Older adults' understandings and perspectives on frailty in community and residential aged care: an interpretive description

OBJECTIVES: Despite growing interest in frailty as a significant public health challenge, comparatively little is known about how older adults perceive and experience frailty, limiting the effectiveness of strategies to improve frailty management and prevention. The objective of this study was to understand how older people, including frail older persons in residential aged care, perceive and understand frailty through an interpretive-descriptive qualitative study. SETTING: Aged care facility, community-based university for older persons and an aged care auxiliary care group in a large metropolitan centre in South Australia. PARTICIPANTS: 39 non-frail, prefrail, frail and very frail South Australian older adults. METHODS: Seven focus groups were conducted. Participants completed one of two frailty instruments depending on setting and indicated whether they self-identified as frail. Data were analysed inductively and thematically by two independent investigators. RESULTS: Frailty was described according to three schemas of (1) the old and frail: a static state near the end of life; (2) frailty at any age: a disability model; and (3) frailty as a loss of independence: control, actions and identity. In addition, a theme was identifying linking mindset, cognition and emotion to frailty. The term frailty was viewed negatively and was often implicated with personal choice. There was little correlation between frailty assessments and whether participants self-identified as frail. CONCLUSIONS: Aside from a disability model, views of frailty as unmodifiable permeated older persons' diverse perspectives on frailty and are likely to impact health behaviours. To our knowledge, this is among the largest qualitative studies examining consumer perceptions of frailty and contributes a clinically relevant schema linking age, prevention and modifiability from a consumer perspective.Mandy Archibald, Michael Lawless, Rachel C Ambagtsheer, Alison Kitso

Understanding consumer perceptions of frailty screening to inform knowledge translation and health service improvements

Published electronically October 2020BACKGROUND AND OBJECTIVES: despite growing support for the clinical application of frailty, including regular frailty screening for older adults, little is known about how older adults perceive frailty screening. The purpose of this study was to examine older adults' perspectives on frailty screening to inform knowledge translation and service improvements for older adults with frailty. RESEARCH DESIGN: interpretive descriptive qualitative design. PARTICIPANTS: a total of 39 non-frail (18%), pre-frail (33%) and frail or very frail (49%) South Australian older adults aged 62-99 years, sampled from community, assisted living and residential aged care settings. METHODS: seven focus groups were conducted and analysed by two independent investigators using inductive thematic analysis. RESULTS: three themes were identified. First, older adults question the necessity and logic of an objective frailty measure. Second, older adults believe any efforts at frailty screening need to culminate in an action. Third, older adults emphasise that frailty screening needs to be conducted sensitively given negative perceptions of the term frailty and the potential adverse effects of frailty labelling. DISCUSSION AND IMPLICATIONS: previous screening experiences and underlying beliefs about the nature of frailty as inevitable shaped openness to, and acceptance of, frailty screening. Findings correspond with previous research illuminating the lack of public awareness of frailty and the nascent stage of frailty screening implementation. Incorporating consumer perspectives, along with perspectives of other stakeholder groups when considering implementing frailty screening, is likely to impact uptake and optimise suitability-important considerations in person-centred care provision.Mandy M. Archibald, Michael T. Lawless, Rachel C. Ambagtsheer, Alison L. Kitso

Using Zoom videoconferencing for qualitative data collection: perceptions and experiences of researchers and participants

Advances in communication technologies offer new opportunities for the conduct of qualitative research. Among these, Zoom—an innovative videoconferencing platform—has a number of unique features that enhance its potential appeal to qualitative and mixed-methods researchers. Although studies have explored the use of information and communication technologies for conducting research, few have explored both researcher and participant perspectives on the use of web and videoconferencing platforms. Further, data are lacking on the benefits and challenges of using Zoom as a data collection method. In this study, we explore the feasibility and acceptability of using Zoom to collect qualitative interview data within a health research context in order to better understand its suitability for qualitative and mixed-methods researchers. We asked 16 practice nurses who participated in online qualitative interviews about their experiences of using Zoom and concurrently recorded researcher observations. Although several participants experienced technical difficulties, most described their interview experience as highly satisfactory and generally rated Zoom above alternative interviewing mediums such as face-to-face, telephone, and other videoconferencing services, platforms, and products. Findings suggest the viability of Zoom as a tool for collection of qualitative data because of its relative ease of use, cost-effectiveness, data management features, and security options. Further research exploring the utility of Zoom is recommended in order to critically assess and advance innovations in online methods.Mandy M. Archibald, Rachel C. Ambagtsheer, Mavourneen G. Casey, and Michael Lawles

