What impact does the built-environment in and around the home have on the chance of a fall related hospital admission and the severity of the fall? 3. How do the above research questions (1. and 2.) differ for people with a dementia diagnosis? Plan of investigation We will perform a longitudinal quantitative retrospective cohort study using linked data from the Secure Anonymised Information Linkage Databank. Our research plan will be split into two parts. The first part will create and develop longitudinal datasets to determine environmental metrics at the lower-layer super output area, residential and individual level. The second part will use the datasets to assess the relationship between the environment and our social care and health outcomes: care home admissions and falls related hospital admissions. Including an indicator for if and when an individual has a dementia diagnosis also enables us to investigate differences in outcomes for people with dementia. Summary of benefits Our research will indicate what characteristics at the individual, residential, local area and national level have an increased risk of an adverse outcome. Therefore, our research will provide evidence that can be used to target people and areas that are at an increased risk. Furthermore, this can be used to promote preventative measures at an individual level and subsequently secure future funding. We hope that our findings will influence policy for modifiable characteristics of the environment, and lead to recommendations for the prevention of falls and care home admissions for older people in Wales. Ultimately, the mitigation of risk through changes in the environment will save valuable funding for the NHS through the potential to prevent adverse outcomes. This research will therefore benefit both service users and delivery units, by minimising risk of adverse outcomes for the individual, and providing targeted evidence for alterations of the environment for delivery units.

Lay abstract: Healthy ageing is the promotion of positive health and wellbeing in older people and is an extremely relevant and important issue due to the impact it can have at an individual and government level. One of the main aspects of healthy ageing indicated by the World Health Organisation, is how people interact with their surroundings and local environment. However, the relationships between an individual’s surroundings and the risk to preventable adverse social care and health outcomes is largely unknown. Two common outcomes that may be influenced by an individual’s surroundings are care home admissions and falls. These outcomes are also known to incur significant costs to the NHS, local authorities and government. The risk to the outcomes may also differ depending on if someone has a dementia diagnosis, and the associated financial costs are increased. We aim to perform a national study for older people living in Wales, investigating the relationships between an individual’s surroundings, key environmental measures, and specific adverse outcomes: care home admissions and falls. As dementia is a global issue we also aim to see if and how the relationships differ for people who have a dementia diagnosis. We will do this by creating measures of accessibility to local services, such as general practices, and measures of how easy it is to walk to local surroundings, such as green spaces, from an individual’s residence. It is possible to see how these measures impact care home admissions and falls by linking and observing anonymised data from the Secure Anonymised Information Linkage databank. Subsequently, by investigating what measures change the chance of a care home admission or fall we can target preventative measures. We hope to discover risk factors for falls and care home admissions in and around the home that can be modified. Using this evidence, we can advise individuals, local authorities and Welsh government on what aspects they should change to reduce the risk of a fall or care home admission. We also hope to discover if the risks are different for those diagnosed with dementia and advise accordingly. By doing this we hope to reduce the pressure on individuals, families and local authorities and help people have a better way of life. We plan to involve key stakeholders and members of the public throughout the project. We will include members of the public in the production of policy and planning recommendations to ensure they accurately reflect services users’ perspectives, thereby maximising the impact of these research outputs on policy makers, other stakeholders and the general public. We aim to disseminate our knowledge to the research community by showcasing our research at relevant events throughout the life course of the project. We will also utilise Swansea University’s existing knowledge transfer team to maximise the dissemination of our findings. The team would focus on providing our research to key decision makers within provider organisations, policymakers and others who can use it to improve health, housing and social care services and policies.

Research activity codes: 2.2 FACTORS RELATING TO PHYSICAL ENVIRONMENT;2.3 PSYCHOLOGICAL, SOCIAL AND ECONOMIC FACTORS
Health categories: GENERIC HEALTH RELEVANCE;NEUROLOGICAL;INJURIES AND ACCIDENTS