Caring for older people and stroke survivors theme presentation by Professor John Gladman, delivered at the NIHR CLAHRC East Midlands launch event on 14 February 2014, Loughborough.

1. Caring for Older People and
Stroke Survivors (COPSS)
John Gladman, Theme Lead, CLAHRC East Midlands
CLAHRC East Midlands is hosted by
Nottinghamshire Healthcare

2. Legacy from previous CLAHRCs
•
CLAHRC-NDL stroke rehabilitation:
- early supported discharge
- return to work
- projects in East Midlands Health Innovation Education Cluster (HIEC)
•
CLAHRC-NDL older people: identification of priority areas taken up by the East
Midlands AHSN:
- urgent care
- dementia
- maintaining health in old age
- falls
- care home medicine
- integrated care
•
LNR-CLAHRC
- projects in East Midlands Health Innovation Education Cluster (HIEC)

3. Phase 1 & 2 projects
• Phase 1
- Implementing evidence based stroke rehabilitation in a hospital
setting (REVIHR)
- Promoting health in frail older people by integration with the
voluntary sector (PROVE)
• Phase 2
- Innovative hypoglycaemia pathway for admission avoidance; a
partnership approach with a local ambulance trust

4. REVIHR Study
Implementing evidence based stroke rehabilitation
in a hospital setting
Aim: To ensure the provision of rehabilitation in stroke units is
evidence based – focus on basic activities of daily living
• Review research literature and guideline recommendations
• Observe and understand (national audit performance,
behavioural mapping and qualitative research) how and why
evidence based practice is achieved or prevented
• Design and deliver a change programme to promote evidence
based care - clinical behaviour and organisational change

5. Why is REVIHR needed?
• Robust stroke unit evidence – faster and better recovery
• Rehabilitation intervention in the UK is minimal (patients
receiving less than 60 minutes of total rehabilitation per day),
with poorer outcomes than in Europe
• Clinicians keen to provide evidence based care
• Patients and carers need to be offered best care possible

6. PROVE
Promoting health in frail older people by
integration with the voluntary sector
Aim: Can at risk older people receive a comprehensive assessment by
the voluntary sector, does doing so lead to logical responses, and what
are the benefits to people and their families and to organisations?
• Review literature
• Observe the process of implementing this process
(AHSN to support the implementation)
• Examine the consequences for people and their families
• Examine the resource implications for all parties
• Qualitative evaluation (realist evaluation)

7. Why is PROVE needed?
• Older people are a major driver of increase in health and social
service use, often in medical crises in context of multiple long term
conditions
• A possible factor in these crises is vulnerability due to a lack of “low
level support” such as can be provided by the voluntary sector
• Offering low level support via the voluntary sector to patients
discharged from elderly care pathways might:
- help them to maintain their health
- reduce demands upon health and social care services
- facilitate better integration between sectors

8. Partnerships – to date
• REVIHR:
- East Midlands Strategic Clinical Network
- NHS rehabilitation clinicians, managers and commissioners
- Nottingham Stroke Research Patient Partnership Group
- National Stroke CLAHRC group
- Stroke Research Network
- Rehabilitation Special Interest Groups
• PROVE:
- East Midlands AHSN
- Health Education East Midlands
- Age UK
- EASY-Care international
- Frail Older People programme (Strategy and Implementation
group for Nottingham South – SIGNS)

9. Future
•
Phase 2 diabetic hypoglycaemia and ambulance service project
- Who? Hypoglycaemia and ambulance called but not admitted: dangerous and costly
- What? Patient advice, clinic referral, GP informed, ambulance staff trained in immediate actions
- Outcomes? Diabetic control, recurrence and resource use
- Partners? East Midlands Ambulance Service
•
Beyond these projects, with partners
- Support for PhDs
- Develop knowledge brokers
- Identify possible phase 3 projects
- Support “response mode” activities
- National and international leadership and implementation activities
•
Workshops
- Your chance to meet us
- Tell us what you want from CLAHRC & partners - older people and stroke

10. Thank you for listening
john.gladman@nottingham.ac.uk
www.clahrc-em.nihr.ac.uk
@CLAHRC_EM
This research was funded by the National Institute for Health Research Collaboration for Leadership in Applied
Health Research and Care East Midlands (NIHR CLAHRC EM). The views expressed in this presentation are those of
the speaker(s) and not necessarily those of the NHS, the NIHR or the Department of Health.