Ewch i’r prif gynnwys

The older person

Mae'r cynnwys hwn ar gael yn Saesneg yn unig.

Elderly lady with female carer in blue uniform

Responding to a need for high quality research to better serve an ageing population.

Background

An ageing population is associated with a corresponding rise in the number of people requiring long-term care, with those entering long-term care having increasingly severe and complex healthcare needs. Currently, there is little evidence base for much of the care provided in care homes, for example, and there have been calls for the development of such a structured approach.

We are therefore committed to developing interventions and carrying out clinical trials to inform public health decisions in this under-represented and ever growing population.

Care homes

We conducted a study to identify the research priorities in care homes. This is the first study to establish the research priorities for older people requiring long term care in the UK. After ranking, the top 15 research priorities included questions on person-centred care, dignity, staffing levels, sensory impairment, and end of life care, as well as questions around public and media perception.

Informing public health research decisions

Setting research priorities assists researchers and policymakers to effectively target research that has the greatest potential public health benefit. Identifying priorities is increasingly being seen as an essential part of the research cycle, with a number of funders indicating that they wish to incorporate the findings of priority setting work into their commissioning processes.

Case studies

Elderly lady walking with carer in park setting

The first study in the UK to establish research priorities for the long-term care of older people.

Background

This study is based on an idea originally conceived as a small pilot at the end of a previous care home study (PAAD Study), and was then developed into a larger UK-wide study.

It is widely recognised that the numbers of older people requiring long-term care are rising, with increasingly complex care needs. However there is little evidence base for much of the care provided in care homes, as less research takes place in this sector compared with hospitals and the community. Given the wide range of areas that require further investigation, and limited resources, one solution is to involve stakeholders in decisions about the priorities for future research.

Study design

Victoria Shepherd

This study provides an exciting opportunity for making sure that future research, in this greatly under-researched area, can be targeted towards areas that provide the most benefit. Older people deserve access to the best evidence-based care.

Victoria Shepherd, Research Associate - Nurse

This was the first study to establish the research priorities for older people requiring long-term care in the UK. Care home staff throughout the UK were invited to form an ‘expert panel’. They took part in a series of consensus building rounds using the Delphi technique to identify, and then rank, the topics they considered were most in need of further research. They were able to take part through a variety of methods: online survey, printed questionnaire, or by attending a local workshop event hosted by research networks.

Positive response and wide involvement

We found that a significantly larger group than anticipated responded to the last round as the link to the online survey was shared by interested individuals, groups and organisations. Care home staff who had not participated in previous rounds, and a number of health and social care professionals including doctors, social workers and care regulators, were keen to take part. The scores from these additional groups were not included in the main findings, but were analysed separately to assess the level of agreement with the findings from the main cohort.

Involving the public and the patients

This study was based on an idea originally conceived as a small pilot at the end of a previous care home study (PAAD Study), which was then developed into a larger UK wide study. The original study benefitted from the involvement of public and patient representatives throughout the design, development and conduct of both the main study and pilot, which in turn led to the development of this priority setting project.

Research impact

The early results show that the most highly rated themes were person-centred care, staffing levels and quality of staff in care homes, and end of life care. The next steps are further work to address the research questions identified as priorities during this study, and also to explore the evidence-practice gap for areas with existing evidence that are not currently implemented. Further work to explore the research priorities of residents, their families and friends would also be valuable.

Identifying priorities is increasingly being seen as an essential part of the research cycle, with a number of funders indicating that they wish to incorporate the findings of priority setting work into their commissioning processes. We hope that by engaging with clinicians, researchers and funding bodies, our findings will have a positive impact on the care of older people through ensuring that the future research agenda is focused on the areas of greatest need.

Mae'r cynnwys hwn ar gael yn Saesneg yn unig.

A selection of medical pills.

A study to examine whether care home patients experience health benefits, such as reduced infections, from taking a daily probiotic supplement.

Background

It is known that older people living in care homes are prescribed far more antibiotics than the general population because of the higher number of infections they have, caused by weakened immunity, close-proximity living and co-existing health conditions.

