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Business Health Matters

Business Health Matters is a collaboration between Active Lancashire and UCLan focussed on workplace health and enabling people to live healthier working lives. The project will see a training package developed that will provide people working in gyms and leisure centres with the skills to conduct health screenings.

This will allow a service to be delivered which provides health screenings within workplaces and then supports people to make positive lifestyle choices such as exercising more and looking after their mental health. The project is supported by wider partners including Lancashire Mind, the NW Coast Innovation Agency, the Chambers of Commerce and UK Active.

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Blackwood Neighbourhoods for Independent Living,

Blackwood Neighbourhoods for Independent Living, is led by innovative Scottish based housing and care provider, Blackwood Homes and Care, builds upon existing award winning work in developing the highly accessible Blackwood House and CleverCogs™ digital Care and support system.

Our aim now is to work with citizens and partners across three demonstrator neighbourhoods where we can bring together a menu of service and products which enable people to live independently, including new homes, a design guide to improve retro fit and adaptations of existing homes as well as future home design. Other aspects of the neighbourhood will include accessible outdoor spaces that will help people sustain physical activity, digital connectivity and infrastructure that allows interoperability, security, and ethical data control. Sustainable energy and transport will reduce peoples’ carbon footprint and reduce transport costs. The coaching and support offer helps people maintain their health and wellbeing.

We will explore new financial products and a value exchange model that encourage and rewards community participation.

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London Rebuilding Society’s Healthy Homes™, Healthy Lives will design fair and affordable, person-centred financial products providing new options and choices to homeowners 55 and over.  Around 1.6m older homeowners live in a ‘non-decent’ home.   They are frequently vulnerable living on low incomes with physical and mental health conditions exacerbated by the state of the home. They want to improve their lives but cannot access support and finance to do so.

 With this finance they will be able to unlock their asset wealth and transform their lives so that they can live in an age friendly, adaptable home, for longer independently, healthier, and happier.  They will be involved in designing their new home, including energy retrofit, access to renewables, smart technologies for energy monitoring and assistive technologies.

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Homes for Living 

Homes for Living is a collaboration between E.ON, Newcastle University, Invisible Creations® and ADL Smartcare to support people to age well so they can stay in their own homes for longer, helping retain their independence and stay connected with their families. It builds on the work of E.ON’s Warm Homes Fund, supplemented by products and services, like safe kitchens and bathrooms, that support active healthy ageing.

The project puts aspiration, dignity, safety and inclusivity at the heart of desirable and smart inter-generational homes. With social purpose at its heart, it will start by supporting the most vulnerable people, initially in the Midlands.

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Tribe Project

Led by Bronze Labs, the mission of the Tribe project, is to address national care inequality at the local level. It includes a digital platform that can both map and predict care ‘dark patches’ where home care provision is either failing or doesn’t currently exist. It will also upskill people in areas of low economic activity and high public service demand so they can create micro businesses, structured as community enterprises, to provide care.

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Evaluating and replicating local accountability platforms for residential care homes and social care services

More people aged over 70 live in developing countries than in developed countries and many of these people need social care. It is sometimes assumed that families in developing countries are more willing and able to offer this support, without recourse to the private sector. In fact, the evidence says otherwise. Over the past decade or so, there has been a very rapid expansion of private provision, including care homes, in many developing countries. Many of these care homes are subject to little, if any, regulation, and there is evidence that service quality is very uneven. Government capacity to enhance regulation is limited and the issue has remained a low policy priority (at least until the Covid-19 pandemic).

Following research in the Argentina city of La Plata, we worked with local organisations, including care home directors and a community group run by older people to develop an innovative, locally-owned project for improving information sharing and quality accountability. Launched in 2019, it consists of a simple, interactive information-sharing platform (http://www.redmayorlaplata.com/).

The site provides information about local care homes that have agreed to a published set of quality principles. It enables service users to provide feedback about providers. Complaints are investigated and providers removed from the site if they are confirmed. The site has other features, including general information for service users to support the selection and assessment of social care providers. By the end of 2019, the site was receiving over 12,000 hits a month and had received over 50 messages about service quality. These included examples of abuse, which were followed up and led to the exclusion of the providers in question.

We feel there may be benefits in extending this activity to other cities in Argentina and beyond. Before promoting this approach, we require more robust evidence about how it was developed, how well it is working, what effects it has had and how easily it may be replicated elsewhere. Part of the funds we are requesting are to support this evaluation.

The Covid-19 pandemic is hitting care homes in Latin America hard and there is growing interest in new ways to improve quality and accountability in the sector. Since we submitted the preliminary proposal, several organisations in Argentina and elsewhere have committed to developing new projects in different cities, based on our experience in La Plata. Part of the funds we are requesting will be to observe and conduct a light-touch review of these new extension activities in Argentina. We will use funds from a separate grant (already awarded) to support similar work in Brazil.

We will present the results of our analysis in a number of different formats, both for academic audiences and for other types of audiences in Latin America and beyond.

Development of an implantable, self-powered heart monitoring sensor for early detection and prevention of cardiovascular events

One of the most common issues associated with ageing is failing health and the development of chronic diseases, the management of which is an increasing challenge affecting both length and quality of life. Cardiovascular disease (CVD) is the most common health condition in an ageing population and the leading cause of death worldwide, accounting for 17.9 million deaths each year, 31% of all global deaths according to the World Health Organisation.

The majority of CVD can be preventable by reducing potential risk factors, such as high blood pressure, high levels of cholesterol, obesity, and physical inactivity. Therefore, real-time, continuous cardiac monitoring will be a critical tool in the prevention of death due to CVD through enabling early detection and diagnosis of risk factors of CVD including high blood pressure (hypertension, the leading risk factor for CVD). Implantable cardiac monitors benefit patients by enabling continuous and remote monitoring of heart function and allow clinicians to diagnose the risk factors earlier and quicker and initiate appropriate treatment of CVD. Most current commercially available cardiac monitors have limited lifespan around 3 years due to battery life.

Consequently, a patient will have to undergo surgery to replace the battery or the entire device at regular intervals. This surgery carries risks such as infection for patients and the high costs for the NHS. A self-powered implantable device that enables lifetime operation for use in at-risk patients will safely enable lifetime heart monitoring without the need for repeated surgeries. In the proposed project, our vision is to create an implantable, self-powered healthcare sensor that enables continuous monitoring of blood pressure from the heart contraction and relaxation.

A piezoelectric type transducer has been chosen for this application since it can generate an electrical output when subjected to a mechanical force, such as generated by the heart itself. The sensor will be located adjacent to the heart inside the chest cavity near left ventricle (lower left chamber of the heart) and monitor the blood pressure by measuring the contractile movement of the left ventricle. The piezoelectric sensor will also generate energy by converting the heart's mechanical movements to electrical energy, which will provide sufficient power to enable continuous monitoring.

The prototype will be tested using a heart phantom that can simulate the left ventricle expansion and compression. The additive manufacturing technologies will enable us to fabricate a piezoelectric sensor and a heart phantom for use in testing. Machine learning methods will be utilised to enable the device to 'learn' the individual heart function of a patient and differentiate between resting state, exercise, and abnormality.

In conclusion, the proposed project will have potential to promote health and well-being by early detection and management of CVD through real-time, continuous monitoring of heart function. It will be also beneficial for people who needs to continuously check their heart health at high risk working environment.

Dynamic muscle function monitoring in older adults: development of a novel wearable device to measure muscle function

As people age, walking often becomes more difficult. This reduces mobility which increases the risk of falls and fractures, which may lead to loss of independent living, social isolation, and increased risk of death. Reasons why walking worsens with age including changes in circulation, nerves, lung function, joints, and muscles. This project focuses on age-related changes in muscle.

A muscle disease known as sarcopenia is common in older adults, affecting 10% - 20% of adults over 65 years. Sarcopenia is characterized by muscle wasting and decreased muscle strength and function. Sarcopenia reduces mobility as the muscles are not strong enough to move the joints efficiently. Sarcopenia is also associated with many age-related chronic diseases and the immune system. Health care costs directly associated with muscle weakness and sarcopenia were estimated to be £2.5 billion in the UK in 2016. As the population ages, sarcopenia will affect a projected 18-32 million Europeans by 2045, an increase of 64% - 72% from 2016.

