older frail adults

Prevention of hospitalisation based functional decline in older frail adults

Project reference number: HLSPH029

Background

Older people are being admitted to hospital as an emergency in increasing numbers. There is some evidence to indicate that elements of hospital care might be potentially harmful to older people; indeed hospital admission in the past 12 months is the single most predictive risk of functional decline in community-dwelling older adults, with up to 60% of older people experiencing functional decline after hospitalisation. This is thought to be mainly due to the effect of immobilisation while in hospital on people who are close to thresholds of strength needed to remain independent. Unpublished data from our small audit study at Kello Hospital (NHS Lanarkshire) revealed that patients spent minimal time (less than 1h/d) in an upright position while in hospital (PIs: AM and DS). There are as yet few studies to examine how we can overcome this conundrum. One suggestion as per the popular social media campaign ‘end PJ paralysis’ is that we should be getting hospital inpatients out of nightwear, out of bed, and into their day clothes to speed up recovery and help minimise harms from prolonged immobility- but to date there have been no studies to evaluate the effectiveness of this. Another suggestion is to avoid admission to hospital by the provision of hospital-level care in the home- a model that is currently under investigation at NHS Lanarkshire, as part of a multicentre RCT (GE: co-I).

Aims

This PhD will use mixed quantitative and qualitative methods to explore the relationship between current clinical practice and functional deconditioning and alternative practices (e.g. hospital at home model and ‘end PJ paralysis’), evaluating their effectiveness in older frail adults. With the exponential growth of the older adult population, there is growing concern that existing models/practices of acute hospital care are becoming unworkable. From a patient perspective, there are many reasons to question whether our current provision is the best option for older adults with frailty. This project will provide evidence to guide the planning of future hospital-level services with a direct effect on the individuals themselves, carers and family, providers and the NHS.

Application deadline

The application deadline for October intake is 1st of July.

Research supervisors

Candidates are encouraged to contact the following researchers for further details:

Modes of study

This project is available as a:

  • PhD: 3 years full-time or 4.5 years part-time.
  • 1 + 3 route to PhD: Undertaking MRes [1 year full-time or 2 years part-time] + PhD as above

Eligibility

Applicants will normally hold a UK honours degree 2:1 (or equivalent); or a Masters degree in a subject relevant to the research project. Equivalent professional qualifications and any appropriate research experience may be considered. A minimum English language level of IELTS score of 6.5 (or equivalent) with no element below 6.0 is required. Some research disciplines may require higher levels.

Specific requirements of the project

The successful applicant will be a qualified Allied Health Professional with excellent communication (oral and written) and teamwork skills. Previous experience in working with older people in a clinical setting is desirable.