An Introduction A Cross-Faculty Centre at the University of Greenwich THE CENTRE FOR POSITIVE AGEING.

An Introduction

A Cross-Faculty Centre at the University of Greenwich

THE CENTRE FOR POSITIVE AGEING

Contents

1

•Defining Positive Ageing – A University of Greenwich Perspective

•The Centre for Positive Ageing - Research Clusters and Scope of Activities

Introduction and Overview of Research Clusters: Pages 2-3

Details of Individual Research Clusters: Pages 4-16•Pain Management .............................................................................................................. Page 4

•Dementia ........................................................................................................................... Page 5

•Sexual Wellbeing ................................................................................................................ Page 6

•Cognitive Ageing ................................................................................................................ Page 7

•Falls and Gait ..................................................................................................................... Page 8

•Digital Technologies and Ageing ......................................................................................... Page 9

•Ageing and Cancer ............................................................................................................. Page 10

•Environment, Housing, Health and Social Care .................................................................... Page 11

•Long-term Conditions ........................................................................................................ Page 12

•Daily Life, Ageing and Life Course ....................................................................................... Page 13

•Organisation of Care Delivery ............................................................................................. Page 14

•Epidemiology of Ageing ...................................................................................................... Page 15

•Physical Activity and Healthy Eating .................................................................................... Page 16

IntroductionDemographic change is one of the most fundamental forms of change that any society faces. And, as most of us are aware, the number of older persons in relation to the overall population is increasing rapidly, particularly in the western world. Over the next 25 years in Britain alone, the number of people aged 65 and older in Britain is expected to grow from 9.5 million to 15 million.

An ageing population, facilitated mainly by better healthcare and healthier lifestyles, is of course something to be celebrated, but it is also an emerging phenomenon that brings with it a range of challenges for the whole of our society. The scope of

these challenges is immense, and their solutions will require focus of purpose and the effective deployment of a wide set of capabilities covering science, technology, economics and policy.

To meet these challenges, the University of Greenwich has established the cross-faculty virtual Centre for Positive Ageing, and one that draws upon relevant research and professional services from across the University. Whilst it also draws upon external networks and links with affiliates and associates locally, nationally and internationally.

Ageing and Healthy Behaviours

Understanding the impact of and supporting (or

preventing) the engagement in a wide range of activities to promote physical and mental

health

Ageing with Long-Term Conditions

Developing support strategies for older adults with a range

of specific, long-term conditions such as chronic pain, falls, and dementia

Ageing Support Infrastructures

Developing support facilities for older adults including services, care homes, and

family / community support networks

Social/Cultural Factors and Ageing

Understanding the importance and impact of social/cultural factors on

older adults and their communities

Policy Development for Ageing

The full understanding and definition of objectives and

outcomes to develop policies in order to support

positive ageing.

‘Positive Ageing’ - denotes the aspirations of individuals and communities to plan for, approach and live life's changes and challenges as they age and approach the end of their lives, in a productive, active and fulfilling manner. The focus embraces the idea of making the most of opportunities, innovations and research which promote a person's sense of independence, dignity, well being, good health and enable their participation in society. 

Defining Positive Ageing – A University of Greenwich PerspectiveThere are many terms that are used for ageing-related initiatives including ‘active ageing’, ‘healthy ageing’ to name but two. The University of Greenwich perspective seeks to emphasise that the process of ageing is not necessarily associated with either activity or good health, but that ‘positive’ steps may be taken to make the best of any scenario.

To reflect this belief, the Centre for Positive Ageing at the University of Greenwich suggests the following definition to cover all five of the ‘key focus areas for positive ageing’ shown below.

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The Centre for Positive Ageing - Research Clusters and Scope of ActivitiesThe Cross-Faculty Centre for Positive Ageing at the University of Greenwich brings together at least 13 research clusters from right across the University. Indeed, individual researchers often work collaboratively across clusters.

From a broader perspective, the scope of the activities undertaken by the clusters is aligned with all five of the key focus areas for positive ageing, as shown below.

Our expertise goes beyond the development of

support strategies for specific long-term conditions and healthy behaviours. Indeed, our collaborative teams can also offer expertise on infrastructural support for older adults; a deep understanding of relevant cultural factors; and the experience and insight necessary for establishing workable and far-reaching policies.

Policy Development fo

r Ageing Ageing and Healthy Behaviours

Agei

ng w

ith Lo

ng-T

erm

Con

ditio

ns

Ageing Support Infrastructures

Social/Cultural Factors and Ageing

Daily Life, Ageing and Life Course

Epidemiologyof Ageing

Cognitive Ageing Sexual Wellbeing

Ageing and Cancer Falls and Gait Pain Management

Organisation of Care Delivery

Digital Technologiesand Ageing Dementia

Physical Activity and Healthy Eating

Environment, Housing, Health and Social Care

Self Management of Long-Term Conditions

3

Pain Management Cluster in ActionThe EOPIC study: Engaging with older people in the design and delivery of chronic pain self-management

The aim of this research has been to achieve a deep understanding of the consequences of ageing with chronic pain and to develop ways to give older people the knowledge, skills and confidence to live independently at home with self-managed pain.