Assessing the health of the muscular system and developing appropriate interventions for sarcopenia is therefore essential for advancing healthy ageing, longevity, and quality of life. Currently there is no reliable non-invasive, low-cost method of measuring muscle health and diagnosing sarcopenia. Our multidisciplinary team propose to develop a novel wearable device (the 'MyoSock') that is low cost, non-invasive and easy to use.

The initial users of the device we will target will be researchers developing pharmaceutical and non-pharmaceutical interventions (e.g. exercises and nutrition). The researchers will benefit from this device by having an objective method of measuring muscle health and of monitoring effectiveness of treatments. The long term goal is to develop this device commercially for both clinical and nonclinical (general muscle activity monitoring) purposes comparable to smart watches such as fitbits or Apple iwatch measuring steps and pulse rate.

The study consists of three elements:

• an engineering part,
• an experimental part,
• and an analytical validation part.

Engineers together with a small UK company who produce 'intelligent' sports garments will develop the 'MyoSock'. It will contain different types of sensors connected by imprinted circuits enclosed in a knee length compression stocking. Signals will be sent to a computer or smartphone. The sensors will measure leg movement and changes in pressure, temperature and electricity generated when muscles contract.

The experimental component will consist of two parts:

• testing the device in a university-based Movement Laboratory and;
• imaging the leg muscles with magnetic resonance (MR) scans.

Participants will include 20 healthy older women aged over 65 years. Women are selected as women have more problems with mobility and fall more often. The Movement Laboratory testing involves participants contracting leg muscles whilst sitting and walking for five minutes. The imaging will take place at the Magnetic Resonance Centre.

The specialized MR scans will measure the volume of muscle, amount of fat in the muscle and indicate types of muscle fibres (slow / fast) present. The third component, analytical validation, will analyse the recordings from the 'MyoSock' and the MR scans. We will investigate relationships between muscle health measurements from the 'Myosock' and changes in muscle volume, fatty infiltration and muscle cell types as assessed by MR scans. An early stage researcher with funding for 3 years will also be working on development of the device.

This project is highly innovative as it involves different sensor types, extracts novel features from signals and applies non-traditional methods to the signals. The detailed MR scans which allow us to 'look inside' the muscle will provide strong validation. In summary, this device could transform the approach to health care of the ageing population by addressing muscle health, essential for healthy ageing.

Flexible living to Age in Place

The housing market in the UK does not respond to the challenges of growing old. Many people struggle with ageing; a principal concern is their housing environment, (Hayes, 2018). The Government concedes that there is a housing crisis and has committed 44bn to fixing the problem. Their focus, however, has been on supply rather than how these houses serve the needs of society, particularly for older people.

The housing sector continues to build houses that are very difficult to adapt; it does not utilise the significant building and digital innovations developed in this area in recent years that could enable people to Age in Place.

Digital and sensor technology- as well as adaptability innovations through Modern Methods of Construction (MMC)- have the capacity to be game changing. These technologies could enable the domestic environment, both new and existing, to be tailored to support the particular needs of the occupant, so that they could remain independent and to live in their homes for as long as possible.

Integration of this technology would represent a significant individual and societal financial saving and reduce the heartache and stress of a change of environment and lifestyle late in life.

According to Age Concern, if houses could be more easily adapted and residential care postponed, there could be a saving of £26,000 per person/year through avoidance of care costs. In the UK, there are very few developers supplying houses for older people, as they are deemed to be expensive and are less efficient in terms of space than typical housing solutions, (Docking, 2019). The literature also suggests that older people do not want to be isolated away from younger people, living in retirement ghettos. Therefore, ageing in place- supported by well-designed homes that are accessible, adaptable and technology-enabled- must be the aim within the sector.

This project has been offered seven plots in Seaham Garden Village- an innovative housing scheme of 1500 houses. The industrial partners have set aside £560K (80K/house) of the £1.4 million budget to dedicate to technical innovation to support independent living and integrate well-being and care services to older people. This high-profile housing development is a collaboration between private developers (IDP Partnership, Plan B, Tolent, Karbon Homes (supported by Homes England) and Northumbria University.

The ambition here is to use the catalyst grant, if successful, to bring together a co-design team that is comprised of healthcare practitioners, architects, designers, building users and academics (with expertise in architecture, health, gerontology, computer science and software engineering) to design these tech-enabled prototype houses.

These dwellings are a unique opportunity to explore how digital sensor-based technology and adaptive technologies can be incorporated in the domestic environment, both new build and existing houses through integration of actuators, modern communication systems, information devices, environmental and wearable medical sensors as well as demountable technologies.

These houses will be transformed into flexible supportive environments across the life course. The team will have the expertise to establish digital models to test the innovation prior to the houses being built; the true validation of the research will be seen in the application, testing and monitoring of the technology, once the houses are built as part of Building Performance Evaluation (BPE) and Post Occupancy Evaluation (POE) using the accelerator funding if successful.

The anticipated outcomes from the catalyst funding will include:

1) Co-design of 'adaptable homes';

2) exploring sensor and adaptive technologies and how they can be embedded in the designs;

3) develop market knowledge to inform scalability and determine routes to market beyond the Garden Village.

4) establishing an approach to retrofitting existing properties.

Integrated Technology Platform to Support Optimal Management  of Ageing with Diabetes

Latest data suggests that in the UK ~10% of the annual NHS £100 billion budget is spent on treating diabetes, equating to £192 million a week. Of this, nearly 80% is spent on treating irreversible, but preventable diabetes-related complications.

Currently there are 3.8 million people diagnosed with diabetes, an estimated 900,000 are yet to be diagnosed, and in 2030 it is expected that more than 5 million people in the UK will have diabetes (as 80-85% of cases of type 2 diabetes is caused by obesity). Uncontrolled diabetes in older people leads to a range of problems.

Hypoglycaemia (low blood glucose) causes a slowing of cognition and may result in acute confusion, accidents and falls and an increased risk of developing dementia. Conversely, hyperglycaemia (high blood glucose) increases the risk of infections, dehydration, and in the longer-term can lead to a significantly higher loss of muscle quality and strength (sarcopenia) as well as irreversible damage to eyes, kidneys, and nerves supplying the feet. This places significant demands on NHS services including GP callouts, ambulance services, A&E attendances and lengthy hospital admissions. Increasing physical activity levels in people with diabetes would lead to better outcomes in terms of less diabetes-related complications, less depression, slower rates of cognitive decline, lower rates of cardiovascular disease and ultimately less healthcare resource use. However, some people with diabetes find it hard to exercise as the risk of hypoglycaemia is increased.

The complex relationship between diabetes, physical and cognitive decline, and ageing is not well understood (understudied) often leading to sub-optimal management of people with diabetes as they get older. This in turn results in higher risk of diabetes related complications and increased incidence of morbidity and disability in this population in later years. The aim of this proposal is to provide a single technology platform that will implement a data-driven approach to the analysis of this complex relationship via automated machine learning (ML)-driven analytics based on the real-time remote monitoring of the key diabetes markers (Blood Glucose, Insulin, Carbohydrates) and incorporating physical activity measures, as well as cognitive assessment scores.

This integrated environment will provide decision support for optimal diabetes management and service planning and provision for healthcare, social and community care.

This will enable a shift from the current unsustainable, static and reactive management model, to a future-proof dynamic, intelligent proactive model that will impact in the following ways, for: -

• Patients: a personalisation of support to enable pro-active engagement and empowerment;
• improved quality of life; healthier ageing;
• Clinicians / Carers: remote monitoring; decision support; prioritisation of those most in need; improved cognitive screening -
• CCG and commissioners / wider NHS / Social service: optimised use of limited healthcare and social care resources; optimal pathways of care

Understanding elderly drivers' behaviour and fitness to drive

Unfitness to drive is a major contributing factor of road crashes and age-related neurodegenerative conditions are a growing area of concern for road safety. With life expectancy constantly increasing, the number of elderly drivers will increase proportionally (people aged over 70 represents 6% of all UK driving licences). At the same time, driving is a key part of maintaining independence especially in rural areas where public transport is less able to match the flexibility of driving one's car.

