Making sense of frailty: An ethnographic study of the experience of older people living with complex health problems

Skilbeck, Julie; Arthur, Antony; Seymour, Jane

doi:10.1111/opn.12172

Cited by 34 publications

(60 citation statements)

References 43 publications

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“…Even the most frail older adults display engagement in daily activities as a subsidy for building resilience against frailty 32 . The perspective of frail older adults also demonstrates the experience of anxiety, insecurity, uncertainty and fear regarding frailty, when daily life becomes precarious and challenging 18,38 . Thus, the sense of control is reduced, and individuals seek support to adapt to their new levels of frailty 18 , to maintain their independence and the continuance of their personality 38 .…”

Section: Priorities From the Perception Of Older Adultsmentioning

confidence: 99%

“…From this perspective, priorities from the perspective of the frail older person are not only medical problems, but also include factors that support the maintenance of the ability to take care of oneself 4,38 . Through a logistic regression, in the bivariate analysis, frail older adults who were satisfied with their ability to take care of themselves were about eight times more likely to rate their health as good than those who were not satisfied with their ability to care for themselves 4 .…”

Section: Priorities From the Perception Of Older Adultsmentioning

confidence: 99%

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Care for frail older adults in the community: an integrative review

Souza

Giacomin

Firmo

2020

Rev. bras. geriatr. gerontol.

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Objective: to identify scientific evidence regarding the care of frail older adults in the community, from the perspective of the older adults themselves. Method: a descriptive, integrative review study was performed. The search for articles was carried out in the Medline, Lilacs, Web of Science, Scopus and SciELO databases. The inclusion criteria were complete available articles; published between 2014 and 2019; written in Portuguese, English, Spanish or French; which had older adults as participants. Results: four categories of analysis emerged from the results: frailty from the perspective of frail older adults; priorities from the perspective of the older adults; the older adults’ perspectives on care by services; and interpersonal relationships in the care of frail older adults. The perception of the older adults has specific characteristics, has maintaining their independence as a focus of care, signals the need to maintain interpersonal relationships, improve communication, and for actions of health education and people-centered services. Conclusion: these points demand the attention of care providers and policy services to improve care delivery and provide actions that are welcomed by this public.

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Section: Priorities From the Perception Of Older Adultsmentioning

confidence: 99%

Section: Priorities From the Perception Of Older Adultsmentioning

confidence: 99%

Care for frail older adults in the community: an integrative review

Souza

Giacomin

Firmo

2020

Rev. bras. geriatr. gerontol.

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“…Existing research has characterised the experiences of living with frailty as highly nuanced, involving complicated and enduring transitions in health and illness. [14][15][16] Older people's understandings of frailty are often multidimensional, encompassing complex and interacting physical, social and psychological factors. [17][18][19] Older adults living with frailty may differentiate between the emotional (ie, feeling frail) and physical (ie, being frail) experiences of frailty, wherein being frail is seen as an imposed medical classification and feeling frail may reflect the psychosocial impacts of age-related disability, physical impairment or traumatic life events.…”

Section: Introductionmentioning

confidence: 99%

Older adults’ understandings and perspectives on frailty in community and residential aged care: an interpretive description

et al. 2020

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ObjectivesDespite growing interest in frailty as a significant public health challenge, comparatively little is known about how older adults perceive and experience frailty, limiting the effectiveness of strategies to improve frailty management and prevention. The objective of this study was to understand how older people, including frail older persons in residential aged care, perceive and understand frailty through an interpretive–descriptive qualitative study.SettingAged care facility, community-based university for older persons and an aged care auxiliary care group in a large metropolitan centre in South Australia.Participants39 non-frail, prefrail, frail and very frail South Australian older adults.MethodsSeven focus groups were conducted. Participants completed one of two frailty instruments depending on setting and indicated whether they self-identified as frail. Data were analysed inductively and thematically by two independent investigators.ResultsFrailty was described according to three schemas of (1) the old and frail: a static state near the end of life; (2) frailty at any age: a disability model; and (3) frailty as a loss of independence: control, actions and identity. In addition, a theme was identifying linking mindset, cognition and emotion to frailty. The term frailty was viewed negatively and was often implicated with personal choice. There was little correlation between frailty assessments and whether participants self-identified as frail.ConclusionsAside from a disability model, views of frailty as unmodifiable permeated older persons’ diverse perspectives on frailty and are likely to impact health behaviours. To our knowledge, this is among the largest qualitative studies examining consumer perceptions of frailty and contributes a clinically relevant schema linking age, prevention and modifiability from a consumer perspective.

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“…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 ).…”

Section: Different Perspectives On Frailty Management Practicesmentioning

confidence: 99%

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

Grouw¹,

Bannink²,

Hout

2020

Front. Med.

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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.

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Making sense of frailty: An ethnographic study of the experience of older people living with complex health problems

Cited by 34 publications

References 43 publications

Care for frail older adults in the community: an integrative review

Care for frail older adults in the community: an integrative review

Older adults’ understandings and perspectives on frailty in community and residential aged care: an interpretive description

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

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