Nurses' Opinions on Frailty

[Development and validation of the Multidimensional Frailty Scale (EFM): Initial phases]

INTRODUCTION

Although various instruments have been developed to assess frailty, they generally do not cover all its dimensions and have not demonstrated satisfactory psychometric properties. The aim of this study was to develop the Multidimensional Frailty Scale, originally called the Escala de Fragilidad Multidimensional (EFM), to assess the physical, cognitive, affective, social, and environmental dimensions of frailty in individuals aged 65 and over and to conduct the initial phases of the validation process. This was carried out over the course of three sequential studies.

METHODS

A series of items were developed for each dimension and then evaluated by a panel of 13 experts. Subsequently, cognitive interviews were conducted with a sample of 23 older adults to examine the response processes. Finally, a pilot study was performed with a sample of 50 individuals aged between 65 and 98 years.

RESULTS

The panel of experts awarded the items a mean appropriateness rating of between 3.18 and 4 out of 4. The cognitive interviews provided insight into response processes and comprehension difficulties. The corrected item-dimension correlations ranged between .02 and .83. Based on the results obtained in the three studies, some items were removed. Following these modifications, the internal consistency of the five dimensions ranged between .71 and .90.

CONCLUSIONS

The results of this study enabled the first version of the EFM to be refined, obtaining satisfactory internal consistency and item functioning indexes.

What do we know about nursing practice in relation to functional ability limitations, frailty and models of care among older people in home- and facility-based care: a scoping review

BACKGROUND

Nursing practice in long-term care, must support the delivery of safe and evidence-based care, especially for older people with functional ability limitations and frailty, with the competency, knowledge and structured working modes such practice requires. Understanding, detecting and preventing these conditions is important in a context where care is given to a significant number of older people with complex care needs. Our aim was to map published literature on how functional ability limitations and frailty among older people (65 and above) in home-and facility-based care (i.e. long-term care) were described by key stakeholders, and to identify models of care (MoCs) targeting these conditions.

METHODS

We followed Arksey and O'Malley's methodological steps and the PRISMA-ScR reporting guidelines. The PubMed, CINAHL and PsycInfo databases were used to identify papers published between June 2002 and June 2022. The search was updated in May 2024. A descriptive analysis was conducted where the identified patterns were organised and categorised with the support of the Pattern, Advances, Gaps, Evidence for practice and research Recommendations framework (PAGER).

RESULTS

A total of 18,875 unique records were identified. Of these, 26 papers were included. The findings implied a discrepancy between the older people's subjective- and the nurses' more objective, 'matter-of-fact' perspective. The older people described both conditions in terms of identity loss and an emotional struggle to remain independent. They also highlighted the importance of positive connotations in relation to their efforts to adapt and accommodate the situation to the conditions. Nursing practice targeting the conditions were predominantly described as being reactive, based on their experiences and guided by 'intuition'. The identified MoCs mainly targeted functional ability limitations while focusing on educating nurses.

CONCLUSION

A point of saturation seems to have been reached regarding research focusing on older people's descriptions of frailty in home-based care. The same cannot be said about older people's or nurses' descriptions concerning functional ability limitations or MoCs. Intervention studies focusing on nursing practice and the development of MoCs that target these conditions preferably in a home-based care context could substantially benefit the development of knowledge within nursing and nursing practice.

TRIAL REGISTRATION

OPEN SCIENCE FRAMEWORK: https://doi.org/10.17605/OSF.IO/FNHSA .

Knowledge, attitude, and practice of frailty management among clinical nurses: a cross-sectional study

BACKGROUND

Frailty is a leading risk factor of falls, incapacitation, functional decline, and even death in aging populations globally. Clinical nurses play pivotal roles in screening, prevention, and intervention to reverse or slow the progression of frailty. The present study aimed to (1) understand the extent and influencing factors of knowledge, attitudes, and practices of clinical nurses for managing frailty, (2) elucidate the relationships of the knowledge, attitudes, and practices of clinical nurses for frailty management.