The Department for Transport (DfT) and DVLA places no restrictions on elderly drivers and there is no evidence that older drivers are at increased risk of traffic accidents. However, age is associated with other medical conditions where the DVLA guidance is determined by symptoms or medical reports. For example, people with certain types of heart failure may drive if symptoms are stable and not likely to distract the driver or otherwise affect safe driving and need not notify the DVLA.

A very common condition associated with ageing is Mild Cognitive Impairment (MCI), a state in between normal ageing and brain function and that of abnormal ageing and dementia. In response to the National Dementia Strategy in 2008 and the Prime Minister's Challenge there has been an increase in people referred to memory clinics from 202 per clinic to 1579 per clinic between 2008/9 and 2014 (a 682% increase). The 2019 national memory clinic audit found that 17% of people attending memory clinics are diagnosed with MCI. Therefore approximately 270 new cases of MCI are diagnosed in each memory clinic.

Currently driving risk is assessed by self reports or by medical reports, that take into account factors such as whether the person presents poor short-term memory, disorientation, lack of judgment, attention disorders. , that do not accurately reflect safety to drive. For those with affected by cognitive impairments, detailed, time-consuming and expensive neuropsychological testing are undertaken in a minority and the usefulness of these in terms of predicting driving ability is unknown.

On referral from a specialist or GP, specialist driving assessment tests can be carried out. In the UK specialist driving assessment centres carry out detailed driving assessments for people with a medical condition which can affect their driving. The DVLA guidance divides MCI into those with, "No likely driving impairment' and those with, 'Possible driving impairment'.

Elderly drivers or people with MCI are not at an increased risk of accident, however they might struggle in certain circumstances such as high speed junctions, high-speed roundabouts and slip roads onto motorways, where drivers are required to look around and make quick decisions. Therefore it is important to investigate new means to understand individual driving risks. In car monitoring technology to measure real-world driving may be a cheaper and more accurate measure of on the road driving behaviour and may better compare with cognitive function.

Furthermore, it can detect particular areas of concern such as high-speed junctions, motorways etc so that advice and potentially driving awareness education sessions could be delivered to reduce risk of accidents. In this project we will collect real world driving behaviour data from patients with MCI and healthy elderly to understand any links between their diagnosis, standardised cognitive function tests and driving behaviour.

This could help detect those at most risk and develop interventions to introduce graduate driving licenses that better support an evolving condition. We will take into account the views of different stakeholders by arranging a series of workshops with a group of healthy elderly and a group of people with MCI, plus opinions and views and we disseminate other stakeholders such as DfT, DVLA, insurance companies, Age UK and dementia charities such as Alzheimer research UK and Alzheimer Society and Sheffield Dementia advisory group.

Interaction, Dementia and Engagement in Arts for Lifelong Learning (IDEAL)

Over the past few years, researchers, governments and social enterprises have become increasingly involved in the development of interventions to improve the quality of life for people living with dementia (PwD). Arts activities such as arts & crafts workshops and art gallery guided tours have been identified as one effective way to give PwD a creative outlet, increased agency, and a reinvigorated sense of social identity. However, for the artists and social enterprises running such interventions, there is little available training on how best to communicate with PwD in order to maximise the benefits of these interventions.

The IDEAL project will address this through collaborative partnership with Equal Arts and Sunderland Culture, two UK organisations who offer creative ageing workshop programmes to support people living with dementia-related cognitive decline and resulting social isolation.

Based on research produced prior to, and as a result of, this funding, we will produce a training service - in the form of workshop packages and an online training programme - which will highlight and identify effective communication strategies for engaging PwD in a meaningful way in these activities. This would include examples of effective workshop activities and, more specifically, communication strategies, such as effective instruction-giving and effective evaluations of PwD work, based on real-world examples from a range of scenarios (i.e. when carers are present, when PwD are without carers, etc.)

In this research, applied linguists and social gerontologists from Newcastle University are building on a previous case study carried out with partners at Sunderland Culture, to investigate effective workshop activities and good communicative practices in arts interventions for people living with dementia (PwD).

Through video analysis of recordings of arts workshops, language and non-verbal conduct were analysed to identify the interactional strategies that workshop facilitators (and carers) use that result in increased, active participation, and which enable people living with dementia to contribute autonomously to the activity.

These insights have been shared with the stakeholder organisation, and have featured in research dissemination activities internationally, with invited talks given in to relevant stakeholders and research centres in Denmark and Sweden (2019), data presentations given in Japan (2018), and findings presented at a leading international conference (Finland, 2019). As a result of this, the NU team has been awarded the next Atypical Interaction Conference 2022, a prestigious international meeting attracting 200-300 scholars from around the world, and will be representing NU at the British Council organised RENKEI meeting in Tokyo, on Healthy Ageing and Dementia (March 2021).

The research dimension in the proposed project expands on the previous pilot study (in which one workshop setting was examined) to five new workshop settings in arts spaces across the Northeast of England. This will provide a more nuanced and detailed insight into effective activities, and related communication strategies, in such arts workshop settings, which will help to inform training materials more effectively.

The workshop programme will initially be delivered across the Northeast of England, with the potential for further roll-out, and the online training programme will be made available (online and as hard copies to order) for wider distribution through Equal Arts, the internationally recognised "creative ageing charity providing arts and creative activities for older people and those living with dementia" (equalarts.org.uk/our-work/creative-age).

Through research-informed training, this project will improve the quality of arts interventions for PwD, which will in turn improve the quality of life for both PwD, and their carers.

Addressing the 'change' in memory.  A herbal self-care approach to cognitive problems in the menopause transition.

The menopause is a natural part of the ageing process for women. It usually takes place between the ages of 45 and 55 years of age, and is a result of changes in hormone levels. Women stop having monthly periods and are no longer able to get pregnant naturally. However, this change in 'fertility status' is only the tip of the ice berg for many women. Menopause is linked to a wide range of unpleasant physical and psychological symptoms that may persist for a number of years as women go through the 'change'.

The most common symptoms include hot flushes, night sweats, vaginal dryness, sleep problems, low mood, anxiety, and problems with memory and concentration. Throughout history, women were expected to 'grin and bear it', and even today, with a range of medical and psychological interventions available to support menopausal women, many still find it embarrassing on inappropriate to seek help. This situation is perhaps not helped by the fact that menopause is a taboo subject when it comes to the workplace.

Employers offer little or no support and working women experiencing the menopause may feel uncomfortable raising an issue that they may find to be negatively affecting their work performance for fear of putting their job at risk. During the menopause transition, many women find problems in learning and remembering new information is particularly challenging in the workplace. Imagine being given new instructions or things to do and being unable to recall them; or staring at a spreadsheet of numbers and not being able to concentrate on what you are supposed to be doing.

These are the sorts of things women report whilst going through the menopause. And it isn't just for a day, or a week. These problems can continue for months and years, and can affect work performance, confidence in one's abilities, anxiety about getting things wrong. All these things can affect job-satisfaction and can lead to time off work whilst trying to recover from this natural time of life. The associated impact on income, family life and overall wellbeing can be considerable and unpleasant.

Hormone therapy is available, but this has been linked to an increased risk of breast cancer, and is not recommended for addressing cognitive problems. We want to see if help might be found in one of our most popular herbs, rosemary. It has been shown to improve memory and concentration in people who are not experiencing problems. It is not yet known if rosemary is able to reduce memory and concentration problems. The research will address this.

First, we want to measure exactly what problems are being experienced. We will do this using a specialist online set of tests and questionnaires. Then we will compare two different methods of administering rosemary and what effects they might have on later completions of the same tests that participants will take over subsequent weeks. One way will be through the daily drinking of water that contains rosemary extract.

The second will be through the breathing of rosemary essential oil aroma. We have previously found that both methods can aid mental performance in people without existing problems. We also know that rosemary contains natural molecules that can positively affect brain chemistry, and we think this is how it can help memory.

