Developing a novel system of care targetting risk factors for five manifestations of frailty to maintain the independence of older people in hospital and post-discharge.

Award Number
Award Type
Programme Development Grants
Programme Grants for Applied Research
Status / Stage
2 April 2019 -
1 October 2020
Duration (calculated)
01 years 05 months
Funding Amount
Funder/Grant study page
Contracted Centre
Bradford Teaching Hospitals NHS Foundation Trust
Contracted Centre Webpage
Principal Investigator
Professor Anne Forster
PI Contact
WHO Catergories
Models across the continuum of care
Understanding risk factors
Disease Type
Dementia (Unspecified)

CPEC Review Info
Reference ID196
ResearcherReside Team


Award NumberRP-DG-0218-10001
Status / StageCompleted
Start Date20190402
End Date20201001
Duration (calculated) 01 years 05 months
Funder/Grant study pageNIHR
Contracted CentreBradford Teaching Hospitals NHS Foundation Trust
Contracted Centre Webpage
Funding Amount£99,063.00


Development of manifestations of frailty (MoF) (falls, delirium, incontinence, reduced mobility and loss of function) in hospitalised older people can result in loss of independence and increased care needs following discharge. MoF may be attenuated or prevented through multicomponent interventions. Separate national guidelines advocate these interventions but risk assessments, content and implementation strategies are poorly specified, and duplicative.To reduce post-discharge loss of independence for older people hospitalised with acute illness through modification of in-patient risk factors for MoF. Research questions relate to identification and modification of risk factors (new risk assessment and care action identification (RACAI) tool); development of a novel system of care; feasibility assessement (delivery, implementation and trial methodology) prior to a multicentre cluster randomised effectiveness trial. Pre-PDG work: We have identified a list of risk factors for the development of the MoF in hospital from the literature. PDG 1 Structured interviews and focus groups to identify key risk factors for development of MoF in hospital, additional to those described in the literature, from the perspective of patients (PDG1a) and staff (PDG1b). Prioritise risk factors for MoF through expert consensus (PDG1c). PDG 2 Systematic literature and graded evidence reviews to identify effective care actions to address risk factors for MoF identified in PDG1 and pre-PDG work. PDG3 Expert group consensus using a modified group technique to agree a list of best practice care actions to target risk factors. Informed by evidence from pre-PDG, PDG1 and PDG2 and input from patient participants. Timelines for delivery – Results and conclusions of PDG1: month 9; PDG2: month 15; PDG3: month 18 Full Programme Grant for Applied Research Workpackage 1 WP1a: Identifying presence of risk factors and specifying care actions WP1b: Development of assessment and care action identification (“RACAI”) tool to identify an individual s risk factors for development of MoF, and a set of appropriate care actions. W1c: Case studies, observations and interviews with key staff in four sites providing acute care for older people. Using positive deviance methods to identify transferrable aspects of high quality patient centred care to inform implementation strategies. W1d: Development of a logic model and intervention implementation framework, informed by W1a, WP1b and WP1c. Workpackage 2 Cluster randomised controlled feasibility study of system of care vs usual care to assess: trial methodology; data collection processes; variation in practices between sites; recruitment and attrition; suitability, utility and feasibility of the intervention, primary outcome measure, and the RACAI tool. Workpackage 3 Multicentre cluster RCT with embedded process and economic evaluations. Evaluation of clinical and cost effectiveness of the system of care on preventing loss of independence post-discharge from hospital (Nottingham Extended Activities of Daily Living three months post registration). Evaluation of engagement with, implementation and effectiveness of the intervention (process evaluation). Anticipated impact and dissemination (PGfAR) Immediate: improved hospital experience for older people, reduced resource use Within 12 months: improved post discharge outcomes, reduced NHS and social care costs Within 36 months: to inform future guidance documents for acute care of hospitalised older people


To reduce post-discharge loss of independence for older people hospitalised with acute illness through modification of in-patient risk factors for MoF.