The frail individual: uncovering the complexities in care and support across three common distinct settings.
File(s)
Author(s)
Sunkersing, David James
Type
Thesis or dissertation
Abstract
Introduction
By 2050, an estimated 2 billion people will be 65 years or older, bringing significant implications for health and social care. One implication – frailty – will affect patients, staff and healthcare settings. There is a need for improved recognition and care and support of frail individuals.
Aims
This thesis aims to uncover the complexities in the care and support of frail individuals across three distinct settings. A high-level study investigated the non-acute care setting, followed by investigating three distinct settings: community, acute hospital care and nursing homes.
Methods
A mixed-methods approach was used. Following a literature review, a survey (questionnaire) helped better understand ‘assessments for frailty’ used in the non-acute care setting. In the community setting, semi-structured interviews were undertaken with patients and healthcare professionals, using a participatory approach. In the acute care setting, a cross-sectional study of frail patients was conducted using patient data records. Regarding nursing homes, an online survey (questionnaire) helped investigate how frailty is assessed.
Results
Frailty is often understood and assessed as physical and mental health deficits. The perceptions of healthcare professionals and frail individuals regarding frail care and support networks overlap, but are distinct with different emphases. In acute care, variation in frail individuals’ living arrangement pre-admission and post-discharge was found, with a high proportion being discharged to a nursing home. Great variation in assessing for frailty was found in nursing homes.
Conclusion
Highlighted is the importance of family and friends in the care and support of frail individuals. Many hospital patients were discharged to settings with enhanced care and support availability, demonstrating the importance of care and support. ‘Assessing for frailty’ may require review to ensure holistic consideration of individuals and better frailty recognition. This may help improve the care and support of a frail individual and outcomes.
By 2050, an estimated 2 billion people will be 65 years or older, bringing significant implications for health and social care. One implication – frailty – will affect patients, staff and healthcare settings. There is a need for improved recognition and care and support of frail individuals.
Aims
This thesis aims to uncover the complexities in the care and support of frail individuals across three distinct settings. A high-level study investigated the non-acute care setting, followed by investigating three distinct settings: community, acute hospital care and nursing homes.
Methods
A mixed-methods approach was used. Following a literature review, a survey (questionnaire) helped better understand ‘assessments for frailty’ used in the non-acute care setting. In the community setting, semi-structured interviews were undertaken with patients and healthcare professionals, using a participatory approach. In the acute care setting, a cross-sectional study of frail patients was conducted using patient data records. Regarding nursing homes, an online survey (questionnaire) helped investigate how frailty is assessed.
Results
Frailty is often understood and assessed as physical and mental health deficits. The perceptions of healthcare professionals and frail individuals regarding frail care and support networks overlap, but are distinct with different emphases. In acute care, variation in frail individuals’ living arrangement pre-admission and post-discharge was found, with a high proportion being discharged to a nursing home. Great variation in assessing for frailty was found in nursing homes.
Conclusion
Highlighted is the importance of family and friends in the care and support of frail individuals. Many hospital patients were discharged to settings with enhanced care and support availability, demonstrating the importance of care and support. ‘Assessing for frailty’ may require review to ensure holistic consideration of individuals and better frailty recognition. This may help improve the care and support of a frail individual and outcomes.
Version
Open Access
Date Issued
2020-10
Date Awarded
2021-02
Copyright Statement
Creative Commons Attribution NonCommercial Licence
Advisor
Bell, Derek
Reed, Julie
Sponsor
National Institute for Health Research (NIHR)
Publisher Department
Department of Medicine
Publisher Institution
Imperial College London
Qualification Level
Doctoral
Qualification Name
Doctor of Philosophy (PhD)