Frailty: an in-depth qualitative study exploring the views of community care staff

Abstract

Background Frailty is seen across various health and social care settings. However, little is known about how healthcare professionals, particularly those who provide care for older adults living in the community view frailty. There is also a dearth of information about the extent to which a shared understanding of frailty exists across the various disciplines of care. Such an understanding is crucial across care professionals as it ensures consistent assessment of frailty and facilitates interdisciplinary working/collaboration which is a key component in the management of frailty. This study aimed to explore: (i) how community care staff from various specialties viewed frailty; (ii) whether they had a shared understanding; and (iii) how they assessed frailty in everyday practice. Methods Semi-structured interviews were conducted with a purposive sample of 22 community care staff from seven specialties, namely: healthcare assistants, therapy assistants, psychiatric nurses, general nurses, occupational therapists, physiotherapists and social workers, recruited from four neighbourhood teams across Cambridgeshire, England. Interviews were analysed thematically. Results There was a shared narrative among participants that frailty is an umbrella term that encompasses interacting physical, mental health and psychological, social, environmental, and economic factors. However, various specialities emphasised the role of specific facets of the frailty umbrella. The assessment and management of frailty was said to require a holistic approach facilitated by interdisciplinary working. Participants voiced a need for interdisciplinary training on frailty, and frailty tools that facilitate peer-learning, a shared understanding of frailty, and consistent assessment of frailty within and across specialities. Conclusions These findings underscore the need to: (i) move beyond biomedical descriptions of frailty; (ii) further explore the interacting nature of the various components of the frailty umbrella, particularly the role of modifiable factors such as psychological and socioeconomic resilience; (iii) care for frail older adults using holistic, interdisciplinary approaches; and (iv) promote interdisciplinary training around frailty and frailty tools to facilitate a shared understanding and consistent assessment of frailty within and across specialities. Electronic supplementary material The online version of this article (10.1186/s12877-019-1069-3) contains supplementary material, which is available to authorized users.

“There’s More to Frail than That”: Older New Zealanders and Health Professionals Talk about Frailty

“…e findings of the present study support calls for a more holistic approach to the assessment of the needs of frail older people that includes psychological and social domains [24]. is study was distinctive asking the same questions of older people and health professionals, and the discussion suggests that embedding a more holistic approach will support the broader understandings of the experience of frailty already held by many of the health professionals who work with older people [28,29]. is is exemplified in the British Geriatrics Society's "Fit for Frailty" best practice guidelines [65].…”

“…is more holistic biopsychosocial perspective has also emerged from interviews with Dutch elders conducted by Puts and her colleagues [17] and has been suggested in previous work with health professionals [28,29].…”

“…ese social understandings also highlight that the label or social construction of frailty can be imposed on older people unwillingly and can contribute to negative stereotyping and the associated perceived implausibility of a good old age [2,3,23,26,27]. While there is an explicit contrast with the biomedical literature on frailty, what is less clear is the extent to which older peoples' perspectives on aging diverge or overlap with the approach of the health professionals working with this age group [28,29].…”

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

“…The biomedical perspective on frailty remains dominant in chronic disease management programs. Therefore, it is argued that different perspectives on frailty should be acknowledged in care programs ( 22 , 28 , 29 ). Current literature on frailty management deals with these different perspectives by proposing a holistic care program, i.e., by integrating the divergent perspectives of older persons and their care professionals ( 28 , 30 , 31 ).…”

“…Therefore, it is argued that different perspectives on frailty should be acknowledged in care programs ( 22 , 28 , 29 ). Current literature on frailty management deals with these different perspectives by proposing a holistic care program, i.e., by integrating the divergent perspectives of older persons and their care professionals ( 28 , 30 , 31 ). Also, it is thought that the development of a measurable, holistic understanding of frailty should be the highest priority on the frailty research agenda ( 5 , 6 ).…”