Projects Delivered

Frailty and multimorbidity are terms used to describe people at risk of worsening health, increasing disability and death. These are often older people who have multiple health problems and frequently present to health and social care services at a point of crisis. However, identifying these vulnerable people earlier may allow extra support and assessment to prevent such crises. There are multiple ways of identifying frail or multimorbid people, but our current record systems for primary care (GP practices), secondary care (hospitals) and social care (carer support in the community) are not well connected. In this project, we aim to bring data together data from GP and hospital records to provide a combined view of patients’ health. Working with a cluster of GP practices in North East Edinburgh, we will provide reports of frailty and multimorbidity that may be used to test new approaches to the care of these patients.

The COVID-19 pandemic has challenged healthcare systems. As a new disease, the best evidence for patient management is still being collected. This is particularly true for older people with existing health problems, who often experience illness differently from younger individuals. Some older people are frail, a term that describes the loss of health reserves required to recover from illnesses such as COVID-19. Specialist geriatric medicine care improves outcomes for frail patients in hospital.

In consecutive hospitalised COVID-19 patients, we will see if the symptoms reported by frail patients, their families or carers differ from younger or non-frail patients. We will describe outcomes of frail patients, to report the risk of dying from COVID-19 and if this is greater than expected for their age and other health conditions. Finally, we will look at whether the pandemic has affected access to specialist geriatric medicine care for frail patients with and without COVID-19.

The COVID-19 pandemic is the biggest public health emergency of modern times. Initial reports suggested that short-term declines in kidney function (acute kidney injury [AKI]) were common in patients with COVID-19, and that pre-existing kidney problems (chronic kidney disease [CKD]) were associated with worse outcomes.

Here, we will use a large dataset containing a range of reliable and accurate data from all patients tested for COVID-19 in 3 large hospitals in Scotland (Royal Infirmary of Edinburgh, Western General Hospital [Edinburgh] and St. John’s Hospital [Livingston]) between March and December, 2020. This presents a unique opportunity to build on the initial, limited data regarding the risk and impact of AKI in COVID19, the implications of pre-existing CKD in COVID-19, and the risk of developing CKD in patients whose COVID-19 episode was complicated by AKI.

This project aims to increase our understanding of the relationship between COVID-19 and kidney disease, and will help plan future kidney healthcare resource allocation.

You can view the publication based on this project on the European Respiratory Journal website: https://erj.ersjournals.com/content/early/2022/04/29/13993003.03168-2021

Procalcitonin is a marker of bacterial infection which can be measured in the blood. It is a relatively new test which is already used in some hospitals, mostly to help doctors understand what is causing severe infections.

We used this test during the COVID-19 pandemic because some data suggested it shows how unwell someone might become in the early stages of COVID-19. It could also be useful to identify patients who have bacterial infections on top of the COVID-19 disease or give doctors a measure of whether the disease is becoming more severe.

We want to find out whether this test was accurate, and whether it added important information beyond some of the more commonplace tests we do in the hospital. Understanding this will help us decide whether we should carry on doing the test in the future.

There is mounting evidence that socioeconomic deprivation increases the risk of death in people suffering from COVID-19 disease, independent of race or associated chronic health conditions.

The Scottish Government collects data on socioeconomic deprivation on a yearly basis using a tool called the Scottish Index of Multiple Deprivation, which breaks down the degree of deprivation in each area of the country according to income, employment, educational, health and housing indicators.

This study will investigate what deprivation indicators contribute to higher death rates among patients admitted to hospital with confirmed COVID-19 disease.

Project output

In October 2023, a journal article was published to share the results of this research: access the journal article

In conclusion, the research team found that overall deprivation status (as defined by the Scottish Index of Multiple Deprivation) was not reliably associated with deaths due to COVID-19. However, they found that the risk of death was doubled for those living in areas with higher levels of income-related deprivation and/or higher numbers of hospitalisations due to alcohol consumption. 

Therefore, for future allocation of resources, there may be greater benefit in looking at specific measures of deprivation - such as income, education level, crime rates, access to amenities - rather than solely the overall deprivation level, particularly in areas where overall affluence may mask pockets of deprivation.

People who survive COVID-19-related severe (critical) illness have complex care needs, requiring support from health and social care professionals in hospital and community settings. Long COVID is increasingly recognised as a public health issue. There is a pressing need for solutions that make better use of data from health records to support care for patients and families during recovery.

The project aims to identify the information that health and care professionals need to provide care for people recovering from COVID. It will also use data to better match up the care needs of people with available treatment options. In addition, the project aims to find ways of presenting this information to health and care professionals that means that they can quickly and efficiently understand what care patients and families need.

The project team will work closely with patients, families and the public to ensure that the work we do is relevant and focused to their needs.

On admission to hospital individuals with suspected COVID-19 will currently have swabs taken to check for the presence of COVID-19 viral RNA by a PCR test.  However, many individuals with presumed COVID-19 never have a positive PCR swab result which may be due to them having ceased shedding the virus by the time they are admitted to hospital. In these individuals, antibody tests may provide additional useful information to confirm their diagnosis.

For the currently available antibody tests it may be necessary to compare paired samples of blood to look for evidence of recent infection as a single blood sample may only be able to determine whether or not there has been evidence of past exposure.

Within NHS Lothian we have collected information about patients admitted with COVID-19. This project would use this information to describe the patterns seen in these patients. This could help researchers and Doctors work out those people who are at higher risk of becoming seriously unwell. Additionally by recognising those at higher risk, we may be able to suggest policy change to protect these groups.