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Home, hospital or care home: preferred place of care for older people with frailty and life limiting conditions in remote and rural areas.

Project Description

The Scottish rural population is aging – 25% of people in remote rural areas are aged over 65, compared to 18% of people living in urban areas.1 As many localities and health care services are facing the challenge of providing health and social care for older people, it is often assumed that people would strongly prefer to be cared for at home. This assumption has some foundation in quantitative data: a 1997 survey of 9105 seriously ill older hospital inpatients in America found that 30% would prefer to die rather than to live in a care home.2 (A ‘care home’ is legally defined as any nursing or residential care facility that provides 24-hour care to its residents).

There is some evidence older people and family carers may in some circumstances prefer institutional care for end of life care3, 4 but less evidence about those who are requiring daily assistance with activities of daily living but are not at the end of life, for example those considering moving to a care home for the remainder of their lives which may be measured in months or years rather than for short end-of-life care.

Little is known about the preferences for care when people are frail in remote rural areas. Home care services are more limited, many small community hospitals have closed, and hospice care is not always available. The availability or not of different forms of support locally (including care at home, and sheltered housing) will shape the choices people think they can make. To be at ‘at home’ has many meanings, whilst for many ‘home’ is a dwelling house, for others home is also a larger geographical area, and they would consider receiving care in this area as still being ‘at home’.5

This PhD student will carry out a qualitative interview study to consider the views and experiences of a) older people and b) their family members when considering moving into a care home/community hospital or to receive care at home.

In preparation, the student will carry out two pieces of work:
• A review of the available qualitative literature on older people’s preferred place of care (in both rural and urban settings)
• An analysis of quantitative data on how care home admissions vary with geographical area. Using data from the Scottish Care Home Census they will compare the various demographic features between different care homes including length of stay and source of admission for urban, rural mainland and island care homes.

We will consider how the differences between care home populations may reflect differences in care provision, and preferences in urban and rural areas. For instance a longer length of stay may indicate an earlier move to a care home; admission from hospital indicates an admission in crisis. The number of patients receiving nursing, residential, and dementia care can also indicate the burden of care required.

This preparatory work will inform the design of the interview study to investigate older people’s and family carers’ views on preferred place of care specifically in remote and rural settings. The student will identify people aged over 80 (and their family members) who either currently require care or are likely to do so soon in two areas: one island community (likely to be Orkney), and rural Caithness.

The student will be based in The University of Aberdeen, which is particularly well-placed to host this research. The supervisors and mentor sit within the Institute of Applied Health Sciences, whose mission is to improve health and health care delivery through excellence in applied health sciences research.

This project is advertised in relation to the research areas of APPLIED HEALTH SCIENCE. Formal applications can be completed online: You should apply for Degree of Doctor of Philosophy in Applied Health Science, to ensure that your application is passed to the correct person for processing.


Candidates should contact the lead supervisor to discuss the project in advance of submitting an application, as supervisors will be expected to provide a letter of support for suitable applicants. Candidates will be informed after the application deadline if they have been shortlisted for interview.

Funding Notes

This project is part of a competition funded by the Institute of Applied Health Sciences. Full funding is available to UK/EU candidates only. Overseas candidates can apply for this studentship but will have to find additional funding to cover the difference between overseas and home fees (approximately £16,625 per annum).

Candidates should have (or expect to achieve) a minimum of a First Class Honours degree in a relevant subject. Applicants with a minimum of a 2:1 Honours degree may be considered provided they have a Distinction at Masters level.


1. van Woerden H. Past, Present and Future Trends in Health and Wellbeing. Annual Report of Director of Public Health 2019. In: Highland N, (ed.). Inverness2019.

2. Mattimore TJ, Wenger NS, Desbiens NA, et al. Surrogate and Physician Understanding of Patients' Preferences for Living Permanently in a Nursing Home. Journal of the American Geriatrics Society 1997; 45: 818-824. DOI: 10.1111/j.1532-5415.1997.tb01508.x.

3. Hoare S, Kelly MP and Barclay S. Home care and end-of-life hospital admissions: a retrospective interview study in English primary and secondary care. British Journal of General Practice 2019; 69: e561-e569. DOI: 10.3399/bjgp19X704561.

4. MacArtney JI, Broom A, Kirby E, et al. Locating care at the end of life: burden, vulnerability, and the practical accomplishment of dying. Sociology of Health & Illness 2016; 38: 479-492. DOI: 10.1111/1467-9566.12375.

5. Chaudhury H, Hung L, Rust T, et al. Do physical environmental changes make a difference? Supporting person-centered care at mealtimes in nursing homes. Dementia (London) 2016. DOI: 10.1177/1471301215622839.

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