Managing frailty in an Irish primary care setting: A qualitative study of perspectives of healthcare professionals and frail older patients

Identifying and Managing Frailty: A Survey of UK Healthcare Professionals

Frailty is a common condition that leads to multiple adverse outcomes. Frailty should be identified and managed in a holistic, evidence-based and patient-centered way. We aimed to understand how UK healthcare professionals (HCPs) identify and manage frailty in comparison with UK Fit for Frailty guidelines, their frailty training, their confidence in providing support and organizational pathways for this. An online mixed-methods survey was distributed to UK HCPs supporting older people through professional bodies, special interest groups, key contacts, and social media. From 137 responses, HCPs valued frailty assessment but used a mixture of tools that varied by profession. HCPs felt confident managing frailty and referred older people to a wide range of supportive services, but acknowledged a lack of formalized training opportunities, systems, and pathways for frailty management. Clearer pathways, more training, and stronger interprofessional communication, appropriate to each setting, may further support HCPs in frailty management.

Health Access, Health Promotion, and Health Self-Management: Barriers When Building Comprehensive Ageing Communities

A new intervention model for promoting healthy ageing grounded on integrated value-based care was developed and tested in the city of Valencia (Spain). Its implementation raised relevant barriers for older adults in their access to health, health promotion, and health self-management linked with their health and digital literacy. This new intervention model included several aspects. On the one hand, researchers together with older adults and their informal caregivers participating in the study, designed personalized care plans, based on older adults' specific needs, to be implemented with the support of a digital solution. On the other hand, researchers and health and social professionals implemented a series of workshops in different locations of the city to encourage a sense of community among participants, reinforcing their trust in the new care model and increasing their adherence. Social activities were at the core of the workshops to understand older people's interaction with the health and social services provided in the neighborhood. Qualitative and quantitative methods were combined to extract information from older participants on how to engage them as active actors of their health and understand their values and preferences. In the present manuscript, we focus on the qualitative results, which show that after a post-pandemic situation, they were more concerned about social isolation and desired face-to-face contact with their professional care team; however, feelings of loneliness and/or sadness were not considered among the reasons to visit health professionals. Some of the conclusions revealed that the use of technology as a supportive tool is well received but with a stress on its role as "supportive", and not replacing the close contact with healthcare professionals. Professionals recognized the benefits of this new approach but required more time and incentives to dedicate the effort needed. The main aim of this study was to present these barriers related to health access, health promotion, and health self-management, as well as the actions developed to face them.

Who Bears Responsibility for the Post-Acute Older Adult: Patient, Family or State?

AIM

This study explores the perceptions of hospital discharge coordinators on the issues raised for the post-acute older adult and their family, using the lens of assisted decision-making and advance directives.

BACKGROUND

New legislation has been developed in Ireland to support assisted decision-making and advance directives that is largely consistent with other countries around the world. The Assisted Decision-Making Act of 2015 was fully commeced in April 2023, following lengthy debate. However, there is a lot of professional uncertainty regarding how to support and integrate Advance Healthcare Directives and assisted decision-making into the care of adults and into the role of nurses working in the community.

METHODS

Utilising a qualitative approach, this study conducted a series of five focus groups, with 23 participants, across the South-East of Ireland. Thematic analysis was used to interpret results. The 32-item consolidated criteria for reporting qualitative research checklist was utilised.

FINDINGS

The central finding in this study concerned the locus of control, as well as findings on burden of care and the role of the nurse. A stark incongruence of beliefs among patient, family and State was identified.

CONCLUSION

Nurses must learn to circumnavigate the complex terrain involved in supporting the older adult's advance decision-making and advance healthcare directives.

Health care for older adults in Europe: how has it evolved and what are the challenges?

Geriatric medicine has evolved to an accepted specialty in 23 European countries. Despite much heterogeneity of postgraduate geriatric curricula, European societies have succeeded in defining a common core curriculum with a list of minimum training requirements for obtaining the specialty title of geriatric medicine. Geriatricians play a leading role in finding solutions for the challenges of health care of multimorbid older patients. One of these challenges is the demographic shift with the number of adults aged 80 years and older in Europe expected to double by 2050. Although geriatric units will play a role in the care of frail older patients, new care models are needed to integrate the comprehensive geriatric assessment approach for the care of the vast majority of older patients admitted to non-geriatric hospital units. Over the last few years, co-management approaches have been developed to address this gap. Innovative models are also in progress for ambulatory care, prevention and health promotion programs, and long-term care. Efforts to implement geriatric learning objectives in undergraduate training, and the generation of practice guidelines for geriatric syndromes may help to improve the quality of care for older patients.

