The lived experience of frailty: beyond classification and towards a holistic understanding of health

Abstract

Purpose Frailty is characterised by decreased physiological reserves and vulnerability to stressors. Although scales, such as the Fried’s Frailty Phenotype (FP), Frailty Index (FI), and Clinical Frailty Scale (CFS), are used to identify frailty, the lived experience of frailty remains understudied. Methods This cross-sectional observational research involved participants aged 65 years and older from Wave 1 of The Irish Longitudinal Study on Ageing (TILDA). Participants were categorised into four independent groups: three frail groups based on the aforementioned scales and a non-frail group. Quantitative variables, including self-rated health, CASP-19 quality-of-life score, and frequency of social activities, were analysed and described. Results The study encompassed 1999 participants with an average age of 72 years, of whom 51% were women. FP exclusively identified 1.6% as frail (n = 32), FI 11.7% (n = 233), and CFS 6.8% (n = 135). More than 60% of all those classified as frail reported their health as good, very good, or excellent, with the lowest proportion (64%) being among frail by FI participants. Frail by FI participants exhibited the lowest mean average CASP-19 score, yet it remained relatively high at 39 out of 57 points. Over 77% of all frail individuals engaged in active leisure activities at least once a month. Conclusion This study underscores the need to comprehend frailty holistically beyond its mere identification. It challenges the prevailing belief that frailty inevitably leads to impaired quality of life and limited social engagement. The findings advocate for a reassessment of how both the general public and healthcare professionals perceive frailty.

Older persons' experiences of frailty: A systematic review

“…Similarly, Grenier (2006) and Grenier and Hanley (2007) This assertion strengthens the need for multidisciplinary holistic assessment in practice and supports the current best practice model of comprehensive geriatric assessment of older people (Chenhuichen et al, 2024;Ellis et al, 2011;Veronese et al, 2022).…”

“…More recently, there is emerging evidence from the social sciences that broadens the biomedical focus. This evidence acknowledges frailty as more than a physical phenomenon and elucidates a broader and alternative view that includes psychological and social dimensions informed by research that explores the perspectives of older persons (Archibald et al, 2020;BritainThinks, 2015;Chenhuichen et al, 2024;Escourrou et al, 2019;Gobbens et al, 2010;IPSOS MORI, 2014;Lim et al, 2023;Nicholson et al, 2012;Pan et al, 2019;Puts et al, 2009;Waldron, 2018;Warmoth et al, 2016;Yueh et al, 2023). This wider perspective suggests that the older person's view of frailty can differ from that of the healthcare definition, in that older adults can dispute the frailty ratings applied to them using the biomedically dominated frailty assessment tools (Cheung et al, 2021;Cluley et al, 2021;Gee et al, 2019;Puts et al, 2009;Shafiq et al, 2023).…”

“…This may relate to different discourses pertaining to the concept of frailty being drawn on, in that older persons perceive frailty as a 'thinking and feeling' phenomenon, whereas healthcare professionals are describing a state of medical and functional decline (Clegg et al, 2013). This was further emphasised in the evidence synthesis in that although participants recognised their physical and functional limits caused by frailty, they did not self-identify as frail, even when they met the biomedical criteria for clinical frailty (Becker, 1994;Chenhuichen et al, 2024;Lekan et al, 2018;St John et al, 2019;van der Vorst et al, 2017;Warmoth et al, 2016). Older persons' view of frailty was predominantly negative, and they believed that self-identifying as frail could contribute to further emotional and physical decline.…”

“…According to Buckinx et al (2015), frailty represents a significant potential public health issue at both patient and societal level because of its multiple clinical and societal consequences, and its dynamic nature. Despite these assertions, many older people live well with frailty (Chenhuichen et al, 2024); thus, the experience of living with frailty is likely to be nuanced.…”