Jonas Wastesson

Research problem and specific questionsLoneliness is associated with poor health and mortality, but the causal relationships between loneliness, mental health and care use are not well understood, and there is a lack of evidence-based methods for care professionals to recognise and respond to loneliness. This programme takes a holistic perspective on loneliness in older adults, how loneliness is understood and experienced, and its relationship with mental health. Our work packages (WPs) will address research gaps to support evidence-based approaches to identify, assess and address to loneliness in practice by:examining inequalities in risk factors and consequences of loneliness, and causal associations between loneliness, mental health and careexploring subjective experiences of loneliness and mental health from a life-course perspectivedeveloping an instrument to assess loneliness in practicecreating a loneliness literacy training programme for care professionalsenhancing care professionals’ response to lonelinessData and methodIn WP1, panel studies will be combined with register data to examine inequalities in loneliness and its causal associations with mental health and care use. In WP2, older adults’ experiences of loneliness and mental health will be explored in interviews, which will also support the development of an instrument to assess loneliness. In WP3, researchers and care professionals will co-design a loneliness literacy training programme to improve care professionals’ competencies to address loneliness. WP4 integrates research across WPs, embeds it in practice and promotes dissemination of findings. Workshops with stakeholders will explore how to enhance care professionals’ response to loneliness.Relevance and utilisationOur research will advance the understanding of risk factors and avoidable consequences of loneliness, produce the first instrument for assessing loneliness validated for use with older adults in Swedish care practice, and develop a unique loneliness literacy programme for care professionals. Close collaboration with stakeholders will ensure our findings can support social care and civil society in addressing loneliness and mitigate its negative outcomes.Plan for project realisationThe programme will be realised by an experienced multidisciplinary team with expertise in loneliness, mental health, gender and socioeconomic inequality, health literacy and care in old age. Collaboration with pensioner and mental health organisations and authorities ensures representation of older adults and the programme’s relevance and feasibility for practice. Scientific quality is supported by an international academic reference group. There will be thorough dissemination to academic, policy and practice communities.A budget of SEK 23.8 million includes staff costs (SEK 15.1 million)

running costs (e.g., meetings, fieldwork, dissemination, administration, IT, offices

SEK 4.4 million)

and indirect costs (SEK 4.3 million).

Research problem and specific questionsMedications play an important role for the mental health and suicidal behaviour (i.e. suicide and self-harm) among older people. This is however an understudied topic, which we aim to change with the proposed project. We aim to investigate in older adults 1) Medication treatment before and after self-harm

2) Medication patterns before suicide

3) Medications, loneliness and bereavement

and 4) Co-designing prevention of suicidal behaviour and involuntary loneliness.Data and methodThe project combines quantitative analyses of high quality Swedish register data (Aim 1-3) with qualitative focus group interviews with key stakeholders (Aim 4). We will analyse longitudinal data from several Swedish registers of people aged ≥65 years (n≈3.1 million). Results from these analyses will serve as a foundation for the semistructured focus group interviews with key stakeholders, including user organisations, health care and eldercare.Relevance This multidisciplinary project integrates different research approaches and uses participatory designs, with the goal of co-designing preventive interventions for older adults. We will use cutting-edge epidemiological methods based on registers with excellent data quality offering the possibility for long-term follow-up. With these methodological advancements and big high quality data, we will be able to address the shortcomings of previous studies. This project will also identify vulnerable high-risk groups for tailored interventions that could increase health and autonomy in older adults.Our focus on medications in this context is novel and highly relevant. Medication treatment is very common among older adults and, thus, a natural point of intervention and potential identifier of loneliness and suicidal behaviour.Plan for project realisation We will start with the register-based studies (Aim 1-3) and the initiation of a Community Advisory Board of older adults. Based on the findings from Aim 1-3, we will design focus group interviews with key stakeholders (Aim 4). We will actively involve end users and health care and eldercare providers in the project to ensure that all important stakeholders are represented and provide input.Feasibility is ensured by availability of all necessary data in-house, and by the combined high and wide competence in our interdisciplinary team.The budget mainly covers funding for a PhD student and a postdoc for the scientific and outreach activities.