Professor Schofield, the lead researcher, won a prestigious MRC grant before she came to the University of Greenwich in 2012, to address the lack of adequate support to ensure good pain management.

The Universities of Greenwich and Teesside have focussed on self-management strategies for older adults and have gone on to develop self-help tools based on their own recommendations, including that the tools should be accessible in printed leaflet format rather than online. They also recommended better information about drugs, and the role of exercise and relaxation in pain management. This project has also involved focus groups with service users and health care practitioners to evaluate the new materials.

EEG and Pain Management

Chronic pain has been reliably associated with activation in specific areas of the brain. Preliminary research supports the possibility that biofeedback technology can help measure (via EEG) and regulate brain activity in order to manage chronic pain. In conjunction with several international collaborators, Trevor Thompson is currently exploring the therapeutic efficacy of EEG-biofeedback relative to other interventions to assess its potential for pain management.

Guidelines and app for the assessment of pain in older adults

The British Pain Society and British Geriatric Society jointly funded the University of Greenwich in 2012 to develop the pain assessment guidelines mentioned above into an iPhone/Android pain assessment ‘app’ as a tool for health professionals.

Dementia Education and Technology

With the overall aim of improving quality of life in older adults in care homes, Dr. Rachel Docking is currently exploring the use of educational videos and simulation training tools in order to help carers with the diagnosis of dementia in those people who experience chronic pain.

In collaboration with the Department of Computing and Mathematical Sciences, video simulations (involving real dementia families) will help carers to identify pain characteristics (predominantly behavioural) in people with dementia. This will facilitate a significant improvement in the assessment and management of pain for dementia sufferers.

Pain Management The Pain Management Cluster consists of staff from a range of backgrounds including; nursing, psychology, epidemiology and physiotherapy.

Led by Dr Trevor Thompson, the group is currently involved in a number of programmes and projects specifically related to chronic pain and older adults including adults with dementia.

Pat Schofield is also a key member of this cluster and was one of the key researchers and authors of the national guidelines: ‘The Assessment of Pain in Older People’, in 2007.

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Dementia Cluster in ActionDementia Challenge Project

A study to evaluate the impact of the Prime Minister’s Dementia Challenge (2012) on dementia care across 4 NHS Trusts. This study is looking at implementation of the buddy scheme, the butterfly scheme, dementia friendly environments and dementia training and the impact these things may have upon the care of adults with dementia.

End of Life Care for People with Dementia

Developing a study to explore the provision of end of life care focussing on place of care and potentially avoiding hospital admissions. Most people with dementia end their lives in acute hospitals which is not ideal. This study is designed to investigate place of death and develop a care pathway for all adults with dementia.

Dementia Carer Website

An online resource specifically for family carers and healthcare providers for people with dementia, with the aim to provide support, toolkits and discussion forums to improve pain assessment and management.

Pain in Dementia: the Attitudes and Experiences of Caregivers

A study exploring caregivers’ attitudes towards dementia, and assessing and managing pain in people with dementia.

Exploration of the occurrence and impact of a community hospital stay for people with

dementia

A case study of three community hospitals to explore their use for people with dementia and the impact on them, their families and the hospital staff.

Pain Education and Dementia in Acute Care

A recently completed study was designed to evaluate the impact of an e-learning, pain education package provided to staff, students and carers working in an acute NHS Trust, who come into contact with patients with dementia. It was funded by the South London Health Innovation and Education Cluster (HIEC).

This pilot research project measured changes in the knowledge, skills and attitudes of staff who provide assessment and intervention for people living with dementia and pain. Preliminary results suggest that there is a lack of knowledge, with staff often assuming that people with dementia do not feel pain in the same way as those without dementia. Feedback from participants shows improved levels of knowledge, recognition of the need to improve skills, and enthusiasm for further training in the management of pain.

Dementia: Improving quality of life and end of life for those affected by dementiaThe Dementia Cluster led by Dr Jo Brooke consists of a range of staff currently involved in a number of studies and developing further studies related to dementia, with a focus on diagnosing and assessing

pain, a dementia care pathway and end of life care for people with dementia.

Phase 1 Phase 2 Phase 3 Phase 4 Phase 5 Phase 6

Recognising there is a problem

Discovering that the condition is

DementiaLiving Well with

DementiaGetting the right help at the right

time

Nearing the end of life including care in the last

days of lifeCare after death

Discussions about end of life care

Coordination, monitoring and reviewing care support

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Sexual Wellbeing Cluster in Action

Theme 1: Ageing and Sexual Health Morbidities

Here we will look at the how common conditions associated with ageing interact with sexual functioning and sexual health generally. There are countless research questions we could raise under this theme, a few of which are listed here.

