Persistent pain (sometimes called chronic pain) is common in later life as a consequence of arthritis and related diseases. Pain can be regarded as persistent when it lasts or recurs for more than 3 months. Having persistent pain can mean that people become less active and lose muscle strength. This can increase the risk of developing or worsening frailty, which is a condition where people become more vulnerable to poorer health and find it harder to ‘bounce back’ from, for example, an illness or fall.

Pain prevalence is high in older people living with frailty and more likely to impact on their lives than in fitter older people. The impact of pain on everyday life is potentially modifiable with appropriate pain management techniques and support. However, this has yet to be realised in older adults living with frailty.

Aims & Objectives

The aim of the POPPY study is to develop guidance so that pain services can better meet the needs of older people living with frailty and to help them to manage their pain and reduce its negative impact on their lives, relationships, functioning and quality of life.


This is a mixed method, co-design study consisting of four phases:

Phase 1. Mapping research evidence from systematic reviews of pain management programmes (PMPs) and psychological therapies that will inform later stages of the study.
Phase 2.  Conducting qualitative interviews with approximately 30 community-dwelling older people (≥ 75 years). Interviews will take place in-person or using telephone/video-conference formats, depending on participant preference. Some participants will be asked to invite their spouse or partner to participate with them in dyadic interviews.
Phase 3. Identification of pain services within three distinct geographical areas. A survey will be administered to service managers to understand the service. This will be followed by interviews with Health Care Professional’s (HCP’s) working within the service.
Phase 4. Co-design workshops with various stakeholders including older people, HCPs and commissioners. This will help develop and operationalise theory-informed pain management guidance specific to the needs of older people with frailty within service contexts.

The POPPY study will have input from an Oversight Patient and Public Involvement (PPI) group that will input across the whole programme. The project will run for 3 years.

Public and Patient Involvement (PPI)

Researchers do not always have first-hand experience of the health condition that they are researching. Patients and service-users can provide their personal experiences and perspectives to guide the research design and delivery. This can improve the quality, relevance and impact of health research. The PPI group on the POPPY study will include older people living with, or managing a long-term painful condition (for example, arthritis), or a spouse or carer of a person living with a long-term painful condition. PPI group will provide lay representative guidance and input across the whole project.

Here are examples of activities our PPI group may be asked to help with:
• Helping researchers decide what are important things to consider when we review the literature.
• Reviewing information that will be shared with study participants.
• Reviewing the topics to include in the interviews with older people to ensure that researchers ask relevant questions.
• Helping to decide the important topics to provide case study examples for the health care professional interviews and workshops.

Partners & Collaborators

Chief Investigators

Professor Anne Forster – Academic Unit for Ageing and Stroke Research, University of Leeds
Dr Lesley Brown – Academic Unit for Ageing & Stroke Research, Bradford Teaching Hospitals NHS Foundation Trust


Professor Andrew Clegg – Academic Unit for Ageing and Stroke Research, University of Leeds
Professor Amanda Williams – University College London
Professor Patricia Schofield – University of Plymouth
Dr Asim Suleman – Hollyns Health & Wellbeing
Dr Deborah Antcliff – The Northern Care Alliance NHS Foundation Trust

Our Researchers:

Nicola Harrison – Research Fellow
Dr Rahena Mossabir – Research Fellow


01/04/2022 – 31/03/2025

Funding agency

National Institute for Health and Care Research (NIHR)

Further information

For further information contact Professor Anne Forster

This project is funded by the National Institute for Health and Care Research (NIHR) Health Services and Delivery Research programme NIHR131319. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care.