Feasibility and acceptability of commonly used screening instruments to identify frailty among community-dwelling older people: a mixed methods study

BACKGROUND:Frailty exposes older people to an elevated risk of a range of negative outcomes. Emerging evidence that frailty can be effectively treated within community settings has stimulated calls for more proactive screening within primary care. Assessing feasibility is a critical preliminary step in assessing the efficacy of interventions such as screening. However, few studies have explored the feasibility and acceptability of administering frailty screening instruments within general practice, and even fewer have incorporated patient perspectives. Our study had three objectives: To 1) assess overall feasibility of the instruments (completion time and rate); 2) assess patient acceptability towards the instruments; and 3) assess the feasibility and acceptability of the instruments to administering nurses. METHODS:The feasibility and acceptability of several frailty screening instruments (PRISMA-7, Edmonton Frail Scale, FRAIL Scale Questionnaire, Gait Speed, Groningen Frailty Indicator, Reported Edmonton Frail Scale and Kihon Checklist) was explored within the context of a larger diagnostic test accuracy (DTA) study. Completion time and rate was collected for all participants (N = 243). A sub-sample of patients (n = 30) rated each instrument for ease of completion and provided comment on perceived acceptability. Lastly, five of six administering nurses involved in the DTA study participated in semi-structured face-to-face interviews, rating the instruments against several feasibility and acceptability criteria (time, space, equipment, skill required to implement, acceptability to patients and nurses, ease of scoring) and providing comment on their responses. RESULTS:The PRISMA-7 returned the highest overall feasibility and acceptability, requiring minimal space, equipment, skills and time to implement, and returning the fastest completion rate and highest patient and nurse acceptability rating. All screening instruments were faster to implement than the two reference standards (Fried's Frailty Phenotype and Frailty Index). Self-administered instruments were subject to lower rates of completion than nurse-administered instruments. CONCLUSIONS:This study has demonstrated that a number of commonly used frailty screening instruments are potentially feasible for implementation within general practice. Ultimately, more research is needed to determine how contextual factors, such as differences in individual patient and clinician preferences, setting and system factors, impact on the feasibility of screening in practice.Rachel C. Ambagtsheer, Mandy M. Archibald, Michael Lawless, Alison Kitson and Justin Beilb

Prevalence and associations of frailty in residents of Australian aged care facilities: findings from a retrospective cohort study

Published online: 4 November 2019OBJECTIVES:Studies conducted among older people have shown that frailty is a common condition associated with an array of adverse outcomes. The aims of this study were to identify the prevalence and associations of frailty in older people residing in several aged care facilities located in Queensland, Australia. METHODS:The database used for this study was drawn from the Aged Care Funding Instrument (ACFI) database of an Australian aged care provider, and contained data from ten aged care facilities in Queensland, Australia. A modification of an eFI originally developed by Clegg and colleagues and based on Rockwood's Frailty Index (FI) of cumulative deficits was used to identify frailty. RESULTS:In total, 592 participants aged 75 years and over were included in the study (66.6% female). Median (IQR) age was 88.0 (9.0) years. Frailty prevalence among the sample was 43.6%, with 46.3% pre-frail and 10.1% not frail. In a multivariate logistic regression analysis incorporating three different models, frailty was significantly associated with three ACFI domains (Nutrition, Depression and Complex Health Care), along with facility size, consistently across two models. In the third model, frailty was also significantly associated with arthritis, diabetes, hypertension, osteoporosis and vision problems, along with male gender. CONCLUSION:There is a need to develop frailty identification and management programs as part of standard care pathways for older adults residing in aged care facilities. Aged care facilities should consider regular frailty screening in residential aged care residents, along with interventions addressing specific issues such as dysphagia and depression.R. C. Ambagtsheer, J. Beilby, C. Seiboth, E. Den

Frailty and seasonality

Abstract not availableElsa Dent, R. C. Ambagtsheer, J. Beilby & S. Stewar

Diagnostic test accuracy of self-reported screening instruments in identifying frailty in community-dwelling older people: A systematic review

