The Community Ageing Research 75+ Study (CARE75+) Remote pathway – is it working as a method for recruiting older adults?

The COVID-19 pandemic brought about a paradigm shift in how we work. In the last three years, we have all got much slicker with Zoom technology and finally got to grips with screen sharing and the mute button.  Well almost….

And for many researchers, the methods we use to conduct research have changed as well. Back in June 2021, the national longitudinal cohort study; the Community Ageing Research 75+ Study (CARE75+) (https://www.bradfordresearch.nhs.uk/care75/) transitioned to a new model of consent and assessment to recruit older adults (≥75 years). Instead of face-to-face recruitment in the comfort of the person’s home, remote consent (recorded during a telephone call) and remote assessments were offered. Methods included assessment by telephone, postal questionnaire, web-form submission and more recently, the option of assessment by video-conference. With over a year of these methods under our belt, how have we done?

By January 2023, 1,529 study invitation letters had been mailed from 18 General Practices (GPs) across England. We use an opt-out method whereby potential participants inform their GP if they do not want their contact details passing to the research team (a method used since 2015). To date, 241 (15.8%) have opted out of having their details passed on. This left 1288 (84.2%) potential participants available for researchers to contact by telephone and see if they wanted to find out more about the study and hopefully take part. 

To date, 390 older adults have consented to participate. This gives an overall conversion rate of 26% (from mail out to consent).  This percentage is a moving target as some people have yet to be contacted. Nevertheless, figures to date suggest lower take-up than the previous in-person pathway using an identical opt-out method with the same target population.  

This is perhaps unsurprising. People generally prefer in-person interactions and researchers previously working on the face-to-face pathway suggest that the opportunity of the physical assessments (e.g. blood pressure and vision tests) often incentivised participation. 

We capture the reasons for declining if they are provided. However sometimes researchers are unable to contact potential participants; people appear increasingly cautious about picking up the telephone to people they do not know. Some researchers have reported older people expressing less good will towards their general practice and suggest this might be influencing their decisions to participate in research. 

For those that have consented, the mean age of participants is 80 years (range 75 – 93) and we have successfully recruited across the range of frailty (fit, mild, moderate and severe). This is positive, although we will compare results with population data once we have a larger sample. There is little point in introducing recruitment methods that fail to reach a proportion of the population we want to include. 

Recruitment of older adults from the South Asian community has not been possible. Researchers have reported that they are often reliant on liaising with the older persons’ family and logistically it is more difficult to get family consensus for participation without a discussion in the person’s home.  

Researcher feedback suggests that remote methods are certainly popular with some older adults. Many lead busy lives and flexible options such as the web-submission option is ideal for the more tech savvy participants. And the Bradford research team highlight the advantage of not being limited by commuting between people, meaning they can carry out assessments on more people in one day. 

Going forward, it will be interesting to see if participants stay the course for the full 3 years of the study. Repeated assessments carried out remotely may be less appealing than home visits which inevitably include a cup of tea and a catch up with a researcher who gets to know the participant over the course of the study. Time will tell.  

2023 will hopefully see us gain momentum with the new face-to-face pathway as we roll out CARE75+2 to new sites. We will run CARE75+2 and CARE75+ Remote concurrently. There are certainly advantages and disadvantages to both methods.

This blog was written by Lesley Brown and Sarah Hallas, Older people with frailty Theme at Yorkshire & Humber ARC.

26 January 2023