Title: Multiple long-term conditions and social inequalities in ageing: Dunhill Medical Trust PhD Cohort
Funder: Dunhill Medical Trust

Abstract: Ageing and its consequences have never been a more important area for doctoral study. Our programme will focus on multiple long-term conditions (MLTCs) and social inequalities, two strengths of Newcastle University (NU) research. This will build on our NU-led James Lind Alliance Priority Setting Partnership on MLTCs in later life that highlighted unanswered questions in this area. We will align the majority of the studentships with our NIHR Infrastructure, to maximise the impact of the DMT investment. This includes: BRC, PRU OPF with its track record of joint working with DMT, NIHRIO, ARC NENC, and School for Public Health Research. In each funder priority research theme, we will offer at least two projects- the following are examples: Theme 1: Understanding the mechanisms of ageing and age-related disease Project a. Epigenetic alterations in cellular ageing 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. Project b. Developing novel methods to characterise clusters of MLTCs and their antecedents 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. Theme 2: Tackling social determinants of healthy life expectancy Project a. Understanding and tackling widening inequalities in ageing populations Inequalities in health have been widening across the UK. Our recent work attributes these changes to lower levels of morbidity amongst the better-off, rather than worsening health profiles for the poorest people. In this mixed-methods project the student will investigate reasons behind widening health inequalities and increased health care costs, and apply this to identifying and modelling the impact of effective interventions. Project b. Understanding the impact of inequalities on pathways and quality of care for hospitalised patients Older people with MLTCs are at high risk of hospital admission, and many report experiencing fragmented, unsatisfactory care with worse outcomes than those without MLTC. This studentship (aligned to the ADMISSION collaborative) will use qualitative methods to understand which aspects of hospital care are key to measuring quality of stay for people with MLTC. Innovative approaches will be developed to extract/measure relevant markers from large hospital datasets and quantify the impact of sociodemographic inequalities. Theme 3. Improving the quality of life for older people Project a. Future needs in new care environments People who need help at home, but do not want or need to go into a care home, can now choose from a range of supported living environments, such as assisted living or extra care. The level and complexity of health and support needs in these settings is expected to grow as the population ages and care home provision remains static. This studentship will use cohort studies and care home data to investigate current, and predict future, needs in both home and care home settings. This work will inform future planning for health and social care support and identify intervention points to promote independence. Project b. End-of-life care and multiple long-term conditions End-of-life and palliative care for older people with MLTC requires development to address unmet and poorly served patient needs. Identifying the target patient group and appropriate point of referral/intervention are key challenges. Tools already exist to assess prognosis in MLTC, but which is most effective at identifying end-of-life is unclear. This study will used mixed methods to critically appraise existing approaches to prognostication for older people with MLTC and develop a novel intervention framework. Theme 4: Preventing, delaying or reducing future health and social care requirements Project a. How can social care data be used to promote equitable outcomes in later life for people with MLTCs? In UK there are over 10,000 registered domiciliary social care providers serving almost one million clients. Social care has a proven impact on health service utilisation and an ability to prevent/postpone admissions to hospitals and care homes. Despite its key role, little information is available on older care recipients or unmet needs. Working with a local Integrated Care System and domiciliary care providers, this studentship will explore the potential for data from domiciliary social care to promote equitable wellbeing and health outcomes for people with MLTCs. Project b. Understanding and mapping trajectories of functional decline in older people 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. Project c. Digital technologies to displace and reduce future needs for health and social care: An ethnographic study of community interventions The COVID-19 pandemic has exacerbated loneliness and isolation amongst older people, and led to delays in accessing services. With the rapid digitalisation of services, older people are potentially further disadvantaged by difficulties in accessing online services. This studentship will use ethnographic methods to critically explore the role of community groups in promoting wellbeing and digital citizenship, and the potential impact on how older people with MLTCs interact with and use health and social care.


Research activity codes: 7.1 INDIVIDUAL CARE NEEDS;7.4 RESOURCES AND INFRASTRUCTURE (DISEASE MANAGEMENT);8.1 ORGANISATION AND DELIVERY OF SERVICES
Health categories: GENERIC HEALTH RELEVANCE