D'Avanzo Barbara, Shaw Rachel, Riva Silvia, Apostolo Joao, Bobrowicz-Campos Elzbieta, Kurpas Donata, Bujnowska-Fedak Maria, Holland Carol
Unit for Quality of Care and Rights Promotion in Mental Health, IRCCS Istituto di Ricerche Farmcologiche Mario Negri, Milan, Italy.
Aston Research Centre for Healthy Ageing, Aston University, Birmingham, United Kingdom.
PLoS One. 2017 Jul 19;12(7):e0180127. doi: 10.1371/journal.pone.0180127. eCollection 2017.
Frailty is a common condition in older age and is a public health concern which requires integrated care and involves different stakeholders. This meta-synthesis focuses on experiences, understanding, and attitudes towards screening, care, intervention and prevention for frailty across frail and healthy older persons, caregivers, health and social care practitioners. Studies published since 2001 were identified through search of electronic databases; 81 eligible papers were identified and read in full, and 45 papers were finally included and synthesized. The synthesis was conducted with a meta-ethnographic approach. We identified four key themes: Uncertainty about malleability of frailty; Strategies to prevent or to respond to frailty; Capacity to care and person and family-centred service provision; Power and choice. A bottom-up approach which emphasises and works in synchrony with frail older people's and their families' values, goals, resources and optimisation strategies is necessary. A greater employment of psychological skills, enhancing communication abilities and tools to overcome disempowering attitudes should inform care organisation, resulting in more efficient and satisfactory use of services. Public health communication about prevention and management of frailty should be founded on a paradigm of resilience, balanced acceptance, and coping. Addressing stakeholders' views about the preventability of frailty was seen as a salient need.
衰弱是老年人的常见状况，是一个需要综合照护且涉及不同利益相关者的公共卫生问题。这项元综合研究聚焦于虚弱和健康老年人、照护者、卫生与社会照护从业者对衰弱筛查、照护、干预及预防的经历、理解和态度。通过检索电子数据库确定了自2001年以来发表的研究；共识别出81篇符合条件的论文并进行全文阅读，最终纳入并综合了45篇论文。综合过程采用元民族志方法。我们确定了四个关键主题：衰弱可塑性的不确定性；预防或应对衰弱的策略；照护能力以及以个人和家庭为中心的服务提供；权力与选择。需要一种自下而上的方法，该方法强调并与体弱老年人及其家庭的价值观、目标、资源和优化策略同步开展工作。更多地运用心理技能、提高沟通能力以及采用工具来克服剥夺权利的态度，应为照护组织提供指导，从而更高效、更令人满意地利用服务。关于衰弱预防和管理的公共卫生宣传应以恢复力、平衡接受和应对的范式为基础。解决利益相关者对衰弱可预防性的看法被视为一项迫切需求。
