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

The Role of Osteopathic Practice in Multimodal Osteoarthritis Care of the Hip or Knee

BACKGROUND: Osteoarthritis (OA) is the second most prevalent cause of Musculoskeletal disorders, affecting 343 million people across the globe. Despite the nearly 50 non-pharmacological treatment modalities presented today, the research available, at present, omits incorporating osteopathic treatments into research protocols, and fails to contribute with evidence showing if treatments presented enhance the general effectiveness of rehabilitation in decreasing pain and disability in patients subjected to OA. METHODS: A literature review based on searches in the following databases: CINAHL, COCHRANE, OVID and PubMed were conducted. All data was processed by the authors independently and subsequently agreed on in terms of relevance for the objectives of the review. RESULT: Ultimately seven articles published between 2004 to 2018 were assessed. Three studies aimed to investigate interventions for OA of the knee alone, three involved both the osteoarthritic hip and knee, while one studied OA of the hip exclusively, but the main focus area remained the same, measuring pain severity and physical function. Six of them were randomized controlled trials, while one of them was a longitudinal study. CONCLUSION: Research suggests that OMT can have a beneficial effect in the management of hip and knee OA, however, the presence of osteopathic interventions is as of today very poor in research available and further research is needed to determine the effects of OMT in multimodal clinical practice

Getting used to assistive devices: Ambivalent experiences by frail elderly persons

The aim was to learn how frail elderly people experienced becoming assistive device users and how assistive devices affected their independence in daily activities. Focus-group methodology was used, including people 80 and older with multiple health problems. Five group discussions were conducted with a total of 18 people including 14 women and four men. Each group met once, for 90-120 minutes, and all discussions were audiotaped. Two themes emerged: Confidence in knowledge and experience and getting used to assistive devices in daily activities. Confidence in knowledge and experience was formed by two categories of experiences from the prescription procedure: trust the expert and trust yourself, and to have confidence in having the right information about assistive devices. Getting used to assistive devices in daily activities was formed by five categories of ambivalent experiences when using assistive devices in daily activities: creates opportunities and limitations; provides security but also raises concerns; the need is seen as transient or permanent; the social environment both encourages and restricts; the physical environment both facilitates and complicates, with less extreme experiences in between. This study indicates that frail elderly people need specifically developed support in the process of becoming assistive device users