Decisions about distributing health resources between different people and medical needs are difficult and controversial. In this project we propose to investigate how healthcare resources should be distributed across the lifespan and across different age groups. This investigation, relatively unexamined within healthcare policy research and ethics, is particularly timely. Shifting demographics, resource constraints, and exacerbated by the pandemic inequalities, pose significant challenges for the NHS and highlight the pressing need to ensure fair treatment for all age groups in healthcare services. In healthcare decision-making, connections between age and resource allocation have predominantly focused on adhering to the apparent requirement that we do not discriminate based on age. This often leads to a simplistic approach that people of all ages should be treated the same in order to be treated fairly. Regrettably, despite best intentions, this approach cannot consistently achieve fairness. Instead, it gives rise to new forms of injustice by obscuring underlying realities and needs. Currently, distinctive needs across the lifespan and the unique ways in which individuals at various life stages are impacted by healthcare are not properly considered in decision-making processes. Important challenges are often overlooked. These, for instance, include transitional phases; the specific requirements on individuals dealing with conditions at atypical ages; and the complex interplay between vulnerabilities associated with different life-stages and socio-economic factors. These omissions contribute to and exacerbate existing inequalities. Many older individuals, lacking post-operative support, experience isolation and diminished well-being. Children with complex medical conditions, waiting on backlogged lists, often miss out on time-critical developmental treatments constraining their life opportunities. Women experiencing menopause and adolescents battling mental health challenges frequently encounter suboptimal care, exacerbating health and social issues that could otherwise be alleviated. Children within palliative care services, which are generally tailored and funded for older patients, may not receive the emotional and physical support they require. This project will illuminate these currently overlooked inequalities. By exploring the critical intersection between age and healthcare justice, this work will help determine how to allocate resources in order to avoid unfair discrimination against different population groups. The study will proceed, first, to identify and analyse age-related assumptions in healthcare resource allocation in order to understand their impact on healthcare access from early life to late adulthood. Second, it will explore the legal and ethical dimensions of healthcare inequalities among age groups in order to identify overlooked injustices. Finally, collaborating with commissioners, providers, patient and policy organisations, it will develop and test the applicability of a 'stage-of-life sensitive' approach for decision-making. This approach will be more responsive to healthcare needs across the lifespan and will be adaptable to different processes and regional policy contexts. Findings will raise awareness of overlooked healthcare injustices among decision-makers, academics, and the public, aiming to prompt policymakers to revise existing guidelines. This will lead to tangible healthcare access benefits for individuals of all ages and needs. We will also establish networks among ethicists, lawyers, healthcare providers, policymakers, and other stakeholders, fostering continued dialogue to facilitate societal change.

Cultural pessimism about ageing endangers intergenerational solidarity; it shapes perceptions of the worth and value of human beings and directs decisions about care, research and funding priorities. SAACY will inform practices and policy development in these areas. Age UK, a leading UK charity for older people, holds ageing to involve teeth, bones, the cardiovascular, respiratory, immune and endocrine systems. Dementia, perhaps surprisingly, features as only one of six systems affected. Yet, with its profound connotations of cognitive loss, dementia has become virtually synonymous with ageing in the popular imagination. This emphasis on cognition impacts upon negative valuations of ageing; and healthcare focus on cognition detracts from other important problems of older age. SAACY seeks to understand the significance of this emphasis on cognition, and to find out where it comes from. Is it led by scientific research; can it be explained by skewed popular scientific accounts or by healthcare practice; or is it culturally driven? This project takes a historical approach, while benefitting from the PI's unique perspective of someone who has achieved academic distinction in neuropharmacology and been active and successful in the health humanities for over a decade. It will chart the dynamic exchange between scientific and medical ideas of senescence, their popular scientific conduit and cultural images of ageing from 1880-today. A century-old body of cellular research explains ageing as a lifelong physiological process. This perspective has lasting import in evolutionary theories of ageing. These can explain physiologically aberrations of the cell cycle (which can lead to cancer), hormonal changes in mid-life (like the menopause) and degenerative conditions typical of older age (like arthritis or cardiovascular disease). They also explain brain