Against a backdrop of aging populations worldwide, it has become increasingly important to identify frailty screening instruments suitable for community settings. Self-reported and/or administered instruments might offer significant simplicity and efficiency advantages over clinician-administered instruments, but their comparative diagnostic test accuracy has yet to be systematically examined. The aim of this systematic review was to determine the diagnostic test accuracy of self-reported and/or self-administered frailty screening instruments against two widely accepted frailty reference standards (the frailty phenotype and the Frailty Index) within community-dwelling older adult populations. We carried out a systematic search of the Embase, CINAHL, MEDLINE, PubMed, Web of Science, PEDro, PsycINFO, ProQuest Dissertations, Open Grey and GreyLit databases up to April 2017 (with an updated search carried out over May-July 2018) to identify studies reporting comparison of self-reported and/or self-administered frailty screening instruments against an appropriate reference standard, with a minimum sensitivity threshold of 80% and specificity threshold of 60%. We identified 24 studies that met our selection criteria. Four self-reported screening instruments across three studies met minimum sensitivity and specificity thresholds. However, in most cases, study design considerations limited the reliability and generalizability of the results. Additionally, meta-analysis was not carried out, because no more than three studies were available for any of the unique combinations of index tests and reference standards. Although the present study has shown that a number of self-reported frailty screening instruments reported sensitivity and specificity within a desirable range for community application, additional diagnostic test accuracy studies are required.Rachel C Ambagtsheer, Mark Q Thompson, Mandy M Archibald, Mavourneen G Casey, Timothy J Schult

General practitioners' perceptions, attitudes and experiences of frailty and frailty screening

BACKGROUND AND OBJECTIVES:General practitioners (GPs) are uniquely positioned to support frailty identification and management. However, awareness of frailty and its treatment remains an emergent concept for many. Consequently, our aim was to explore GPs' perceptions, attitudes and experiences of frailty and frailty screening. METHOD:A qualitative focus group study was conducted with 22 South Australian GPs. GPs were recruited through a combination of purposive, convenience and snowball sampling. Data were analysed using a thematic analysis approach. RESULTS:GPs saw frailty as a cycle of worsening decline punctuated by experience of negative outcomes. Participants largely felt that they already knew who their frail patients were without the need for formal screening. Consequently, there was varied support for formal screening, largely dependent on its intended purpose. Few GPs had actively intervened to prevent the onset or progression of frailty, with most strategies aimed at stabilisation and management. DISCUSSION:This study suggests that Australian GPs may be open to a proactive approach to frailty assessment and treatment, given appropriate training and resources.Rachel C. Ambagtsheer, Mandy M. Archibald, Michael Lawless, David Mills, Solomon Yu, Justin J. Beilb

Application of an electronic Frailty Index in Australian primary care: data quality and feasibility assessment

BACKGROUND:The primary care setting is the ideal location for identifying the condition of frailty in older adults. AIMS:The aim of this pragmatic study was twofold: (1) to identify data items to extract the data required for an electronic Frailty Index (eFI) from electronic health records (EHRs); and (2) test the ability of an eFI to accurately and feasibly identify frailty in older adults. METHODS:In a rural South Australian primary care clinic, we derived an eFI from routinely collected EHRs using methodology described by Clegg et al. We assessed feasibility and accuracy of the eFI, including complexities in data extraction. The reference standard for comparison was Fried's frailty phenotype. RESULTS:The mean (SD) age of participants was 80.2 (4.8) years, with 36 (60.0%) female (n = 60). Frailty prevalence was 21.7% by Fried's frailty phenotype, and 35.0% by eFI (scores > 0.21). When deriving the eFI, 85% of EHRs were perceived as easy or neutral difficulty to extract the required data from. Complexities in data extraction were present in EHRs of patients with multiple health problems and/or where the majority of data items were located other than on the patient's summary problem list. DISCUSSION:This study demonstrated that it is entirely feasible to extract an eFI from routinely collected Australian primary care data. We have outlined a process for extracting an eFI from EHRs without needing to modify existing infrastructure. Results from this study can inform the development of automated eFIs, including which data items to best access data from.Rachel C. Ambagtsheer, Justin Beilby, Julia Dabravolskaj, Marjan Abbasi, Mandy M. Archibald and Elsa Den

Does CGA Improve Health Outcomes in the Community? An Umbrella Review

Published June 2023Abstract not availableRachel C. Ambagtsheer, Mark Q. Thompson, Graeme R. Tucker, Timothy Schultz, Justin Beilby, Renuka Visvanatha