The Community Ageing Research Study (CARE 75+)

Description

Background

Frailty is a state of vulnerability to poor resolution of homeostasis after a stressor event. The existing healthcare response to frailty is predominantly reactive and secondary care based. Improved management of frailty requires an integrated approach spanning primary care, secondary care and social services. Improved integrated pathways of care should include evidence based interventions where possible. However, there is limited evidence available from clinical trials. One reason for this is that recruitment of older people with frailty in to clinical trials has been disappointing. The Community Ageing Research Study (CARE75+) (ISRCTN16588124) is a longitudinal study providing observational data and a recruitment platform for research with older people.

Aim & objectives

Our aim is to establish a cohort of older people (n = 1000) for observational research collecting an extensive range of health, social and economic outcome data. Additionally CARE 75+ is a research platform for additional studies (sub-studies), and in the future will support randomised controlled trials using a Trials within Cohort (TwiCs) methodology.

  • To demonstrate the feasibility of recruitment to the CARE 75+ study.
  • To investigate the clinical utility of the electronic Frailty Index (eFI), a tool for the identification and severity grading of frailty in primary care.
  • To investigate longitudinal frailty trajectories and health and social care resource use.
  • To provide a recruitment platform for intervention development work and qualitative research with older people.
  • To investigate the feasibility of embedding trials of interventions to improve outcomes for older people with frailty.
  • To identify older people with frailty for the planned series of studies in the Collaboration for Applied Health Research & Care (CLAHRC) 2 programme.
  • To establish a bio-bank for future frailty and ageing research.

Methods

Potential participants are recruited via their GP practices.  Participants undergo a range of cognitive, physical and psychosocial assessments at baseline, 6, 12, 24 and 48 months. Assessment are face-to-face in the person’s home, with an optional modified follow-up at 6 months via telephone or the internet.  CARE 75+ participants are highly phenotyped, with detailed demographic information collected alongside measures including:

  • Frailty (phenotype model; Cumulative Deficit Model; Clinical Frailty Scale; Edmonton Frail Scale; electronic Frailty Index (eFI) (developed and validated by this team and available to 99% of UK general practices)
  • Health-related quality of life (SF36 and EQ5D)
  • Cognition (Montreal Cognitive Assessment)
  • Mood (Geriatric Depression Scale)
  • Activities of daily living (Barthel index and Nottingham Extended Activities of Daily Living)
  • Resilience (Brief Resilience Scale)
  • Loneliness (de Jong-Gierveld loneliness scale)
  • Pain (the Geriatric Pain Measure Short Form)
  • Comorbidity

Blood samples are taken at baseline and 12 months for the establishment of a bio-bank for a resource for future research.

Impact

CARE75+ study is an innovative trial design with the potential to enhance participation of older people with frailty in to clinical trials and to increase capacity to conduct high quality research with older people with well-defined frailty. To date CARE 75+ has identified participants for two sub-studies, with recruitment to a fourth starting in 2017. CARE 75+ is recruiting participants from Leeds, Bradford, Newcastle, the West Midlands, Yorkshire and the South-West Peninsula.

Participant criteria

Inclusion criteria

  •  Community dwelling older people (aged > 75 years)

Exclusion criteria

  • Care home residents (note – attempts will be made to retain participants who move to a care home post consent)
  • Bedbound at home
  • Have terminal cancer
  • In receipt of the Amber Care Bundle (estimated life expectancy of three months or less)
  • In receipt of palliative care services

Timescales

January 2014 – December 2018

Funding agency

NIHR CLAHRC2 Yorkshire and Humber

Further information

Partners & Collaborators:

The CARE cohort is being developed as part of the NIHR CLAHRC Yorkshire and Humber – Primary care-based management of frailty in older people theme. http://clahrc-yh.nihr.ac.uk/our-themes/primary-care-based-management-of-frailty-in-older-people


The NIHR CLAHRC Yorkshire and Humber is a partnership between 31 organisations including NHS, Higher Education, Local Authorities, Charities, Industry and the Regional Innovation Hub. A full list is available on our website www.clahrc-yh.nihr.ac.uk.

Recruitment at 08/01/2018 n = 700

John Young (Theme Lead) john.young@bthft.nhs.uk
Andrew Clegg (Deputy Theme Lead) Andrew Clegg@bthft.nhs.uk
Lesley Brown (Theme Manager) lesley.brown@bthft.nhs.uk