Date Published: July 19, 2017
Publisher: Public Library of Science
Author(s): Barbara D’Avanzo, Rachel Shaw, Silvia Riva, Joao Apostolo, Elzbieta Bobrowicz-Campos, Donata Kurpas, Maria Bujnowska, Carol Holland, Gianni Virgili.
Frailty is a common condition in older age and is a public health concern which requires integrated care and involves different stakeholders. This meta-synthesis focuses on experiences, understanding, and attitudes towards screening, care, intervention and prevention for frailty across frail and healthy older persons, caregivers, health and social care practitioners. Studies published since 2001 were identified through search of electronic databases; 81 eligible papers were identified and read in full, and 45 papers were finally included and synthesized. The synthesis was conducted with a meta-ethnographic approach. We identified four key themes: Uncertainty about malleability of frailty; Strategies to prevent or to respond to frailty; Capacity to care and person and family-centred service provision; Power and choice. A bottom-up approach which emphasises and works in synchrony with frail older people’s and their families’ values, goals, resources and optimisation strategies is necessary. A greater employment of psychological skills, enhancing communication abilities and tools to overcome disempowering attitudes should inform care organisation, resulting in more efficient and satisfactory use of services. Public health communication about prevention and management of frailty should be founded on a paradigm of resilience, balanced acceptance, and coping. Addressing stakeholders’ views about the preventability of frailty was seen as a salient need.
This meta-synthesis included the points of view of different stakeholders: frail and non-frail older people, caregivers, and health and social care professionals. We generated four synthetic themes (third-order constructs) across them, depicted in our tentative model of frailty (Fig 2). Uncertainty about the malleability of frailty showed that becoming frail was not universally perceived as preventable and amenable to change across all stakeholders or at all stages. Reflecting on the synthesized findings, this theme represented a pivotal belief which then impacted on the nature of the remaining themes and determined different paths in the response to frailty. Thus, a belief or disbelief in the malleability of frailty took up a central position in the model. This uncertainty about the malleability of frailty represents an awareness of being in transition, drawing on the Third and Fourth Age dialectic, which finds older adults inhabiting a liminal space between dependence and independence, activity and passivity .
If we want frailty to be approached as a malleable and preventable condition, a bottom-up approach is needed. Not only should the real needs of frail older people and carers be listened to, but also the tools themselves through which frailty can be managed should come from their own context and resources. This lifeworld-led care paradigm means involvement of the person and family in identification of needs and intervention, enhancement of useful coping strategies, and addressing of the negative ones. The absence of qualitative studies involving psychologists suggests that future research is needed to address their point of view about their own role in support of prevention and intervention. Although several papers addressed the importance of the relationship in the process of care and in the person-centred approach, health and social professionals still need to understand the meaning of building relationship in the context of care. This should be addressed in qualitative research to be better approached in health and education settings.