A mixed methods evaluation of outcomes and experiences of older adults identified as being at risk of frailty and attending a frailty-prevention group

Abstract

Background: Frailty is a syndrome associated with poor health outcomes and, with an ageing population, it has become a focus for research and intervention. Pre-frailty, as a distinct stage of emerging age-related changes, is less well considered in the literature. Interventions to prevent progression from pre-frailty to frailty are being introduced, but lack supporting evidence on the needs and outcomes of this group. There is a need for improved understanding of patient outcomes, including experiential accounts of the application of such outcomes to daily lives.

Methods: The research used a mixed methods realistic evaluation of the experience and outcomes of people identified as being at risk of developing frailty and engaged in a frailty-prevention course. Pre/post-test data, relating to physical and functional health outcomes generated at three time points, were analysed for 212 participants. A mixed methods exploration, using framework analysis, of experiences and perceptions of participants occurred based on nineteen semi-structured interviews with eight participants. This considered the way physical health, functional status, well-being and activity participation are understood and interact.

Results and Findings: Classification of frailty highlighted that 64.7% of the sample were living with frailty and a further 29.4% with pre-frailty. At baseline there were weak, but significant associations, between increased lower frailty classification and more favourable functional outcomes for all measures, except for the Falls Efficacy Scale. Functional and frailty measures showed improvement after the twelve-week intervention, which was maintained for functional measures only at six-month follow-up. The mixed methods analysis developed knowledge from these outcomes, highlighting that the experience of participants did not closely align with measured outcomes. Participants rejected the term frailty, yet engaged with the need to mitigate for, and adapt to, age-related deterioration that threatened independence and well-being. This was achieved through occupational adaptation to preserve function and well-being.

Conclusion: Considering frailty in terms of physical and functional status, mental well-being and occupational performance aligns with the experiences of those living with pre-frailty and frailty. The frailty-prevention intervention was highly acceptable to participants as it adopted a function and assets-based approach to health, which aligned with their conceptualisation of health and self-management. Additionally, improvement, or at least maintenance, of function, was of greatest importance to participants.

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Identifiers

ORCID for Sarah Mercer: orcid.org/0000-0002-3004-2012

ORCID for Bronagh Walsh: orcid.org/0000-0003-1008-0545

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