The cost of chronic antibiotic use

High antibiotic use increases the risk of antibiotic resistance in care homes that can spread within care homes and to hospitals and the community. Infections in care home residents cost the NHS more than £54 million a year in hospitalisation alone, and infections are the commonest reason for residents to be hospitalised. Reduction in antibiotic use and antibiotic resistance could improve residents’ quality of life, save money, and help preserve the usefulness of existing antibiotics. There is an urgent need to reduce antibiotic resistance through infection prevention in care homes.

Potential benefits of probiotics

Probiotics are live bacteria that may confer health benefits by improving immune function and reducing carriage of potentially harmful bacteria. Probiotics are safe and cheap and are widely available as supplements. However, research involving their effectiveness in care home residents is currently lacking.

Other than vaccination and good hygiene, there are few proven ways to prevent infections in older care home residents - so they represent an important target in efforts to combat antibiotic resistance. Our study should answer the question whether or not daily probiotics prevent infections.

Professor Chris Butler, Chief investigator PRINCESS study, University of Oxford

PRINCESS will be the first rigorous randomised controlled trial of daily probiotic versus placebo probiotic over 12 months on antibiotic administration for infections.

Study design

The trial is designed to focus on antibiotic use for all care home residents - including those lacking mental capacity and who are most frail. Previous studies in care home populations, including a recent study carried out by the same research team (PAAD Study), showed that 72% of care home residents lacked mental capacity to consent for themselves. Evidence shows that those lacking capacity are likely to be more frail than those with capacity, and have an increased vulnerability to infection, and so are more likely to benefit from any reduction in infections and subsequent requirement for antibiotics.

Recruitment targets

We aim to recruit 330 residents from care homes in Wales and England to take part in an individually randomised trial of a probiotic preparation vs. placebo preparation, and follow them up for 12 months. The aim is to trial the probiotic preparation (containing Lactobacillus rhamnosus, LGG and Bifidobacterium animalis subsp. lactis, BB-12) to determine whether this product prevents infections over a 12 month period in older people living in care homes.

Measuring probiotic effectiveness

Trial participants will take a once daily dose of study product for 12 months, taken as a capsule or sprinkled on food. They will be asked to provide (optional) blood, saliva and stool samples at the start of the study, and three and 12 months later. Participants will also complete questionnaires either by themselves or with the help of someone else.

We will assess total days on antibiotics for infections, including respiratory, urinary tract, skin and gastro-intestinal infection, and other measures such as changes in immune response to influenza vaccination.

Involving the public and patients

Public and patient involvement has greatly benefitted the trial. Two members of the public have been recruited through Involving People (Wales) to advise the research team throughout the whole life-cycle of the trial. Additional lay members form part of the independent committee overseeing the trial.

Their invaluable involvement in the initial planning and design of PRINCESS, and ongoing involvement during the trial itself, will maximise the quality of the research and ensure that the study is feasible and relevant. Ultimately, it is hoped that involving members of the public will have a positive impact on ensuring the trial findings improve outcomes for older people living in care homes.

Research impact

Other than vaccination and hygiene methods, there are few interventions proven to prevent infection in care home residents. The trial will provide information on a safe and widely accessible intervention for the prevention of infection, antibiotic use and antibiotic resistance in care home residents.

The results will help care home residents, and those caring for them, to make evidence based decisions either to take or not take this probiotic product in order to maintain their optimal health and wellbeing.

Funder: National Institute for Health Research Efficacy and Mechanism Evaluation (NIHR-EME) Programme

Chief Investigator: Professor Chris Butler

Theme leads

Dr Rachel Lowe (née Breen)

Research Fellow - Senior Trial Manager

Email:
breenr@caerdydd.ac.uk
Telephone:
+44 (0)29 2068 7512
Busse, Monica

Yr Athro Monica Busse

Professor

Email:
busseme@caerdydd.ac.uk
Telephone:
+44 (0)29 2068 7559