METHODS

This cross-sectional study was conducted from March to April 2024 on 524 clinical nurses in a tertiary hospital in Zhejiang Province, China. The survey instruments included a questionnaire inquiring about the knowledge, attitudes, and practices of nurses in terms of frailty management, a demographic data form, and a self-designed frailty educational information questionnaire. Data were analyzed by descriptive statistics, univariate analysis, multiple linear regression, and structural equation modeling.

RESULTS

Of 524 nurses, Only 37.2% were rated as good in terms of knowledge, attitude, and practice of frailty management, while 55.7% were rated as moderate. Among them, the proportion of nurses with good knowledge (10.3%) and practical skills (13.4%) is much lower than their attitude (65.3%). Structural equation modeling found that knowledge and attitudes were related to frailty management practices, with significant associations between knowledge and practices(β = 0.499, p < 0.001). Of the total effect size of knowledge influencing practice (total effect = 0.624, 95% CI: 0.455,0.791), approximately 20.0% was mediated by attitudes (indirect effect = 0.125, 95% CI: 0.076,0.187). Multiple linear regression analysis showed that age, organizational support, familiarity with relevant guidelines, familiar with the term frailty, and department all had a significant effect on the total score(adjusted R2 = 0.264, p < 0.001).

CONCLUSIONS

Despite inadequate knowledge and limited experience in frailty management, clinical nurses' attitudes towards frailty management were positive, indicating potential for improvement. The model was useful to explain practices in frailty management, thereby providing a theoretical basis for development of targeted training programs.

CLINICAL TRIAL NUMBER

Not applicable.

Explaining the Association Between Number of Teeth and Frailty in Older Chinese Adults: The Chain Mediating Effect of Nutritional Status and Cognitive Function

AIMS

The objective of this research is to investigate the association between the number of teeth and frailty in the geriatric population.

DESIGN

This cross-sectional study was conducted in Shanghai Fifth People's Hospital, Fudan University, from May 2021 to September 2021.

METHODS

A cohort of 538 community-dwelling older adults aged 60 years or above was included in the analysis. The Tilburg Frailty Indicator, Mini-Mental State Examination and Mini Nutritional Assessment Short-Form were employed to assess frailty, cognitive function and nutritional status, respectively. The statistics software SPSS v21.0 and its process plug-in were employed for statistical analysis, and the significance of intermediary effects was tested using the bootstrap sampling test method and the process plug-in.

RESULTS

The number of teeth influenced frailty through three mediating pathways: (a) nutritional status (effect = -0.038); (b) cognitive function (effect = -0.021); (c) nutritional status and cognitive function combined (effect = -0.038). The total mediating effect accounted for 50.26% of the overall effect.

CONCLUSION

These findings highlight the need to raise awareness of oral health care among older adults and implement comprehensive interventions to promote active aging and improve their overall well-being.

The role of speech-language pathologists in frailty: An Australian qualitative study of perceptions, practices, and opportunities

PURPOSE

Frailty is an important geriatric syndrome, yet the role of speech-language pathologists (SLPs) in identifying and managing frailty remains unclear. The purpose of this study was to explore the perspectives of SLPs regarding frailty, including enablers, barriers, and opportunities for multidisciplinary improvements to frailty prevention and management.

METHOD

In this exploratory qualitative study, data were collected from SLPs through online semi-structured interviews and analysed using a qualitative descriptive approach.

RESULT

Seven Australian SLPs from acute, rehabilitation, geriatric, and community settings were interviewed. Three overarching themes were created: (1) SLPs understand the clinical manifestation of frailty but do not use explicit language to describe it; (2) SLPs acknowledged the importance of addressing knowledge gaps and barriers in frailty management; and (3) SLPs do not currently have an established identity within the frailty field, but do have a role within the multidisciplinary team and the care of people living with frailty.