Dementia and Sexuality:

How is dementia amongst sexual minorities (such as Lesbian, Gay or Transgender people) treated and managed?

What impact does dementia have on sexual and intimate lives for those living with dementia and their partners/loved ones?

How can those living with dementia be enabled to have a fulfilling sexual and intimate life?

Cancers and Sexuality

What are the impacts of certain cancers (such as prostate cancer) on sexual functioning and intimate life?

HIV

As many people with HIV can expect a normal life expectancy and as the population of people with HIV ages, what are the impacts of living long-term with HIV on sexual and intimate life?

How do the morbidities of ageing interact with HIV to affect quality of life and prognosis?

How can older people with HIV be enabled to have a fulfilling sexual and intimate life?

Theme 2: Sexual and Intimate Lives of Older People

This theme will focus on the ways in which older people are crafting diverse sexualities and ways of living together as a response to demographic, economic, social and cultural change. This is an enormous area and some research questions are listed below:

What are the experiences of the growing and ageing population of ‘solo livers’: people who actively choose to live alone in adulthood and old age?

What are the non-heterosexual, non-normative ways of organising households, intimate and sexual life for groups like older LGBT people?

How are the ‘post-pill’, ‘post sexual liberation’ ‘post divorce’ generation living older sexual and intimate lives?

Sexual WellbeingThe University of Greenwich has an excellent reputation in research and practice in the area of sexual health and sexualities.

Our Sexual Health Research & Practice Group carries out applied and community-based research on many aspects of sexual health including living with HIV and life-course issues.

Led by Dr Peter Keogh, the group brings together

professionals with expertise in sociology, applied social sciences, health care research and nursing studies. The Sexual Health & Intimacy research cluster will undertake research on all aspects of the sexual and intimate lives of older adults under two thematic areas: Ageing and sexual health morbidities and Sexual and intimate lives of older people.

Decreased Sexual

Functioning

Dementia, Sexualities and

Intimacy

Pain and Sexual

Functioning

Cancers

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Cognitive Ageing Cluster in Action

Researchers in the Cognitive Ageing Cluster are involved in several research projects. Two are featured here:

Spotlight on Driving in Older Adulthood:

Mobility for older adults, and in particular the ability to drive, is crucial for maintaining an independent life and for continuing to work later in life. The number of older drivers is predicted to double in the next 20 years (IAM, 2010), which prompts a need to ensure older driver safety on the roads. Better understanding of perceptual and cognitive processes associated with safe navigation within a traffic environment can inform practice and policy designed to ameliorate any age-related decline in performance, and ultimately aims to improve the safety of older drivers on the road.

Spotlight on Memory for Faces

Face recognition ability peaks at 35 and decreases linearly with ageing in most people. Face identification in the context of memory loss also decreases (e.g. checking identity cards). A sudden decline in both skills provides an early warning of dementia – associated with temporal lobe atrophy. These factors may impact on social functioning as well as on susceptibility to becoming a victim of crime. Future methods include longitudinally testing those at most risk of dementia for face recognition skills in combination with EEG and investigating technologies that might provide more reliable proof of identity.

Cognitive AgeingThe Cognitive Ageing Cluster consists of staff with backgrounds in psychological and cognitive science from the Faculty of Engineering & Science and the Faculty of Education & Health.

This cluster is lead by Professor Paul Ward, and includes Drs Damian Poulter, Trevor Thompson, and Josh Davis.

The primary goals of this group are to understand

changes in thinking processes in older adulthood, how these changes affect everyday behaviour, and how this data can be used to mitigate cognitive skill decay. The purpose is help older adults to continue to contribute to society and live productive lives.

Cluster Focus1. To detail the extent and rate of perceptual, cognitive and neurological decline with ageing via the use of cognitive process-tracing methods and measures of performance. 2. To detail the impact of cognitive decline and skill decay on everyday life.3. To leverage this information to develop and design instructional strategies (or to generate recommendations for the design of human-centred technologies) that can help older adults maintain current cognitive skills, and reduce the rate of cognitive skill decay.  

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Falls and Gait Cluster in Action

Ongoing research of the group has established that chronic global pain and specifically foot pain were strongly associated with falls. These findings are already informing clinicians in their assessment of patients and allow for better evaluation of preventive measures and treatments.

The group is also focussing on developing a UK national registry on falls. The objective is to establish a database for research studies on falls occurrence and sequelea. The database will contain information about occurrence of injurious falls requiring medical intervention, healthcare utilisation and treatment following falls, and course of recovery and falls recurrence.

