Award Title: Developing the evidence and associated service model to support older people living with frailty to manage their pain and to reduce its impact on their lives: a  mixed method, co-design study.
Funder: Department of Health and Social Care

Abstract: Aim_x000D_
To understand how pain management services for older people with frailty should be organised and delivered._x000D_
_x000D_
Background _x000D_
Pain is common in later life and especially common in older people with frailty. Frailty is described as becoming more vulnerable to poorer health in later life. For older people with frailty, pain can be particularly impactful on their lives, on their ability to socialise and participate in activities. Pain can make frailty worse._x000D_
 _x000D_
The negative impact of pain on a person’s life should not be an inevitable part of getting older. There are treatment options to enable people to cope better with pain and minimise the impact. Pain Management Programmes (PMPs) and psychological therapies aim to improve strength and movement and enable engagement in enjoyable activities. Whilst the content of PMPs varies, they typically include pain education, exercise, coping strategies, goal setting and peer support. However, PMPs and pain services generally, have not typically been aimed at, or designed for, older people living with frailty. _x000D_
_x000D_
Improving care for older people with frailty is an NHS priority. Our aim is to find out what a good pain service for older people living with frailty should be._x000D_
_x000D_
Methods: _x000D_
The research will be overseen by a patient and public involvement group (Oversight PPI Group) who will provide lay representative guidance and input throughout the project. _x000D_
The research will include:_x000D_
_x000D_
1) A review of studies which investigated PMPs and psychological therapies for pain, which included older people. This will enable us to identify what might be important and appropriate for older people with frailty._x000D_
_x000D_
2) Interviews with older people living with frailty and pain to understand how pain impacts on them and how they could be better supported with pain management and access to pain services. For some interviews, we will include their spouse or partner (or another significant person in their life). _x000D_
_x000D_
3) We will interview Health Care Professionals (HCPs) including nurses, psychologists, physiotherapists and GPs, as well as the commissioners who make decisions on what health services should be funded. We will include HCPs from various pain services in different locations. The interviews will help us understand the challenges of working with older living people with frailty in different services and how they might need to change to better engage with this group._x000D_
_x000D_
4) With the Oversight PPI Group, we will use the learning from the review and the interviews to create ‘knowledge resources’. We will use these resources in workshops which will include older people, HCPs and commissioners to help co-design a pain service specifically for older people living with frailty. The workshops will ensure that all views are considered. _x000D_
 _x000D_
Following the workshops, we will work with the Oversight PPI Group and commissioners to develop guidance and information for the elements of a good pain service for older people with frailty. This will detail who should deliver it, how a service might fit into, or alongside, existing services, and if services need to be tailored or modified for people with different levels of frailty or from different ethno-cultural communities. _x000D_
_x000D_
Dissemination_x000D_
Findings and information will be distributed nationally to achieve widespread impact on services and to help individuals with frailty to improve their quality of life and function.

Lay Abstract: Research question_x000D_
How should pain management services for older people with frailty be organised and delivered?_x000D_
_x000D_
Background_x000D_
Improving care for older people living with frailty is a core aim of the NHS Long Term Plan (2019). Pain prevalence is particularly high in older people with frailty (median prevalence 44%) and negatively impacts on their mobility, daily life, ability to socialise and sleep. Pain accelerates frailty progression. The impact of pain on daily life is potentially modifiable and therefore presents an attractive target for services to facilitate improvements in the lives of older people living with frailty._x000D_
_x000D_
Although pain disproportionally affects older people living with frailty, there is a notable gap in research and provision of pain management services for this group. The need to develop new models of care for older people living with frailty is highlighted in the NHS Long Term Plan. Research to investigate how pain management services for older people with frailty should be organised and delivered will help inform robust commissioning decisions._x000D_
 _x000D_
Aim_x000D_
To develop content, delivery mode, implementation strategies, commissioner and professional guidance for pain management services that enable older people with frailty to manage their pain and reduce its impact on their lives, relationships, function and quality of life._x000D_
_x000D_
Methods_x000D_
This study will have 4 phases and use mixed research methods. An Oversight Patient and Public Involvement Group (Oversight PPI) will contribute to all research components._x000D_
_x000D_
Phase 1. Mapping review of trials of PMPs and psychological therapies will map research evidence to develop hypotheses about processes and change mechanisms to inform strategies that meet the specific needs of older people with pain and frailty._x000D_
Phase 2. Qualitative interviews with 30 older people with pain and frailty, including joint interviews with their significant other, to determine how their pain needs can be met and potential service models that might optimise their access and provide support._x000D_
Phase 3. In three Clinical Commissioning Groups (CCGs) we will identify what pain services have been commissioned (referral source, eligibility, exclusions, delivery mode) and undertake qualitative interviews with healthcare professionals (HCPs) and commissioners to identify opportunities and barriers to engaging older people with pain and frailty._x000D_
Phase 4. With the Oversight PPI Group, we will create knowledge resources from research components 1, 2 & 3. We will use these in sequential co-design workshops (3 sites) with stakeholders (older people, HCPs, commissioners) to produce pain management guidance specific to the needs of older people with frailty for varied service contexts. _x000D_
_x000D_
Timelines for delivery: _x000D_
• Months 1-11 Mapping review _x000D_
• Months 4-17 Interviews with older people; families/carers; qualitative analysis_x000D_
• Months 5-17 Interviews with HCPs & commissioners; qualitative analysis_x000D_
• Months 21-27 Co-design workshops _x000D_
• Months 31-36 Key outputs; Pain and Frailty Service Commissioning Pack; dissemination_x000D_
_x000D_
Dissemination and Impact_x000D_
Main output will be a Pain and Frailty Service Commissioning Pack to support commissioning of services aligned with the needs of older people with frailty and pain. This will be nationally disseminated, building on existing links with NHS England, NHS RightCare, CCGs and pain services, with potential for national impact, together with benefits for individuals.

Research Activity Codes: 8.1 ORGANISATION AND DELIVERY OF SERVICES
Health Categories: MUSCULOSKELETAL;NEUROLOGICAL