CONCLUSION

Participants' understandings of frailty varied and highlighted the lack of education about frailty as barriers to effective service provision. Additional research is required to produce formal recommendations for SLPs regarding frailty management, which may include frailty education to SLPs and awareness of SLPs' role within the multidisciplinary team.

Development and Validation of a Game for Older Adults on Lifestyles and Frailty

BACKGROUND

Games are a promising strategy for rehabilitating older adults. The effect of games on promoting healthy lifestyles and preventing frailty remains uncertain. This article aims to describe the process of development and validation of the game "Bem-me-quer para a saúde"® to promote the acquisition of healthy lifestyles and prevent frailty in over 65-year-olds.

METHODS

This study comprised three distinct phases, spanning from December 2023 to June 2024. The first phase comprised a thorough review of the scientific literature on the frailty and lifestyles of older adults, a second phase of game design, and a third phase of content and semantic validation conducted by specialized nurses and older adults.

RESULTS

After revising literature, this study utilized an e-Delphi with a panel of 14 specialist nurses who underwent two rounds of evaluation. The "Bem-me-quer para a saúde"® game includes a puzzle board with 54 pieces and 30 educational cards. In the final phase, we evaluated the game on a cohort of 50 older adults, highlighting its reflective, interactive, and educational aspects.

CONCLUSIONS

The game presented sufficient evidence of content validity and relevance to clinical practice. We should conduct additional research to evaluate its impact on lifestyle modification and frailty prevention.

Definition and assessment of psychological frailty in older adults: A scoping review

OBJECTIVES

The confusion surrounding psychological frailty and its components prompts the need for a standardized conceptual definition. To address this, we aimed to (1) identify the psychological variables included in multicomponent frailty assessment instruments used with older adults and examine their operationalization; and (2) formulate a thorough conceptualization of psychological frailty based on the variables identified.

METHODS

This study followed the most recent recommendations for conducting scoping reviews and is reported in accordance with PRISMA-ScR guidelines. We systematically searched the CINAHL, MEDLINE, PsycInfo, Scopus, and Web of Science databases, with additional searches in Google Scholar and reference lists.

RESULTS

Sixteen instruments were identified. The results suggested that: (1) In multicomponent frailty assessment instruments, psychological variables are poorly represented; (2) A wide variety of psychological variables are included in the instruments, the most frequent being cognitive functioning and affective functioning (e.g., depressive symptoms, emotional loneliness, anxiety symptoms, poor coping, and suicidal ideation); and (3) The way in which variables are referred to and operationalized varies across instruments.

CONCLUSIONS

Including both cognitive and affective variables in psychological frailty assessments may lead to inaccuracies. We suggest distinguishing between two separate dimensions within psychological frailty: cognitive frailty and affective frailty. A conceptual definition for each dimension is provided. This proposal aims to advance the debate regarding the conceptualization and assessment of psychological frailty, with further research and discussion needed to ensure its practical applicability.

Frailty Assessment and Its Impact on Loneliness among Older Adults Receiving Home-Based Healthcare during the COVID-19 Pandemic

The purpose of this study was to identify the effect of frailty on loneliness among older adults receiving home care, in correlation to their socioeconomic and homebound statuses. This cross-sectional study recruited 218 individuals aged ≥65 years receiving home-based health services from the "Help at Home" program in the Region of Evrytania, Greece through an open invitation from the municipality authorities from March to June 2022. The Tilburg Frailty Indicator (TFI) was used for the evaluation of frailty, the UCLA Loneliness Scale version 3 was used for loneliness, and social isolation was accessed through five questions (living alone, frequency of interaction with children, relatives, friends, and participation in social organizations). The mean age of the participants was 81.48 ± 9.06, 61.9% were female, 54.1% experienced high levels of loneliness (UCLA-3 mean 45.76 ± 11.10 [range 20-68]), and 46.3% of the participants were found to be socially isolated. Also, 58.3% of the individuals were identified as frail (TFI mean 5.95 ± 3.07) [TFI range 0-13], with 57.3% experiencing physical frailty, 43.6% experiencing psychological frailty, and 27.1% experiencing social frailty. An analysis of covariance (ANCOVA) using UCLA-3 as the dependent variable revealed that loneliness across all domains of TFI was significantly higher in participants with frailty (total frailty [Yes] 49.27 vs. [No] 40,87 p < 0.001) (physical frailty [Yes] = 48.99 vs. [No] = 41.42, p < 0.001, psychological: 48.60 vs. 43.57 p < 0.001, and social: 53.38 vs. 42.94 p < 0.001), particularly compared to non-frail individuals, even after adjusting for potential confounding effects (covariates: gender, age, marital status, family status, living status, educational level, annual income, chronic diseases, homebound status, and social isolation). Our findings indicate that frail older adults experienced higher levels of loneliness, suggesting that frailty and loneliness are independently associated among older adults who receive home-based healthcare.

