Improving care for older people with acute infections

What is the problem?

Acute infections in people over 75 years are often difficult to diagnose and linked to both over prescription of antibiotics and unplanned hospital admissions (Rhee & Stone 2014; Beckett et al 2015; Millet et al 2015). There has been considerable research into both causes and ways to (safely) reduce overuse of antibiotics and unplanned hospital admissions for older people, but primarily focussed on care home settings (Feldstein et al 2018; Nguyen et al 2019; Raban et al 2020; Smith et al 2020). Despite various initiatives, overuse of antibiotics remains an issue in care homes due to significant barriers to the successful implementation (Vicentini et al 2024). For older people living independently, some with the support of formal or informal carers, there is little research on these issues or how to safely reduce antibiotic prescribing.

As the number of people over 75 years increases and becomes more ethnically diverse, health inequalities are also increasing. Health outcomes and life expectancy are worse in deprived areas than in affluent, and in southern England compared with northern areas (Bambra, 2022; Munford et al, 2023). People from underserved groups, including minoritised ethnicities and lower socioeconomic status, are at higher risk of contracting infectious diseases and carrying antibiotic resistance bacteria (Ayorinde et al 2023).

There is a need to understand what leads to inequalities in care and health outcomes for older people with acute infections and how we can improve care and reduce inequalities. This work will address the ICB priority of tackling inequalities and supporting older people towards the end of life.

What is the aim of the research?

The aims of the RCF project are:

To review the current literature on drivers of over and under prescribing of antibiotics and unplanned hospital admissions for acute infections in older adults from marginalised populations
To co-design, with diverse public and stakeholder contributors, future research to improve care for older people with infections
- Determining target populations (age range; those in care/nursing homes and/or those living independently; which older populations are most under-represented).
- Identifying evidence gaps and co-designing appropriate research questions and studies to address those gaps.
- Identifying potential interventions and co-designing intervention development and feasibility study designs.

How will Bristol, North Somerset and South Gloucestershire ICB RCF be used?

The RCF funding will support the time for an SRA to conduct PPI and stakeholder consultations, to carry out a rapid literature review, and to write grant applications.

We will recruit a diverse public advisory group to co-design the future research project(s), ensuring a that people with a range of backgrounds are included (see details in next section).

We will build a research team with the right expertise. Dr Cabral has established links with the HSA through her work with the Bristol HPRU and with academic primary care clinicians through her membership of SPCR. She will identify appropriate collaborators from her existing networks.

We will conduct a rapid review of the literature to establish the current evidence base and gaps. This will identify literature on drivers of overuse of over and under prescribing of antibiotics and unplanned hospital admissions for acute infections in older adults. We will also conduct an overview of reviews of intervention studies with relevant populations (an overview of reviews is recommended by Cochrane where there are already several existing systematic reviews). Public contributors will collaborate in the review, participating in decisions around review focus, study inclusion and exclusion, synthesis and reporting.

We are planning to write complementary applications to both HSDR and RfPB to investigate practice and develop an intervention.

Who is leading the research?

The project is led by Dr Christie Cabral, Senior lecturer at Centre for Academic Primary Care, University of Bristol.

Further information

For more information or to get involved in this project, please contact bnssg.research@nhs.net.