1.0 in older age. The three most common

1.0 Introduction

This is a
multidisciplinary research, which the aim is to investigate mental health
inequalities in Ireland through diet and lifestyle. To achieve this research
there will be an integration between environmental sciences to determine the
social determinants of mental health in Ireland and nutrition as it is one of
the key mediators describing deprivation and well-being. The project will use
the data gathered from the Trinity, Ulster and Department of Agriculture (TUDA)
Ageing Cohort Study, this database has collected data from 5,186 participants
from North and South of Ireland. This is a unique database with information on
nutrition and diseases of ageing on each individual since 2008. The results
gathered in this research will provide the evidence needed to inform future
health policy aimed at better health in older age reducing mental health
inequalities in Ireland.

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2.0 Background

Mental health
disorders are currently affecting 15% of older people worldwide (WHO,2017) and
it’s the leading cause of disability and ill health in older age. The three
most common disorders in ageing as highlighted by WHO are, dementia, depression
and anxiety.

The prevalence
of dementia worldwide is estimated at 35.6 million, of which 60,000 are living
in the island of Ireland (Prince et al, 2014; Connolly et al, 2014) and these
figures are expected to triple by 2050. Economically the total cost of managing
dementia is estimated at €1.69 billion annually in the Republic of Ireland and
£23 billion in the UK (Cahill et al., 2012; Prince et al, 2014; Connolly et al,
2014). Depression, often accompanied by anxiety, affects an estimated 10% of
the Irish population and the economic cost of treating depression is estimated
at €3 billion annually in Ireland and £7.5 billion in the UK (National
Collaborating Centre for Mental Health 2010). Globally, the total number of
people with depression was estimated to exceed 300 million in 2015. Nearly that
number again suffers from a range of anxiety disorders (WHO, 2017).

Promoting better
mental health is key to promote healthier ageing and address the challenges
that individuals will encounter in later life, not only in health but
economically and societal also. Health and socioeconomic position are both part
of the seven dimension of human well-being concept (Bhuiya et al., 1995).
Nutrition has been suggested as one of the key mediating factors to explain
health inequalities observed across the social gradient (Darmon et al, 2008).
Additionally, optimal nutrition it is essential for maintaining mental health
(Moore et al, 2016). Another study showed that lower socioeconomic position
individuals are more likely to have an unhealthy diet, eat less fruit and
vegetables and be obese (Maguire et al, 2015).   

There is some
evidence to suggest that food access inequalities are prevalent within society
and that older people are particularly vulnerable as they are more likely to
have mobility and fragility concerns that may limit their ability to bypass the
local food environment (Darmon et al, 2008). This is an everyday concern for
older people, from a lower socioeconomic background and dealing with mental
health.

There are many
approaches to measure health inequalities, the challenge is to measure them
accurately. Therefore, evidence-based policy making would be more effective to
compare results from different areas or countries. Deprivation is a ‘state of
observable and demonstrable disadvantage relative to the local community or the
wider society to which an individual, family or group belongs’ (Pornet et al.,
2012). As stated by Townsend, ‘the concept of deprivation covers the various
conditions, independent of income, experienced by people who are poor’.
Therefore, deprivation is a vast concept, closely linked with poverty
(Townsend, 1987).

By measuring
deprivation would give an insight of the socioeconomic background from an
individual, a family, a country and even a continent (Guillaume et al., 2015).
Since individual data are often poorly collected in routine GP databases, this
can be assessed by using socioeconomic characteristics of the place of
residence (Guillaume et al., 2015). To measure area-based socioeconomic
background the census, surveys and questionnaires are often used to gather this
information.

Mental health
disorders are determined by a combination of biological, genetic, environment
and social factors which needs further investigation. The main focus of this
research is to investigate health inequalities as we age in the island of
Ireland and provide evidence that this is of direct relevance to policy makers.

 

3.0 Research objectives

The overall aim
of this research is to promote better ageing for the island of Ireland and to
investigate health inequalities during the ageing process. To inform future
health policy makers aimed at addressing mental health inequalities.

1)     
To investigate the role of area-level
socioeconomic deprivation in mental health in older adults from the TUDA study
living in the island of Ireland, using geo-referencing technologies to map data
from two jurisdictions.

2)     
To investigate the EDI (European Deprivation
Index) and score Ireland in addition to create a model of deprivation
comparable to Europe.

3)     
Compare and contrast the influence of nutrition
and lifestyle factors with area-level socioeconomic deprivation measures on
cognitive and mental health outcomes within both health systems on the island
of Ireland (Qualitative and Quantitative)

4)     
Apply the state-of-art brain imaging
technologies to provide more in depth investigation of the link between brain
function and social determinants factors.

5)     
Publish findings and inform media of outcomes in
Ireland and internationally.

 

4.0 Methodology

It is essential
to use the Trinity, Ulster and Department of Agriculture (TUDA) cohort study to
achieve the aims mentioned above. It was designed to investigate nutritional
factors and health, including mental health in ageing adults.

TUDA Study design (existing data) – Designed
to assess nutritional, genetic and lifestyle factors to prevent age-related
disease in 5,186 adults over 60 years old. All participants underwent detailed
neuropsychiatric evaluation that measured cognition, depression and anxiety.
Physical Self- Maintenance Scale (PSMS) and Instrumental Activities of Daily
Living scale (IADL) were also assessed. Anthropometry, blood pressure, bone
health (by DEXA scan), metabolic measures, comprehensive questionnaire data and
information on 33 single nucleotide polymorphisms (SNPs) involved in
micronutrient dependent metabolic pathways and brain health.

Mental Health Assessment (existing data)
– Cognitive function was comprehensively assessed using a battery of tests,
including the Folstein Mini-Mental State Examination (MMSE), most commonly used
clinical tool worldwide to assess global cognitive function and examines
orientation, registration, attention and concentration, recall and language
(Folstein et al., 1975). The maximum score is attainable is 30, with a score

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