Investigating aspects of the frail elderly and their care in the context of a randomised controlled trial of geriatrician led acute home care
This DPhil research project will be part of an on-going multi-site RCT of geriatrician-led acute care in the home vs. inpatient admission http://gas.ndph.ox.ac.uk/~cgahahrct/index.html. The DPhil project could take one of two directions:
1) A focus on participants with cognitive impairment (currently 80% of the study population) to examine the relationship between cognitive impairment, dementia, functional decline and delirium (a single episode or persistent delirium) across the two settings. There is also an opportunity to examine the association of pre-existing factors, and the role of frailty, that might increase the risk of vulnerability to transient and persistent delirium. There is the potential to supplement the randomised data with a consecutive series of 500 patients, who were assessed on an acute medical take, and have detailed phenotyping that includes cognitive assessment and follow-up for readmission and mortality for two years.
Another aspect that could be assessed is the performance of the questionnaires (MOCA, IQCODE, CAM, Barthel and EQ-5D) used in the RCT, the role of information provided by an informant in the measure cognitive impairment and the possibility of reducing the number of items to reliably measure informant based cognitive impairment.
2) Alternatively the DPhil project could take a health system perspective by examining the impact of geriatrician-led acute care in the home on the local health systems of two or more contrasting sites that are recruiting to the trial. This might include examining variables that promote or hinder the adoption of these types of services, for example case mix, mental health issues, readiness of the health service, availability of other services, and the impact on cost.
Research Experience, Research Methods and Training
During this project the student will be based in the Clinical Trial Service Unit, and work with a small research team that is funded to examine models of care for frail older people, and the Cochrane Review Group Effective Practice and Organisation of Care (EPOC). The DPhil candidate will have the opportunity to work with Sarah Pendlebury on the cognitive impacts of acute cerebrovascular disease and systemic illness in the Centre for Prevention of Stroke and Dementia; and to visit Glasgow to work with Terry Quinn. The candidate would have the opportunity to visit the Institute of Cardiovascular and Medical Sciences, University of Glasgow to validate results of their work using datasets from other recently completed trials. TQ is co-ordinating editor of the Cochrane Dementia and Cognitive Improvement Group and there will be opportunities to work on Cochrane systematic reviews around delirium and cognitive decline.
In addition to Professor Shepperd, this project would be supervised by Dr Sarah Pendlebury of the Stroke Prevention Unit and the Oxford NIHR Biomedical Research Centre, Nuffield Department of Clinical Neurosciences, and Dr Terry Quinn of the Institute of Cardiovascular and Medical Sciences, University of Glasgow.
This project would suit a candidate with a clinical background, quantitative skills and an interest in this population.