Background

There are unfair and avoidable differences in health and wellbeing for older people living with frailty, particularly for people from ethnic minority groups. Despite greater need, ethnic minority groups have poorer access to care. This is due to numerous obstacles including a lack of cultural inclusivity, discrimination, language and communication barriers. We must better understand what drives these unjust differences to result in poorer wellbeing – especially for those with many characteristics that combine to result in multiple disadvantages.

Well-being in Later Life in Bradford (WeLL-Bradford) study will gather detailed information on the health and well-being of older people with frailty and caregivers they live with. We will use the detailed information to study care transitions, care needs and care networks, and how these are influenced by characteristics such as age, frailty, gender, socioeconomic factors and ethnicity. We will study how wellbeing changes in later life and how finances, living conditions, and shifting support networks across the life course impact wellbeing. This will help us find out what factors may improve or reduce wellbeing in later life.

Uniquely, WeLL-Bradford will focus on experiences of older people with frailty who experience multiple disadvantages. We want to understand their experiences to find ways to address long-standing unequal opportunities for wellbeing in later life. Importantly, the focus of WeLL-Bradford on older people with frailty will ensure that we include people who are often missed by current national studies.

Aims & Objectives

To establish feasibility of the WeLL-Bradford risk-stratified longitudinal frailty cohort and use mixed qualitative and quantitative methods to investigate the evolving needs and experiences of care for individuals, and intersectional influences of wellbeing. This is the first step in preparation for a definitive national multisite study (WeLL-UK) to investigate how policy and practice should be developed to maximise wellbeing in later life frailty.

Research questions

  1. How should inclusive methods of study recruitment and follow-up be co-developed and refined to maximise WeLL-Bradford recruitment of intersectionally marginalised groups, in preparation for wider roll-out?
  2. Is it feasible to recruit and retain WeLL-Bradford participants across different intersectional groups, with a focus on ethnicity and socioeconomic position?
  3. Is it feasible to integrate WeLL-Bradford into an existing routine linked health and care dataset to risk-stratify participants, in preparation for rollout as a multi-site study?
  4. Does the experience of care and care transitions vary according to intersectional characteristics and how does this shape wellbeing in the final phase of life?
  5. What is the relationship between the requirement for care and the provision of informal and formal care, taking account of intersectional characteristics?
  6. How do precarity indicators such as housing tenure, migration history, relationship dissolution and financial stability impact on wellbeing in the final stage of life?

WeLL-Bradford will generate novel findings on factors that improve or reduce wellbeing in later life, with a particular focus on care transitions, care needs and care networks. The research will take full account of how multiple characteristics such as age, frailty, gender, socioeconomic factors and ethnicity interact to impact on outcomes. Findings will be shared widely to help inform how policymakers, services and communities can maximise well-being in the final phase of life for those most at risk of poor outcomes.

Methods

WeLL-Bradford will recruit 400 ethnically diverse older people (aged 65 years and over) in Bradford living with moderate or severe frailty, and household caregivers. We will follow them up every six months for two years. We will collect detailed information from study participants about their health and care and link this with data already collected by GPs, hospitals and Local Authority data on people receiving home care services and care home residents.

We will use the data to identify groups of participants at higher risk of certain life events – needing carers at home, falling, moving into a care home, or reaching the end of their life. We will interview people at risk of these events to explore in-depth how their circumstances in life have affected their physical, emotional, social and financial wellbeing.

Partners & Collaborators

Bradford Teaching Hospitals NHS Foundation Trust

University of Leeds

University of Manchester

University of Edinburgh

University of Hull

Timescales

01/10/2024 – 31/07/2028

Further information

This project is funded by the Nuffield Foundation.

For further information please contact:
Lesley Brown, Research Project Manager Lesley.brown@bthft.nhs.uk