Multimorbidity Projects

Multi-causality and Multimorbidity

There are two self-evident truths of Chronic Liver Disease (CLD); in many patients multiple causes interact leading to CLD and most patients with CLD experience multimorbidity. We propose the term “Multi-causality” to capture the intersection causes of CLD - in particular alcohol use disorders and overweight/obesity. Multimorbidity is the coalescence of multiple end-organ pathologies in the same patient and is well recognised particularly by the NIHR.

Inequalities

Prof Chris Whitty has established priorities for the NIHR CRN that includes delivering research in areas of high disease prevalence that are often poorly engaged in research in order to address inequalities. The hepatology strategy will address both health and research inequalities. We recognise that the wider determinants of health including poor nutrition, smoking, poverty and mental health/addiction contribute to the high levels of alcohol use and obesity that drive CLD. Any effective approach to CLD must address health and research inequalities and must take an inclusive approach encompassing these wider determinants of health.

Working together to address research into the Causes, Management and Prevention of liver disease and its Comorbidities

We have secured support from the wider Hepatology community. We have had preliminary conversations within the NIHR CRN community and with potential partners. We have approached NIHR CRN Diabetes, Gastroenterology, Cardiovascular, Mental Health/Addiction, Cancer, Primary Care and Public Health Specialties so far.

The group will hold a series of workshops to address Aetiology, Diagnosis, Treatment and Prevention of chronic liver disease attributable to alcohol and obesity by  establishing:

• What is already known

• What are the pressing research questions that need to be addressed

• What is unknown

We envisage the formation of working groups that will aim to develop:

• Review articles summarizing the current state of best practice

• Grant proposals for cross-disciplinary work

• Establishing an agenda for future research

Hearing loss in the aged and those with dementia 

The 2020 Lancet Commission on Dementia Prevention and Care highlighted that hearing loss acquired in midlife (aged 45-65 years) is the most significant modifiable risk factor for dementia. Addressing hearing loss may reduce the risk of dementia by 8%.1 First-line treatment for this type of hearing loss is hearing aids. Of those offered hearing aids, however, only half use it most of the time and one in five not at all.

Research opportunities

Unanswered research questions in this field center around the mechanisms behind the association between hearing loss and dementia (cause, effect, common demographic), how best to test and integrate hearing assessment in dementia clinics and vice versa, how best to manage hearing loss and improve hearing aid use in older adults, how best to manage memory problems in hearing clinics (both NHS and Any Qualified Provider (AQP) models), how to prepare for the arrival of novel approaches to hearing loss (drugs, genes, cells to protect or restore hearing). 

Recent high-profile developments provide opportunities to bring hearing loss and dementia research communities together to develop high quality research projects. These include: the 2020 DHSC Round Table on hearing loss, the NIHR Hearing Health Informatics Collaborative and Translational Research Collaboration (latter in set-up), Hearing Medicines Discovery Syndicate, HTA funded FAMOUS trial of monitoring after hearing aid fitting and the EU Horizon 2020 funded SENSE-Cog SI trial. These wide ranging initiatives will catalyse further research into hearing loss and dementia. They do not, however, consider the most efficient and inclusive routes for accessing study populations, research delivery processes and workforce available. This is where the NIHR CRN’s input is critical and can add value to the development of research in this field. 

 Understanding the delivery mechanism for studies that want to sit across the clinical settings used to assess both hearing loss and cognition will be crucial to ensuring that future developments in this field can be optimised.  

Clusters A and E are undertaking a joint project to develop consensus on how to address Multiple Long Term Conditions/Multimorbidity through research programmes, producing a CRN-wide adopted approach, to be piloted across the CRN and broader NIHR and external stakeholders. This work forms part of a cross-NIHR Programme in support of the NIHR strategic priority of MLTC-M as described within Best Research for Best Health: the next chapter, and is aligned to the NIHR strategic framework for MLTC-M.

Addressing Multiple Long Term Conditions - Multimorbidity

Multiple Long-Term Conditions (Multimorbidity) (MLTC-M) is an NIHR and global priority. Around one in four adults in England are living with two or more health conditions and it is known that they are at higher risk of mortality and a poorer quality of life, reflecting a growing burden on individuals and the health and care system. There are many challenges inherent in conducting research focussed on people with multiple long-term conditions and the CRN project aims to articulate those challenges and barriers and explore possible processes and solutions to them.  

Many research studies have specific exclusions relating to multiple long-term conditions. An important aspect of this work is to ensure our research studies do not unjustifiably exclude people with MLTC-M.  This guidance will then be disseminated into the clinical research community to facilitate a beneficial change to the research environment for those with multiple long-term conditions.