Doctor Kinda Ibrahim

Current research

Research grants 

• NIHR ARC Wessex: The development and iMplementation Of a multidisciplinary medication review and Deprescribing Intervention among Frail older people in primarY care, £139,666 
• NIHR ARC Wessex; Developing a community pharmacy-based intervention to identify people with undiagnosed liver cirrhosis, £140,227                        
• NIHR ARC Wessex: PD Life Study – Exploring the treatment burden and capacity of people with Parkinson’s and their caregivers, £101,333                   
• NIHR Research for Patient Benefit (RfPB), Programme: PB-PG-0317-20043 – Assessment of patients aged 65+ years with an upper limb fracture for frailty and sarcopenia for the prevention of future falls and fractures: a feasibility study. 2019-2021  £248, 512
• NIHR ARC Wessex: GOOD Nasal Irrigation and Gargling to Halt Transmission of COvid-19 to care-home-based Vulnerable InDividuals: The GOOD-NIGHT COVID pilot study. 2020 £11,357
• NIHR ARC Wessex: Medicines optimisation: improving safety and reducing treatment burden among people taking non-steroidal anti- inflammatory drugs or disease modifying anti-rheumatic drugs. 2019-2021 £78,447
• NIHR ARC Wessex: Moving to a new model of dementia care combining nursing home and shared care apartments: the views and experiences of a range of stakeholders.2018-2020  £27,397
• NIHR ARC Wessex: Improving physical activity of older people in the community through trained volunteers: The ImPACt study. 2020-2021, £62,983    
• NIHR Southampton BRC. The Microbiome in Ageing, Nutrition and Appetite. 2019-2021, £21,392
• NIHR Southampton BRC. Fortified foods pilot study. 2017-18, £13,996
• The Higher Education England (HEE) Writing for Publication programme fund 2017-2018, £1,50

Active research projects 

A third of older people take five or more regular medications (polypharmacy) potentially increasing the risk of side-effects, hospital admission and death. These effects are higher among people living with frailty who lose their in-built reserves and become vulnerable to changes triggered by small events such as a change in medication. National recommendations suggest that medications taken by frail older people should be reviewed annually by their GPs to identify and reduce/stop inappropriate medications (deprescribing).Yet this does not happen routinely due to GPs’ lack of time, increased workloads and worries about stopping medicines. Recent recommendations suggest involving other non-medical prescribers such as practice pharmacists and advanced nurse practitioners (ANPs) in reviewing medications. However, it is unknown how staff could work together most effectively and whether they have any training needs.

This research will investigate how practice-pharmacists, ANPs and GPs could best work together with patients living with frailty to perform regular medication review. The study involves four work packages (WPs). We will review previous literature to identify what makes a successful medication review and how to safely reduce/ stop inappropriate medications (WP1). Interviews with GPs, practice-pharmacists, ANPs, frail older patients and carers will be conducted (WP2). These will discover views about where medication review should take place, the role of each of the involved parties in the process, type of medications that could be deprescribed, staff development and training needs, barriers and facilitators for implementation, and strategies to address these barriers. Information gathered from WP1&2 will be used to develop the intervention: a structured medication review process using pharmacists, ANPs and GPs most effectively and involving frail patients and their families in decisions about medications (WP3). The intervention will be refined further through a series of workshops with service users, clinicians and commissioners. A training programme to implement the intervention and increase staff confidence in reducing/ stopping medications safely will be developed and delivered to GPs, practice-pharmacists and ANPs based on the Polypharmacy Action Learning Sets approach adopted by the Wessex Academic Health Science Network (AHSN) . Finally, we will assess whether itis feasible and acceptable for staff in four GP practices to be trained and to implement the intervention with their patients (WP4).

Understanding treatment burden in people with Parkinson’s

PwP need to do many things to look after their health including manage multiple medications, attend healthcare appointments and lifestyle changes such as improving diet and exercise. The effort of looking after their health and its impact on them is termed ‘treatment burden’. Some PwP need help from their family or friends (caregiver) to complete these tasks. Caregivers may also experience treatment burden themselves when caring for someone with Parkinson’s. People’s ability to manage treatment burden is termed ‘capacity’ and is influenced by physical, mental, social and economic factors. People are overburdened when the workload of looking after their health exceeds their capacity. This can lead to poor adherence with treatment, poor quality of life and worse health outcomes. Therefore, the aim of this research is to understand the factors that influence treatment burden and capacity in PwP and their caregivers.

Physical activity is important for older people. It has many benefits including maintaining older people’s ability to perform activities of daily living, be independent, and improve their well-being. However, many older adults living in the community do not engage in regular physical activity.

We want to know if we can train volunteers to run exercise sessions for older people who attend community clubs with a focus on social interaction. We are interested in finding out the views and experiences of older people and volunteers taking part and what factors may promote or hinder the delivery and uptake of the exercise sessions. The study will take place remotely via video in community social clubs managed by Brendoncare. We will invite older adults (members) who attend these clubs to join an exercise session during their usual weekly meeting. We will develop and evaluate a training package for the volunteers who lead these clubs to enable them to run the exercise sessions. Participants will be encouraged to performed exercises to help improve their muscle strength and balance, with the use of elastic resistance bands. We will measure how active and physically able the club members are before we introduce the exercise sessions. After 6 months of these exercise sessions, we will repeat these measurements to see if this has improved their physical activity levels and physical abilities. We will also interview volunteers and club members to gain their views and experience of the exercise sessions.

