Explaining discrepancies in self-reported quality of life in frail older people: a mixed-methods study

Anne Van Der Vorst,Nico De Witte,Ruth G M Vogel,Gertrudis I J M Kempen,G A Rixt Zijlstra,Jos M G A Schols

doi:10.1186/s12877-017-0641-y

Abstract

BackgroundMost research on multidimensional frailty focuses on deficits and risks of adverse outcomes. However, although some frail older people report a low quality of life (QoL), others still report a relatively high QoL. More knowledge about these discrepancies might give new insight into developing frailty prevention strategies. Therefore, this mixed-method study aimed (a) to identify characteristics related to QoL among frail older people; and (b) to explain discrepancies between higher and lower levels of QoL, with a specific interest in identifying strengths frail older people with a higher QoL still have.MethodsSemi-structured interviews were held with community-dwelling, frail older people with higher (n = 16) and lower levels of QoL (n = 18). Frailty was assessed with the Comprehensive Frailty Assessment Instrument, which measures environmental, physical, psychological, and social frailty. Other quantitative measures included socio-demographic characteristics, overall QoL, meaning in life, and mastery. The qualitative part focused on the meaning and maintenance of QoL (among other factors), despite being frail. Possible explanations for discrepancies in QoL were explored.ResultsFrail older people with a higher QoL were older, had lower levels of psychological frailty, and reported higher meaning in life compared to those with a lower QoL. Outcomes of qualitative analysis showed that participants in the high QoL subgroup adapted more effectively to difficulties, had more things in prospect, performed more activities, and were more satisfied with their social network compared to the low QoL subgroup.ConclusionThis exploratory study suggests possibilities to promote and improve QoL by strengthening specific resources among frail older people.

Highlights

Most research on multidimensional frailty focuses on deficits and risks of adverse outcomes
While some studies assess multiple domains of quality of life (QoL), this study focuses on overall QoL, which is defined as ‘an individual’s overall satisfaction with life and general sense of well-being’ [20], and for which one question seems to be a particular adequate measure [21]
Quantitative comparison The outcomes of the quantitative analyses showed that participants in the high QoL subgroup (≥ 8; n = 16) were significantly older, had lower levels of psychological frailty, and reported higher scores on meaning in life compared to the low QoL subgroup (≤ 6; n = 18) (Table 1)

Summary

Introduction

Most research on multidimensional frailty focuses on deficits and risks of adverse outcomes. Some frail older people report a low quality of life (QoL), others still report a relatively high QoL More knowledge about these discrepancies might give new insight into developing frailty prevention strategies. Current approaches on frailty seem to be dominated by a “deficit approach.” They mainly focus on things people cannot do any longer and the risks of adverse outcomes [5, 6], or define frailty as an accumulation of deficits [10]. Despite this deficit approach in research, older people themselves seem less focused on shortages. This suggests that a strengths-based approach, which offers the opportunity to get a better understanding of people’s strengths and abilities [14, 15], might be of value for frailty prevention strategies

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