Digitally Enabled Deprescribing and Medicines Optimisation for Older Adults Living with Frailty in Northern Ireland: A Patient-Centred Mixed-Methods Study

Summary

Northern Ireland has an ageing population, with many older adults living with frailty, multimorbidity and complex medication regimens, which places them at risk of medication-related harm, avoidable hospitalisation and reduced quality of life.

These risks are further exacerbated by variable levels of health literacy and limited support for older people to understand and actively participate in decisions about their medicines, including deprescribing potentially inappropriate treatments.

Despite increasing policy emphasis on medicines optimisation and deprescribing, a critical gap remains in scalable, patient-centred approaches tailored to frail older adults and embedded within local geriatric pharmacotherapy pathways in Northern Ireland.

This project will investigate the relationships between health literacy, frailty status, and medication use among older people living with frailty in Northern Ireland, and will use these insights to co-design and test a digitally enabled, patient-centred intervention to support safer prescribing and deprescribing.

The study will begin with a cross-sectional survey and clinical assessments to characterise health literacy, frailty, medication burden, and outcomes related to medicines use in a representative sample of older adults across health and social care settings.

Validated tools will assess health literacy and frailty, and a structured medication review, based on established seven-step medicines review principles and impact tools, will identify potentially inappropriate medicines and deprescribing opportunities.

A mixed-methods component will explore, through qualitative interviews, how frail older people understand their medicines, navigate polypharmacy, and perceive deprescribing conversations with pharmacists and other prescribers.

These data will inform the co-design, with older people, carers, pharmacists and other clinicians, of a digital intervention that integrates tailored health literacy resources, self-reported frailty measures, and a shared decision-making tool focused on deprescribing and medicine optimisation.

The intervention will be deliberately aligned with clinical pharmacy services in Northern Ireland to maximise its relevance for geriatric pharmacotherapy practice.

Finally, a pilot/feasibility randomised controlled trial will assess the acceptability, usability and implementation of the digital intervention in routine care and generate preliminary data on its effects on medication appropriateness, adherence, patient-reported outcomes and healthcare utilisation among frail older adults.

By combining epidemiological, clinical and co-design methods, this project will provide an in-depth understanding of the intersection of frailty, health literacy and medicines use and deliver a prototype digital tool that can be scaled within Northern Ireland’s health and social care system and, via international collaboration, adapted to other healthcare settings.

Please note:  Research Proposal - 5 pages in total

The proposal must include:

• Background to the project - 2 pages
• Problem to be addressed/Aim and Objectives - 1 page
• Methods to be used -1 page
• Anticipated outcomes -1 page
• List of references

Please also note that the use of AI in generating the research proposal is prohibited.

Important Information: Applications for more than one PhD studentship are welcome, however if you apply for more than one PhD project within Biomedical Sciences/Pharmacy and Pharmaceutical Sciences, your first application on the system will be deemed your first-choice preference and further applications will be ordered based on the sequential time of submission.

If you are successfully shortlisted, you will be interviewed only on your first-choice application and ranked accordingly. Those ranked highest will be offered a PhD studentship.

In the situation where you are ranked highly and your first-choice project is already allocated to someone who was ranked higher than you, you may be offered your 2nd or 3rd choice project depending on the availability of this project.

AccessNI clearance required

Please note, the successful candidate will be required to obtain AccessNI clearance prior to registration due to the nature of the project.

Essential criteria

Applicants should hold, or expect to obtain, a First or Upper Second Class Honours Degree in a subject relevant to the proposed area of study.

We may also consider applications from those who hold equivalent qualifications, for example, a Lower Second Class Honours Degree plus a Master’s Degree with Distinction.

In exceptional circumstances, the University may consider a portfolio of evidence from applicants who have appropriate professional experience which is equivalent to the learning outcomes of an Honours degree in lieu of academic qualifications.

• Sound understanding of subject area as evidenced by a comprehensive research proposal detailing background, research questions, aims and methodology
• A comprehensive and articulate personal statement demonstrating interest in the subject area

Desirable Criteria

If the University receives a large number of applicants for the project, the following desirable criteria may be applied to shortlist applicants for interview.

• Applicants should hold, or expect to hold a First Class Honours Degree in a relevant subject area
• Applicants should hold, or expect to hold a relevant Masters Degree at a level equivalent to commendation or distinction at Ulster
• Practice-based research experience and/or dissemination
• Experience or knowledge of research methods or other approaches relevant to the subject domain
• Work experience relevant to the proposed project
• Experience of presentation of research findings

Equal Opportunities

The University is an equal opportunities employer and welcomes applicants from all sections of the community, particularly from those with disabilities.

Appointment will be made on merit.

Funding and eligibility

This project is funded by:

• Department for the Economy (DfE)
• Vice Chancellor's Research Scholarship (VCRS)

PhD scholarships are available for this project to all applicants worldwide, regardless of residency or domicile, and will cover:

• Tuition fees.
• A maintenance allowance of approximately £22,000 (exact rate is to be confirmed) per annum for three years, subject to satisfactory academic performance.
• A Research Training Support Grant (RTSG) of approximately £900 per annum.

Applicants who already hold a doctoral degree or who have been registered on a programme of research leading to the award of a doctoral degree on a full-time basis for more than one year, or part-time equivalent, funded from any source, including self-financing students, are NOT eligible to apply for an award.

Students in full-time employment are not eligible for an award.

Part-time PhD scholarships may be available at a 0.5 pro rata rate of the full-time scholarship, which would require a six-year registration period.

Due consideration should be given to financing your studies.

The University will award a successful candidate one of the following scholarships for the project, depending on the funding available at the time an admissions offer is made:

1. Department for the Economy (DfE) PhD Scholarships
2. Vice Chancellor’s Research Scholarships (VCRS)

Please note that the Terms and Conditions for scholarships are subject to change for 2027/28.