1. What dynamics affect equity in access to public emergency services for stroke among the elderly? CHRISTOPHER HIENG CHIE TIE - SLMS (INFECTION & IMMUNITY) VANESSA SOUSA MORENO – SLMS (EASTMAN DENTAL INSTITUTE) LU GRAM – SLMS (INSTITUTE OF GLOBAL HEALTH) LOUISE GUIBRUNET – BEAMS (INSTITUTE FOR SUSTAINABLE RESOURCES) PAULA MORGENSTERN – BEAMS (ENERGY INSTITUTE) NICK ZAFEIROPOULOS – SLMS (INSTITUTE OF NEUROLOGY)

2. Background  WHO projects an increasingly ageing population for the UK and the world at large  Thus elderly will form a key vulnerable population in the near future  Equity is one of the founding principles of the NHS  Evidence gap in access to health care among the elderly, particularly in access to emergency services

3. The world will have more people who live to see their 60s than ever before 605 million In emergency situations, especially vulnerable 2 billion Unable to flee or travel long distances Most die of NCDs 2000 2050 World's population >60 years http://www.who.int/ageing/about/facts/en/

4. ~ 152,000 strokes in the UK every year (>1 every five minutes) 4-6% of the total expenditure on the NHS

5. Aims and objectives  Understand how individual, social and infrastructural factors affect access to emergency services for treatment of stroke for the elderly  Understand the complex relationships between these factors  Understand how interrelated factors affect equity in access to emergency services  Develop policy recommendations

6. Conceptual Framework Acknowledging the need for emergency services -Knowledge -Beliefs -Attitudes Contact to emergency services -Social support -Communicati on systems Getting to the hospital -Spatial distribution of emergency centres -Transport In the hospital -Availability of care -Quality of care

7. Methodology Data Collection  Existing literature  Routine data (forensic, NHS, ambulance calls, hospital satisfaction survey)  GIS data  In-depth interviews with stakeholders (carers, hospital staff and patients)  Survey with vignettes coded using codebook Analysis  Systematic Review  Analysis of routine data  Mapping  Thematic analysis  Multivariable statistics

8. Timeline Task / Time Units123456789 Ethical approval Literature review Secondary data analysis In-depth interviews with stakeholders Qualitative analysis of interviews Survey Quantitative analysis of survey data Synthesis and policy recommendations Dissemination and public engagement

9. Expected outcomes  Produce conceptual map of factors and their relations  Policy recommendation document  Public engagement and dissemination  Publications  Funding proposal for intervention research Social factors Infrastructure Individual factors

10. Questions?