We aim to identify if either of these methods produces better objective performance and/or more positive subjective feelings than that observed in a no treatment control group. If rosemary can reduce the problems with memory and concentration experienced during the menopause, then the women taking the treatment might feel better about work performance, and this might positively affect job satisfaction and mood.

As a result, they may find their life generally is better, because they have had the stress and worry associated with the memory problems removed. It could be that nature
can offer a helping hand at a time when a natural event is providing a challenge.

Characterisation of lower limb loading during sports movements in active older adults using a super force plate facility

There is already well documented evidence to show the benefits of staying active into older age on health, wellness and maintaining independence. This has led to a growing population of older adults engaging with sport and exercise, with 3.4 million over-55s taking part in sport on a weekly basis (up 28% since 2006).

However, despite the documented benefits, little is known about the movement patterns and joint loading experienced by this population during sport-specific activity. This knowledge is required to create specific support to help people to stay active for longer. This project will involve the customisation of a new state-of-the-art research facility (vsimulators.co.uk) to recreate sports settings for the collection of detailed information on the movement patterns of active older adults when performing sports tasks such as stopping, twisting, jumping and turning.

This is the first such project of its kind. It will provide a unique facility and procedures to obtain new knowledge that can be applied to the development of a suite of specific support for the safe performance of sport and exercise for active older adults.

The main aim of this catalyst project will be to assess the feasibility of using the new research facility comprising 3.6-m square force-sensitive floor, cameras to monitor movement throughout the entire area and ability for virtual reality, to accurately reproduce complete sports movements for active older adults. This will be achieved by comparing data collected in the new facility with data collected for similar movements performed in sport settings.

The project will provide new knowledge on the typical forces between the shoe sole and the floor surface and the loads experienced by the knee and ankle joints of this population during sports tasks, and will form the foundation for future applications of the facility through collaboration with industry and academic partners.

One target application already identified for this new facility and method will be the development of footwear specifically designed for older adults participating in sport and exercise, working in collaboration with project partner Cosyfeet (Somerset, UK). Studies of sports shoes and surfaces have previously focused on younger populations. It is anticipated that the desirable characteristics of footwear for older adults will differ from those for younger populations.

The process of ageing influences our ability to perform dynamic sports movements, with older adults typically experiencing a restricted range of joint motion, moving more slowly and travelling shorter distances when performing sports tasks such as those observed in tennis, squash, badminton and netball. This places different demands on footwear, thus influencing the required characteristics for safe performance. The design priorities for footwear may also be influenced by characteristics of the ageing population, such as greater focus on comfort due to foot health challenges or chronic knee pain associated with osteoarthritic changes. Currently there are numerous options available when selecting footwear for sports, but knowledge of the desirable characteristics to help active older adults select footwear to wear for sports is not available. The development of a facility to provide new knowledge of the movement strategies of older adults performing sports tasks will help us to understand the amount of joint loading, the level of cushioning and the amount of shoe-surface grip suitable for this population.

In summary, the provision of a facility for the detailed investigation of sport-specific tasks for the active older population will transform the field of healthy ageing by ultimately allowing the provision of recommendations for safe and comfortable conditions to facilitate continued activity for this growing population, enhancing health and wellbeing and improving quality of life and longevity.

Evaluating the Lifecurve approach and app for rehabilitation and healthy living in later life

As we get older we tend to assume that we will get more and more dependent on others leading us to need care and support at home and ultimately may need to enter a care home. However research has shown that if we take suitable preventative actions from around the age of 55 we need not lose the ability to carry out functional activities of daily life such as walking, shopping, cooking a meal or transferring to a toilet. It is possible therefore, if we take this preventative activity and exercise from an early enough age and consistently enough, that the vast majority of us can stay independent at home until the last few months of life. This we call compression of functional decline in that the decline we suffer occurs at the very end of life. This is the life journey that most of us want. We can track your physical life journey (your Lifecurve) through your ability to undertake 19 activities of daily life (your Lifecurve score) over time.

We have developed in partnership with Health and Social care colleagues and a spin out university company an App which you can use on a smart phone or tablet to record your Lifecurve Score and which will tell you the kinds of activities and exercises that evidence shows will maintain your physical independence. It will show you stories from others who have successfully remained independent. It will let you set tasks to do for yourself and will monitor if you do these tasks. It will allow you to compare yourself with others of your age and gender. It will also record your scores over time and show them to you. Your data and tasks choices and activities will be recorded by the app anonymously and we can use this data to see what you do that is helpful and if using the app helps slow or arrest your functional decline.

We plan to roll this app out across Scotland as part of this research study. The app users will help make the app as user friendly as it can be, to improved the content of the App. The research level data from the use of the app will provide initial research data on the effectiveness of the app and Lifecurve approach on promoting independence in later life. The data will also allow us to plan a full scale Randomised Controlled Trial (the gold standard for health research) to determine the
effectiveness of the approach in the future. We will also be able to nudge you to curtain activities as they become available or evidence for them develops and to send you surveys to fill in electronically.

If successful the Lifecurve app and approach could have considerable effect on healthy ageing, leading to longer and more independent lives and reducing the burden on health and social care services. The launch of the APP has been delayed for 3 months due to the COVID pandemic because some of the activities it encouraged were group activities, required non essential travel or could not be conducted with social distancing in place. We and the company are now happy that the modified APP and the activities it contains are COVID compliant. The COVID pandemic has severely limited older adults ability to socialise outside the home and our levels of daily activity. If this continues it posses an increasing threat to functional independence in later life. It is therefore even more important in the post COVID world that we offer advice and support to older adults as to how to maintain their functional independence and stay active at home.

We have setup the roll out of the app, a project support website (https://stillgoingproject.co.uk/) and the research evaluation methodology and we are now seeking funding with this application to undertake an evaluation of the success or otherwise of the app and the Lifecurve approach.

Continuous monitoring of vascular age by pulse wave velocity using wearable ECG and PPG monitors

Background:   While healthy ageing is one of the most important challenges of our time, it is difficult to monitor ageing during normal life. Longterm vascular ageing is the results of many injurious events that occur during everyday life and currently go undetected. The ability to continuously measure ageing with low cost devices would open opportunities to test interventions that aim to slow ageing in a large number of individual people. Progressive stiffening of the blood vessels is one of the most important features of human ageing.

Importantly, arterial stiffness can be measured non-invasively as pulse wave velocity (PWV) and is viewed as the most important biomarker of vascular age, but it currently requires costly and bulky equipment and trained researchers to measure.

However, personal devices like fitness bracelets and smart watches are now able to measure a variety of biological information including blood flow and electrical activity of the heart. This information could be used to calculate PWV with each heartbeat in real time and provide immediate information on the biological age of the blood vessels. More importantly, this approach would allow the identification of factors that accelerate and slow ageing in an individual person and monitor the success of 'anti-ageing' therapies in an individual person. So far, no technology is available that fulfils this task.

Objectives of the proposed research:  In the current project, we wish to develop low-cost methods to allow monitoring of individual 'vascular age' at scale during real life using wearables or design a prototype device with available components.

In this first phase of the project, we will set up a developmental tool kit to integrate data from ECG (electrocardiogram, electrical activity of the heart) and PPG (photoplethysmography, blood flow in the skin) sensors, calculate PWV, and create useful visualization of integrated data. We will then test the accuracy, validity, and performance of PWV measurements in people at different age and with vascular disease under different conditions and compare the results with gold standard methods (tonometry) to measure PWV.

Furthermore, we will design a prototype device build from low-cost standard sensor components (by Surrey Sensors Ltd.) and evaluate if existing low-cost devices can be used for continuous monitoring of PWV over time to help us decide on the focus of the next steps.

Future Direction:   Reaching these objectives will form the basis of moving forward with a second application next year. In this second step, we will build a small number of prototype devices to and/or develop a software solution for using sensor data from existing fitness devices for continuous PWV measurements. We will then test the utility and applicability of continuous PWV in real life in people of different ages to establish normal values.

