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What matters most in acute care: an interview study with older people living with frailty

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posted on 2022-04-13, 10:20 authored by James David van Oppen, Timothy John Coats, Simon Paul Conroy, Jagruti Lalseta, Kay Phelps, Emma Regen, Peter Riley, Jose Maria Valderas, Nicola Mackintosh
Abstract Background Healthcare outcome goals are central to person-centred acute care, however evidence among older people is scarce. Older people who are living with frailty have distinct requirements for healthcare delivery and have distinct risk for adverse outcomes from healthcare. There is insufficient evidence for whether those living with frailty also have distinct healthcare outcome goals. This study explored the nature of acute care outcome goals in people living with frailty. Methods Healthcare outcome goals were explored using semi-structured patient interviews. Participants aged over 65 with Clinical Frailty Score 5-8 (mild to very severe frailty) were recruited during their first 72 hours in a UK hospital. Purposive, maximum variation sampling was guided by lay partners from a Patient and Public Involvement Forum specialising in ageing-related research. Qualitative analysis used a blended approach based on framework and constant comparative methodologies for the identification of themes. Findings were validated through triangulation with participant, lay partner, and technical expert review. Results The 22 participants were aged 71 to 98 and had mild to very severe frailty. One quarter were living with dementia. Most participants had reflected on their situation and considered their outcome goals. Theme categories (and corresponding sub-categories) were ‘Autonomy’ (information, control, and security) and ‘Functioning’ (physical, psychosocial, and relief). A novel ‘security’ theme was identified, whereby participants sought to feel safe in their usual living place and with their health problems. Those living with milder frailty were concerned to maintain ability to support loved ones, while those living with most severe frailty were concerned about burdening others. Conclusions Outcome goals for acute care among older participants living with frailty were influenced by the insecurity of their situation and fear of deterioration. Patients may be supported to feel safe and in control through appropriate information provision and functional support.

Funding

This study was supported by the British Medical Association Foundation for Medical Research (Lift Into Research – transcription and publication expenses) and National Institute for Health Research (Doctoral Research Fellowship NIHR300901 – salary for JDvO).

History

Citation

van Oppen, J.D., Coats, T.J., Conroy, S.P. et al. What matters most in acute care: an interview study with older people living with frailty. BMC Geriatr 22, 156 (2022). https://doi.org/10.1186/s12877-022-02798-x

Author affiliation

Department of Health Sciences

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  • VoR (Version of Record)

Published in

BMC Geriatrics

Volume

22

Issue

1

Pagination

156

Publisher

BMC

eissn

1471-2318

Acceptance date

2022-01-11

Copyright date

2022

Available date

2022-02-25

Language

en

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