Health promotion for mild frailty based on behaviour change: Perceptions of older people and service providers

Abstract

Mild frailty is common among older people, but it is potentially reversible with health promotion interventions. Behaviour change may be a key to preventing progression of frailty; however, we know little about what interventions work best and how a behaviour change approach would be perceived by this group. The aim of this study was to explore how mildly frail older people perceive health promotion based on behaviour change and what factors affect engagement with this approach. We conducted semi‐structured interviews with 16 older people with mild frailty who received a pilot home‐based behaviour change health promotion service, including a dyad of older person/family carer, and two service providers delivering the service in two diverse areas of South England. Interviews were audio‐recorded, transcribed and thematically analysed. The concept of goal setting was acceptable to most participants, though the process of goal setting needed time and consideration. Goals on maintaining independence, monitoring of progress and receiving feedback were reported to increase motivation. Physical/mental capability and knowledge/perception of own needs were main determinants of the type of goals chosen by participants as well as the approach used by the project workers. Older people with complex needs benefited from care coordination, with a combination of goal setting and elements of social, practical and emotional support in varying proportions. Mildly frail older people responded well to a behaviour change approach to promote health and well‐being. Further consideration is needed of the most effective strategies based on complexity of needs, and how to overcome barriers among people with cognitive impairment.

Care for frail older adults in the community: an integrative review

“…Regarding the measurement of frailty, five articles used the Clinical Frailty Scale 11,15,[22][23][24] , four used the Frailty Phenotype 14,23,25,26 , three used the Tilburg Frailty Indicator [27][28][29] , two used the Comprehensive Frailty Assessment Instrument 10.30 , five defined frailty without an instrument or objective measurement 4.14. [31][32][33] , one article used Prisma-7 6 and one the Edmonton Frailty Scale 34 .…”

“…[31][32][33] , one article used Prisma-7 6 and one the Edmonton Frailty Scale 34 . Of these, in two articles 14,23 there was the combination of more than one instrument. In nine articles, the measurement of frailty was not explicit 18.35-42 .…”

A Multi-Domain Intervention Protocol for the Potential Reversal of Cognitive Frailty: “WE-RISE” Randomized Controlled Trial

“…The WE-RISE at Home program strongly promotes the continuation of self-management following the instructed sessions at the comforts of their own home. The elements of social engagement via phone call with instructor, autonomy to select the activities of choice at home and setting targets to achieve for each session are promising components that heighten motivation to carry out activities independently (65). The WE-RISE intervention hopes to provide easier accessibility whilst enabling "age-friendly" health care delivery.…”

The perspectives of health professionals in Denmark on physical exercise and nutritional interventions for acutely admitted frail older people during and after hospitalisation

“…(2015) points out that being person‐centred requires establishing a person‐centred culture and working with the beliefs and values of patients as well as shared decision making. One study found that health professionals experienced that it was difficult for some frail older people to identify goals that they would find motivational and relevant, and also how much they wanted professionals to push them towards achieving these goals (Avgerinou et al., 2019). With regard to nutritional goals, other studies found that staff need to communicate with patients and their carers about their usual eating habits and be sensitive to the patients’ wishes, in order to be able to assess the patients’ motivation to eat (Chapman et al., 2015; Soderhamn & Soderhamn, 2009).…”

“…A focused literature search in PubMed, CINAHL and Embase on the perspectives of health professionals on frailty in general, and specifically on physical activity, identified studies that showed that health professionals view a number of factors as important in care or interventions for frail older people. Among these are: establishing a relationship between patient and professional (Avgerinou et al., 2019; Bindels, Cox, Widdershoven, van Schayck, & Abma, 2014; Frost et al., 2018; Gwyther et al., 2018; Lette, Baan, Van Den Berg, & De Bruin, 2015); and having a person‐centred approach or tailoring interventions to individual needs (D'Avanzo et al., 2017; Frost et al., 2018; Giguere et al., 2018; Lette et al., 2017; Shaw et al., 2017). Moreover, organisational factors such as poor communication or lack of co‐ordination and collaboration can create difficulties (Giguere et al., 2018; Gwyther et al., 2018; Lette et al, 2015; Sadler et al., 2019).…”