Wandering

Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67904/2/10.1177_153331758800300109.pd

Stakeholders' views and experiences of care and interventions for addressing frailty and pre-frailty:a meta-synthesis of qualitative evidence

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

Frailty and resilience:Are they necessarily mutually exclusive?

Frailty is often seen as the absence of resilience. There is evidence to support prevention and intervention strategies for frailty across the range of robust to frail older adults. The role of health psychology in the design and implementation of interventions and the development of understanding that frailty can be addressed even amongst the very old is central to progress in improving quality of life for people at all stages of frailty and also to improving resilience. This chapter reviews the concept of frailty, currently based largely on a physically described syndrome, and examines the role of psychological and social variables in the interaction between frailty and outcomes for the individual. The phenomenon of resilience despite frailty is examined in the context of outcomes of research that suggest that support for developing resilience is needed alongside interventions for frailty