Another aspect of research is to further our understanding of the relationship between pain,

anticipatory postural adjustments and falls during the ageing process. The group has a particular interest in studying how lower body musculoskeletal pain affects gait initiation in old age. The aim is to study patterns of gait initiation that may have a negative impact on the efficiency of gait and may constitute predictors for falls. Functional gait analysis is also a related topic of research and particularly investigates cognitive dual-task costs on gait efficiency and falls. The knowledge gained will be crucial in finding ways to improve gait adaptability and dynamic stability to prevent falls, and also in planning and monitoring interventions.

Falls and Gait: A multidisciplinary approach to falls prevention and gait evaluation during ageing

The Falls and Gait cluster consists of staff from a range of disciplines, including nursing, physiotherapy, psychology and sports science.

This multidisciplinary group promotes the study of the complex interaction between physiological, psychological and biomechanical factors to account for falls and decline in postural stability and the efficiency of gait during the ageing process.

The group is involved in a number of projects related

to pain and risks of falls in older adults, falls and dementia, and pain, ageing and gait initiation.

This cluster brings together the following staff: Dr Sandhiran Patchay, Professor Pat Schofield, Professor Paul Ward, Dr Rachael Docking, Professor Suzanne Leveille, Mark Goss-Sampson and Brendon Stubbs.

31% Accident/Environment

17% Gait/Balance Disorder

15% Other Specified

13% Dizziness/Vertigo

10% Drop Attack

5% Unknown

4% Confusion

3% Visual Problem

3% Postural Hypertension

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Digital Technologies and Ageing Cluster in Action

Social Bookmarking

This project considered the use of social bookmarking as a means to support collaborative learning and sharing of resources. It involved over 160 participants across three Schools, including Health and Social Care, who were encouraged to integrate social bookmarking into their learning and teaching.

Participants were instructed to tag their resources with an appropriate module code tag so that a repository of module specific bookmarks was created. Over a 4 month period, 153 users created 1430 bookmarks with 5032 tags. Many of the participants are involved in nursing care of older people in a variety of settings, and saw this approach as valuable to their own practice, but also saw potential benefits for their clients in using social bookmarking.

Maritime City

The aim of this research project is to develop a unique and innovative inter-professional assessment support tool, to facilitate student discussion of risk factors and decision making, relative to defined scenarios relating to complex, social and family situations. The tool has been developed as a joint exercise by staff from the School of Health & Social Care, and the School of

Computing & Mathematical Sciences (CMS), and supported by a number of games students from CMS. The project has been trialled with social work students and presented at workshop to a range of Health and Social work professionals from a range of external organisations across the country. Response to this has been very positive and the project has been formally evaluated with a view to rolling out as a product. Initial scenarios have focused on childcare, based on the “Baby P” case, but the team is now working on a scenario focused on dementia sufferers and carers.

Pandora

The Pandora project was a multi-partner EU project that developed an Advanced Training Environment for Crisis Management, based on Augmented Reality and Games technologies. The Pandora environment is now being developed as a commercial tool to support training in a variety of situations. A project is currently being developed to use the Pandora environment for an approach to train care workers, working with older persons in residential care homes, to recognise and deal appropriately with pain issues for dementia sufferers.

Digital Technologies and Ageing: Exploiting digital technologies to age positively The Digital Technologies Cluster consists of staff from the computing and digital media disciplines, linking and working with staff from many other disciplines across the University, in multi-disciplinary teams.

Led by Professor Liz Bacon and Professor Lachlan

MacKinnon, the teams are currently involved in a number of projects training staff working with older people, and developing assistive applications that can be applied in such work.

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Ageing and Cancer Cluster in Action

The OMGIANT trial is a prospective multi-centric study of the prevalence of vulnerability (assessed through comprehensive geriatric assessment or CGA) in elderly head and neck cancer patients undergoing curative radio(chemo)therapy. The study validated G-8 as the optimal screening tool to identify patients in need of a full CGA. The latter enables identification of multidimensional health problems at presentation, and their evolution during therapy. Moreover, CGA results correlate with quality of life during and after treatment.

Cognitive problems influence the abilities to understand risks and benefits of cancer therapy, to comply with treatment plan and to recognize the symptoms of toxicity that need attention. Therefore, cognitive assessment is a standard part of a CGA. The PROACTIVE trial aims to validate the user-friendly Freund Clock Drawing Test, with its predefined cut-off score of ≤ 4, against the time-consuming Folstein Mini Mental State Examination as gold standard, as a preferred screening tool for cognitive dysfunction within the CGA.

Figure 1: Examples of the Clock Drawing Test

Cognitive impairment associated with chemotherapy is an important side-effect among

cancer survivors. As some patients report cognitive complaints before start of therapy, an association with psychological risk factors such as distress and worry has been suggested. Distress is a multi-factorial unpleasant emotional experience of a psychological (cognitive, behavioral and emotional), social and/or spiritual nature that may interfere with the ability to cope with cancer and its symptoms and treatment. The CONCEPT trial aims to determine if the Distress Thermometer could predict cancer-related cognitive impairment already before the start of treatment.

