Detecting frail, older adults and identifying their strengths: results of a mixed-methods study

Sarah Dury,Ellen De Roeck,Michaël Van Der Elst,Dominique Verté,Nico De Witte,Bram Fret,Peter Paul De Deyn,Tinie Kardol,An Sofie Smetcoren ,Lieve Hoeyberghs,Deborah Lambotte,Jan De Lepeleire,Eva Dierckx,Jos M G A Schols ,Anne Van Der Vorst,G A Rixt Zijlstra ,Birgitte Schoenmakers,Daan Duppen,Sebastiaan Engelborghs,Gertrudis I J M Kempen ,Liesbeth De Donder

doi:10.1186/s12889-018-5088-3

Abstract

BackgroundThe debate on frailty in later life focuses primarily on deficits and their associations with adverse (health) outcomes. In addition to deficits, it may also be important to consider the abilities and resources of older adults. This study was designed to gain insights into the lived experiences of frailty among older adults to determine which strengths can balance the deficits that affect frailty.MethodsData from 121 potentially frail community-dwelling older adults in Flemish-speaking Region of Belgium and Brussels were collected using a mixed-methods approach. Quantitative data were collected using the Comprehensive Frailty Assessment Instrument (CFAI), Montreal Cognitive Assessment (MoCA), and numeric rating scales (NRS) for quality of life (QoL), care and support, meaning in life, and mastery. Bivariate analyses, paired samples t-tests and means were performed. Qualitative data on experiences of frailty, frailty balance, QoL, care and support, meaning in life, and mastery were collected using semi-structured interviews. Interviews were subjected to thematic content analysis.ResultsThe “no to mild frailty” group had higher QoL, care and support, meaning in life, and mastery scores than the “severe frailty” group. Nevertheless, qualitative results indicate that, despite being classified as frail, many older adults experienced high levels of QoL, care and support, meaning in life, and mastery. Respondents mentioned multiple balancing factors for frailty, comprising individual-level circumstances (e.g., personality traits, coping strategies, resilience), environmental influences (e.g., caregivers, neighborhood, social participation), and macro-level features (e.g., health literacy, adequate financial compensation). Respondents also highlighted that life changes affected their frailty balance, including changes in health, finances, personal relationships, and living situation.ConclusionThe findings indicate that frailty among older individuals can be considered as a dynamic state and, regardless of frailty, balancing factors are important in maintaining a good QoL. The study investigated not only the deficits, but also the abilities, and resources of frail, older adults. Public policymakers and healthcare organizations are encouraged to include these abilities, supplementary or even complementary to the usual focus on deficits.

Highlights

The debate on frailty in later life focuses primarily on deficits and their associations with adverse outcomes
The participants in this study were a heterogenic group, which can be seen in for example the high standard deviations of the mean scores per frailty domain, which were highest for physical and psychological frailty. This means that participants score both way above and below the mean score, which might be explained by the fact that the different risk factors for frailty, based on which most of the participants were selected, differ per frailty domain [36], referring to multidimensional frailty
Life changes and turning points experienced by older people and effect on frailty, quality of life (QoL), care and support, meaning in life, and mastery We discovered that, did adverse life events (e.g., [50]) affect the participants’ frailty and life outcomes, and positive life events affected their frailty in a positive way

Summary

Introduction

The debate on frailty in later life focuses primarily on deficits and their associations with adverse (health) outcomes. This study was designed to gain insights into the lived experiences of frailty among older adults to determine which strengths can balance the deficits that affect frailty. Living at home for as long as possible is often preferred by (frail) older people [6]; effective measures to identify frail, older adults in need of care and support are lacking [7]. A growing number of studies have explored frailty in terms of the experience of physical issues, and psychological, social, cognitive, and environmental problems, stressing the need for a more multidimensional view of frailty [17,18,19]. Frailty requires a broader perspective in terms of measurement, detection, and intervention strategies

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