ageing as a continuous variation in cognitive able-ness in a biologically changing body, and emphasise that, like cells of other organs, brain cells age. But this explanation carries little weight in a society in which dementia epitomises the ultimate condition of loss, of personhood in older age. Media hype about curing Alzheimer's and extending life are eagerly absorbed by a culture hailing youth; it also justifies priority of cure-focused research and amplifies aversion to old age. The experiential consequences of memory loss are devastating, and there are genetic forms of dementia for which a cure might become available. Yet, appreciating the physiological similarities between e.g. age-related loss of mobility and loss of memory would help lift stigma of failure from dementia. SAACY argues that societal fears about dementia are partly explained by the research trajectory that memory loss in older subjects has taken. Almost from the moment brain cells came under scrutiny, cognitive ageing was considered an organic disease of the brain; the focus became brain cell disorganisation as pathological, and brain involution as something needing to be cured gained scientific, medical and cultural ascendancy. SAACY investigates the pathways and rationales that have led culture selectively to assign truth value to some scientific concepts and not others. It explores the origins of and reasons for the cultural emphasis on ageing as pathological decline rather than continuous physiological change. It will insist that notions of development have an explicit place within the scientific research agenda. It ensures that concepts like life-experience will move from the margins of literary scholarship to become constitutive of the cultural transcript of ageing. In its Ageing Society Grand Challenge, the UK Government sets out an agenda for how to 'build a Britain fit for the future'. SAACY provides a firm basis on which to meet the Government's Healthy Ageing Challenge, a basis that values care as well as cure, and stresses that healthy ageing comes from embracing continuous change, at every age.

Dementia is and will increasingly become a workplace issue. Out of the 800,000 people living with dementia in the UK, approximately 7.5% of them are under the age of 65 and may still be working when diagnosed. Furthermore, an increasing number of family caregivers will be in employment while caring for a family member living with dementia. There is an urgent need to further understand the impact of dementia on the workforce and to develop innovative research-informed supports to improve the economic and social well-being of people affected by dementia. The Working with Dementia (WWD) Network Plus will create a research network that includes the views and real-world experiences of people living or working with dementia and other non-academic stakeholders, such as employer representatives, in the research process. The aim is to shift our current understanding of working with dementia, drive positive change, and open new horizons to enhance labour market experiences for those affected by dementia. By doing so, we aspire to play a pivotal role in alleviating the social and financial inequalities associated with dementia in society. Working with Dementia research requires an integrated understanding of the individual, organisational, societal, and economic factors at play to develop innovative and impactful research solutions. We will achieve this through the following objectives: Establish a Transdisciplinary Research Network: Create and grow an inclusive transdisciplinary research network to address the identified issues by assembling experts from diverse academic fields, individuals with experiences of living and working with dementia, health and social care, third-sector experts, and employer stakeholders, fostering collaboration and knowledge exchange. Collaboratively Shape the Research Agenda: Explore existing research and real-world experiences to inform and shape the research agenda, ensuring alignment with the Network's aims and objectives. Empower Researchers: Provide comprehensive support and resources for career development, including mentorship, training, and knowledge-sharing platforms, to enhance research capabilities and sustain careers in dementia and work research. Support and Fund Innovative Research Projects: Seed fund and promote innovative transdisciplinary research projects aimed at enhancing labour market experiences for individuals living with dementia and their family caregivers, encouraging a culture of collaboration and innovation. Drive Societal Impact: Engage in creative dissemination strategies, policy advocacy, and public engagement efforts, as well as fund innovation projects to ensure research findings reach a wide audience, drive positive change in societal perceptions, policies, and practices related to dementia and employment, and contribute to a more inclusive and supportive labour market environment. Our transdisciplinary approach will allow us to work collaboratively with these groups to cultivate integrated knowledge of working with dementia, shape the aims of the network, and ultimately develop impactful research solutions. We firmly believe that research should translate into change in the real world, benefiting individuals, organisations, and society. The WWD Network Plus will ultimately improve the lives of those affected by dementia by advancing societal understanding of dementia and work and improving work-based support available to individuals and organisations.