Empowering independence in older people

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Question Answer
Researchers involved: Dr Andy Clegg, Prof. John Young, Dr Sara Humphreys, Prof. John Wright, Sarah de Biaise, Kuldeep Sohal and Dr Stefan Williams
Main disease areas impacted: Elderly frailty
Key partners: University of Bradford

Project Overview

One in ten people aged over 65 and up to half of those aged over 85 are affected by frailty.  Frailty can occur naturally as part of the ageing process and as a result of becoming frail, older people are at an increased risk of falls, disability, hospitalisation and in some cases, death.

We typically require more support from the health and social care system as we get older but health services aren’t always joined up.  By linking together different sources of health information from across Bradford, researchers will be able to better plan and coordinate services so that patients receive more efficient care.

From analysing de-identified data , data scientists can more clearly understand which types of treatment and community services best support recovery and independence.  In the future they can look at the health records of certain populations, for example those aged over 85, to evaluate and understand if their efforts are having an impact on health.

Why is this research project important?

Older people with frailty are majority users in health and social services.  The rapid increase in multi-morbidity and frailty in older people is one of the biggest challenges to health and social care delivery.  This project will addresses NHS priorities as defined in the Five Year Forward View by working with two key Vanguards in the region.  The West Yorkshire’s Urgent Care Vanguard will identify new approaches to improve the coordination of services and reduce pressure on A&E departments and the Airedale and partners Enhanced Health In Care Homes Vanguard will offer older people better, joined up health, care and rehabilitation services.

What data are being used in this project?

  • Routine primary care data
  • Routine secondary care data
  • Routine social care data
  • Linked data from CARE 75+ cohort study

What methods are you using to conduct this work?

This project builds on existing research based on the electronic Frailty index (eFI).  Data from primary care, secondary care and social services will be linked using a common pseudonym to identify the target population for supported self-management.  De-identified linked data will be used at a population level at the baseline and to evaluate the impact of our interventions.

Who will benefit from your research?

To use the eFI to link health, social care and research datasets to identify the target population for SSM in frailty.

To implement an Self Supported Management care pathway for people with frailty based on the NHS England Healthy Ageing Guide, targeted at those most likely to gain benefit, to improve quality of life in older age and enable more efficient use of primary care, secondary care and social services.

What will be the intended outcome of your research project?

We anticipate that our new care pathway will improve the health and wellbeing of older people living with frailty and reduce use of GP, hospital and social care services. We will measure the improvements by collecting data on important outcomes for older people, the NHS and social care. These include: the proportion of older people with frailty who continue to live at home after 12 months as a key indicator of health and wellbeing; use of GP and hospital services; and use of social care services.

Are there any early findings?

Early findings have suggested that older people living with moderate and severe frailty are more dependent on primary care, secondary care and social services than those with mild frailty.

Watch this video to find out more about the eFI tool and its development to date.