Managing frailty in an Irish primary care setting: A qualitative study of perspectives of healthcare professionals and frail older patients
Fiona Kennedy, Rose Galvin, Frances Horgan
Abstract
Frailty is a complex, multi-dimensional, age-related condition which confers a risk of serious and costly adverse outcomes 1 . Its' prevalence in community-dwelling older people in Ireland was found to be 24% 2 . The predicted trend in ageing demographics places frailty management as a key public health priority as the Irish healthcare system struggles to meet its demands 3 . Primary Care, often the first point of contact for patients, is the appropriate setting to address the majority of the healthcare needs of the population and in Ireland the Health Service Executive (HSE) advocates reform and transition from hospital-based care to community-based Primary Care, to provide accessible and timely care for patients closer to their home The Irish Longitudinal Study on Ageing has highlighted the impact of frailty in Irish society 2 . Findings from their study on healthcare utilisation in Ireland demonstrated a strong association between frailty and unplanned hospital care. Homecare support and general practice were cited as the most commonly used services, elucidating the importance of a responsive Primary Care service to address the needs Abstract Objectives: Little is known about the views of key stakeholders on frailty in Primary Care in Ireland. The aim of this study was to explore the views of Irish healthcare professionals and patients on frailty and its management in Primary Care. Methods: A qualitative descriptive design was used. Seventeen healthcare professionals and three patients were recruited using purposive sampling. Data were collected using semi-structured interviews which were analysed thematically. Results: Three themes were identified: (i) Perceptions of Frailty (ii) Current Management of Frailty and (iii) Comprehensive Geriatric Assessment in Primary Care. The results demonstrated variability in perspectives on frailty. Healthcare professionals described a fragmented service often delivering substandard care to frail older patients. The general consensus was that frailty management required an adequately resourced Primary Care service. Support for frailty screening and Comprehensive Geriatric Assessment was evident while the suitability of the current pathway for patients requiring assessment was questioned. Conclusion: This study highlights an absence of a shared and complete understanding of frailty among healthcare professionals and a fragmented model of care for community-dwelling frail older patients. Based on these findings, inter-professional training, investment in Primary Care, the development of a frailty pathway and an interface service is recommended.