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Improving the outcomes of health and social care for frail people and their carers



NIHR Themed Call: Specification Document

Supporting information:

This call shows the importance NIHR attributes to tackling the challenges posed to the NHS, social care and wider society by the ageing population of the UK. The call builds on the previous NIHR theme of “Complex Health and Care Needs in Older People” and its work in the field of multi-morbidity.

Around 6.5% of people aged over 60 years have frailty in England, rising to 65% of those aged over 90 years. Frailty has been shown to develop at an earlier age in some parts of society and in some groups of people. Frailty may be viewed as a long-term condition, and it is believed some aspects of health and wellbeing may be improved with appropriate interventions or therapy.

Many people may not recognise themselves as frail or want to be considered as such. However, identifying people with frailty is important to enable a fuller assessment of health and social care needs and the provision of appropriate interventions and support. Common conditions such as dementia often contribute to frailty, making health and social care needs more complex, and also complicating the health and social care responses to those needs.

There is a need for better evidence to support and promote healthy ageing and to provide evidence for health and social care interventions that may slow or prevent further declines in health, support independence and/or improve wellbeing, and that take account of the wider health and social care needs of the individual and their family or other carers.

How to apply:

Research proposals must be within the remit of at least one participating NIHR programme. Applications which span the remit of one or more NIHR programme will be welcomed. In these cases proposals should be submitted to the programme within whose remit the major part of the work lies. The inclusion of patient, service user, carer and public views and experiences are considered important by each participating programme.

Applicants who are unsure which programme to apply to may wish to send a short summary (maximum 1 page) of their research proposal to

Applicants from England may wish to contact their local RDS to discuss their application.

All applicants should take note of:

  • the remit of each of the participating programmes (see list below)
  • the existing NIHR portfolio of published and funded projects in these areas to avoid duplication of research (themed calls)
  • that after the initial call close dates, the participating programmes will continue to be interested in receiving research proposals for the promotion of Improving the outcomes of health and social care for frail people and their carers in areas not otherwise well covered in their portfolios.

Participating Programmes:

The following NIHR managed research programmes:

Efficacy and Mechanism Evaluation (EME)
Health Services and Delivery Research (HS&DR)
Health Technology Assessment (HTA)
Invention for Innovation (i4i)
Programme Grants for Applied Research (PGfAR)
Public Health Research (PHR)Research for Patient Benefit (RfPB)

The following NIHR research training programmes:

NIHR Research Professorships
NIHR Fellowships
HEE/NIHR Integrated Clinical Academic Programme

For areas of specific interest to the programmes please see below. For further information on the remits and call open and close dates of the participating programmes please see our themed calls pages.

EME Programme:

Applications to the EME Programme may test interventions for the diagnosis, prevention or treatment of frailty and causative conditions. Applications should examine the efficacy of interventions, and may explore the mechanisms underlying possible efficacy.

Applications are welcomed that establish the efficacy of interventions to prevent, reverse or reduce the loss of functional abilities and independence in frail people. Interventions should seek to address the underlying condition or functional difficulty and the inclusion of mechanistic work within the proposed research is welcome.

Of particular interest are studies that evaluate interventions that are simple to deliver and where outcomes may be assessed at relatively short time points, e.g. months rather than years, although provision for simple longer term follow up may be included. Suitably designed studies that evaluate a number of interventions are welcome.

Interventions may include physical, psychological, pharmacological or behavioural elements and may be delivered by clinicians, other professionals or carers, or maintained by individuals themselves.

The assessment of environmental interventions, such as home modifications, is not within the scope of this call. Applications concerning exercise interventions will only be considered where there is clearly a novel scientific basis for the intervention.

HS&DR Programme:

The HS&DR Programme funds research to produce evidence on the quality, accessibility and organisation of health and social care services. Robust mixed methods studies are invited with a focus on organisation and delivery of services, costs, quality and patient, service user or carer experience. Although other topics may be proposed within this broad remit, the following are of particular interest; models of service provision combining health and social care
services delivering across the pathway for frailty. Proposals may evaluate frailty-focused services and the impact on health and social care outcomes from prevention, early detection and management, promotion of self-management, urgent care admission avoidance, supported discharge and re-ablement, and end of life care. Proposals for studies encompassing evaluation of whole pathway approaches, and producing evidence for how people with frailty and social care needs can be better supported to use these services are especially welcome.

