‘StOP UTI’ - STrategies in Older People’s care to prevent Urinary Tract Infection: a realist synthesis of the evidence

What are we trying to find out?
How and why different approaches to recognising and preventing bladder infections in older people might work in long-term care settings.

Why is this important?
Bladder infections are common in older people living in care homes and are often difficult to recognise because signs and symptoms, such as becoming confused, may look like other conditions such as dementia. This may result in over and under-treatment. Over-treatment with repeated antibiotic use leads to resistance to antibiotics, which means they do not work as they should. Under-treatment may increase the risk of kidney infection, other problems including need for hospital admission, lifethreatening infection, or even death due to sepsis. Guidance and research on recognising and preventing bladder infections in older people relate mainly to hospitals or long-term care settings in non-UK countries. We do not know enough about this in long-term care settings in the UK such as nursing and residential homes.

How will we find out?
We will review the evidence using a research approach called realist synthesis, focusing on how and why approaches to spotting and preventing bladder infection in older people’s care may work, for whom and in what settings. We will also look at the evidence about how to support change in long-term care settings to make things better. Our initial ideas about how these approaches may work will be discussed with a range of people and groups who are directly affected by problems with bladder infections in these settings through a workshop and interviews. This will include care home residents and their carers, members of the public, care home providers, care home staff and experts working in the field of older people’s care. We will then look for further evidence to test and refine the findings so that we can describe how, why and in what settings the approaches work.

Patient/resident and public involvement (PPI)
Involvement of care home residents, carers and the public is important to this realist synthesis project to ensure we include different viewpoints and that the research focuses upon what is important to care home residents. A carer of someone in residential care is a member of the project team and has contributed to the planning of the research and helped write this application. She will chair the Advisory Group we appoint to advise on the research and how to maximise the impact of our findings. This group of experts will be consulted with throughout the project. There will be PPI involvement in the workshop and some of the interviews will be conducted by our lay researcher.

How will we tell people about the results?
Our research will be the start of a process to develop more relevant and practical interventions that can be used and tested out in trials in long-term care settings in the UK to find out how well they work. A report, summary and articles will provide practical examples and recommendations relevant to care home staff, care home managers, researchers, educators, carers and relatives for use to improve the recognition and prevention of bladder infection in older people’s long-term care and to plan further research to investigate them. We will turn our findings into a range of different resources and digital communications with input from experts who support the adoption and spread of innovation, such as
the Academic Health Sciences Network, for sharing via care home networks and associations.