Cancer cachexia is a metabolic process affecting up to 80% of advanced-stage cancer patients. Moreover, 20 to 40% of all cancer deaths are caused directly by cachexia. Head and neck (H&N) cancer patients are especially vulnerable since tumour localisation can interfere with food intake, since alcohol and tobacco abuse – two etiological risk factors of H&N cancer – are associated with nutritional deficits, and since the intensive treatment leads to progressive weight loss. The double-blind, placebo-controlled randomised NUTRIOM trial evaluates if omega-3 fatty acid supplementation can prevent weight loss in H&N cancer patients undergoing curative radiotherapy. In addition, we would like to identify potential risk factors, biomarkers and objective measurement tools which can predict therapy-induced cachexia .

Ageing and CancerThe Ageing & Cancer Cluster (led by Dr. Philip Debruyne) is a joint collaboration of the University of Greenwich with researchers based at the General Hospital Groeninge in Kortrijk (Belgium).

The cluster is involved in a number of clinical trials funded by the Belgian National Cancer Plan related to management of elderly cancer patients and patients suffering from head & neck cancer. Older

cancer patients are at increased risk of health deterioration during treatment. Accurately identifying fit, vulnerable and frail patients is a critical step to guide individualized treatment and improve quality of life.

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Environment, Housing, Health and Social Care Cluster in Action

This cluster seeks to develop research in respect of the effect and relationship of the living environment and dementia and has two foci: ageing in place in private sector housing (with a policy emphasis favouring ‘personal responsibility’); and enhancing health and wellbeing in purpose built dementia friendly care homes, largely in the social housing sector. Here our purpose is concerned also with equity of dementia services across housing sectors and drawing from research and good practice to help promote health and wellbeing.

As people ‘age in place’ it is likely that their housing conditions will be deteriorating around them and that maintenance and repair will become neglected, although equity release schemes are available. The house may be large and expensive to run, leading to relatively high bills (such as fuel costs) and the owner both lonely and isolated from their community. The house design and layout may become increasingly inappropriate and unsafe for someone with dementia, for example there may be greater risk of home accident, in particular falls, fire or safety issues such as leaving the gas on, an increased inability to recognise where rooms are, or their purpose, with potential exported costs to other services.

There is also the personal side, such as the

sudden loss of a partner and carer, whether or not the person with dementia is already known to the authorities and/or Lasting Powers of Attorney are in place if necessary, and what packages of assistance are available locally ranging from meeting basic needs to helping enhance quality of life. There is a need to balance needs with wants, choice and voice which will change with declining mental capacity. Some elements can be factored in to help reduce risk, including assistive technologies. However support can feel ‘bolt on’ and not ‘built in’.

Our cluster is also keen to develop its research interests to the wider social and environmental determinants of health for those with dementia, for example access to decent food and opportunities for exercise as well as more general activities to help reduce loneliness and isolation. We are keen to support the development of more effective partnership working to help make existing housing stock increasingly ‘fit for purpose’ as well as enhancing wellbeing and quality of life (factoring in lifestyle issues including diet and exercise and well as cultural activities help with memory and recall) for those remaining in their own homes with dementia.

Environment, Housing, Health and Social CareAs a key social determinant of health, the living environment requires maintenance and adaptation to meet changing health, safety and wellbeing needs as our population ages.

The Environment, Housing, Health and Social Care Cluster consists of staff from a range of backgrounds including environmental health, housing, fire safety in building design, psychology and physiotherapy.

Led by Dr Jill Stewart, the group is currently

consolidating their areas of work around ageing in place in physical housing and meeting the changing needs of residents with dementia.

Dr. Stewart is supported by Dr Rachel Crockett, Brendon Stubbs, Dr Oliver Robinson and Professor Edwin Galea.

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Self-Management of Long-term Conditions Cluster in Action

Engaging with Older People and their Carers to Develop and Deliver Interventions for the Self-Management of Chronic Pain (EOPIC)

The aim of the programme is to take a multi-disciplinary approach which emphasises the interconnections between chronic pain, physical and emotional functioning, material resources and social aspects of everyday lives of older adults, as played out in their particular social context and linked to their earlier biographies

Access and Use of Health Information by People Living with Type 2 Diabetes

This is a study exploring how people living with Type 2 Diabetes access and use health information when self-managing their condition.

Identifying Pain in People with Diabetic Neuropathy

A qualitative study exploring how people living with Type 2 Diabetes describe and interpret pain associated with diabetic neuropathy to assist healthcare professionals in diagnosing the condition and raise patient awareness of the signs and symptoms of diabetic neuropathy.

Research interests of cluster staff

Dr Jo Brooke – a nurse consultant in dementia and psychologist, interested in developing work on the management of stroke in community services and including.

Val Chandler – is a Research Fellow, interested in the link between Alzheimer’s and Diabetes, as

well as the role of obesity as a precursor to long term illness.

Dr Rachael Docking – is an epidemiologist, interested in dementia and pain, particularly how accurately pain can be assessed in those with dementia and within end of life care.

Dr Rona Dury – Rona is a Senior Lecturer in Primary Care - with a specific interest in long term condition management, in particular respiratory care management from the patient and health care professional‘s perspective. Her most recent publication has focussed on medication non-compliance in the older patient.

Dr Paul Newton – is a Research Fellow and medical sociologist interested in all aspects of how long term conditions are managed on a day-to-day basis, in particular patients’ experiences of self-management and healthcare professionals’ perspectives of, and approaches to, managing long term conditions. His most recent work has focussed on Type 2 Diabetes.

Professor David Thompsom – David Thompson is a Professor of Nursing interested in the management (particularly rehabilitation and secondary prevention) of people with cardiovascular disease, including patients’ (and their families) experiences of self-management and healthcare professionals approaches to the organisation and delivery of services to manage this condition.

Long-term Conditions: Research to improve patients’ experiences of living with long-term illness

The Long Term Condition Cluster led by Dr Paul Newton comprises of a range of staff currently involved in research, teaching and practice relating to long term conditions. The cluster looks at various long term conditions e.g. Diabetes, COPD, stroke, sight and vision disorders, neurodegenerative diseases; chronic pain; coronary heart disease, multiple sclerosis and cancer, to name but a few.

We are currently researching all aspects of ageing

and long term conditions including patient self-management and clinical approaches to the management of long term conditions. A key aim of the cluster is to ensure patient perspectives enhance the support available for self-management and are used to improve healthcare delivery, and that research underpins and informs all aspects of current education/training in long term conditions.

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Daily Life, Ageing and Life Course Cluster in Action

The Learning Alliance Methodology: Contributions and Challenges for Health Service Provision in Kent, UK.

During 2009-2011 a LA project was implemented in the south of England. The LA methodology in this particular case was related to planning health service provision that targeted different racial and ethnic groups living in the area. Other members have worked on a South East Coastal Communities project to explore the health needs of Gypsies and Travellers in Kent and train community members as health outreach workers, part of an EU project that examined the relationship between pension reforms, financial planning and pensioner poverty.

Pain Narratives in BME Communities

Against a background of pain and its interplay with body-mind, language and culture, this research project aims to capture the pain narratives of a group of individuals from three cultural backgrounds (South Asian, Afro-Caribbean and Chinese people) as well as health professionals (nurses, general practitioners and social workers) in order to identify in their narratives the language used to describe their pain experiences, pain diagnoses and management.

The Learning Alliance Methodology, Palliative Care and End of Life Practices in BME

Communities

Using the LA approach and taking into account the ageing and demographic trends related to BME communities in the UK (specifically in mid- and north- Kent), a current research proposal seeks to implement a one-year feasibility study. This will explore the main health needs felt by BME communities in Kent with the purpose of discovering the palliative health needs of those communities in order to better understand the end of life practices of different minority groups. This knowledge base will build the capacity and capability required within primary community services, ensuring that palliative services are tailored towards the needs of an increasingly diverse ageing population. The need to adapt services to newly emerging demographic trends of various ageing populations in terms of ethnicity, gender, sexual orientation, religion and disability is becoming an increasingly compulsory issue as recognised by The End–of- Life Care Strategy (2008). This feasibility study, starting with BME issues, expects to address in the long term, all the remaining intersectional issues (socioeconomic class, gender, sexual orientation, religion, disability) that impact on the capacity to age positively.

Daily Life, Ageing and Life CourseThis cluster consists of an interdisciplinary team with backgrounds in health and social sciences, including nursing, sociology, anthropology, psychology and social work. In the past, members in this cluster have carried out research on the health needs of Black and Minority Ethnic (BME) groups, pension reform and the financial aspects of ageing.

In particular a methodology that has been used to make research more innovative and interesting is that of Learning Alliances (LA). Rooted in the action research approaches, LA allows for links and connections among multi-stakeholder networks

(practitioners, researchers, policy-makers, activists) at different institutional levels (local, national, and international).

The LA approach is an innovative methodology that is being developed to address cross-cutting issues related to older people (i.e. chronic pain, end of life practices and palliative care, particularly in minorities) and daily life course issues (i.e. pension planning/provision) in the UK.

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Organisation of Care Delivery Cluster in Action

Social Enterprise in Health

In 2010 a Department of Health white paper claimed that National Health Service would become the largest social enterprise sector in the world. Although this prediction is yet to be witnessed, the three-fold increase in social enterprise healthcare start-ups in the period 2012-2013 suggests a promising future (Social Enterprise UK, 2013).

