Carol1-150x150Led by Professor Carol Brayne, Professor of Public Health at the University of Cambridge, this theme is built upon established collaborations between universities, commissioners and provider organisations and a record of  highly successful applied health research. The overall aim of this theme is to develop the evidence base that will support the efficient delivery of safe, timely and coordinated patient-centred services to the older population transitioning to the fourth age of life and at the end of life. Modern society has achieved improved health and extended lifespan which, in turn, has led to an ageing population and growing pressures on health and social care services to support older people with increasing physical and cognitive frailty, as well as to address the needs of those approaching the end of their lives. It is clear that the current configuration of services does not take into account how physical frailty, cognitive decline and end-of-life care needs, develop, nor the ways to optimise the individual’s and their families’ experiences during these final stages of life, without being unaffordable to society.

One challenge is to develop a better evidence base for a happier and healthier old age as well as to avoid unnecessary costs in the ‘third age’, and even larger economic, social and human costs that are associated with ineffective and potentially harmful interventions in the ‘fourth age’, which contribute to poor quality of life experience for patients, carers and families.

A second challenge is increasing the public recognition of the importance of dementia which has sparked recent policy initiatives to raise awareness of dementia across healthcare settings, including financial incentives to service providers for case-finding. The so-called fourth age of frailty is strongly associated with increased dementia and is frequently part of terminal decline leading up to death.

A third challenge is to provide good patient-centred end-of-life care which is increasingly recognised in public discourse, policy, commissioning and clinical practice. Building on our CLAHRC CP research and implementation work and the strong academic-service partnerships built over recent years, we will focus on addressing the challenges for patients, carers, clinicians and service providers of avoiding undesired admission, stopping interventions, sharing clinical data and providing bereavement support.