Previous research projects 

Southampton Arm Fracture Frailty and Sarcopenia Study (SAFFSS)

Falls and fractures are a major health problem for older people. There are over 255,000 falls-related emergency hospital admissions per year in England. Upper limb fractures (often called ‘fragility fractures’) are frequently the first sign of osteoporosis (fragile bones). Frailty and sarcopenia (muscle loss and weakness associated with ageing) are more common in people with osteoporosis and both are associated with an increased risk of falling, increasing the risk of fracture. We hypothesise that assessing people with upper limb fractures for sarcopenia and frailty, in addition to osteoporotic fracture risk, can offer an opportunity to use appropriate existing care pathways that address these conditions to reduce the number of falls and fractures. The aim of this study is to evaluate the feasibility of assessing people aged 65+ years, who attend fracture clinic with an upper limb fracture, for frailty and sarcopenia in addition to routine assessment for fracture risk due to osteoporosis. We will demonstrate whether it is practical and acceptable (to patients and staff) to assess for frailty and sarcopenia in a busy fracture clinic typical of those found in every general hospital.

Medicines optimisation: improving safety and reducing treatment burden among people taking non-steroidal anti-inflammatory drugs or disease modifying anti-rheumatic drugs. 

Despite awareness of their risks and guidelines on their use, NSAIDs are still widely prescribed and bought. This may relate to lack of availability of effective pain relief alternatives. Gastrointestinal bleeding risk is well described, but certain groups (including older people and those with chronic kidney disease or heart failure) may be at particular risk of other important adverse events such as acute kidney injury. Identifying those at high risk would helpfully inform de-prescribing strategies. DMARDs are used in inflammatory conditions and effectively reduce disease progression. They require initialisation in secondary care and subsequent blood monitoring, particularly for liver abnormalities. However, abnormal results related to the DMARDs are relatively rare and frequent monitoring represents a treatment burden and cost for both patients and the health service. Some people on DMARDs are potentially at low risk and monitoring could be reduced. In addition, some individuals may be able to reduce or stop their DMARDs when sustained low disease activity or remission is achieved both reducing costs and the risk of dose-dependent adverse events. This project aims to identify the characteristics of people who might stop or require less monitoring fora NSAID and DMARDs prescribing

Perceptions of appetite, its loss and influential factors amongst community dwelling older individuals. 

Appetite loss in later life, often known as the anorexia of ageing, affects over 20% of older people in the community, rising to over 40% in hospital. The anorexia of ageing is associated with a number of major health burdens in the older population, including incident malnutrition, sarcopenia and frailty, as well as mortality. Therefore, strategies to identify and manage the anorexia or ageing to prevent individuals from developing these sequelae are important. Despite this, there is currently little evidence for effective management strategies. This is in part due to the complexity of appetite loss in later life, which is due to multiple different mechanisms including changes to underlying physiology, the rewarding effect of eating and wider environmental and social factors. However, importantly, there primarily remains a lack of knowledge about the older individual’s account of appetite and appetite loss in later life. Therefore the aim of this research is to understand the factors influencing appetite loss in later life, older people perceptions and their adaptive behaviour.

Moving to a new model of dementia care combining nursing home and shared care apartments: the views and experiences of a range of stakeholders. 

A new nursing home which unusually has attached shared care apartments opened in July 2018 in Wessex. It offers a full range of care and services in one place to support individuals, families and couples affected by dementia. There is a planned move of all residents and staff from a nearby care home to the new home. We know that involuntary moves with poor planning can trigger negative emotions including anger, discontent, sadness and anxiety. These moves also have a higher risk of death, especially among residents with frailty and dementia. However, the extensive planning and early involvement of residents and their relatives could improve their experiences of the move. The aim of this study is to understand the expectations and experiences of residents, their relatives and the care home staff of this move to a new care home.

Grip Strength Measurement Implementation Study (GRImP) 

Low grip strength is found in sarcopenia, and is a recognised marker of poor current and future health. Grip strength is often measured in research studies but is not used in clinical practice. This study evaluated the implementation of routine grip strength measurement on Medicine for Older People wards, supported by the NIHR CLAHRC: Wessex. This study was based on Normalisation Process Theory (NPT) combining qualitative and quantitative methods with economic analysis. The GRImP study has led to a significant impact on the routine clinical practice of MOP wards at Southampton General Hospital. For example, the GRImP study identified that 80% of older people admitted to MOP had low grip strength and were frail and at risk of poor healthcare outcomes. This has increased the awareness of nurses and other health professionals about the importance of identifying and managing frailty, the value of mobility and exercises and the significance of good nutrition in older people. Furthermore, Kinda trained 155 nursing staff to measure grip strength, improving their skills and knowledge of research.

Fortified foods for older people

This is a collaborative project between the University of Southampton and the food Bioscience team at the University of Reading. The aim is to investigate the feasibility of providing fortified food to improve protein and energy intake among older patients including those with dementia and frailty whilst in hospital. This study is supported by the NIHR Southampton Biomedical Research Centre (BRC).

Research projects