Mireille Gillings Professor of Health Innovation
Professor of Health Policy Services and Research
Ageing, Frailty, and Multimorbidity
Ageing, Frailty, and Multimorbidity
Ageing, Frailty, and Multimorbidity
Ageing, Frailty, and Multimorbidity
Ageing and Frailty
We have led research evaluating the clinical and cost-effectiveness of different treatment pathways in primary care, and across the interface between primary and secondary care, for a range of interventions for the prevention and management of falls, fracture and frailty and the development and implementation of novel, cost-effective approaches to managing high volume musculoskeletal conditions in primary care and emergency care settings (Lamb). Our research aims co-producing and evaluating interventions for the management musculoskeletal pain, the most common disabling condition of later life, and interventions aimed at preventing falls in older people to improve mobility, reduce pain and enhanced quality of life, independence and reduce the use of hospital and health service resource.
Linking to vulnerable populations, we were one of the first groups to use primary care settings successfully to recruit large numbers of people with dementia into trials.
Ageing and Frailty Current Activity
- Current activity also includes several NIHR feasibility studies for randomised controlled trials of novel interventions for commonly encountered conditions in primary care.
NIHR ARC National Priorities – Ageing, Dementia and Frailty, NIHR Applied Research Collaboration (ARC) National Priorities, 26808, £1,875,000, 01 October 2020 – 30 September 2023. CI Prof Helen Roberts, co-applicant SE Lamb.
PROCURE - Partial Rotator Cuff Tear Repair Trial, NIHR HTA, NIHR128043, £1,483,587.80, 01/01/2020 – 28/02/2029, CI SE Lamb.
Research for Patient Benefit (RfPB) Programme: NIHR201031 – Anti-TNF (Adalimumab) injection for the treatment of adults with frozen shoulder during the pain-predominant phase: a multi-centre, randomised, double blind, parallel group, feasibility study. 01 March 2021 – 31 March 2023. £249,991.00. CI J Nanchahal, Co-applicant SE Lamb.
A randomised controlled to estimate the effectiveness of interventions to improve mobility and pain in older people with neurogenic claudication. Also includes a project to develop a clinical prediction tool for mobility decline in primary care and to examine the impacts of multi-morbidity.
Lower back pain is a common cause of disability in older adults. Conservative treatments are a favourable treatment option but their effectiveness is not known. The BOOST study aimed to estimate the clinical and cost-effectiveness of a physiotherapist-delivered, combined physical and psychological intervention.
Oxford Pain and Lifestyle Survey: (NIHR programme grant): Lamb (PI)
The OPAL study is a prospective cohort study seeking to determine the causes and consequences of mobility and functional disability in later life, and the role that musculoskeletal problems (particularly low back pain) have in that process. Our objective is to develop a prognostic tool which will help patients, GPs and other health professionals to identify when low back pain should be prioritised as a treatment target older people.
- HIP HELPER - Improving patient recovery following hip fracture through caregiver support: a feasibility study. NIHR200731 01Sept2020 – 01 Sept 2021. £249,987.00 CI T Smith, Co-applicant SE Lamb.
- PEP-TALK: A behaviour change physiotherapy intervention to increase physical activity following hip and knee replacement: a pragmatic randomised controlled trial. NIHR Research for Patient Benefit – Competition 32 (Ref: PB-PG-1216-20008). £350,000. 01/08/2018 - 31/07/2021 CI Toby Smith Co-Investigator Sarah Lamb.
- Risk-benefit and costs of uncompartmental (compared to total) knee replacement for patients with multiple co-morbidities: a non-randomised study, and different novel approaches to minimise confounding. £268,076. NIHR HTA (Ref: 15/80/40) (01/06/2017-30/11/2019) Prieto-Alhambra-D (University of Oxford)
- CORKA Community based rehabilitation after knee Arthroplasty (CORKER) C.I. Karen Barker, University of Oxford. NIHR HTA 01/04/13 01/08/2014 - 31/12/2019 £1,482,960 (University of Oxford)
- PreFIT – Prevention of Fall Related Injury Trial: NIHR HTA. (Ref: ISRCTN 71002650 8/14/41) £2.9 million. 06/2010 – 02/2019. CI Lamb S. (University of Warwick/Oxford)
- PROVE Physiotherapy Rehabilitation for Osteoporotic VErtebral fracture trial (PROVE) NIHR HTA (Ref: 10/99/01) 01/01/2013 - 31/03/2018 £1,272,201 CI Barker K (University of Oxford)
- PDSAFE – A randomised controlled trial of the effectiveness of PDSAFE to prevent falls among people with Parkinson's Disease NIHR HTA (Ref:10/57/21) 01/03/2013 - 31/08/2017 £2,777,037 CI Ashburn A (University of Southampton)
- DAPA – Physical activity programmes for community dwelling people with mild to moderate dementia. NIHR HTA (Ref: 09/80/04) 04/2011 – 09/2015. £1.78 CI Lamb S. (University of Warwick/Oxford)
- SARAH – Exercises for arthritis of the hands. NIHR HTA (Ref: 07/32/05) £976,955.70 CI Lamb S (University of Warwick) 11/ 2008 - 05/2013
We have a substantial programme on the epidemiology of multimorbidity, and are translating this into new interventions. We have contributed to the development theory for the study of multimorbidity for over a decade and have contributed to developing the evidence base for the epidemiology of multimorbidity in England, Ireland, Spain, Australia and other countries. Our current research aims at further developing the evidence base on the epidemiology of multimorbidity (GEMINI) (Valderas and Lamb) and on interventions for organising and delivering care for people with multimorbidity for increased efficiency of the health care delivery and improved patient experience and GP satisfaction, including research to improve our understanding of how multimorbidity impacts on the management of patients with suspected cancer (SPOCC) (Valderas & Abel, see Early Cancer Diagnosis), and how using Patient Reported Outcomes can improve care for people with multimorbidity (PROMETHEUS, Valderas, see Measuring the experience and outcomes of primary care).
