Research project - STRENGTH

Unpaid carers provide essential emotional, practical, and physical support to older people with complex health conditions, often over prolonged and uncertain periods.

In the UK, the number of older people living with severe frailty or multimorbidity is increasing, and much of the responsibility for day-to-day care falls on family members, friends, and neighbours. While caring can be meaningful, it is also associated with significant emotional strain, declining physical and mental health, and reduced quality of life for carers themselves.

One under-recognised aspect of the caregiving experience is anticipatory grief: the distress experienced in anticipation of the loss of a loved one. For carers of older people with complex health conditions, anticipatory grief is often prolonged, ambiguous, and intertwined with ongoing caregiving responsibilities. Unlike post-bereavement grief, anticipatory grief typically lacks formal recognition and structured support pathways, particularly outside cancer and dementia care, where more targeted services and interventions exist.

Existing evidence suggests that anticipatory grief is associated with poor sleep, anxiety, depression, reduced self-care, and increased health service use among carers. Early recognition and support may prevent deterioration in carers’ wellbeing and reduce the risk of complicated grief following bereavement. However, there is currently limited empirical evidence focused specifically on carers of older people with frailty or multimorbidity, and no established intervention models tailored to this group.

This study addresses this gap by combining evidence synthesis, empirical mixed-methods research, and stakeholder consultation to develop a robust, context-sensitive logic model. The logic model will articulate how anticipatory grief support for unpaid carers could work in practice, identifying key mechanisms, intervention components, and delivery pathways suitable for future co-design and feasibility testing.