Studying for a doctoral degree (PhD) with GIAM

• Principal and co-supervisors: Dr Federica D'Andrea and Professor Juanita Hoe 
• Contact: Federica.DAndrea@uwl.ac.uk

Project summary 

Olfactory loss is common in the later stages of life. Half of the population aged 65 and above and more than 80 percent of people aged 80 and older have been reported to experience a decline in their sense of smell. Olfactory decline is increasingly receiving attention as an early sign of neurodegenerative diseases such as dementia. A growing body of evidence shows that a decrease in the sense of smell is a risk factor for cognitive decline, significantly impacting quality of life and increasing the likelihood of depressive symptoms. This is relevant as depressive disorders are one of the most widespread mental disorders in the later stage of life, which affect approximately seven percent of the world’s older population. 

Encouraging results have been found from studies involving olfactory (smell) training, indicating its potential to increase olfactory performance in older people. Olfactory training offers a set of non-invasive methods by which olfactory exposure may benefit olfaction and perhaps also health and cognition. 

This PhD proposal seeks to explore the benefits of olfactory training for older people. The project is important as it will help us to understand the impact of smell on health and well-being of older people, explore the mechanisms underpinning olfactory memory training and its potential to lead changes at the performance and cortical levels. The findings from this research will inform the design and development of interventions that promote olfactory abilities and potentially reverse olfactory loss. 

• Principal and co-supervisors: Dr Shadreck Mwale and Professor Katie Featherstone 
• Contact: Shadreck.Mwale@uwl.ac.uk 

Project summary 

African and African Caribbean older people living with mental health conditions are a key population at high risk of inequitable access to and experiences of health and social care services (MacRaild, 2000 Adelman et al, 2011; Tuerk and Sauer, 2015; Cooper et al, 2010), experience failings in care (NAO 2007;2010) and have poor health and wellbeing outcomes (Kapadia et al, 2022; Nazroo, 1998;2001; MacRaild, 2000; Shafiq et al, 2020). However, little research has specifically examined their experiences of health and social care services. 

NICE guidelines identify older people from minority ethnic groups experience unequal access to services (NICE, 2018 b) and require services provide reasonable adjustments to meet the requirements of the Equalities Act 2010 (NICE, 2015 a) however do not provide recommendations to health and social care services on how to achieve this in practice. Research thus far provides only generalised understandings of the experiences of ethnic minority older people (Truswell, 2016;2019) and we know very little about African and African Caribbean older people’s experiences of services. 

While Black people are more likely to be overrepresented in mental health services, there is little research that has sought to examine the intersections between mental health and ageing among African and African Caribbean older people and their impact on experiences of and access to health and social care services. 

In response, this studentship will explore the experiences of African and African Caribbean older people living with mental illness, their care partners and families, support seeking, trajectories of care and their encounters with services. 

• Principal supervisor: Professor Juanita Hoe 
• Contact: Juanita.Hoe@uwl.ac.uk 

Project summary 

As the world population ages, the number of people living with dementia is increasing. Of these, around two-thirds of people with dementia live at home and are supported by a family member or a close friend. National policy is to support people with dementia to maintain independence and live at home for as long as possible. Traditionally people living with dementia are cared for by a spouse or a close family member, usually a daughter, or daughter-in-law. However, due to the decline of conventional nuclear families through changes in domestic relationships and separate living situations, people living with dementia are now frequently cared for by an extended member of their family, for example, a niece, nephew or cousin, or a close family friend. 

Carers are a diverse group, and a better understanding is needed of more contemporary caring situations and the impact this has on individuals within these roles.  As the unpaid care currently provided by families and friends in the UK is valued at £13.9 billion a year, any significant withdrawal of this support would have considerable societal and economic impact. It is crucial therefore that we understand how best to help and support these carers within their caring roles. 

This PhD proposal seeks to explore the experiences of extended family members caring for people living with dementia at home. The project is important as it will help us to understand the reasons why people take on the caring role, identify the personal impact being a carer has on individuals and their relationships with the person cared for, examine their ability to access the information, support and services needed, and to distinguish any specific needs they may have as carers. The findings will be used to design strategies and develop interventions that better support extended family members and friends in their caring role. 

• Principal supervisor: Professor Juanita Hoe 
• Contact: Juanita.Hoe@uwl.ac.uk 

Project summary 

As the population ages the prevalence of dementia within Black and minority ethnic older populations is increasing. As more people from ethnic communities in the UK are expected to present with dementia, they will need access to appropriate services. Previous research has shown that many people from ethnic minority backgrounds perceive dementia to be a natural part of ageing and do not engage with services. Despite interventions to increase awareness of dementia and encourage older black and minority ethnic populations to seek diagnosis and support where needed, the take up of services remains fragmented and inconsistent. 

