How can we continue to involve older people in primary-care research despite the restrictions of a pandemic?

Problem

An essential consideration in health research is to conduct research with members of the public rather than for them. However, evidence for how to conduct public and patient involvement (PPI) in health research remains limited. Few studies implementing PPI with older people in frailty research have been identified, despite benefits that can be achieved such as improved enrolment, relevance and dissemination. Furthermore, there has been a drop in public and patient involvement during the Covid-19 pandemic. We aimed to involve older people in co-designing a randomised control trial (RCT) intervention to reverse frailty and build resilience. We also wished to encourage wider use of PPI with older people by outlining our approach.

Approach

Older people were invited to co-design a frailty intervention in three structured PPI settings. Community dwelling over 65-year-olds attending a weekly educational programme on successful aging were invited to join two group discussions, facilitated by a general practitioner (GP), where they co-designed an exercise intervention using the Socratic education method. Older adults were invited to contribute feedback on the intervention in one-on-one, semi-structured telephone interviews, during a 9 month feasibility study conducted in a primary care (PC) setting during the Covid-19 pandemic. Older adults attending PC were invited to join three, forty minute, online workshops to optimise the definitive intervention. Multidisciplinary team input from physiotherapists, dieticians, gerontology consultants and GPs as well as previous systematic review and meta analysis findings were applied in the co-design.

Findings

18 contributors to the group discussions (mean age 75, 61% female) helped co-design 11 home-based resistance exercises. 132 telephone interviews with 94 contributors (mean age 77, 63% female) shaped intervention format, gender balance and GP follow up. 10 contributors to 3 workshops (mean age 71, 60% females) co-designed dietary protein guidance and patient communication. The design of an intervention including resistance exercise and dietary protein supplementation was supported by our systematic review and meta analysis findings and multidisciplinary team input.

Consequences

We enabled the meaningful involvement of 122 older people in the co-design of an intervention to reverse frailty and build resilience, by providing diverse ways to contribute. Inclusive involvement can be achieved during a pandemic. Feedback enhanced the feasibility of an RCT intervention in real-world primary-care.