Designing new health promotion services for older people with mild frailty: What should we include?

Problem

Mild frailty is common in community-dwelling older adults. It is characterised by increased vulnerability due to loss of physiological reserves, and emerging difficulties with instrumental activities of daily living (e.g. shopping, housework, finances). It is associated with an increased risk of functional decline, moves into long term care, hospitalisation and mortality. Though mild frailty may be reversible, few health promotion services are targeted towards this population. In light of our developmental work for a new health promotion service, we summarise key recommendations for the content and delivery of new services for mild frailty.

Approach

We undertook a comprehensive, mixed methods approach to identify core components for developing health promotion services for older people with mild frailty. To explore effective service components, we systematically reviewed 1) current interventions targeted at pre- or mildly frail populations and 2) the content of home-based behaviour change interventions in pre-frail/frail populations. This was followed by six focus groups and 17 interviews with 53 older people with mild frailty, carers, community health and social care professionals and homecare workers. We asked about current ways of promoting health, barriers/facilitators to this and potential content for a new service. We thematically analysed the data using a constant comparison approach. Recommendations from this initial work were then developed and refined through three service development workshops with older adults, professionals and key stakeholders.

Findings

Our systematic reviews showed that currently there was little evidence for effective interventions in this area, but providing education and helping to enable people through reducing barriers or increasing capability were promising ways of encouraging behaviour change. Evidence suggested that muscle strengthening exercise may be an important domain to include, but too few studies had been conducted to be conclusive on this or other possible domains. Qualitative data suggested new services should be personalised, providing support and encouraging behaviour change around a broad range of domains (e.g. mobility, social networks, mood, nutrition) and factors affecting health promotion (e.g. transport, knowledge). Older people and professionals thought the service should focus on maintaining independence and be delivered by trained non-specialists, with multiple appointments at home over a sustained period of time. Development workshops reinforced these recommendations, advised clear boundaries as to what the support worker should and should not cover (e.g. personal finance) and emphasised the need for greater flexibility when agreeing the number of appointments a client may require.

Consequences

Currently, there is a gap in services to promote health in mild frailty. New health promotion services could benefit from focussing on enabling older people with mild frailty to undertake activities that facilitate their independence and wellbeing. Key ways to encourage this appear to be sustained non-professional support over time, personalising the service and focussing on behaviour change.