What are lay UK public perceptions of frailty: a scoping review

Prevalence, perceptions, and experiences of frailty among older migrants from Low- and Middle-Income Countries to High Income Countries: A mixed method systematic review

BACKGROUND

Frailty is increasingly becoming a public health concern, especially among vulnerable populations. Older migrants from Low- and Middle-Income Countries to High Income Countries present with poorer health and are at increased risk of becoming frail. This review aims to explore the prevalence, perceptions, and experiences of frailty among older migrants from Low- and Middle-Income Countries to High Income Countries.

METHODS

This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. Five electronic databases were comprehensively searched for relevant literature published from January 1, 2000, to April 30, 2023. Quality appraisal for the quantitative studies was done with the Joanna Brigg's critical appraisal tool for analytic cross-sectional studies, and the qualitative studies were assessed with the Critical Appraisal Skill Program tool for qualitative studies.

RESULT

Seven studies met the inclusion criteria. Frailty was assessed using modified versions of the Frailty Phenotype and Frailty Index. The prevalence of frailty using the Frailty Phenotype was 16.6 %, and 17 % to 61.9 % according to the Frailty Index. The perceptions and experiences of frailty were characterised by chronic ill-health and a review of healthy pre-migration and early migration lives.

CONCLUSION

Despite the variation in frailty assessment methods, the high prevalence of frailty among older migrants was highlighted across the included studies. The perceptions and experiences of frailty reflect a state of resignation which can complicate the state of frailty. There is the need for ongoing research among migrant groups to identify their predisposition to frailty for early intervention.

Older persons' experiences of frailty: A systematic review

OBJECTIVES

The objective of this study was to synthesise the evidence of older persons' experiences of frailty.

BACKGROUND

The world's population is ageing with those aged over 60 years expected to total 2 billion by 2050. Although not exclusive to ageing, there is a higher prevalence of frailty in older adults, with corresponding demand for related healthcare. While definitions of frailty are debated, there is emerging consensus that sole reliance on biomedical conceptualisations is inadequate to capture the complex needs of older persons living with frailty. In addition, the voices of older persons have largely been excluded from frailty discourses. There is a consequent need for an expanded approach.

METHODS

A meta-synthesis was conducted of the literature on older persons' experiences of frailty. CINAHL, Medline, Embase and ASSIA databases were systematically searched up to January 2024. Reference lists of retrieved sources and grey literature were also searched. Studies were independently evaluated for inclusion by two reviewers using predetermined inclusion criteria. Included studies were quality appraised using a standardised tool, and extracted data were thematically analysed and synthesised.

RESULTS

Eight hundred and thirteen studies were identified as potentially relevant. Following title and abstract review, 52 studies were selected for full-text review. Thirty-four studies were subsequently excluded as they did not address the systematic review question, leaving 17 included in the final review. An additional two studies were identified via grey literature sources. Older persons' experiences of frailty were synthesised with reference to three themes: (i) living with frailty: a multidimensional experience; (ii) living with frailty: acceptability and associations; and (iii) living with frailty: resisting and adapting and losing control.

CONCLUSIONS

Older persons' experiences of frailty revealed a resistance to the biomedical use of the term generally used in clinical practice. Instead, a more nuanced and multidimensional understanding of frailty was identified in the experiences of older persons.

IMPLICATIONS FOR PRACTICE

Health and social care personnel should therefore consider an expanded approach in practice that incorporates the perspective of older people who strive to maintain independence and control when living with frailty. Doing so may enhance shared understanding and person-centred care planning between older persons and professionals.

The lived experience of frailty: beyond classification and towards a holistic understanding of health

PURPOSE

Frailty is characterised by decreased physiological reserves and vulnerability to stressors. Although scales, such as the Fried's Frailty Phenotype (FP), Frailty Index (FI), and Clinical Frailty Scale (CFS), are used to identify frailty, the lived experience of frailty remains understudied.

METHODS

This cross-sectional observational research involved participants aged 65 years and older from Wave 1 of The Irish Longitudinal Study on Ageing (TILDA). Participants were categorised into four independent groups: three frail groups based on the aforementioned scales and a non-frail group. Quantitative variables, including self-rated health, CASP-19 quality-of-life score, and frequency of social activities, were analysed and described.

RESULTS

The study encompassed 1999 participants with an average age of 72 years, of whom 51% were women. FP exclusively identified 1.6% as frail (n = 32), FI 11.7% (n = 233), and CFS 6.8% (n = 135). More than 60% of all those classified as frail reported their health as good, very good, or excellent, with the lowest proportion (64%) being among frail by FI participants. Frail by FI participants exhibited the lowest mean average CASP-19 score, yet it remained relatively high at 39 out of 57 points. Over 77% of all frail individuals engaged in active leisure activities at least once a month.

CONCLUSION

This study underscores the need to comprehend frailty holistically beyond its mere identification. It challenges the prevailing belief that frailty inevitably leads to impaired quality of life and limited social engagement. The findings advocate for a reassessment of how both the general public and healthcare professionals perceive frailty.