Daniel How, one of our current research interns, working with Dr Giebel and Prof Gabbay at the University of Liverpool, tells us about his motivation, research focus and why it matters!

What inspired you to pursue a research internship alongside your medical career?

I am a doctor specialising in old age psychiatry. I have worked in different clinical environments, from a community mental health team to an inpatient ward. During my training as a doctor, I have been very interested in dementia as a condition. I have seen how the lives of those with dementia – and the people around them – are affected. In my current job seeing patients with dementia on an acute inpatient ward, I have realised that not all those who suffer from dementia receive equal care.

Clinical and academic work are very different from each other, and it is a real privilege to be able to experience these two aspects of medicine. I am particularly interested in thinking about ways in which we can help to reduce inequalities in care for dementia patients. I see dementia patients whose health outcomes can diverge greatly based on their social circumstances. For example, there are patients who experience diagnostic delays, missed follow-up appointments, poor medication adherence, and more frequent hospitalisations, not because of their clinical condition, but because services struggle to adapt to certain patients. Observing this has made me want to investigate this further through research and to address these inequalities.

How does your clinical background influence the way you approach research questions?

The research questions that I am drawn to stem directly from the issues that I encounter every day in my clinical practice. For example, as a doctor I am especially interested in the medication that patients are prescribed or not prescribed and why some patients might end up on long-term medication that are no longer of any benefit.

Clinically, I can see that access to medication can vary with sociodemographic factors such as deprivation, ethnicity, living situation and carer support. For this reason, my research topic has made sociodemographic factors a core part of my research rather than just a background variable.

As a doctor, I can see that lasting, system-wide change tends to happen, not one patient at a time, but through system changes, especially in an organisation as large as the NHS. When coming up with a research question, I focus on things that could realistically inform service design.

Can you share the main focus of your current research project and why it matters?

Around 1 million people in the UK have dementia. Psychotropic medications such as antidepressants, antipsychotics, and anti-dementia medications like cholinesterase inhibitors and memantine are widely prescribed in people with dementia. However, as dementia progresses, the balance of benefit and harm for these medications can change, with the risk of adverse effects such as falls, delirium, and stroke increasing.

Deprescribing is the intentional discontinuation or the reduction in dose of a medication and is one way of mitigating these adverse effects. Deprescribing in people with dementia is complex because doctors must weigh up several factors, such as a patient’s cognition, mental health, physical health, and carer dynamics.

Deprescribing is less researched and less regimented than prescribing, and so more prone to bias. The deprescribing of medication in people with dementia can vary by sociodemographic characteristics such as age, sex, and socioeconomic status. My research project will focus on the sociodemographic determinants of deprescribing, looking specifically into who has these medications stopped or reduced, how this varies by sociodemographic group, and whether any differences translate into unequal clinical outcomes.

What’s been the biggest challenge in balancing research with your medical responsibilities?

As part of my research internship with EquaDem, I get to spend one day a week working with the EquaDem team at the University of Liverpool. The rest of my week is spent working on an inpatient dementia ward in Mersey Care NHS Foundation Trust.  It can be difficult adjusting to academic work for one day a week as I still spend most of my time working in hospital. I also have to juggle all of this with completing the rest of my medical training, and my on-call commitments – which involves working night shifts and weekends. Because the EquaDem team have been so welcoming and supportive, it has made things much easier for me, and I am really enjoying working with a like-minded group of people who are all passionate about research.

How has this experience changed your perspective on medicine or patient care?

Working on this research project has shaped my clinical practice in ways I didn’t initially anticipate. It has simultaneously helped to broaden my outlook, and also to provide more holistic patient-centred care. By thinking about not only the individual patient sitting in front of me, but also the whole healthcare system that surrounds them, I have been able to take a wider scope and consider how patients from varying subgroups access the dementia care pathways in my hospital. At the same time, having developed my research skills in reading literature on dementia, I have found that I am better able to critically analyse papers, thinking about how the actual research trials were done, and the ways in which this could affect how I interpret the evidence for the individual patient sitting in front of me.

How do you hope your research will impact clinical practice or patient outcomes?

From my own clinical practice, I have seen inequalities in the care of dementia patients. These inequalities can then have an adverse impact on patient outcomes. The focus of my research project is on the importance of the medication that a patient receives or does not receive. As a doctor, I have observed that the reasons why patients receive or do not receive medication, does not always vary solely based on their clinical condition, but also based on their sociodemographic group. I hope that my research can highlight any ways in which certain subgroups can be identified as being particularly vulnerable and in need of additional support so that we can close the gap in these inequalities and ensure that more people with dementia receive the best care available.