Multimorbidity Current Activity
Effectiveness of the Multi-PAP PLUS intervention in young-old patients with multimorbidity and polypharmacy aimed at improving physician drug prescription in primary care: cluster RCT
Professor Jose Valderas, PI: Dr. Isabel Del Cura Gonzalez, Servicio Madrileño de la Salud)
Fondo de Investigaciones Sanitarias, Instituto de Salud Carlos III. PI18/01515
- Developing tools for preventing delirium in primary care. RfPB 1/4/2017 (24 months) £235.000. Role: Co-App PI Prof David Melzer, RD&E NHS Foundation Trust, Exeter, UK
- Longitudinal analysis of multimorbidity and polypharmacy patterns in indivudals aged 65 or older: electronic health care record based cohort study. Fondo de Investigaciones Santiarias, Instituto de Salud Carlos III. 1/9/2016 (36 months). PI Dr Concepcion Violan, Jordi Gol IDIAP, Spain
- Meta-synthesis of patients' and health professionals perceptions of multimorbidity in General Practice. University of Exeter (partly funded through Improving the management of long term conditions with the clinical use of patient reported outcome measures in Primary Care, National Institute for Health Research CSA). PI Prof. Jose M Valderas
- Modelling the impact of co-morbidity in the diagnosis of cancer in general practice. Co-PI Prof Jose M Valderas and Prof Willie Hamilton, University of Exeter
- Umbrella review of systematic reviews and updated meta-analyses of observational studies on inverse comorbidity between cancer and central nervous system disorders. University of Valencia, Spain. PI Prof Rafel Tabares Seisdedos, University of Valencia, Spain
- Development of a conceptual model for the study of co-morbid conditions: an example with hypertension and osteoarthritis. University of Exeter. PI Prof. Jose M Valderas
- Determinants and impact of incident multimorbidity in the English Longitudinal Study of Ageing. University of Exeter. PI Prof. Jose M Valderas
- Risk-benefit and costs of unicompartmental (compared to total) knee replacement for patients with multiple co-morbidities: a non-randomised study and different novel approaches to minimise confounding. NIHR HTA. 1/2/2017 (24 months) PI Dr Daniel Prieto-Alhambra, University of Oxford, UK
- Comorbidity as a predictor of referral to, and outcome from, surgery in primary care patients with newly diagnosed osteoarthritis in the hip: Effectiveness of the multi-PAP intervention in young-old patients with multimorbidity and polypharmacy aimed at improving physician drug prescription in primary care: cluster RCT. Fondo de Investigaciones Sanitarias, Instituto de Salud Carlos III. 1/9/2015 (36 months). PI Dr Isabel Del Cura Gonzalez, Servicio Madrileño de la Salud, Spain
- From programme theory to logic models for multi-specialty community providers: a realist evidence synthesis. NIHR HS&DR 1/7/2016 (12 months) PI Prof Rod Sheaff, University of Plymouth, UK
- Person Centred Coordinated Care. National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West Peninsula. PI: Prof Richard Byng 1/1/2014-31/12/2019
- Innovating care for people with multiple chronic conditions in Europe. The ICARE4EU project. European Commission 7 Framework Programme. 2013-2016. PI François Schellevis, NIVEL, Netherlands
- Improving the management of long term conditions with the clinical use of patient reported outcome measures in Primary Care, National Institute for Health Research PI Prof. Jose M Valderas 1/3/2011-29/2/2016
- Agent Based Simulation as a tool to support polypharmacy prescribing practice in multimorbidity. National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West Peninsula. PI Dr Daniel Chalk. 9/3/2015-31/1/2016
- Quality and Outcomes of Care for Chronic Conditions in Older Patients Diagnosed with Breast, Colorectal, or Prostate Cancer Compared to Non-Cancer Controls: An Observational Study Using the Clinical Practice Research Datalink (CPRD). Cancer Research UK. Co-PI Prof. Jose M Valderas 1/7/2013-31/12/2015
- Prioritising and optimising multiple medications in elderly multi-morbid patients in general practice (PRIMUM). - A pragmatic cluster-randomised controlled trial. BundesMinisterium fuer Bildung und Forschung. PI Dr Christiane Muth, University of Frankfurt, Germany 1/3/2010-28/2/2014
For selected multimorbidity publications by our Health Services Policy and Research Group (led by Professor Jose Valderas) see the following page: