Background Chronic breathlessness is a debilitating symptom with major detrimental impact on individuals, carers, across health care settings. Little is known about prevalence, impact, or experience of breathlessness in the older, frail population.Aims For older adults at risk of frailty: to explore the impact of chronic breathlessness on patients’ and carers’ psychological wellbeing and quality of life (QoL), and to explore how chronic breathlessness is identified and assessed in primary care, considering patient, carer, and health care practitioner (HCP) experiences. Methods A multiple-methods thesis incorporating a systematic review and mixed-methods study. My quantitative narrative systematic review of published literature aimed to determine how clinicians identified and assessed breathlessness across health care settings. My mixed-methods study included: a quantitative cross-sectional survey to determine prevalence and psychological impact of chronic breathlessness, and clinical factors associated with breathlessness, in the primary care setting; qualitative in-depth interviews further explored psychological impact and experiences of management in primary care for patients, carers, and HCPs. Mixed-methods findings were synthesised using modified critical interpretative synthesis, then integrated with the systematic review results.Findings Chronic breathlessness is prevalent (40%) in older, frail adults and associated with worse psychological outcomes and poorer QoL. People with chronic breathlessness give up activities because of their breathlessness which is conflated with the underlying disease and not recognised as therapeutic target by patient or HCPs. Chronic breathlessness is often ‘one of many’ symptoms and in the primary care context of ‘one appointment, one problem’, remains invisible and unmanaged. HCPs can feel helpless and do not routinely ask about impact of breathlessness on QoL.Conclusions Lack of routine assessment in primary care means older, frail adults with chronic breathlessness may not access evidence-based symptom-targeted interventions. Systematic identification, assessment, and management in primary care may help improve psychological health, QoL, and overall wellbeing