The aim of this health service research is to explore how social enterprises operate in the new health and social care system. It focuses on how social enterprises may provide better person-focused integrated care for older people, and to evaluate services used by this patient group.

Social Networks in Health

Network forms of organisations are becoming increasingly important in health care. Policy recommendations suggest that networks can promote communication, collaboration and co-ordination, concepts that are particularly relevant to the care of older adults who may have complex needs that are met by a range of different services. Social network analysis can also be used to study familial relationships and networks of support in the community.

Quality Improvement

A recent study has shown that when nursing staff are given feedback from patients who have recently been treated on their ward in face-to-face facilitated meetings, standards of care do improve over time. The challenge is now to find ways of gathering feedback from older patients including those with communication difficulties to incorporate into quality improvement initiatives in a range of settings.

Organisation of Care DeliveryThe Organisation of Care Delivery Cluster consists of staff from a range of backgrounds including nursing, paramedicine, research and enterprise. Led by Professor Liz West, the group are currently involved in research in Social Enterprise, Social Networks, Workforce Issues and Quality Improvement. Cluster members include:

Liz West: Liz is a Research Professor at the University of Greenwich. She has investigated how the number of nurses and the number of doctors affect patient mortality in Intensive Care Units and would like to investigate how staffing levels affect the quality of life of older patients and care home residents. She is also interested in the functioning of multi-disciplinary teams and how professional and inter-organisational networks of organisations can promote co-ordinated care.

Matt  Lane: Matt is a Senior Lecturer in Emergency Care at the University of Greenwich and a Paramedic with the London Ambulance Service NHS Trust. Matt will be using his previous experience in the clinical

and business sector to research the role of social enterprise in healthcare.

James  Lambert:  James is a Business Development Manager at the University of Greenwich. He has produced research on the services delivered by London’s voluntary sector and has experience of delivering public sector contracts in both the voluntary and private sectors.

Rachel Reeves: Rachel is a Principal Research Fellow at the University of Greenwich. She has a background in nursing and psychology and has been involved in the development and implementation of the National Patient Survey Programme. Her current research focuses on how patient feedback can be used more effectively to improve the quality of care.

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Epidemiology of Ageing Cluster in Action

English Longitudinal Study of Ageing

The English Longitudinal Study of Ageing (ELSA) collects data concerning such issues as health, employment and financial status, access to support services and participation in wider society amongst others. Participants are recruited from a representative sample of the population aged 50 and older. Funding is currently providing for data collection to take place over 12 years. The research team is engaged in examining this data base considering the link between drinking, pain and quality of life and drinking and whether their are differences in elderly wine, spirits and beer drinkers.

MOBILIZE Boston Study

The MOBILIZE Boston Study is an ongoing population-based study of novel risk factors for falls in older adults in Boston and surrounding towns. The 765 participants aged 70 and older were recruited from 2005-2008 in a door-to-door effort in Boston and 5 surrounding towns. To join the study, eligible elders were able to walk short distances without help from others, were planning to stay in the area for at least 2 years, and were free from terminal illness and moderate to severe cognitive impairment. The study data includes information about established fall risk factors in addition to extensive pain assessment, cognitive and physical performance information, and environmental assessment. Currently, a third follow-up assessment of the cohort is underway, funded by the National Institute on Aging. Falls data are collected monthly using falls calendar postcards.

Elizabeth West has been involved in the analysis of several large existing datasets, particularly the British Household Panel Survey, which has been used to answer questions such as, why nurses leave the nursing profession, whether people

working in caring occupations experience more stress than people in other kinds of jobs and whether the wages of caring workers are higher or lower than the financial rewards associated with other jobs. She has also recently been involved in a study of the reciprocal association of depression and smoking which used the ELSA dataset. The programme of work using the National Inpatient Survey of Acute Trusts in the NHS forms an important component of her current work.

Rachael Docking has previously worked on the Cambridge City over-75s Cohort study which is a long-term follow-up study of a representative population-based sample of older people which started in 1985 from a survey of over 2,600 men and women aged 75 and above. Rachael took advantage of this study for her PhD research completing primary analysis to examine the epidemiology of back pain in older adults, specifically the prevalence and onset of disabling and non-disabling back pain, and the risk factors for back pain onset in this population. Her research focused on social/psychosocial risk factors, namely depression and loneliness /isolation. The results from this added to the limited literature around the epidemiology of pain in older adults and identified that future work into interventions for pain within this group should focus on psychosocial interventions directed towards depression and social difficulties. Rachael is interested in further developing epidemiological studies to examine specific pain management methods which could be applicable for older adults, including those with dementia/cognitive impairment.