Furthermore, we hope to validate the measurements by comparing results with invasively measured PWV during routine catheter procedures in the hospital. In a third step, we plan to perform a proof-of-concept study to demonstrate the abilities of continuous PWV measurements to detect acute responses of arterial stiffness to life-style interventions such as healthy diet and chronic changes in arterial stiffening over time (vascular ageing trajectory).

In a future stage, we hope to be able to test the continuous PWV measurements in larger groups of people, potentially in collaboration with industry, NHS, and using sensor data from devices that people already own. Large data sets can then be analysed together with other individual health related data by machine learning to identify ageing patterns and effect of healthcare interventions on trajectories of vascular ageing.

The Contribution of Physical Activity to Social Connectivity and Wellbeing in Older Adults Living with Dementia

This proposal aims to better understand the experiences, benefits, and constraints on provision, of physical activity for adults living with dementia in Dementia Friendly Communities (DFCs) in England. There are approximately 850,000 people living with dementia in the UK and dementia costs the UK £34.7bn p.a., with prevalence and costs predicted to rise.

Dementia is understood as a syndrome in which there is deterioration in a person's memory, thinking, behaviour and/or ability to perform everyday activities. People affected by dementia are identified as having a higher risk of being socially isolated, often do not feel connected with their communities, and feel more lonely than other social groups. This includes people living with dementia and their carers, and is attributed, in part, to the stigma associated with dementia.

There is considerable evidence that physical activity programmes can enable people living with dementia to stay connected with their local communities and achieve improved physical and mental health. However, adults living with dementia have been neglected in analyses of physical activity in later life, and the range of benefits of physical activity programmes are not well understood. In 2019, Sport England produced a Dementia Friendly Sport and Physical Activity Guide which indicates that, while there is evidence of the benefits of physical activity for adults living with dementia, they often do not feel able to participate in physical activity programmes. The reasons are increasingly well understood and include access to transport, facilities that are enabling (signage, availability of helpers, dementia friendly design, ability to accommodate specific physical and cognitive needs) and having confidence that they will not be stigmatised or excluded by staff and members of the public. Improved physical activity programmes have the potential to normalise living with dementia by challenging the stigma of the disease; enabling people affected by dementia to make choices about their lifestyles choice; promoting inclusion and a sense of connection with their communities; and improving the wellbeing of people living with dementia.

England is one of the few countries to have as policy that over half of the population will be living in a DFC by 2020 - a target that is being met. DFCs are collaborations of local people and organisations, often geographically defined, formally recognised as working to a common aim of promoting dementia awareness and inclusion of people affected by dementia. A national evaluation of DFCs identifies that while most DFCs include physical activity programmes, these are often ad hoc and constrained by location, transport infrastructure and people knowing what is available.

The research will focus on how DFCs promote engagement with physical activities. Building on earlier work of the researchers, the project will commence with a survey of up to 50 DFCs from across England to map the range of physical activities organised and facilitated within the DFC, what works, and what are the challenges and barriers. It will follow up with a detailed case study of three DFCs to understand how people affected by dementia are identified within local communities and enabled to access and join physical activity programmes.

The research aims to better understand how the changing needs of people affected by dementia are addressed and how physical activities promote inclusion and participation, to inform DFCs of the best ways to incorporate physical activity in their provision. The research will be informed by, and inclusive of, people living with dementia in the design, data collection and dissemination.

The research team will publish a report on their findings that will be made publicly available via multiple websites (locally and nationally), and will also test innovative ways to disseminate their findings via activities in local museums and libraries in one DFC and local dementia groups.

Every year, 1,200 veterans leave the military after the age of 50 and look for civilian work that they value. However, many struggle to navigate the civilian job market and may spend years in low paid or precarious work before they find a second career.

Simultaneously, while employers value the skills and experience that come from long military service, they are often uncertain about how to bring in and develop the talent of 50+ Service leavers. A career pipeline that can better match 50+ Service leavers with employers who can make good use of their skills is therefore urgently needed and will ensure that military-acquired skills continue to contribute to the UK economy.

In partnership with the Officers Association and Forces Employment Charity, I will work with 50+ Service leavers in building a transformative career support service that will help veterans find a 'new mission' in the civilian workforce, delivering an effective solution that allows veterans to gain at least five extra years of healthy and independent living. The project focuses on long-service veterans who have been underemployed since leaving the military and could benefit from personalised and peer-to-peer support like mentoring, job trials and career planning.

By tapping into the comradeship and shared experience of military service, 50+ veterans will help one another in building successful civilian careers. More widely, this project will provide a model for supporting older jobseekers in building second careers.

Physical activity has been engineered out of our lives; mechanization, automation and digitization have left us sedentary, indoors and tied to our screens. Physical inactivity adversely effects health, mental wellbeing and quality of life at all ages and across all sectors of society. As our population ages the cumulative effects of this lack of physical activity, movement and connection with the outdoors is severely detrimental to average healthy life expectancy. Midlife and older adults represent the most inactive portion of the population.

If people have appropriate information, opportunities and tools at the right time they have higher levels of activation, tend to experience better health and engage in healthier behaviours. The built environment impacts our health and wellbeing as it affords opportunities to be physically active in the spaces between and around buildings. Good design creates physical activity opportunities through access to green spaces, walking and cycling connections and links to community facilities.

The national housing shortage will be met by developers driven by profit, delivering thousands of houses in the same mould. We intend to show that the return on investment in better design, will increase their profits while also improving health. By creating better, more desirable places to live, the value of land and houses increases. By embedding opportunities for physical activity at the design stage, creating active aging environments, communities grow and grow healthier.

An overactive bladder is a common medical condition, particularly among the elderly. It leads to urinary incontinence (UI) and influences the quality of life for around 40% of those above 75 (>6million people in UK). People often consider this as a natural progression to old age and do not actively seek any treatment. However, UI is one of the main factors why the elderly lack confidence and give up their independence to move to care homes.

Conventional approaches to treat UI, e.g., drugs and bladder-catheterisation have several side effects (e.g., dry-mouth, constipation, confusion). Invasive electrical stimulation of the Tibial nerve (around the ankle) is an established alternative treatment. But a needle electrode inserted into the leg can be painful and distressing. Recently, a non-invasive version of this method has been demonstrated to be successful for older adults. However, it comprises multiple hospital visits per week over a duration of 2 months. Such a long treatment process leads to reduced adherence especially for the frail elderly who have already accepted UI to be a part of their life.

We propose an instrumented sock that the user can wear comfortably throughout the day, while electrodes weaved into it will stimulate the tibial nerve when necessary. The stimulation parameters will use an AI-based algorithm (via a smartphone) set by the clinician. The proposed system can be tried by a larger section of the population without surgery or repeated hospital visits. Hence, users will have much greater privacy and flexibility in managing incontinence.

Co-developing a sustainable, meaningful, digital platform to enhance mobility and active ageing of community dwelling older adults (>75 years).

In the UK there are 850,000 people living with dementia (PLWD). Half of all PLWD receive insufficient post-diagnostic support, suffering from high rates of social isolation, loneliness, and low quality of life. With increasing rates of dementia, PLWD have highlighted a need for opportunities to support one another, for sharing information and to foster a sense of hope and resilience. Marginalized and socially disadvantaged individuals, such as members of Black, Asian and Ethnic Minority groups and the LGBTQ community, have both higher risks of developing dementia and then greater difficulties accessing and receiving support post diagnoses.

The proposed project is to co-develop a peer-to-peer mentorship program (P2SP), utilising video-conference technology, with PLWD and their care partners, where appropriate. There will be an emphasis on including those who are experiencing compound marginalization, both living with dementia, as well as being a member of a marginalized group. Collaborations with Volunteer, Community and Social Enterprises will be incorporated into the project design to maximize adoption from marginalized populations. The P2SP will benefit health care providers by offering another option for social prescribing post-dementia diagnoses.

The desirability, feasibility and viability of the P2SP has already been reviewed and is enthusiastically supported by national and international dementia advocacy groups. Led by Dr Laura Booi, a social gerontologist with over a decade of experience co-developing ventures with PLWD and care partners, this project will also work in collaboration with the National Innovation Centre for Ageing and in conjunction with Dementia Alliance International.

