Background

With an ageing population, older adults will have more complex health and social care needs and many of these older adults will be living in care homes. Despite the growth in care home populations, care home residents are often excluded from research that could potentially benefit their care. The purpose of our scoping review was to explore resident-related barriers and facilitators to including older people living in UK care homes in research and to identify potential approaches to modify such barriers.

What did we do?

We conducted a scoping review of the available literature. From an initial 3934 identified articles, 90 reports were eligible for inclusion. Barriers and facilitators were identified from the included articles and were synthesised into 7 themes and related
subthemes: (1) research design; (2) understanding and beliefs about research (resident and care home staff); (3) communication; (4) relationships; (5) eligibility criteria (resident and care home); (6) preference-based decisions; and (7) care home staff and environment. Given the complex interplay of the factors identified, both direct and indirect factors were included.

A number of recurring barriers and facilitators to the inclusion of care home residents in research were reported. However, isolating resident-related barriers was complex as both direct and indirect factors must be considered as influential as to not over-simplify the interactions.

Recommendations for researchers

Understanding the barriers and facilitators to the inclusion of older people living in care homes will enable these factors to be addressed and increase the evidence- base for care provided to older people living in care homes. From our findings we were able to develop a number of recommendations for researchers outlined below:

Research Methods

• Work with care home research organisations (e.g., ENRICH)
• Be flexible, understanding and supportive
• Use a collaborative working style to work with residents, their relatives and staff
• Include residents who lack capacity to consent vis use of a consultee
• Embed public involvement at all stages of your project

Communication

• Discuss and identify realistic research targets with the care home manager at the start
• Provide accessible, tailored communication tools (e.g., using large font or images) to ensure potential participants are fully informed
• Provide active appreciation through feedback

Preference-based Decisions

• Widen participation opportunities by utilising legal arrangements that enable staff to act as a nominated consultee
• Try to allay concerns about research motives faced by any of the stakeholders
• Work with care homes to raise residents’ and their relatives’ awareness of research opportunities

Care Home and Staff

• Recognise that staff have an invaluable role and can act as a bridge for communication
• Be flexible and understand the differences in each care home’s culture
• Provide training so that staff can better understand how to support research
• Make allowance for staffing pressures and the unique environment of care homes may impact research

Relationships

• Demonstrate willingness to work with, and be guided by, staff
• Be respectful and supportive to residents, relatives, and care home staff and consider making them research partners
• Consider spending time in the care home before research begins

Eligibility Criteria

• Consider eligibility criteria carefully and avoid exclusion of potential participants because of age, multi-morbidity or frailty as these individuals are representative of the care home population

If you would like to read more about our review you can access it here