Toward improved homecare of frail older adults: A focus group study synthesizing patient and caregiver perspectives

Abstract

Background Adopting a better understanding of how both older adults and health care providers view the community management of frailty is necessary for improving home health, especially facing the coronavirus disease 2019 (COVID‐19) pandemic. We conducted a qualitative focus group study to assess how both older adults and health care providers view frailty and virtual health care in home health. Methods Two focus groups enrolled home‐living older adults and health care professionals, respectively (n = 15). Questions targeting the use of virtual / telehealth technologies in‐home care for frail older adults were administered at audio‐recorded group interviews. Transcribed discussions were coded and analyzed using NVivo software. Results The older adult group emphasized the autonomy related to increasing frailty and social isolation and the need for transparent dissemination of health care planning. They were optimistic about remote technology‐based supports and suggested that telehealth / health‐monitoring/tracking were in high demand. Health care professionals emphasized the importance of a holistic biopsychosocial approach to frailty management. They highlighted the need for standardized early assessment and management of frailty. Conclusions The integrated perspectives provided an updated understanding of what older adults and practitioners value in home‐living supports. This knowledge is helpful to advancing virtual home care, providing better care for frail individuals with complex health care needs.

Recognizing the Needs of High-Need High-Risk Veterans

“…[6][7][8][9][10][11][12][13] Older adults with frailty, therefore, merit a biopsychosocial approach to healthcare delivery. [7][8][9]11,12,14,33,34 Taking a biopsychosocial approach to provision of individualized supports in the four geriatric domains may reduce the burden of the specific physical, functional, psychological, and social concerns that we found HNHR patients in our healthcare system to be experiencing, while also supporting the commonly held goal of avoiding long-term institutionalization through successful "aging in place". 35 Our findings support more specifically that HNHR Veterans with frailty may benefit from increased alignment with existing VA programs that employ a biopsychosocial approach in addressing their multidomain needs, possibly in conjunction with expansion of these programs.…”

“…Increased attention to identifying members of these groups and aligning them with biopsychosocial interventions that are targeted to their specific needs may support achievement of Veterans’ personalized healthcare goals, which often include postponement or avoidance of extended stays in nursing homes. 33 , 34 , 37 Next essential steps to improve the current state of care for vulnerable, HNHR patients, includes developing integrated evidence-based interventions 38 and home- and community-based services that address provision of sufficient functional supports at home, connection with social and psychological supports, mitigation of fall risk, provision of transportation to healthcare appointments, and reduction of hospitalizations.…”

Web-based software applications for frailty assessment in older adults: a scoping review of current status with insights into future development

“…However, throughout the course of the pandemic, many patients or providers who may have been deemed as “technologically limited” have adapted and become proficient in using video calls for other activities such as exercise, socializing, and learning [ 43 ]. While an initial learning curve is expected, there is a generally positive perspective towards virtual care applying computerized technologies within the new generation of older adults [ 45 ].…”

Individual goal-setting in municipal homecare: A participatory appreciative action and reflection study

“…5 Healthcare seems to value keeping the individual alive as long as possible but has forgotten to emphasize quality of life as well. 32 The stakeholders reasoned that organizational rigidity it is an obstacle when the organization decides which staff should make the home visits regardless of the older individual's wishes. The individuals do not feel confident with the staff, leading them to give up on their goals and refrain from interventions.…”