Counselling People with Dementia: a feasibility study investigating the potential for accessible therapy delivered through a social enterprise model

We want to test an accessible, community-based, counselling model to help meet the emotional health and well-being needs of people with dementia.

There is a clear gap in counselling for people with dementia (PwD) and carers. The people I interviewed spoke about difficult emotional challenges linked to their experience of loss and concerns about the future. Currently, counselling interventions are poorly accessed by PwD and under-researched. Most therapists have no training in this area and typically, those working in dementia services have no counselling skills. Despite support being a Human Right for PwD, many health staff and therapists are not aware of the potential benefits of therapy. It is clear from my interviews that this is not true.

I want to work with Zinc, PwD, carers and counsellors to develop an accessible counselling model that can significantly improve the mental health of PwD and others. Firstly, we need to test the research methods. and then test the dementia-friendly counselling model.

Success means that a) PLwD, carers and counsellors are involved in the research process ensuring our ideas and methods are ethical, creative and fit for purpose; b) Using the findings from testing the methods, counselling process, and potential investor feedback, we co-create a tiered counselling training and delivery package for use across different public services, the third sector, community groups and businesses; c) Sale and delivery of the package enables accessible and tailored counselling opportunities, helping to tackle loneliness and stigma; d) PwD and carers can choose how and where they access therapeutic support.

In the UK there are over 7 million unpaid carers who provide vital support to relatives, partners or friends who require help with daily living. Unfortunately, many of them feel lonely, unsupported and are lacking information on how to best manage their role in the long term. The most common support available are peer support groups. These are attended by some carers, but others struggle to leave their homes or do not feel comfortable opening up face to face with strangers. What might more accessible support for those carers look like?

I propose to develop an online platform that will allow unpaid carers of older adults to join a chat group with peers and a support worker where they will receive guidance and emotional support. They will also have access to information to support them in their role and exercises to help them manage their wellbeing. The chat-based format will not be attractive for everybody, but for some people this medium really works.

It is also attractive for providers as it could allow them to reach greater numbers of carers at reasonable cost. Of course, such a platform needs to be designed carefully to ensure that carers feel comfortable chatting and receive the information and support they would like. I will develop the solution in close collaboration with carers while also drawing on the latest insights from social psychology and wellbeing research.

Development of an Intelligent Robotic Knee Device to Support and Monitor Rehabilitation Therapy for the Ageing Population with Knee Osteoarthritis

Knee osteoarthritis is one of the leading causes of chronic pain and disability in older people. Rehabilitation exercise is an essential treatment to reduce osteoarthritis pain, improve knee function and increase mobility. It is important for clinicians to be able to monitor certain signals such as load (weight) and motion during the exercise, so that they can develop a personalised rehabilitation plan for each patient. Currently, clinicians have no access to these signals and they have to use questionnaires and simple functional tests to evaluate the effect of the exercises. This relies heavily on individual experience rather than personalised monitoring, so patients often do not receive the best treatment to meet their needs.

This project will develop a knee device to support and monitor rehabilitation and provide scientific evidence for clinicians to evaluate the rehabilitation progress for their patients. This will ensure that patients get the best rehabilitation treatment which will relieve pain, improve overall physical knee function and prevent disability.

Patients will wear the device during their rehabilitation exercises and daily activities. Real-time feedback from the device will enable patients to monitor and manage their rehabilitation progress. Physiotherapists can adjust the exercise programme remotely to meet the patients’ individual needs by analysing signals collected from the device. Patients will also get real-time muscle support from the device to help them achieve exercise goals or do daily activities such as walking, gardening or climbing stairs. With this device, older people can enjoy physical activities, living longer and more fulfilling lives.

Development of the WESTERN plan for supporting active ageing in retirement and care facilities

This research aims to address the problem of maintaining mobility, wellbeing, and quality of life in older adults in sheltered accommodation, assisted living, care homes and people who require outreach care. In other words, this project will aim to provide a personalized programme that transforms these settings into ones that facilitate rather than impeded active ageing.

Often when individuals reside in such facilities there is a tendency to succumb to an ageing stereotype characterized by a detachment from the wider social community, a reduction in physical activity, apathy towards cooking and eating healthy, balanced meals, and feelings of helplessness. Consequently, age-associated conditions such as cognitive impairment, loss of physical function, frailty and poor mental health are highly prevalent within this population.

Fortunately, many of these issues are preventable (or at the very least, can be decelerated) through simple lifestyle behaviors. Providing a system to motivate, prompt and support older adults to include health-enhancing ‘self-care’ behaviors into their daily routines can promote active ageing, and curb any preventable mental, physical, and emotional decline.

The WESTERN plan (Walking, Exercise Snacking, Tai-chi, Edification, Relationships, Nutrition) aims to provide a simple, personalized programme that is rooted in behavioral science to optimize motivation, engagement, and acceptability. The plan, which will be provided on a target-user informed digital platform for integration of behavior change techniques, scalability and dissemination, will provide structure for users, care staff and family members and act as a basis for continued growth, value, belongingness and thriving health and wellbeing in residents.

Exploring How to Use Mixed Reality and Telepresence to Tackle Loneliness and Reduce Feelings of Social Isolation

In the UK, it is estimated that around 1.5 million aged 50 and over suffer from chronic loneliness, and 40% of older people say the television is their only company. These numbers are continually rising, putting a strain on social services such as the NHS, as well as other relatives who want the best for their loved ones. How is loneliness still a problem today, in a world dominated by ‘social’ media, where we have so many tools and technologies to connect with one another? The answer may lie in the shallow experience of connectedness these technologies provide.

Connectedness is more than just being connected. It requires a shared understanding, the chance to socialize, agency and independence, and to share meaningful experiences and interact with other human beings. Through co-design workshops, low-fi prototypes, and user studies, I will explore how mixed reality— technology which lets us combine the real and digital worlds—may help establish deep relationships to relieve loneliness. We can chat and gossip with friends and family as if they are in the same room with us, and even host events from our own living room.

The benefits greatly outweigh the costs: for example, the devices necessary to fulfill my vision of tackling loneliness by connecting people through mixed reality would cost less than a branded refrigerator. As a researcher and co-director of a community interest company, I bring a unique set of skills and intrinsic motivation to work on projects with tangible benefits for ordinary people.

he Problem: Exclusion and isolation of autistic people; Lack of knowledge and understanding of the needs of older autistics; Barriers to contributing to society (right not privilege), though (older) autistics have a lot to offer; Experience and expertise of (older) autistic people undervalued.

Proposed Solution: Autistic people will have a major role in developing it. The following scenarios illustrate what it will look like.

Scenario 1: Older autistic person living with their parents; Unnecessarily dependent; Parents getting older and contacted charities whose solutions continue dependence.
Using the solution: Tools and information about confidence building and assertiveness; Links to groups of autistic people to discuss problem and possible solutions and for companionship; Tools to structure thinking about options and work out what is best. E.g. mindmapping tools; Links to advocates who can help them.

Benefits: Able to plan for changing living situation; Increased control of own life, independence, self-confidence and assertiveness; Increased opportunities for relationships and activities; Improved health.

Scenario 2: Frustrated older autistic person; other people take advantage of them and put them down at work; no opportunities to use or develop their skills; Not given the training that leads to opportunities; Age discrimination

Using the Solution: Confidence building and assertiveness tools; Tools and information to identify new options; Links to advocates: guidance in completing applications for new job or college/university or talking to employer about training and a better job.

Benefits: Awareness of range of options; Able to determine and implement changes; Greater satisfaction and feeling of worth.

Aim: To develop a community based, easily accessible self- referral tool to identify individuals in the community who are at risk of a fall and/or a fracture.

Vision: For each community to host self-service screening kiosks located with GP surgeries, pharmacies, libraries etc. Older adults, or their friends or family, would answer a series of questions taken from a previously validated questionnaire and be classified as Low, Moderate or High risk of a fall or fracture. All users irrespective or classification will be offered a resource package containing information and activities to maintain good balance and bone strength.

Individuals identified as moderate to high risk of a fall, will be invited to a full fall and fracture prevention health check. This assessment will by a trained fall prevention specialist. This will include muscles strength and balance assessments, bone fracture risk assessment, eyes, ears and feet assessment. Following this assessment, specific recommendations will be made as to how to lower fall and fracture risk.

