An older person's independence depends on whether they receive the right assessment at the right time—and doctors currently lack clear guidance on who benefits most from community-based Comprehensive Geriatric Assessment (CGA). The 2023 Chief Medical Officer Report identified this as a critical knowledge gap. Without knowing which older people to target, health services cannot efficiently deploy CGA, a holistic assessment of complex needs. The researcher will analyse data from seven trials involving 46,907 participants—87% of all community CGA trial data globally—to identify which characteristics (frailty, mental health, multimorbidity, deprivation) predict benefit. They will then model clinical and cost-effectiveness using routine UK data from over 2 million older people. If successful, this work could transform how the NHS targets interventions to prevent loss of independence. It would allow clinicians to direct CGA toward those most likely to benefit, reducing disability and falls while making efficient use of limited resources. The researcher will also co-design new models of care with NHS England and the World Health Organisation, supporting the international Decade of Healthy Ageing. A falls prediction model developed in primary care will be refined using hospital electronic health records, positioning the work at the frontier of UK health data science.
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Research questions How should community-based Comprehensive Geriatric Assessment (CGA) for older people be targeted to maximise independence? What is the clinical, cost-effectiveness and equity impact of implementing targeted community-based CGA across the UK? How should a novel community intervention be developed to prevent future loss of independence? How should a primary care falls prediction model be refined for evaluation using hospital electronic health record clinical data? How should research outputs be translated into models of care to maximise independence of older people in the UK and internationally? Background Maximising independence is the core priority of the 2023 Chief Medical Officer (CMO) Report and is the top priority for older people. The problem is we do not know which older people benefit most from interventions to maximise independence in the community and hospital. Aim To find out how interventions should be targeted to maximise independence for older people in the community and hospital. Methods WP1: Which older people are likely to benefit from community-based CGA CGA involves the holistic assessment and treatment of an older person's complex needs. The 2023 CMO Report identifies a crucial knowledge gap regarding which older people benefit most from community CGA. I will lead new individual participant data meta-analysis (IPDMA) to investigate how community CGA should be targeted, based on key characteristics (frailty/mental & physical health/multimorbidity/deprivation). I have negotiated agreements in principle to share trial data for seven CGA trials totalling 46,907 participants (87% of total across all community CGA trials). WP2: Clinical and cost-effectiveness of UK implementation of targeted community CGA I will model WP1 findings in routine UK data from over 2 million older people to investigate clinical and cost-effectiveness of UK CGA implementation, taking account of inequalities. WP3: Preventing future loss of independence Preventing future loss of independence for people who are yet to experience frailty and disability is a CMO Report priority. I will build on WP1/WP2 findings to co-design and test feasibility of a novel intervention to prevent future loss of independence. WP4: Falls prevention in hospital to maximise independence I have led development and validation of a primary care falls prediction model. I will evaluate the model in secondary care using rich hospital electronic health record clinical data, positioning the work at the frontier of UK health data science. WP5: Development of new models of care to maximise independence for older people I will co-design new models of care based on WP findings and drive translation into practice in partnership with NHS England, commissioners and practitioners, patients and the public. Impact/dissemination The Professorship will drive a step change in my research career to become an established global leader. The global trials repository will be an internationally-leading resource for pioneering ageing research. NHS England National Clinical Director for Older People and Director of Community Services have confirmed the Research Professorship would be potentially transformational for health policy. The World Health Organisation Scientific Lead for Geriatric Medicine has confirmed that outputs would support delivery of the international Decade of Healthy Ageing Collaboration.
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