Frailty knowledge, training and barriers to frailty management: A national cross-sectional survey of health professionals in Australia

OBJECTIVE(S)

To understand Australian health professionals' perceptions of their knowledge and previous training about frailty, as well as barriers to frailty assessment and management in their practice.

METHODS

A cross-sectional online survey was developed and distributed to health professionals (medical, nursing and allied health) engaged in clinical practice in Australia through convenience and snowball sampling techniques from March to May 2022. The survey consisted of five sections: frailty training and knowledge; confidence in recognising and managing adults with frailty; the importance and relevance of frailty; barriers to assessing and managing frailty in practice; and interest in further frailty training. Responses were analysed using descriptive statistics.

RESULTS

The survey was taken by 736 health professionals. Less than half of respondents (44%, 321/733) reported receiving any training on frailty, with 14% (105/733) receiving training specifically focussed on frailty. Most respondents (78%, 556/712) reported 'good' or 'fair' understanding of frailty. The majority (64%, 448/694) reported being 'fairly' or 'somewhat' confident with identifying frailty. Almost all respondents (>90%) recognised frailty as having an important impact on outcomes and believed that there are beneficial interventions for frailty. Commonly reported barriers to frailty assessment in practice included 'lack of defined protocol for managing frailty' and 'lack of consensus about which frailty assessment tool to use'. Most respondents (88%, 521/595) were interested in receiving further education on frailty, with a high preference for online training.

CONCLUSIONS

The findings suggest frailty is important to health professionals in Australia, and there is a need for and interest in further frailty education.

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.

Defining and assessing psychological frailty in older adults: a scoping review protocol

INTRODUCTION

Frailty is widely acknowledged as a multidimensional construct encompassing physical, psychological and social aspects. However, the lack of consensus in defining and operationalising psychological frailty challenges the holistic approach to frailty advocated by health professionals. Consequently, there is a need to develop a comprehensive definition of psychological frailty based on contributions made by experts in the field, primarily existing frailty assessment tools. This scoping review will aim to identify the key psychological variables that are considered in frailty assessment tools used with older adults as well as to analyse how these psychological variables have been operationalised.

METHODS AND ANALYSIS

The study will be conducted in accordance with recommendations from several methodological frameworks for scoping reviews and will be reported following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews statement guidelines. A systematic literature search will be performed in the CINAHL, MEDLINE, PsycInfo, Scopus and Web of Science databases, supplemented by a search in Google Scholar and reference lists. The focus will be on studies that describe the development of multicomponent frailty assessment tools including at least one psychological variable. Study selection and data extraction will be independently conducted by three reviewers working in pairs. Data will be presented in tabular form, and the data will be analysed using qualitative content analysis.

ETHICS AND DISSEMINATION

This study does not require ethical approval since it is based on secondary data analysis. The findings of the review will be disseminated through publication in a peer-reviewed scientific journal and will be presented at conferences and seminars.

TRIAL REGISTRATION NUMBER

The scoping review was registered in Open Science Framework on 29 March 2022 (https://osf.io/bn24y).

Frailty in Community-Dwelling Older People

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