Old Age Neuroscience and the ORCHARD portfolio

Overview

Over half of people admitted to NHS-hospitals are aged 65 or older and older people occupy 70% of hospital bed days with numbers predicted to rise.  Most have unplanned admissions usually to acute medical or old age medicine services.  Up to a half have a cognitive disorder (e.g. delirium, co-existing dementia) and around 40% are physically frail with an increased vulnerability to stressors such as a sudden decline in health. Recent studies have shown that infection, which is common in hospital patients, and delirium, are potentially modifiable risk factors for future dementia. Our work aims to understand how the systemic effects of hospital illnesses including infection interact with the brain to cause delirium and future dementia, as well as accelerated ageing and frailty. This will help us to maintain brain health and overall fitness by developing prevention strategies and new treatments to reduce the risks of future cognitive and physical decline.

Research

Our research is informed by a PPI group including people with lived experience of frailty, unplanned hospital admission and cognitive decline. Older hospital patients are under-represented in research (NIHR INCLUDE) and therefore under-studied. Our research seeks to address this gap through undertaking:

• prospective studies of older patients presenting to acute medicine, complex medicine and the Same Day Emergency Care Units (eg Ambulatory Assessment Unit) with multimodal biomarker collection and long-term follow-up for cognitive and functional status;
• assembly of retrospective “big data” datasets of individual Electronic Patient Record (EPR) data linked to brain imaging and mental health data for research and audit, service planning and improvement;
• healthcare innovation including development of AI tools to aid clinical decision making (eg delirium susceptibility score, dementia risk prediction, automated brain analysis tools);
• service development to improve the process of care for older hospital patients (eg implementation of routine cognitive and frailty screening for older hospital patients) informed by our research.