Research problem and specific questions Deprescribing is a novel concept relating to a process where medications are reduced or stopped in order to avoid medication-related harms and improve patient outcomes. This proposal addresses two main challenges for deprescribing: (1) integrating deprescribing in routine care for older adults

(2) adapting deprescribing activities to the Swedish context, a country where deprescribing have yet to be introduced.Data and methodThis mixed-method project combines register-based data analysis, with qualitative research and participatory design. We use a mixed approach in order to: (a) describe the current deprescribing activities in Sweden (nation-wide register data covering all older adults in Sweden)

(b) gain detailed knowledge of the barriers and facilitators for deprescribing activities among patient and health care professionals (qualitative research and survey)

and, (c) creating a roadmap for future deprescribing interventions in Sweden (co-design of health care interventions). We believe that that the selected methods are the necessary steps to introduce relevant and patient-centered deprescribing activities in Sweden.Plan for project realisation This participatory research project will be executed in three steps. First, we will conduct analysis of register data to have an up-to-date understanding of the need, current activities, and efficacy and safety of deprescribing in Sweden. Second, we will conduct a series of interviews with patients and health care professionals focusing on barriers and facilitators for deprescribing in the Swedish context, and invite health care professionals to rank their most needed resources to routinely conduct deprescribing. Based on the two first steps, we will conduct a series of workshops with stakeholders (patient representatives and different health care professionals) to co-design a deprescribing intervention that is feasible and scalable in the Swedish setting.RelevanceThe novel process of deprescribing has the potential to reduce the high levels preventable medication-related harms in older adults. Medication-related harms lead to much individual suffering and high economic cost. Ideally, this project will improve medication use in older adults by shifting the attention from prescribing to deprescribing. By including end-users throughout the project, we believe that this project will be highly relevant for patients, policy makers, and health care providers.

We need post-COVID research on the most severely affected group in the pandemic – older adults. Focus has so far mainly been on younger individuals, although older adults are likely to be severely affected because of their lower resilience to stressors. We will therefore provide results based on large unselected longitudinal nationwide data.Among older adults, we aim to 1) Investigate use of healthcare and eldercare among COVID-19 survivors (including creating an indicator of post-COVID in older adults)

2) Identify risk factors for post-COVID

3) Study outcomes of post-COVID

and 4) Explore the role of medications and dementia in post-COVID.We will analyze several Swedish registers of people aged &gt

=65 years (n~2.6 million) and the Swedish Dementia Registry (n~100 000), and also include international comparisons. We will study the use of healthcare (e.g. hospitalizations, medications) and eldercare (home care services, nursing home admission) among COVID-19 survivors compared to non-infected. Adjusted regression models (e.g. Cox proportional hazard, propensity matching) will be used to study outcomes (e.g. mortality) and different risk factors (e.g. sociodemography, multimorbidity, depression and cardiovascular diseases). Also medications (e.g. polypharmacy, diuretics and anticoagulants) and dementia will be analyzed in detail.The findings will lead to mitigating the long-term effects of the pandemic as well as other infectious diseases like the seasonal influenza.

We urgently need research on the most severely affected in the COVID-19 pandemic – older adults. In Sweden, ~90% of the deaths have occurred in people aged &gt

=70 years. Still, few studies on COVID-19 among older adults have based their findings on big data. To address these major knowledge gaps, we will provide results based on large unselected longitudinal nationwide data. Among older adults, we aim to 1) Identify risk profiles for severe outcomes of COVID-19

2) Show outcomes of medication treatment and dementia

3) Study long-term consequences of COVID-19

and 4) Investigate coverage and outcomes of vaccination. We will analyse several Swedish registers of people aged &gt

=65 years (n~2.6 million) and the Swedish Dementia Registry (n~95 000), and also include international comparisons. Adjusted regression models (e.g. Cox proportional hazard, propensity matching, nested case-control design) will be used to estimate independent risk of outcomes (e.g. hospitalisation, mortality, long-term consequences and vaccination) of different factors (e.g. sociodemography, place of residence, nursing home/own home, eldercare, frailty, multimorbidity, polypharmacy, dementia, depression, diabetes, cancer and cardiovascular diseases). Also medications (e.g. ACE inhibitors, statins and anticoagulants) will be analysed. The findings will contribute to mitigating the effects of this pandemic as well as future ones. Thus, long-term advantages are expected, including for the seasonal influenza.