Care for frail older adults in the community: an integrative review

a descriptive, integrative review study was performed. The search for articles was carried out in the Medline, Lilacs, Web of Science, Scopus and SciELO databases. The inclusion criteria were complete available articles; published between 2014 and 2019; written in Portuguese, English, Spanish or French; which had older adults as participants.

Results:

four categories of analysis emerged from the results: frailty from the perspective of frail older adults; priorities from the perspective of the older adults; the older adults’ perspectives on care by services; and interpersonal relationships in the care of frail older adults. The perception of the older adults has specific characteristics, has maintaining their independence as a focus of care, signals the need to maintain interpersonal relationships, improve communication, and for actions of health education and people-centered services.

Conclusion:

these points demand the attention of care providers and policy services to improve care delivery and provide actions that are welcomed by this public.

Keywords:
Health of the Aged; Frailty; Review Literature as Topic; Culturally competent Care; Perception; Frail Elderly

Objective	No. of older adults	Sex	Mean age
Explore the influences on care preferences of frail older adults with recent acute illnesses²²22 Etkind SN, Lovell N, Nicholson CJ, Higginson IJ, Murtagh FEM. Finding a 'new normal' following acute illness: a qualitative study of influences on frail older people's care preferences. Palliat Med. 2019;33(3):301-11..	17	10W and 7M	84
Explore the experiences of frail older adults with depression and anxiety and their views on seeking help and ways in which services can be adapted to better meet their needs³¹31 Frost R, Nair P, Aw S, Gould RL, Kharicha K, Buszewicz M, et al. Supporting frail older people with depression and anxiety: a qualitative study. Aging Ment Health. 2019:1-9..	28	19W and 9M	80,71
Explore opinions to determine whether there are effective daily strategies that can be adopted to reduce, reverse or prevent frailty³²32 Bujnowska-Fedak MM, Gwyther H, Szwamel K, D'Avanzo B, Holland C, Shaw RL, et al. A qualitative study examining everyday frailty management strategies adopted by Polish stakeholders. Eur J Gen Pract. 2019;25(4):197-204..	9	6W and 3M	73-89
Explore how slightly frail older people perceive health promotion and the factors that affect behavior change²³23 Avgerinou C, Gardner B, Kharicha K, Frost R, Liljas A, Elaswarapu R, et al. Health promotion for mild frailty based on behaviour change: perceptions of older people and service providers. Health Soc Care Community. 2019;27:1333-43..	16	13W and 3M	80
Explore health, health management and behavioral factors that contribute to enabling high-risk patients to avoid unplanned hospitalizations³⁵35 Dew R, Wilkes S. Attitudes, perceptions, and behaviours associated with hospital admission avoidance: a qualitative study of high-risk patients in primary care. Br J Gen Pract. 2018:460-8..	21	19W and 12M	58-96
Investigate how people have managed to remain resilient as they age in remote places, despite the gap in formal support services³⁷37 Gibb H. Determinants of resilience for people ageing in remote places: a case study in northern Australia. Int J Ageing Later Life. 2018;11(2):9-34..	14	Not reporter	61-80
Explore the perceptions of behaviors undertaken by older adults with mild frailty and the components for new health promotion services at home²⁴24 Frost R, Kharicha K, Jovicic A, Liljas A, Iliffe S, Manthorpe J, et al. Identifying acceptable components for home-based health promotion services for older people with mild frailty: A qualitative study. Health Soc Care Community. 2018;26:393-403..	14	8W and 6M	75-94
Contrast the frail experiences of older adults with the perceptions of others about existential loneliness³³33 Larsson H, Edberg A, Bolmsjö I, Rämgard M. Contrasts in older persons' experiences and significant others' perceptions of existential loneliness. Nurs Ethics. 2019;26(6):1623-37..	15	7W and 8M	86
To explore how frail older patients experience daily life one week after discharge from acute hospitalization²⁹29 Andreasen J, Lund H, Aadahl M, Sorensen E. The experience of daily life of acutely admitted frail elderly patients one week after discharge from the hospital. Int J Qual Stud Health Well-being. 2015;10:1-11..	14	7W and 7M	80.6
Explore the perceptions of older adults about frailty and their beliefs about its progression and consequences¹¹11 Warmoth K, Lang I, Phoenix C, Abraham C, Andrew M, Hubbard RE, et al. 'Thinking you're old and frail': a qualitative study of frailty in older adults. Ageing Soc. 2016;36:1483-1500..	29	17W and 12M	66-98
Explore access to health and social care services for frail older adults to determine the prospect of developing more accessible services³⁶36 Kurpas D, Gwyther H, Szwarnel K, Shaw RL, D'Avanzo B, Holland CA, et al. Patient-centred access to health care: a framework analysis of the care interface for frail older adults. BMC Geriatr. 2018;18:1-17..	9	Not reported	> 2
Explore the experiences, understandings, meanings and malleability of frailty for individuals; and describe the development of viable interventions in clinical practice¹⁵15 Shaw RL, Gwyther H, Holland C, Bujnowska M, Kurpas D, Cano A, et al. Understanding frailty: meanings and beliefs about screening and prevention across key stakeholder groups in Europe. Ageing Soc. 2017:1-30..	25	16W and 9M	> 2
Explore how older people with complex health problems experience frailty in their daily lives³⁸38 Skilbeck JK, Arthur A, Seymour J. Making sense of frailty: an ethnographic study of the experience of older people living with complex health problems. Int J Older People Nurs. 2018;13(1):e12172 [11 p.]..	10	7W and 7M	84
Examine perceptions and knowledge about frailty among older adults²⁵25 Schoenborn NL, Rasmussen SEVP, Xue Q, Walston JD, McAdams-Demarco MA, Segev DL, et al. Older adults' perceptions and informational needs regarding frailty. BMC Geriatr. 2018;18:1-7..	29	21W and 8M	76.3
Describe how existential loneliness was narrated by frail older adults²⁶26 Sjöberg M, Edberg A, Rasmussen BH, Beck I. Being acknowledged by others and bracketing negative thoughts and feelings: Frail older people's narrations of how existential loneliness is eased. Int J Older People Nurs. 2019;14: e12213 [9 p.]..	22	10W and 12M	76-101
Examine how older people deal with frailty in a transitional care program and discuss the implications for improving service delivery¹⁸18 Walker R, Johns J, Halliday D. How older people cope with frailty within the context of transition care in Australia: implications for improving service delivery. Health Soc Care Community. 2015;23(2):216-24..	20	13W and 7M	80
Explore how older people living in disadvantaged neighborhoods deal with aging issues⁴⁰40 Bielderman A, Schout G, Greef M, Schans C. Understanding how older adults living in deprived neighbourhoods address ageing issues. Br J Community Nurs. 2015;20(8):394-9..	20	13W and 7M	72.5
To investigate the concept of perceived control related to health care from the point of view of frail older adults¹⁴14 Claassens L, Widdershoven GA, van Rhijn SC, van Nes F, van Groenou MIB, Deeg DJ, et al. Perceived control in health care: a conceptual model based on experiences of frail older adults. J Aging Stud. 2014;31:159-70..	32	19W and 13M	65-84 = 17 ≥85 = 15
Explore the experience of frail older people and case managers in a complex case management intervention⁴¹41 Sandberg M, Jakobsson U, Midlöv P, Kristensson J. Case management for frail older people: qualitative study of receivers' and providers' experiences of a complex intervention. BMC Health Services. 2014;14:2-12..	14	10W and 4M	83
Develop an interpretative structure based on older adults’ understanding of independence and autonomy for receiving specialized care⁴²42 Hillcoat-Nallétamby S. The meaning of "independence" for older people in different residential settings. J Gerontol Ser B Psychol Sci Soc Sci. 2014;69(3):419-30..	91	68W and 23M	80.8
Explore the experience of meaning in life, as well as the loss of meaning for socially frail older adults³⁰30 Duppen D, Machielse A, Verté D, Dury S, Donder L, Consortium D. Meaning in Life for Socially Frail Older Adults. J Community Health Nurs. 2019;36(2):65-77..	56	34W and 22M	79.3

