PhD studentships

People are prescribed many medications, particularly as they get older. Some very commonly used treatments have been linked with poorer brain function and the development of dementia when used over a long period of time. These include some types of painkillers, antidepressants and allergy treatments to give just some examples. This effect on the brain is thought to be due to interference with the signaling chemical acetylcholine – and such medications are called anticholinergics. It has recently been suggested that anticholinergics also increase the risk of delirium, an acute brain injury often associated with illness in hospitalised patients. This project will use Scottish national data to understand how the anticholinergic burden of prescribed medications is related to the risk of developing delirium and future dementia. Hospital prescribing data will also be reviewed to better understand how delirium changes the prescribing behaviour of clinical staff. As peoples’ medications are often changed over time, statistical models will be used to understand the cumulative exposure of individuals to anticholinergic medications of different strengths over many years. Such a detailed analysis has not been done before for delirium and could help to identify possible targets for reducing the risk of future dementia in these patients.

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As for most complex diseases, variation in delirium risk among patients is likely determined by genes, hence it is imperative to link relevant genetic variation to variation in risk of developing delirium. Yet there is very little understanding of the role of genetic variation in delirium, with only small studies with inconclusive results published. The aim of this project is to use state of the art resources and techniques to identify genes that contribute to the risk of delirium.

Once we can identify what genes are relevant to delirium we can use techniques that identify drugs that could be used to treat delirium. As these drugs would be already licensed to treat other conditions, this would speed-up clinical trials and benefit patients in a much shorter time span.

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Delirium is a significant challenge for as many as 20% of adults in hospital (Meagher et al 2014). Up to 20% of patients experience persistent delirium in the months following discharge (Cole et al 2009) and evidence suggests an association with long-term cognitive impairment (MacLullich et al 2009). Changes in cognitive function may require new or enhanced access to health and social care services. The experience of people, who live with persistent delirium and their families, is poorly understood. This PhD studentship offers opportunity to research their experiences, explicitly seeking to understand the service needs and outcomes for this group of older adults and to explore how they interact with social networks and environments.

The project works with an established supervisory team and a range of experienced clinical advisors to ensure that the realities of clinical practice and support post-discharge can be reflected in the study.

There is opportunity for the successful applicant to shape the project’s design. The research is conceptualized as a mixed methods project with significant qualitative components and opportunity to explore the use of creative and inclusive research approaches. Data-driven elements and social network analysis could be included to explore the needs of this complex population.

Find out more, here.

Delirium is a significant challenge for as many as 20% of adults in hospital (Meagher et al 2014). Up to 20% of patients experience persistent delirium in the months following discharge (Cole et al 2009) and evidence suggests an association with long-term cognitive impairment (MacLullich et al 2009). Changes in cognitive function may require new or enhanced access to health and social care services. The experience of people, who live with persistent delirium and their families, is poorly understood. This PhD studentship offers opportunity to research their experiences, explicitly seeking to understand the service needs and outcomes for this group of older adults and to explore how they interact with social networks and environments.

The project works with an established supervisory team and a range of experienced clinical advisors to ensure that the realities of clinical practice and support post-discharge can be reflected in the study.

There is opportunity for the successful applicant to shape the project’s design. The research is conceptualized as a mixed methods project with significant qualitative components and opportunity to explore the use of creative and inclusive research approaches. Data-driven elements and social network analysis could be included to explore the needs of this complex population.

Find out more, here.

People experiencing persistent delirium are likely to be affected by hospital associated deconditioning during an admission (Guilcher 2021). 68% of patients may be discharged from hospital with abilities below their pre-admission functional level (Gill et al 2009). Older people who experience deconditioning are at greater risk of poor health outcomes while mortality rates may be reduced by enhanced ward-based interventions (Smith 2020).

This studentship offers an opportunity to work with an established supervisory team and experienced clinical advisors to address the challenge of deconditioning in older people who have delirium during hospital admission. There is opportunity to use hospital records data to articulate the nature of the population who experience persistent delirium in hospital and to explicitly explore their pre-morbid functioning and impacts of deconditioning. From this starting point, the studentship will engage with initiatives such as ‘Therapy Activity Champions’ and evaluate local interventions to address deconditioning, working with clinical advisors to facilitate real world impact.

There is opportunity for the successful applicant to shape the project’s design. The research is conceptualized as a mixed methods project with significant data driven work to articulate the target population and potential to use qualitative approaches to the evaluation components of the study.

Find out more, here.