Perspectives of older adults, caregivers, healthcare providers on frailty screening in primary care: a systematic review and qualitative meta-synthesis

Background

Screening is often recommended as a first step in frailty management. Many guidelines call to implicate frailty screening into practice in the primary care setting. However, few countries or organizations implement it. Understanding and clarifying the stakeholders’ views and issues faced by the implementation is essential to the successful implementation of frailty screening. However, the systematic review on stakeholders’ views of frailty screening in primary care is decidedly limited. Our objective was to explore the perspective of older adults, caregivers, and healthcare providers on frailty screening and determine the enablers and barriers to implementing frailty screening in primary care.

Methods

A systematic search of six databases and other resources was conducted following JBI’s three-step search strategy. The search resulted in 7362 articles, of which 97 were identified for further assessment according to the inclusion criteria. After the full-text screening, quality assessment and data extraction were carried out using the tools from Joanna Briggs Institute (JBI). Moreover, reviewers used the approach of meta-aggregative of JBI to analyze data and synthesis the findings.

Results

Six studies were included. A total of 63 findings were aggregated into 12 categories and then further grouped into three synthesized findings:1) capacity of healthcare providers and older adults; 2) opportunity in the implementation of frailty screening; 3) motivation in the implementation of frailty screening. These themes can help identify what influences the implementation of screening from the perspective of stakeholders.

Conclusions

This meta-synthesis provides evidence on the barriers and enablers of frailty screening in primary care, from the aspects of psychological, physical, social, material, etc. However, stakeholder perspectives of frailty screening have not been adequately studied. More research and efforts are needed to explore the influencing factors and address the existing barriers.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12877-022-03173-6.

Effects of a modified Otago exercise program delivered through outpatient physical therapy to community-dwelling older adult fallers in Greece during the COVID-19 pandemic: a controlled, randomized, multicenter trial

Aim

To investigate the effectiveness of a video-supported OTAGO exercise program (OEP) in balance, functional ability, fear of falls and number of falls in Greek older adults with a history of falls.

Findings

A 6-month OEP helped older adults to improve their balance and functional ability test scores as well as reduce fear and number of falls, both after the intervention and at the 12-month follow-up. However, the adherence to the program remained unaffected.

Message

The OEP contributes to the well-being of older adults with a history of falls by improving all their relevant skills and scores. More long-term research under less adverse conditions is required to solidify these findings.

Background

The pandemic has led to the isolation and social exclusion of older adults and cut them off from any exercise activity. Thus, it is more than ever necessary to implement organized interventions to prevent falls in older people as they remain a global health problem associated with serious injuries, chronic disability, and high costs for the healthcare system. Otago exercise program (OEP) can effectively reduce the number of falls.

Aim

To study the effect of a 6 months modified video supported OEP in balance, functional ability, fear of falls and number of falls in Greek older people who have fallen.

Method

150 fallers aged 65–80 years [Median age 70 (67–74), 88.7% women] were divided into two groups (intervention and control). Primary outcomes included changes in Short FES-I, CONFbal scale, 4-Stage Balance test, BBS, TUG test and number of falls, while the secondary outcome consists of the monthly adherence to exercise after the intervention. Analysis of variance with repeated measures was applied.

Results

There were statistically significant between groups differences after 6 months with the OEP group to shows improved values in TUG time score (17.8 vs 3.9%, p < 0.001, 95% CI), 4-Stage Balance Test (6.85 vs 1.09%, p < 0.05 95% CI), 30-Second Chair Stand Test 7.35 vs 2.93%, p < 0.001), BBS score (13.27 vs 3.89%, p < 0.001, 95% CI), Short FES-I (35.78 vs 13.01%, p < 0.001, 95% CI) and number of falls (69.12 vs 18.70%, p < 0.001, 95% CI). All the above differences remained statistically significant in the 12 months follow-up (p < 0.05), when differences in the CONFbal score were also observed (p < 0.001, 95% CI). No differences were found in adherence to OEP (p > 0.05).

Conclusions

A modified OEP decreases the number of falls, improves the balance and functional ability of older adults and reduces the fear of falling. However, it did not contribute to satisfactory adherence to exercise.

Trial registration number/date of registration

NCT04330053/April 1, 2020.