DOI: 10.5176/2251-3833_GHC12.47
Authors: Gareth Jones, Carolyn Wallace, Joyce Kenkre, Pradeep Khanna and Mark Prossor
Abstract: Introduction: Ageing successfully with relatively minor health related conditions is one of the most important goals for people as they grow older. Unfortunately, this is often not achieved by the majority of people who accumulate health problems with advancing age. The frailty syndrome describes the accumulated disease, disability and adverse health related deterioration through the ageing continuum. Consequently frailty will in the future present people, their carers, communities, health and social care services with significant burden. This burden includes increased health care costs, diminished quality of life and wellbeing. The Welsh Government acknowledges these issues and the need to develop effective solutions as a public health priority. Primary care clinicians often find managing multiple common health problems in older people challenging. Whereas primary care organisations are ideally positioned to incorporate the concept of frailty into practice through patient centred care and social context [1]. However, no universally accepted operational definition or tool has been developed to identify frailty in primary care. In recent years health and medical researchers have begun to focus their efforts on the development of a universally accepted operational definition for frailty. These attempts have focused on the accumulation of physical deficits. Typical categories within an index being: non-frail = 0 deficit, pre-frail = 1-2, deficits and frail = 3-5 deficits. Previous research has focused on physical markers, disease, disability, risk stratification and death to determine outcomes. No studies have considered the influence of adverse life course events to predict possible future frailty risk status. Furthermore, socio-environmental and cognitive aspects of frailty have received little attention.Justification of study: To formulate a comprehensive life course frailty index and working tool for primary care of factors associated with people at high risk of progression from non-frail to pre-frail and frail conditions. Early detection of frailty through a comprehensive life course index of factors could enable intervention potentially delaying or reverse people’s progression to increased frailty status. This could allow people to remain active and in their own homes longer, enable service planning and reducing associated costs.Gaining an understanding of people’s socioeconomic and cognitive experiences through the non-frail, pre-frail and frail transition states could potentially identify areas for further consideration in terms of quality of life and wellbeing. Evaluation of educational aspects of potential benefits of wellbeing/support products for pre-frail and frail people gained during the interview process.Aim: The purpose of this paper is to present the protocol of a PhD study which has the aim to formulate effective Frailty Index (FI) to be used in practice.Design, methods/methodology: Observational, mixed methods (quantitative and qualitative). The frailty index will be formed primarily through using quantitative method. Qualitative data will provide additional information for consideration of cognitive and social aspects of frailty to be included within the index.Stage 1: Documentary analysis of 300 purposive sample of case notes representative of pre-frail and frail people and 300 non-frail (control) to gather information on health and social factors which may indicate predisposing factors of frailty.Stage 2: 1000 questionnaires (identified pre-frail/frail and non-frail factors, SF12v2, ICECAP-O) non-frail (n=250x2), pre-frail or frail people (n=250x2).Stage 3: 15-20 in-depth Interpretive Hermeneutic Phenomenological interviews (IHP) with pre-frail or frail people.Stage 4: Case studies capturing data from case notes, questionnaires and in-depth interviews and the researchers reflective diary. Triangulation will be achieved through meta matrix techniques [2].Stage 5: Workshops x 2 will evaluate the frailty index and develop the operational tool. Workshop 2 will test the frailty tool. Workshops will include health and social care professionals and the involving people group.Stage 6: Pilot test of frailty tool with 12 pre-frail/frail and non-frail people.Analysis: Quantitative analysis will use PASW software. Qualitative explication and analysis consisting of 6 stages incorporating NVIVO software [3].Research implications: Combining the evidence within the categories could inform the development of a new frailty index. This index could improve predictive value for people at higher risk, enabling early intervention/support in the community. Employing early intervention can potentially delay or reverse people’s progression to increased frailty status allowing them to remain active and in their own homes longer with enhanced health, quality of life and wellbeing reducing associated costs.
Keywords: Frailty, Primary care, Older people, Cognitive, Wellbeing, Index, Quality of life
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