Developing culturally appropriate services may improve service utilisation and social inclusivity. To achieve this a better understanding is required of the needs of these populations to identify how service uptake can be improved. 

This PhD proposal seeks to investigate the needs of Black and minority ethnic older populations and identify barriers and enablers to seeking help and obtaining support. Candidates may choose to focus on one specific population or community. Needs will be identified using the Camberwell Assessment of Need for the Elderly (CANE). This tool offers a multidimensional approach to assessment and measures met and unmet needs in several areas including physical, psychological, social and environmental domains. This project is important as detecting unmet needs enables gaps in service provision to be identified and allows health policy to introduce changes that can reduce health inequalities and improve health outcomes. 

• Principal and co-supervisors: Dr Snorri Rafnsson and Dr John Hughes 
• Contact: Snorri.Rafnsson@uwl.ac.uk 

Project summary 

Multiple long-term conditions (multimorbidity) are thought to affect as many as 50% of older adults (aged 65 years and over) and are associated with significant disability, poor quality of life, and high health care utilisation and costs. In the absence of an effective cure, many common chronic illnesses, including heart disease, diabetes, asthma and arthritis, require patients to regularly monitor physical indicators, manage medication regimes and components of their lifestyle such as diet and exercise. As a result, self-care, and in particular self-management, interventions for such chronic conditions have increasingly become an essential component of national health systems around the world. Although improving the way multimorbidity is managed is now a key priority for the NHS, there remains a lack of research exploring how older individuals living with multimorbidity self-care for their chronic illnesses and wider preventative and health protective activities. 

This two-phased PhD project will conduct a rigorous, exploratory sequential mixed methods design to evaluate the characteristics and benefits of self-care approaches for older adults with multimorbidity attending The Royal London Hospital for Integrated Medicine (RLHIM), which is located within University College London Hospitals (UCLH) NHS Trust. The successful PhD candidate is expected to further develop the project themselves under the guidance of the supervisory team which is based in the UWL’s School of Biomedical Sciences. 

In addition to adding to the relevant evidence-base, it is anticipated that the findings from this PhD research will also be of value for informing personalised packages of self-care which would be delivered within UCLH. Specifically, the package of care would aim to address a range of symptoms associated with multimorbidity in older adults. 

• Supervisors: Dr Snorri B. Rafnsson, Prof. Juanita Hoe, Dr Shadreck Mwale
• Contact: Snorri.Rafnsson@uwl.ac.uk 

Project summary

One of the most urgent modern-day issues regarding how to meet the needs of growing older populations is information and communication technology (ICT) adoption and use. Previous research has suggested ICT can support ‘Ageing in Place’ policy, which enables older adults to live independent lives and continue doing what they value on their own terms. For older adults, maintaining a sense of independence is essential, as it enables them to enjoy better quality of life. Maintaining strong connections with their communities, family and friends allows independent living in older age and contributes to better health and well-being.

Recent research has highlighted number of barriers to using ICT among older adults, including health issues, sensory loss, lack of technical skills, and reluctance to use new technologies. Studies have also found that a lack of digital skills and access can have a huge negative impact on a person's life, leading to poorer health outcomes and a lower life expectancy, and increased loneliness and social isolation. The term ‘digital divide’ has been used to denote the discrepancy between those who “have” and those who “do not” have access to ICT. In general, older adults are relatively more affected than other age groups. However, recent evidence suggests that, especially among older ethnic minority adults, the digital divide is even wider although its implications and underlying reasons in this population are still poorly understood.

Some important questions that remain unanswered include:

1. What are older minority group adults’ needs and preferences for using ICT for interacting with friends and family?
2. How do personal and cultural factors influence the use of ICT among the minority ethnic elderly group?
3. Is a simple videophone service feasible to use by older minority group adults for interacting socially?

This three-staged PhD will draw on relevant theoretical frameworks and apply mixed research methods to investigate needs and preferences for social interactions among community-residing older minority ethnic adults. Specifically, it will explore views, perceptions, and barriers towards adopting and using ICT for social purposes in this population. The final phase will determine the feasibility of using the Konnekt^TM videophone device for social interactions, including potential benefits and obstacles.

This PhD project will contribute new evidence on a population group hitherto largely excluded from research on ICT and social connections. It will critically assess the quality of the available evidence and identify important gaps. The project will generate evidence that will help inform culturally tailored strategies and recommendations for promoting independence and quality of life among older minority ethnic adults through technologically supported social interactions.