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

Yvonne La Grouw,Duco Bannink,Hein Van Hout

doi:10.3389/fmed.2020.00489

Yvonne La Grouw, Duco Bannink + Show 1 more

Open Access

https://doi.org/10.3389/fmed.2020.00489

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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.

Highlights

A growing number of community-dwelling older people with disabilities and chronic disease experience acute health incidents such as falls, COPD problems and heart failure
The critical criteria were: [1] the older patient should be in frail health; [2] the older person should have recently experienced an acute health incident; [3] the older person should be involved in a frailty management program; and [4] the care professionals should be experienced with frailty management
Our study shows that it is relevant to look at the content of the intrinsic motivation of older people with frail health—what intrinsically motivates them in dealing with their frail health—instead the extent to which they are motivated to participate in a frailty management program

Summary

Introduction

A growing number of community-dwelling older people with disabilities and chronic disease experience acute health incidents such as falls, COPD problems and heart failure. This leads to Emergency Department (ED) overcrowding in hospitals [1, 2]. Frailty management programs in primary care focus on optimizing the physical and psychological functioning of older people with frail health through early risk identification and intervention. Examples of care programs that can be typified as frailty management are “proactive care” [7, 8], “preventive care” [9], “reablement” [10], and “screening for frailty” [5]. Such frailty management programs demand a joint effort by care professionals and older persons, one in which care professionals are expected to promote or facilitate physical activity, a healthy lifestyle and meaningful and pleasurable activities, and older persons are expected to make health optimizing decisions, to adjust their lifestyles and to comply with medication therapy

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