Frailty can be conceptualised as a multidimensional, clinical condition related to age, during which multiple physiological and psychological systems gradually lose their reserves, and individuals become less able to cope with daily stressors or acute illnesses. Older adults living with frailty are more vulnerable to adverse health outcomes, including institutionalisation and mortality, particularly when exposed to events such as a chronic disease diagnosis, an acute infection or a fall.
Research suggests that frailty is a dynamic process and that there are opportunities along its pathway to transition out of, manage and/or prevent its adverse consequences. Early identification of frailty through screening programmes may provide the opportunity to identify prefrail and frail individuals, and direct them to appropriate preventative health interventions to assist them to improve personal health and well-being, resulting in better management of societal healthcare costs.
Operational concepts of frailty have moved on from the earlier physiological phenotype or accumulation of deficits models. A broader multidimensional approach for measuring frailty has been adopted that also acknowledges psychological elements like well-being and quality of life, and social elements such as lack of social contacts or environmental and situational factors.Embracing this approach, some studies have tested and noted success with multicomponent interventions. In varying combinations, interventions incorporating physical training, cognitive training, nutritional advice and social support have resulted in significant improvements in frailty measures in community dwelling older adults and people in residential care homes. Such multicomponent interventions may also prevent future health risk and social isolation.
Against this background of evidence for multicomponent interventions, this study forms the second phase of qualitative research with stakeholders on frailty prevention and screening. The first phase aimed to explore how frailty prevention and screening would be accepted and adopted by European stakeholders, including frail and non-frail older adults, family caregivers, and health and social care professionals. Previously, older adults’ and other stakeholders’ views on frailty screening had not been sought. The findings from the first phase demonstrated consistent results across the three countries involved (UK, Poland and Italy), and emphasised the need for a holistic approach to frailty care and early intervention. Participants raised the need for integrated and coordinated health and social care services, as well as personalised screening programmes and advocacy in the organisation of care. Central to all stakeholders was the significance and primacy of the psychological and social elements of frailty. Physical frailty was thought of as less malleable or preventable, and of less importance provided individuals retained psychological resilience. Furthermore a meta-synthesis of qualitative evidence highlighted the need to understand the acceptability of frailty screening among the general population of older adults, their caregivers and other stakeholders, including the health and social care staff who may conduct assessments or deliver interventions, and to address the understanding of the malleability, reversibility or preventability of frailty.
This study completes the picture by exploring European healthcare policy-makers’ opinions on frailty and the feasibility of frailty screening programmes and healthcare interventions suggested by stakeholders during this earlier work, examining their responses to the findings of the first phase.