Where appropriate, interventions will be offered to help to prevent a future fall and fracture. This may include an invitation to our strength and balance class and/or referral to an optician, audiologist, pharmacist or podiatrist. Where necessary, we will liaise with the health service for referral to specialist services such as home hazard assessment or the fall prevention clinic at the local day hospital or equivalent.

Glaucoma is among the top three causes of irreversible visual impairment in the UK and Worldwide. The impact of sight loss in glaucoma is complex, affecting aspects of daily functioning, mobility, and quality of life. Glaucoma cannot be cured; treatments are designed to slow or halt disease progression, necessitating lifelong hospital monitoring. There is growing difficulty for the hospital eye services to effectively monitor the glaucoma patient caseload. Indeed, people with glaucoma are losing their sight due to lack of timely monitoring.

There is a need for innovative changes in the current glaucoma patient pathway in order to achieve better patient outcomes and higher quality care.

Smartphones are increasingly being used to collect health information. Digital phenotyping refers to using smartphone generated data to build a picture about an individual’s lifestyle and health state.

There is scope for this data to be translated into indicators of clinically symptomatic behaviour. For example, these data could aid clinical decision-making as reduced mobility may indicate a decline in visual functioning and progression of glaucoma. Care providers can be alerted by these digital signals and schedule a clinical assessment and intervention, such as treatment augmentation, provision of visual aids, or counselling support.

Combined with routine clinical data, digital phenotyping could emerge as a powerful tool to establish the real-world impact of glaucoma and help to prevent avoidable sight loss. This approach may ultimately facilitate a more sustainable approach to glaucoma care by measuring outcomes which are relevant and meaningful to the patients themselves.

What is the problem I am solving?

How would you feel if, while reading this text, letters and words started merging or disappearing, making your reading impossible, and you knew there was nothing you could do to recover your reading ability? Frightening. Devastating. That is precisely the experience of millions of people in the world who have had a stroke or live with neurodegenerative conditions affecting the back of the brain – the area that controls vision.

Science cannot repair a damaged brain, but in my research, I found a way to manipulate the text displayed in a reader device to compensate for this brain damage and make reading possible again. My idea is to convert these manipulation techniques into a commercially viable app to bring reading back to the lives of people with brain injury.

What are the key benefits of this innovation?

This app will:

1) fill a global gap in healthcare, since no other assistive readers exist for people with neurological conditions,
2) be universally available, free of charge, across all operating systems and web-browsers so no one with access to the internet will face barriers to use it,
3) have customized settings to suit the type and severity of neurological impairment,
4) operate in any language, that is, give millions of people in the world the opportunity to read again, and
5) my international implementation plan will make the reading app widely recognised in healthcare and rehabilitation settings worldwide.

Our existing approach to healthcare is reactive and based on limited physiological information, collected months, years or even decades apart. Digital health technologies propose to solve this but often requires individuals to actively administer self-testing. This is a daunting prospect for any individual, particularly for the elderly. We propose to overcome this with the development of a toilet-based precision healthcare platform deployed in the home to measure urinary biomarkers of disease.

It is zero-effort taking samples autonomously without user intervention and can measure biomolecular signatures of health from urine over time. The aim is to take a personalised medicine approach to detecting disease early at the population scale. I lead the Analytical Systems Research group at Imperial College London, miniaturising the technology that is used conventionally to test patient samples in centralised facilities today. We are developing methods to detect urinary biomarkers for cancer, diabetes and heart disease and there is a growing body of literature reporting biomarkers for the early detection of Alzheimer’s disease and dementia.

While the core technology is well-developed, there are significant, largely non-technical, barriers to the adoption of ‘big-tech’ precision health solutions by the general population, which we will explore and investigate strategies to solve as part of this project: we will research the barriers to adoption by users and stakeholders, how the molecular data generated can and should be used, as well as conducting pilot projects focussed on the user interaction and engagement elements of the system.

Glaucoma is the second leading cause of irreversible blindness. It affects 1 in 50 people over 40 years old, all of whom must currently travel to hospital once or twice a year for vision checks. Over 1M such "monitoring" assessments are carried out by the NHS every year.

These hospital visits are not only inconvenient: they are unsustainable. Even before COVID, NHS backlogs meant that twenty patients a month were going blind due to delayed glaucoma appointments, and patient numbers are expected to double by 2030. Hospital-only monitoring is also insufficient for the 1 in 23 people with the most aggressive form of glaucoma. Such individuals are liable to experience sudden, irreversible sight loss between hospital appointments.

The solution is home-monitoring. If people could check their own vision at home, then sight loss could be detected more quickly, conveniently, and cheaply. People could choose to test their vision more frequently, or when they started to notice a change: allowing sight loss to be flagged and treated sooner. Lower risk patients could attend fewer hospital appointments: reducing unnecessary travel, and freeing up resources to focus on those most in need. And by testing vision at home, more time in the clinic could be spent talking to the doctor face-to-face.

That is why over the last eight years we have developed Eyecatcher: the world's first validated vision test for glaucoma home-monitoring. The challenge now is to scale up Eyecatcher, and get it into the hands of patients, in a sustainable, cost-effective way.

Ageism in the fashion industry is widespread and costly to businesses, consumers and wider society. Consumers feel excluded from mainstream fashion because ageing is not reflected positively, if at all, in the industry or in the imagery we see in magazines and adverts. The industry defines what we should wear by shaping what we think and feel is age appropriate.

This restricts people’s choices and makes it hard for people to express themselves through mediums of fashion (clothing, dress, hairstyles & make up) in a way that makes them feel good about their age. Businesses lose out by failing to cater to the aesthetic needs and desires of an ageing population who want to look and feel good.

This project wants to re-dress ageism in fashion by,

• 1) raising awareness with fashion brands and wider industry businesses of ageism, and the ways it manifests in the industry;
• 2) understanding and providing innovative solutions to the challenges businesses face in addressing ageism, such as how to diversify imagery by using older models in a way that retains a brands image and appeal, and doesn’t alienate younger consumers.

This will benefit consumers by increasing choice and freedom to express who they are, and crucially, feel good about it, no matter what their age. It will benefit businesses by opening up to new markets and customers, and it will benefit wider society by reducing anti-ageing narratives and imagery, which perpetuate negative attitudes and stereotypes that underpin ageism in society.

Increasing physical activity in older age helps to reduce, delay or even reverse the development of chronic diseases, and can improve mobility, enhance wellbeing and reduce social isolation. However, most older adults don’t get enough physical activity to benefit. Some of this may be due to negative social stereotypes about what older adults can and cannot do, and depictions of older people as frail and incapable. Negative stereotypes make older adults feel less welcome or accepted in the spaces where activity happens, deter physical activity and reduce social support. They can also deter the providers of products and services that promote physical activity from catering for older adults.

This project aims to challenge and reverse negative stereotyping of ageing and physical activity through creating ‘trigger films’ to spark a societal shift in opinions and attitudes, prompting people to see things differently. This needs action at a whole-society level. Cultural and social changes in attitudes and norms in other stigmatised groups have been influenced by specific, memorable moments that caught public attention. For example, TV shows with provocative storylines about homophobia and mental health, or David Attenborough’s Blue Planet triggering combined public, policy and industry action to reduce plastic use.

I will bring expertise in communication theory and behavioural science to harness this approach and apply it to the portrayal of physical activity in later life, working with creative industries and older adults themselves. We will co-create attention-grabbing and attitude- shifting video resources and test their effects on reducing stereotypes across society.

As people live longer, the number of older adults globally is growing. This presents a growing problem: the number of older adults experiencing loneliness. Currently, over a quarter of adults over 65 are socially isolated. In the UK alone, over a million older adults go more than a month without speaking to friends, family or neighbours, and 1.4 million are chronically lonely. Loneliness is associated with increased risk of dementia, heart disease, poor mental health and early death.

The risk loneliness poses to public health explains why addressing loneliness for older adults is a key priority for the UK government and the UN.

