PhD: Frailty progression and maintaining independence to age in place: can routine data help?
This research is led by Schenelle Dlima as part of her PhD Fellowship. For more information about Schenelle’s research interests see our PhD Fellowship page.
What are we trying to do?
- Understand the current state of evidence on frailty indices (a frailty assessment tool) that are constructed from routine data.
- Examine frailty changes before, during, and after the COVID-19 pandemic using routine data.
- Use routine data to understand the factors that led to worsening frailty states in the population.
- Identify potential ageing-in-place indicators in older people with frailty living in the community.
Why is this important?
Frailty is a clinical condition that makes an older person more vulnerable to worsening health, increasing disability, greater dependency, and even death. Older people with frailty are also more likely to move to nursing, and residential homes, where they can receive formal support. However, frailty is not a one-way path to permanent disability and dependency. Identifying early stages of frailty can help intervention in a timely manner, thus improving the chances of frailty reversal and preventing worsening of the condition. This could help ensure that older people with, or at risk of, frailty continue living in the homes and communities they are familiar with, i.e. they can ‘age in place’. This helps relieve pressures on older people, their carers, and health and social care systems.
In recent times, the COVID-19 pandemic may have led to more people becoming frail in the UK. Mandated lockdowns during the pandemic led to older people doing less physical activity and experiencing poor mental health, factors which are known to worsen frailty. We are using routine health data to identify older people who developed frailty during the pandemic, and whose frailty levels worsened. We are also looking at factors that contributed to worsening frailty, helping clinicians design targeted plans for patients.
Regarding frailty and ageing-in-place, there is a call to reframe the goal from “managing the condition” to “living well with the condition”. This means that older people with frailty who live at home can still lead fulfilling lives, engage with their community, maintain a good quality of life, and age successfully. We plan to explore potential indicators that capture the various ageing-in-place experiences in older people with, or at risk of, frailty. These indicators will help service providers and policymakers understand how older people with frailty are ageing in their own homes and communities, helping develop tailored care plans.
How are we doing it?
- We are conducting a scoping review on frailty indices based on routine data. Frailty indices are frailty assessment tools used in primary care practice in the UK, such as the electronic frailty index (eFI). This review will help identify gaps and future directions for research in this area.
- We plan to use primary care and hospital data to examine frailty changes before, during, and after the COVID-19 pandemic in Scotland. This will be a secondary data analysis.
- Using a survey, we plan to consult experts and build consensus on indicators that are important for frail older people who are ‘ageing in place’ that are feasible to routinely collect in health and social care practice. The experts will be those with experience in gerontology, geriatric care, social and community care, and the care of older people with frailty.
Who are we working with?
- DataLoch
- University of Manchester Healthy Ageing Research Group (HARG)
- Public contributors
Funding info:
This PhD studentship, is one of 6 that has been made available through a partnership between The Dunhill Medical Trust, ourselves at the National Institute for Health and Care Research (NIHR) Applied Research Collaboration Greater Manchester (ARC-GM), The University of Manchester, and the NIHR Policy Research Unit in Older People and Frailty / Healthy Ageing.
Contact info:
PhD Fellow
Schelle Dilma