Objective	No. of older adults	Sex	Average age
Examine whether the perspectives of frail older adults living in the community on the quality of primary care according to the dimensions of the Chronic Care Model are associated with the productivity of patient-professional interactions²⁷.	464	336W and 128M	82.4
Examine loneliness, health-related quality of life and health complaints regarding the use of outpatient health care among older adults living at home³⁹.	153	102W and 51M	81.5
Analyze the explanatory power of the variables that measure health strengthening factors for self-rated health among frail older adults living in the community⁴.	161	89W and 72M	82
Describe care needs perceived as met and not met by frail older adults using a multidimensional assessment tool and explore associations with sociodemographic and health-related characteristics⁶.	1,137	760W and 377M	80.5
Examine the health needs of older residents in the community living in Porto, Portugal, diagnosed with moderate or severe dementia, associated with functional dependence, cognitive decline, limitations in activities of daily living and levels of frailty³⁴.	83	55M and 28H	79.95

Objective	No. of older adults	Sex	Average age
Obtain insights into the lived experiences of frailty among older people to determine which forces can balance the deficits that affect frailty¹⁰10 Dury S, Dierckk E, Vorst A, Elst M, Fret B, Duppen D, et al. Detecting frail, older adults and identifying their strengths: results of a mixed-methods study. BMC Public Health. 2018;18(1):1-13..	121	76W and 45M	78.8
Identify the risks that could threaten the independent life of frail older adults²⁸28 Verver D, Merten H, Robben P, Wagner C. Perspectives on the risks for older adults living independently. Br J Community Nurs. 2017;22(7): 338-45..	29	22W and 7M	83.6

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E-mail: revistabgg@gmail.com

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[1] Correspondence Gislaine Alves de Souza gislaine.as@gmail.com