Understanding frailty: meanings and beliefs about screening and prevention across key stakeholder groups in Europe

Abstract

Innovative methods to manage frailty are critical to managing the needs of an ageing population. Evidence suggests there are opportunities to reverse or prevent frailty through early intervention. However, little is known about older adults', families' and practitioners' beliefs about the malleability of frailty. This study examined European stakeholders' accounts of the acceptability and feasibility of frailty screening and prevention to inform future intervention development. Semi-structured focus groups and individual interviews were conducted in three European Union countries (Italy, Poland and the United Kingdom) with key stakeholders -frail and non-frail older adults, family care-givers, and health and social care professionals. Thematic analysis identified four themes: synchronicity between the physical and the psychological in frailty, living with frailty in the social world, the need for a new kind of care, and screening for and preventing frailty. Findings emphasised the need for a holistic approach to frailty care and early intervention. Integrated care services and advocacy were important in the organisation of care. Central to all stakeholders was the significance of the psychological and social alongside the physical elements of frailty and frailty prevention. Support and care for older adults and their

Preventing frailty in older people: An exploration of primary care professionals' experiences

“…Professionals should be aware that not all older people are frail. A "knowledge gap" and lack of understanding of the nature of frailty and its reversibility are not only highlighted in this study, but was also recognised by Shaw et al () and Gwyther et al (). In this context, we would also like to point out that, based on their clinical vision and/or using a frailty assessment instrument, professionals may believe that a person is frail and that interventions need to be deployed, but the older person in question may have a different view on this.…”

“…Secondly, the professionals' working experience is related to the organisational model of the Italian healthcare system, which is based on universal coverage funded by a solidarity tax. However, the social and health issues facing this region bear similarities to other parts of Europe, particularly those which have similar social and physical geographies (Gwyther et al, ; OECD/EU, ; Shaw et al, ). A key strength of this study was the multi‐professional nature of all the focus groups which contained at least one each of the following: a home care worker, general practitioner, physiotherapist, district nurse and a social worker.…”

“…Many factors influence health and social care professionals' decision‐making processes (Clemens & Hayes, ; Craig & Smyth, ; Gabbay & le May, ), including their personal attitudes, knowledge and experience, as well as the organisational cultures and the structures in which they work. In the study conducted by Shaw et al (), which examined the views of professionals and stakeholder in three European countries, it was identified that consideration of professionals' beliefs in relation to the effectiveness of screening and the feasibility of intervention was notable factors, which could impede instigating screening. Professionals need to believe that screening and interventions work for these to be instigated.…”

Perceptions and experiences of frailty interventions: quantitative and qualitative results from a survey of partners within the European Innovation Partnership on Active and Healthy Ageing (EIP-AHA)

“…All participants were given the questionnaire designed to compare their experiences and perceptions of delivering and evaluating good practices. A novel questionnaire was compiled following discussions with the research team and based on work conducted as part of the larger FOCUS project, for example, questions regarding barriers and facilitators to frailty interventions were planned, but also confirmed by qualitative work (Shaw et al forthcoming). Partners were asked how they defined frailty, whether they screened for frailty as part of the recruitment and eligibility process, and then whether they measured frailty pre- and/or post-intervention.…”

The emergence and utilisation of frailty in the United Kingdom: a contemporary biopolitical practice

“…Moreover, suggestions are based on methodologically inadequate studies, making questionable claims that frailty is reversible (Liu and Latham, 2009; Theou et al , 2011). This adds to clinicians’ scepticism about the usefulness of the routine identification of frailty; unlike many other medical conditions, the causes, prognosis and benefits of therapeutic interventions for frailty for the individual patient are unclear (Rockwood, 2016; Gwyther et al , 2018; Shaw et al , 2018).…”