Abstract
Mild frailty is common in later life, increasing the risk of hospitalisation, loss of independence and premature death. Targeted health promotion services may reduce adverse outcomes and increase quality of life; however, effective, well-developed theory-based interventions are lacking. We aimed to explore perceptions of health promotion behaviours undertaken by older people with mild frailty, barriers and facilitators to engagement, and identify potential components for new home-based health promotion services. We carried out 17 semi-structured qualitative interviews and six focus groups with 53 stakeholders, including 14 mildly frail older people, 12 family carers, 19 community health and social care professionals, and 8 homecare workers, in one urban and one semi-rural area of England. Transcripts were thematically analysed. Older people with mild frailty reported engaging in a variety of lifestyle behaviours to promote health and well-being. Key barriers or facilitators to engaging in these included transport, knowledge of local services, social support and acceptance of personal limitations. Older people, carers and professionals agreed that any new service should address social networks and mobility and tailor other content to each individual. Services should aim to increase motivation through focussing on independence and facilitate older people to continue carrying out behaviours that improve their well-being, as well as provide information, motivation, psychological support and practical support. Stakeholders agreed services should be delivered over a sustained period by trained non-specialist workers. New services including these components are likely to be acceptable to older people with mild frailty.
Highlights
Frailty in later life is associated with greater risk of hospitalisation, functional decline, falls, worsening mobility and death (Clegg, Young, Iliffe, Rikkert, & Rockwood, 2013)
Within United Kingdom (UK) National Health Service (NHS) policy, there is a focus on targeted prevention and encouraging behaviours supporting health promotion (NHS England, Care Quality Commission, Health Education England, Monitor, Public Health England, Trust Development Authority (TDA), 2014)
Far fewer older people are receiving social care owing to reductions in public funding which is likely to lead to higher numbers of older people with unmet needs (Iparraguirre, 2017)
Summary
Frailty in later life is associated with greater risk of hospitalisation, functional decline, falls, worsening mobility and death (Clegg, Young, Iliffe, Rikkert, & Rockwood, 2013). Mild (or pre-or early) frailty, where individuals are between robust and frail is more common and may be present in up to half of all older adults in high-income countries, depending on the definition used, compared to 11% who are frail (Collard, Boter, Schoevers, & Oude Voshaar, 2012). Over time, this population is more likely to become robust or remain stable than those with frailty (Gill, Gahbauer, Allore, & Han, 2006), suggesting mild frailty could be an important opportunity for promoting health and delaying frailty. There is a paucity of policies focussing on preventing frailty in those already on a pathway to frailty (Drennan et al, under review), with a concurrent lack of services and interventions in this area
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