Epidemiology of AgeingEpidemiologists conduct research on large groups of people in order to better understand the occurrence and causes of health problems at the population level. Scientists at the University of Greenwich are involved in a number of large longitudinal studies that are ongoing in the UK and US. These studies provide exceptional data resources for the academic

research community. This cluster brings together the work of Dr John Foster, Professor Liz West, Professor Suzanne Leveille, and Dr Rachael Docking

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Physical Activity and Healthy Eating Cluster in Action

The importance of physical activity and healthy eating in promoting health and preventing disease has been recognised by healthcare practitioners, researchers and policy makers in recent years. This has contributed to public health initiatives such as the “Change 4 Life” campaign and the introduction of health trainers. However the focus of these campaigns is often on younger people, particularly children and families.

Similarly, research on the development and evaluation of such interventions tends to centre on the effects in younger people and general population samples. Where there is research into interventions to promote physical activity and healthy eating in older people, the interventions are targeted to participants already experiencing age-related conditions such as dementia, falls and impaired mobility. The impact of interventions to promote healthy behaviours to increase well-being and prevent disease is less well researched in older people.

Drawing on the expertise represented in the cluster, a variety of research methods will be used to address these aims including:• Systematic review and meta-analysis of existing

research;• Qualitative interviews and questionnaire based

studies of older people’s experiences of physical activity and healthy eating;

• Randomised controlled studies of the effects of interventions to promote physical activity and healthy eating in older people.

Increasing our understanding of how healthy behaviours such as physical activity and healthy eating can be encouraged and supported in older people may contribute to increased health and well-being in this group and thus to positive aging.

Cluster Staff

Rachel Crockett is a Senior Research Fellow and registered Health Psychologist with a particular interest in evaluating interventions to support healthy behaviours.Paul Newton is a Research Fellow and Medical Sociologist with interests in self management of long term conditions.Lucie Pollard is a nutrition expert with an interest in nutrition throughout the lifecycle and is currently Faculty Operating Officer for Education and Health.Morag Redfern is Head of Department for Adult Nursing and Paramedic Science. Her interest in physical activity and healthy eating is focused on application within healthcare related to improving outcomes for older adults.

Physical Activity and Healthy Eating: Researching health-related behaviours to promote wellbeing in older people

This cluster is concerned with promoting physical activity and healthy eating in older people. The cluster is led by Dr Rachel Crockett who is a registered Health Psychologist with a particular

interest in evaluating interventions to support healthy behaviours.

Cluster Aims1. To establish the relationship between uptake and maintenance of physical activity and healthy eating behaviours the promotion of good health and prevention of disease in older populations.2. To understand facilitators and barriers to physical activity and healthy eating in older people as a basis for developing interventions to support effectively these behaviours in older people.3. To evaluate the effectiveness of interventions to promote physical activity and consumption of healthy diets in older people.

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Our Advisory Group

• The Centre for Positive Ageing has an active and involved service user advisory group from a range of backgrounds and represent older adults and carers. They contribute to the activity of the centre in many ways including advice upon research development and activity, business planning and strategic vision. The members of the advisory board include; Ann Pascoe, Gordon Baker,, David Elks, Jean Span, Bridget Sojurner, Kathleen Merryck , Jean Gaffin and Mary Sinfeldt.

Our Affiliate MembersWe include members from around the globe who contribute to an collaborate on activities within the

centre. Our affiliate members include the followingDr Gareth Jones (Aberdeen) Dr John McBeth (Keele)Professor Tom Boterberg, Associate Professor of

Radiation Oncology and Consultant Radiation Oncologist, Ghent University (Hospital), Ghent, Belgium; Lies Pottel, PhD student (AZ Groeninge and Ghent University); Michelle Lycke, PhD student (AZ Groeninge and Ghent University); Lore Ketelaars , Chartered Geriatric Onco-Psychologist (AZ Groeninge); Mark Jenson (Seattle) Lance McCracken (KCL); Gisèle Pickering (France) Louise Tarrant (Bath); David Barron (Oxford); Val Chandler (Greenwich) Peter Molyneux (UK); Sue Adams (UK); Peter Archer (UK); Amanda Cheesley (UK) ; Dawne Garrett (UK) Sasha Scambler (UK)

Our Associate MembersWe have a number of staff from local NHS and Social care organisations who are involved in our activity

and they are our associate members.

PatronsWe have identified patrons who oversee the work that we do and they are:

Baroness Sally GreengrossMartin Green – Chair ECCA

Key Initial Contacts

Professor Pat Schofield – Lead Academic for the Centre for Positive AgeingE-mail: [email protected]: 020 8331 8885

James Lambert – Business Development Manager for the School of HealthE-mail: [email protected]: 020 8331 9552/9918

A Cross-Faculty Centre at the University of Greenwich

THE CENTRE FOR POSITIVE AGEING