HTA Programme:

The HTA Programme invites applications for research to evaluate the clinical and cost effectiveness of health and social care interventions that prevent or slow the onset or progression of frailty, and reduce the impact of frailty on patients, service users and carers and the wider NHS and care system.

The inclusion of social care outcomes in addition to health outcomes is encouraged. In these cases, applications should demonstrate the inclusion of appropriate expertise in social care research and links to appropriate social care organisations, whether statutory, private or third sector organisations.

Proposals may be for primary research or for evidence synthesis and may use any study design, provided it is clearly justified.

Areas of particular interest include, but are not limited to:

  • Large randomised trials of multi-domain interventions designed to slow the progression of frailty and loss of independence for people with mild or moderate frailty, and promote their wellbeing
  • Studies of interventions to help reduce or mitigate the early onset of frailty observed in certain populations and groups
  • Studies that make use of existing electronic databases and health and/or social care record systems to maximise the efficiency and timeliness of research

i4i Programme:

The NIHR i4i programme is a translational funding scheme which advances healthcare technologies and interventions for increased patient benefit in areas of existing or emerging clinical need. It supports research and development of medical devices, active implantable devices and in vitro diagnostic devices. Applications fitting the i4i programme remit are encouraged but not limited to technologies that prevent, reverse or reduce the loss of functional abilities and independence in frail people Applicants are encouraged to contact the i4i secretariat before submitting an application. The i4i programme will not support basic
research activities such as biomarker discovery.

PGfAR Programme:

The PGfAR scheme will support programmes of research which involve a number of interrelated and linked components, using a range of methodological approaches, to answer clinically important questions relevant to the prevention and treatment of frailty.

Applications employing novel methodological approaches to demonstrate patient benefit at an individual or population level are encouraged. Examples include development and testing of interventions (including links with industry); using observational data to demonstrate benefit; public health interventions; use of existing data from previous research, or routinely collected health care data. Applications which clearly demonstrate multidisciplinary approaches, and
are conducted in geographical locations of high health care need will be welcomed. Research may be carried out in community, primary or secondary care settings.

PHR Programme:

The PHR Programme evaluates non-NHS public health interventions intended to improve the health of the public and reduce inequalities in health. The programme is keen to consider proposals that operate at a population level and which focus on the environmental and social determinants of frailty.

PHR is interested in scalable interventions that operate at a population level and/or across the life-course, to prevent frailty.

PHR is interested in population interventions aimed at reducing the impact of frailty and/or the health inequalities characteristic of it. Where justified proposals may focus on populations that are defined by social determinants, rather than by frailty. Health economic evaluations are of interest and we recognise that interventions may be multi-component and that long term follow-up may be necessary to demonstrate effect.

RfPB Programme:

Applications to the RfPB Programme should arise from daily practice in NHS and social care services, and must demonstrate a trajectory to patient, service user, and/or carer benefit. The programme supports applications which are regionally derived and are concerned with studying the provision and use of NHS and social care services, evaluating the effectiveness and cost effectiveness of new innovations and interventions, and developing and refining new interventions, scales or outcome measures. The programme also welcomes applications for feasibility studies, and applications exploring the potential for improving health and wellbeing
through needs assessments, methods development, evidence synthesis, systematic reviews, and qualitative, mixed methods and exploratory studies.

NIHR Research Training Programmes:

All NIHR research training programmes are aimed at developing tomorrow’s research leaders and are available at a range of levels depending on the applicant’s background and experience. The new Fellowships programme, Research Professorships and Integrated Clinical Academic Programme will participate in this call, and further NIHR training awards will be potentially involved in the call at a later date.

The opening and closing dates for the participating research programmes is available at our themed calls pages.