Care Professionals Manage the Future, Frail Older Persons the Past. Explaining Why Frailty Management in Primary Care Doesn't Always Work

Abstract

Frailty management focuses on optimizing the physical and psychological functioning of older people with frail health through early risk identification and intervention in primary care. Such care programs demand a joint effort by primary care professionals and older persons, one in which professionals are expected to promote or facilitate self-management practices and older persons are expected to adhere to the professional advice. It is known that patients and professionals hold different perspectives on frailty, but we know little about how this may affect their cooperation in frailty management. In this article, we therefore study how different perspectives of older persons and their primary care professionals play a role frailty management in practice. Nine cases of frailty management were reconstructed through semi-structured interviews with older persons, their family doctor and practice nurse. Drawing from literature on managing complex problems, we analyzed how “factual” and “normative” orientations played a role in their perspectives. We observe that the perspectives of care professionals and older persons on frailty management were substantially different. Both actors “manage” frailty, but they focus on different aspects of frailty and interestingly, care professionals' rationale is future-oriented whereas older person's rationale past-oriented. Primary care professionals employed practices to manage the medical and social factors of frailty in order to prevent future loss. Older persons employed practices to deal with the psychological, emotional and social aspects of the different types of loss they already experienced, in order to reconcile with loss from the past in the present. These findings raise fundamental questions regarding the different perceptions of and priorities around not only care for frail older people in general, but also implied professional-patient relations and the value of a risk-management approach to care for older people with frail health. The distinction between these perspectives could help care professionals to better respond to older patients' preferences and it could empower older persons to voice preferences and priorities that might not fit within the proposed care program.

Providing care for older adults in the Emergency Department: expert clinical recommendations from the European Task Force on Geriatric Emergency Medicine

“…Whereas medicine in general and Emergency Medicine in particular is disease-oriented and highly protocolized, older people in the Emergency Department (ED) often present with frailty syndromes or atypical complaints that may make protocol-driven approaches unsuitable. Although knowledge on frailty syndromes is increasing, it remains a challenge to translate this knowledge reliably into daily clinical care [5][6][7].…”

How do primary care clinicians approach the management of frailty? A qualitative interview study

“…It is therefore unsurprising that the approach to management was similarly non-uniform and largely dependent on clinician’s role and experience. This finding was similarly replicated in a focus group study of community nurses in Scotland [ 28 ], and of a study of nine patients and their health professionals in the Netherlands [ 29 ]. There is a strong argument for addressing the identification of frailty to facilitate a more cohesive and structured approach.…”

Identifying and Managing Frailty: A Survey of UK Healthcare Professionals

“…A holistic approach to assessment has also been reported by UK community nurses, general practitioners, and other HCPs in qualitative interview and focus group studies ( Coker et al, 2019 ; Mulla et al, 2021 ; Papadopoulou et al, 2021 ) and European surveys ( Bruyère et al, 2017 ). Qualitative studies in the Netherlands have found that proactive monitoring, planning, multidisciplinary collaboration are key parts of primary care frailty management ( La Grouw et al, 2020 ), with nurses feeling that optimizing nutritional status, support from the environment and improving mobility were especially important ( Gobbens et al, 2022 ). The clear changes in care as a result of frailty assessment are encouraging, as qualitative work suggests that making a difference and not being a tick box exercise is important to motivate HCPs to identify frailty ( Anantapong & Tinker, 2019 ; Mulla et al, 2021 ).…”

“…The clear changes in care as a result of frailty assessment are encouraging, as qualitative work suggests that making a difference and not being a tick box exercise is important to motivate HCPs to identify frailty ( Anantapong & Tinker, 2019 ; Mulla et al, 2021 ). However, it should be acknowledged that patients and HCPs often have differing perspectives on frailty management and what can be achieved ( D’Avanzo et al, 2017 ; La Grouw et al, 2020 ).…”

“…Multidisciplinary teams are considered a vital part of frailty management, but challenges have also been identified, particularly in community settings, about information sharing between HCPs ( Anantapong & Tinker, 2019 ; Coker et al, 2019 ; Kennedy et al, 2021 ; La Grouw et al, 2020 ; Roberts et al, 2023 ). In contrast to the “Fit for Frailty” guidelines, care plans related to frailty were only developed by 54% of our respondents and were not easy to share.…”