Perspectives of Frailty and Frailty Screening: Protocol for a Collaborative Knowledge Translation Approach and Qualitative Study of Stakeholder Understandings and Experiences

Abstract

BackgroundAccompanying the unprecedented growth in the older adult population worldwide is an increase in the prevalence of frailty, an age-related clinical state of increased vulnerability to stressor events. This increased vulnerability results in lower social engagement and quality of life, increased dependency, and higher rates of morbidity, health service utilization and mortality. Early identification of frailty is necessary to guide implementation of interventions to prevent associated functional decline. Consensus is lacking on how to clinically recognize and manage frailty. It is unknown how healthcare providers and healthcare consumers understand and perceive frailty, whether or not they regard frailty as a public health concern; and information on the indirect and direct experiences of consumer and healthcare provider groups towards frailty are markedly limited.MethodsWe will conduct a qualitative study of consumer, practice nurse, general practitioner, emergency department physician, and orthopedic surgeons’ perspectives of frailty and frailty screening in metropolitan and non-metropolitan South Australia. We will use tailored combinations of semi-structured interviews and arts-based data collection methods depending on each stakeholder group, followed by inductive and iterative analysis of data using qualitative description.DiscussionUsing stakeholder driven approaches to understanding and addressing frailty and frailty screening in context is critical as the prevalence and burden of frailty is likely to increase worldwide. We will use the findings from the Perceptions of Frailty and Frailty Screening study to inform a context-driven identification, implementation and evaluation of a frailty-screening tool; drive awareness, knowledge, and skills development strategies across stakeholder groups; and guide future efforts to embed emerging knowledge about frailty and its management across diverse South Australian contexts using a collaborative knowledge translation approach. Study findings will help achieve a coordinated frailty and healthy ageing strategy with relevance to other jurisdictions in Australia and abroad, and application of the stakeholder driven approach will help illuminate how its applicability to other jurisdictions.

Older adults’ understandings and perspectives on frailty in community and residential aged care: an interpretive description

“…This research is outlined in the protocol developed by Archibald and colleagues, 13 which describes a collaborative knowledge translation approach 29 to understanding how older adults and healthcare providers perceive frailty and frailty screening, in order to refine the research problem and guide future research and translation efforts. This study is underpinned by a constructivist epistemological position.…”

“…Open access empirical data exist on the perspectives of older adults in Australia. 13 This study contributes knowledge to this area by examining how older persons along the frailty trajectory perceive and experience frailty in order to inform knowledge translation and service improvement initiatives in a Centre for Research Excellence (CRE) in Frailty and Healthy Ageing in Australia. Existing research has characterised the experiences of living with frailty as highly nuanced, involving complicated and enduring transitions in health and illness.…”

General practitioners’ perceptions, attitudes and experiences of frailty and frailty screening

“…This project is part of a broader research program exploring perspectives on frailty and frailty screening among key stakeholders within Australia. 30 We adopted a qualitative descriptive design using a focus group methodology. Focus groups are a 'data collection technique that capitalises on the interaction within a group to elicit rich experiential data'.…”

“…We based this decision on widely observed disparities between Australian urban and rural areas, especially with respect to service accessibility [34][35][36] and health status 36,37 and to prior research showing that GPs' age may have a strong influence on clinical practice style, work practices and quality of care. [38][39][40] Consequently, we deliberately sought to recruit GPs to participate in at least three focus groups comprising between six and nine participants in each: 30 one urban 'older group' (focus group [FG] 1; GPs aged 40 years and over); one urban 'younger group' (FG2; GPs aged under 40 years); and one rural group (FG3; GPs of any age). A local senior GP led the recruitment effort; we additionally requested that recruited participants invite their contacts to join the groups.…”

Orthopaedic Surgeons Perceptions of Frailty and Frailty Screening

“…However, very little is known about the optimal identification and management of frail patients in acute care environments, how best to operationally define frailty, and which assessment tools can be used feasibly used in acute care settings [11]. Another critical component to optimizing frailty identification and management in clinical practice is generating a baseline understanding of how acute care providers perceive frailty and frailty screening-a consideration that has received insufficient attention in the literature [12,13].…”