Our project aims to reduce loneliness in older adults. We propose a novel, enjoyable and engaging way for older adults to get to know new people easily within their community, as well as build and deepen relationships with each other, their families, friends and wider society. Our solution is particularly relevant for when older adults have had to move, often due to bereavement, downsizing or requiring additional support or care needs.

We are proposing an augmented reality board game that facilitates storytelling, reminiscing, and capturing and celebrating lives. This creates quality connection and is a social experience played in-person or remotely. Most importantly, this is an experience initiated and directed by older adults themselves. We are co-designing this game with older adults of low socioeconomic status, ensuring an accessible, low cost and inclusive solution.

The gut-sleep-brain axis: Targeting the gut microbiota and sleep quality by individualized non-pharmaceutical approaches to promote healthy ageing

We live in an ageing society struck by cognitive decline and high prevalence of dementia. With the numbers continuously increasing, it is estimated that dementia will triple by 2035. Besides its detrimental impact on healthy longevity and quality of life, this will lead to substantial economic and societal burden. To make matters worse, one third of the UK adult population presents disordered sleep and the prevalence further increases with ageing.

This is alarming provided the amounting evidence establishing sleep problems as causal predictors of age dependent cognitive impairment and dementia. Unfortunately, sleep problems in ageing are complex, often with multiple causes in an individual with no one-size-fits-all treatment approach. Thus, there is a lack of effective treatments of sleep problems. The available pharmaceutical means have significant side effects, can be used for a limited time only and the cognitive benefits of drug induced sleep are minimal or lacking. Furthermore, sleep problems are commonly overlooked and/or ineffectively addressed in both the primary and secondary healthcare system.

The potential solution requires a range of options to support individually tailored interventions addressing the specific needs. Our proposal builds on emerging evidence showing a reciprocal relationship between gut health, sleep and brain functions. We aim to develop effective, low cost, individually tailored and broadly accessible intervention alternatives with no side effects using a range of innovative non-pharmaceutical methods including brief behaviour therapy, auditory closed loop stimulation of deep sleep and dietary supplements to improve sleep quality, brain function and gut health in older people.

For older adults, exercise improves fitness and health, maximises participation, increases functional independence and enhances quality of life. Higher fitness-levels are linked to lower levels of emotional distress and depression, improved mobility, functionality and independence encouraging a higher level of behavioural activation and social inclusion.

Adherence and compliance with recommended exercise guidelines remains poor amongst ageing adults who frequently avoid participation for fear of falling, exacerbating symptoms or provoking pain or fatigue. The shortage of appropriately qualified trainers means some institutionalised elderly are sedentary for over 12 hours a day, their only energy expenditure being when getting in and out of bed.
We have created a series of bed and chair-based programs for older adults, some of whom may be resistant to exercise, providing a graduated course of physical activity suitable for everyone, from the very frail to the healthy agile.

We will engage older adults who may be isolated, bedbound, frail, have multiple health conditions, physical disabilities, learning difficulties or mental health issues, and lead them through specialised bed and chair-based exercises given remotely, linked by a live-stream platform such as Webinar or Zoom, presented on large-screen TV, through their own smartphone, tablet or laptop enabling everyone to work in a group. The sessions will be supplemented by videos and an App.

During the next 12 months we will complete the filming, select the live-stream platform and test the system in community settings with the aim of producing a solution ready to roll out to the Care Home sector.

Upstream Strength Training Interventions to Improve the Ageing Trajectory of Women in Midlife

Falls in later life are a major threat to healthy ageing. They can lead to pain, injury, and loss of independence. Falls have a significant impact on health services, both immediate hospital care and long-term aftercare.

The 60+ age group is growing faster than any other age group, therefore problems related to falls will increase. Women express fear of falling more than men and they sustain more hip fractures from falls. Current approaches focus on older people who have had a fall or are at risk of falling. More proactive approaches are needed earlier in life.

Muscle strength is an essential ‘building block’ for healthy ageing. Strength declines as we age but it can be maintained through exercise. Approximately half of all women aged 45 years and over, do no regular strength exercises.

The aim of this project is to find ways to make it easier for women in midlife to do regular muscle strength training. This would enable them to arrive at the ‘start line’ of later life in better health and with greater physical reserves.

We would work closely with women in midlife to understand their thoughts and opinions about strength training. We want to understand what makes it harder for them and what might make it easier. We will co-create a range of potential ideas and solutions, these will be tested out with other women and with key partners including healthcare professionals, academics, designers, fitness professionals and people who influence policy.

Beyond the 10 000 steps: Managing less visible aspects of healthy ageing at work

Beyond 10,000 Steps, led by the University of Edinburgh's Business School, will work with employers and older workers to understand ways in which health needs can be addressed to enable productive later-life employment.

The project has a particular focus on less visible aspects of health, such as cognitive decline, menopause effects, health consequences of combining work and caring, and financial wellbeing.

The findings from quantitative and qualitative research will be used to develop a suite of innovative projects and data-driven interventions to improve the health and wellbeing of older workers.

Connecting through culture as we age: arts and technology collaborations to support healthy ageing

Led by the University of Bristol, the 'Connecting through culture as we age' project aims to tackle inequalities related to the accessibility and content of digital arts and culture, enable vital research and development, and establish new business models to encourage inclusive digital innovation in the arts and cultural sector.

Connectivity and Digital Design for Promoting Health and Well-being Across Generations, Places and Spaces

This project, led by the University of Stirling in collaboration with the University of Plymouth’s Centre for Health Technology, aims to improve access to online resources for older people in a bid to enhance lifecourse health and well-being.

The project will examine how digital health resources can be designed using intergenerational co-production with older and younger people. The feasibility and impact of delivering these digital products to engage older people in structured activity programmes in the areas of physical activity and sports and leisure reminiscence will be investigated.

Designing homes for healthy cognitive ageing: co-production for impact and scale (DesHCA)

Experts at the University of Stirling are leading a major new research project to create future-proof housing to meet the needs of the world’s ageing population. Led by Professor Alison Bowes, the project, ‘Designing Homes for Healthy Cognitive Ageing: Co-Production for Impact and Scale (DesHCA)’, will bring together Scotland’s leading experts on dementia and dementia design, the building industry, architects, housing providers and people in the community. It is being supported by the royal charity Silviahemmet. They will work together to identify housing innovations that can better support people living with cognitive conditions, such as dementia, for longer.

Extending active life for older people with cognitive impairment through innovations in the visitor economy of the natural environment  (ENLIVEN)

ENLIVEN will help older people living with cognitive impairment – including dementia – to be more active and independent and experience a better quality of life through increasing their contact with the natural environment. The team will work with businesses, social enterprises and third sector organisations to develop and test innovative ways of adapting services and improving accessibility, in order to address and overcome the barriers that stop people living with cognitive impairment from accessing nature-based outdoor activities. The project will also aim to reduce inequalities in healthy ageing by including people who have experienced a wide range of structural disadvantages, such as people from minority ethnic groups or from socio-economically disadvantaged areas.

Healthier Working Lives and Ageing for Residential Care Workers: developing careers, enhancing community, promoting wellbeing (HWL)

Healthier Working Lives (HWL), led by the University of Edinburgh in conjunction Codebase, Creative Venue, Legal & General, Scottish Care, and the University of Reading, looks at ways of improving the employment experiences of residential care workers, focussing on those aged over 50. The project addresses challenges in their recruitment and retention.

Through co-design and co-production with employees and managers working in the independent and local authority residential care homes, it seeks to promote innovation and develop employment practices and technologies that will contribute to enhancement of the health, wellbeing and working lives of older workers employed in residential care.

Supportive environments for Physical and social Activity, healthy ageing and Cognitive health (SPACE)

SPACE explores how where we live affects dementia and brain health as we get older. The complex social and physical environments where we live make some people more vulnerable than others to developing cognitive impairment. We do not know how these factors interact to make urban environments a problem for brain health, nor which are the best policies and interventions for promoting healthy ageing.

We will provide evidence for policies and practices that provide supportive urban environments to promote healthy ageing. It is important that the environment where we live is scientifically designed and improved to maximise our brain health.