Background Screening is an important component of understanding and managing frailty. This study examined older adults’, caregivers’ and healthcare providers’ perspectives on frailty and frailty screening. Methods Fourteen older adults and caregivers and 14 healthcare providers completed individual or focus group interviews. Interviews were audio recorded, transcribed verbatim, and analyzed using line-by-line emergent coding techniques and inductive thematic analysis. Results The interviews yielded several themes with associated subthemes: definitions and conceptualizations of frailty, perceptions of “frail”, factors contributing to frailty (physical,, cognitive, social, pharmaceutical, nutritional), and frailty screening (current practices, tools in use, limitations, recommendations). Conclusion Older adults, caregivers and healthcare providers have similar perspectives regarding frailty; both identified frailty as multi-dimensional and dynamic. Healthcare providers need clear “next steps” to provide meaning to frailty screening practices, which may improve use of frailty-screening tools.

Background Many definitions and operationalisations of frailty exclude psychosocial factors, such as social isolation and mental health, despite considerable evidence of the links between frailty and these factors. This study aimed to investigate the health domains covered by frailty screening tools. Methods A systematic search of the literature was conducted in ac­cordance with PRISMA guidelines. MEDLINE, CINAHL, EMBASE, and PsycInfo were searched from inception to December 31, 2018. Data related to the domains of each screening tool were extracted and mapped onto a framework based on the biopsychosocial model of Lehmans et al. (2009) and Wade & Halligans (2017). Results Sixty-seven frailty screening tools were captured in 79 arti­cles. All screening tools assessed biological factors, 73% assessed psychological factors, 52% assessed social factors, and 78% assessed contextual factors. Under half (43%) of the tools evaluated all four domains, 33% evaluated three of four domains, 12% reported two of four domains, and 13% reported one domain (biological). Conclusion This review found considerable variation in the assessment domains covered by frailty screening tools. Frailty is a broad construct, and frailty screening tools need to cover a wide var­iety of domains to enhance screening and outcomes assessment.

Background There are many mobile health (mHealth) apps for older adult patients, but research has found that broadly speaking, mHealth still fails to meet the specific needs of older adult users. Others have highlighted the need to embed users in the mHealth design process in a fulsome and meaningful way. Co-design has been widely used in the development of mHealth apps and involves stakeholders in each phase of the design and development process. The involvement of older adults in the co-design processes is variable. To date, co-design approaches have tended toward embedding the stakeholders in early phases (eg, predesign and generative) but not throughout. Objective The aim of this study was to reflect on the processes and lessons learned from engaging in an extended co-design process to develop an mHealth app for older adults, with older users contributing at each phase. This study aimed to design an mHealth tool to assist older adults in coordinating their care with health care professionals and caregivers. Methods Our work to conceptualize, develop, and test the mHealth app consisted of 4 phases: phase 1, consulting stakeholders; phase 2, app development and co-designing with older adults; phase 3, field-testing with a smaller sample of older adult volunteer testers; and phase 4, reflecting, internally, on lessons learned from this process. In each phase, we drew on qualitative methods, including in-depth interviews and focus groups, all of which were analyzed in NVivo 11, using team-based thematic analysis. Results In phase 1, we identified key features that older adults and primary care providers wanted in an app, and each user group identified different priority features (older adults principally sought support to use the mHealth app, whereas primary care providers prioritized recoding illnesses, immunizations, and appointments). Phases 2 and 3 revealed significant mismatches between what the older adult users wanted and what our developers were able and willing to deliver. We were unable to craft the app that our consultations recommended, which the older adult field testers asked for. In phase 4, we reflected on our abilities to embed the voices and perspectives of older adults throughout the project when working with a developer not familiar with or committed to the core principles of co-design. We draw on this challenging experience to highlight several recommendations for those embarking on a co-design process that includes developers and IT vendors, researchers, and older adult users. Conclusions Although our final mHealth app did not reflect all the needs and wishes of our older adult testers, our consultation process identified key features and contextual information essential for those developing apps to support older adults in managing their health and health care.

BACKGROUND There are many mHealth apps for older adult patients, but research has found that, broadly speaking, mHealth still fails to meet the specific needs of an older adult user. Others have highlighted the need for embedding the user in the mHealth design process in a fulsome and meaningful way. Co-design has been widely used in the development of mHealth apps, and is described as involving stakeholders in each phase of the design/development process. Involvement of older adults in co-design processes has been variable. Co-design approaches to date have tended towards embedding the stakeholders in early phases (e.g., pre-design/generative) but not throughout. OBJECTIVE The aim of this paper is to provide reflections on the processes and lessons learned from engaging in an extended co-design process to develop an mHealth app for older adults, with older users contributing at each phase. The aim was to design an mHealth tool to assist older adults to coordinate their care with healthcare providers and caregivers. METHODS Our work to conceptualize, develop and test the mHealth app consisted of four phases: Phase 1- consulting stakeholders; Phase 2- app development and co-designing with older adults; Phase 3- field testing with a smaller sample of older adult volunteer testers; and Phase 4, reflecting, internally, on lessons learned from this process. In each phase, we drew on qualitative methods, including in-depth interviews and focus groups, all of which were analyzed in NVivo 12, using team-based thematic analysis. RESULTS In Phase 1, we identified key features that older adults and health care providers wanted in an app, and each user group identified different priority features (older adults principally sought supports to use the mHealth app, while providers prioritized recoding illnesses, immunizations, and appointments). Phases 2 and 3 revealed significant mismatches between what older adult users wanted, and what our developers were able and willing to deliver. In Phase 4 we reflected on our abilities to embed the voices and perspectives of older adults throughout the project, when working with a developer not familiar or committed to the core principles of co-design. CONCLUSIONS While our final mHealth app did not reflect all of the needs and wishes of our older adult testers, our consultation process identified key features and contextual information essential for those developing apps to support older adults in managing their health and health care. Furthermore, our reflective process identified important factors to consider when health researchers and gerontologists set into the app development sector.