Title: Digital and Remote Enhancements for the Assessment and Management of older people living with frailty (DREAM)
Funder: Department of Health and Social Care

Abstract: Development work question How can Comprehensive Geriatric Assessment (CGA) of older people be enhanced in non-hospital settings? Background CGA is a coordinated, multi-disciplinary, multi-dimensional process to identify, plan and manage the holistic needs of older people in partnership with them and their families. There is a paucity of high-quality evidence for CGA undertaken in non-hospital settings. Enhancing CGA could improve outcomes and uptake and meet the needs of an increasingly ageing population. Aims and Objectives The aims of the PDG are to develop a model of enhanced CGA (eCGA) and develop and strengthen the team for a future Programme Grant. The objectives of the PDG are: 1. To conduct meaningful stakeholder engagement with older people, their families, health and social care professionals 2. To define eCGA by: identifying gaps and proposing additional components/procedures to include in eCGA specifying ways in which traditional face-to-face CGA procedures might be safely and effectively delivered remotely and using novel technologies 3. To explore, through semi-structured interviews and focus groups with older people, families, health and social care professionals: the barriers and facilitators to implementing eCGA the important outcomes for older people, carers, health and care professionals the potential for eCGA to exacerbate health inequalities, the impact of differences in digital access/literacy, and how this might best be mitigated against 4. To refine our initial programme theory and logic model for an eCGA model incorporating decision making processes following assessment and workforce competencies for intervention delivery. 5. To design a programme of future research which will include: testing the feasibility of novel remote components/procedures that will form the eCGA a protocol for an internal pilot RCT and definitive trial of the eCGA intervention Development work plan Work Stream 1 (WS1) will define components and procedures of eCGA through iterative scoping reviews and stakeholder engagement. WS2 will establish the feasibility, acceptability and outcomes of eCGA through interviews and focus-groups with (a) older people and their families recruited from the NIHR-funded Care75+ cohort, and (b) health and social care professionals recruited from professional networks. We will develop a programme theory, logic model and battery of potential outcome measures as part of WS3 guided by the NASSS (non-adoption, abandonment, scale-up, spread and sustainability) implementation framework. Stakeholder engagement will be a thread throughout our work, and we plan an in-built evaluation of the engagement process. The development work will for the foundations of our future programme. Timelines for delivery Months 1 -10: WS1 defining eCGA Months 4-11: WS2 establishing feasibility, acceptability and outcomes of eCGA Months 3-15: WS3 developing programme theory Months 7-15: Developing programme grant application Months 1-15: Stakeholder engagement We estimate submitting the PGfAR application in July 2023. Anticipated impact and dissemination Our team and collaborators include national and international influencers in the care of older people. Our stakeholders include service and research users supported by our experienced PPIE lead and our PPIE representative. During the PDG we will identify any gaps in the team or collaborators to further support future impact.

Lay abstract: The population is getting older. For some people this can mean having several health problems and difficulty doing everyday things. A Comprehensive Geriatric Assessment (CGA) is a process involving older people (usually aged 65 and over), their families, and health and social care staff to identify and help manage these problems and prevent new problems arising. This can mean that people are less likely to need hospitalisation or to go into a care home because their health is better managed. At present, however, many older people have difficulty accessing healthcare, and COVID-19 has led to fewer face-to-face hospital appointments, which means that people may not currently be getting the best care. Our research wants to see if we can develop a process of remote assessment and care called enhanced CGA (eCGA). This would look at how best to meet the needs of older people and their families. This will involve us looking at research that has already been done to see where alternatives to face-to-face contact could be used (or not). This could include using telephone or video, as well as novel digital technology such as Apps, smart speakers or sensors. We will interview older people and their families, and staff, to ask: what would be acceptable to them to use what might help or hinder eCGA how best to measure to see if eCGA has a positive impact on health and well being With the information, we will devise a plan of what would be part of eCGA and how this could work in practice. All our research will be completed in collaboration with a stakeholder group of older people, their family members, and health and care professionals. They will meet eight times during the 15-month project. The stakeholder work will be led and supported by our Patient, Public Involvement and Engagement (PPIE) lead and our PPIE representative. The outcomes of our development work will be a detailed plan of eCGA, developed with stakeholders, and a proposal for a future programme of work. Our future programme to evaluate eCGA would involve a series of research studies to: check that enhanced CGA is suitable for older people, families and staff understand how eCGA could affect the health of people with different backgrounds, such as ethnicity, income and education check the practicalities of testing and delivering eCGA, and see whether it is possible to do a large scale trial assess whether eCGA is better than what is currently provided, and whether it is cost-effective The anticipated impact of our work is: improved ability to manage everyday things reducing need for health and care services by having better health better experience of care

Research activity codes: 7.1 INDIVIDUAL CARE NEEDS
Health categories: GENERIC HEALTH RELEVANCE