检测体弱、老年人并识别其优势：一项混合方法研究的结果。
Detecting frail, older adults and identifying their strengths: results of a mixed-methods study.
机构信息
Department of Educational Sciences, Vrije Universiteit Brussel, Pleinlaan 2, 1050, Brussels, Belgium.
Research Foundation Flanders (FWO), Egmontstraat 5, 1000, Brussels, Belgium.
出版信息
BMC Public Health. 2018 Jan 30;18(1):191. doi: 10.1186/s12889-018-5088-3.
BACKGROUND
The debate on frailty in later life focuses primarily on deficits and their associations with adverse (health) outcomes. In addition to deficits, it may also be important to consider the abilities and resources of older adults. This study was designed to gain insights into the lived experiences of frailty among older adults to determine which strengths can balance the deficits that affect frailty.
METHODS
Data from 121 potentially frail community-dwelling older adults in Flemish-speaking Region of Belgium and Brussels were collected using a mixed-methods approach. Quantitative data were collected using the Comprehensive Frailty Assessment Instrument (CFAI), Montreal Cognitive Assessment (MoCA), and numeric rating scales (NRS) for quality of life (QoL), care and support, meaning in life, and mastery. Bivariate analyses, paired samples t-tests and means were performed. Qualitative data on experiences of frailty, frailty balance, QoL, care and support, meaning in life, and mastery were collected using semi-structured interviews. Interviews were subjected to thematic content analysis.
RESULTS
The "no to mild frailty" group had higher QoL, care and support, meaning in life, and mastery scores than the "severe frailty" group. Nevertheless, qualitative results indicate that, despite being classified as frail, many older adults experienced high levels of QoL, care and support, meaning in life, and mastery. Respondents mentioned multiple balancing factors for frailty, comprising individual-level circumstances (e.g., personality traits, coping strategies, resilience), environmental influences (e.g., caregivers, neighborhood, social participation), and macro-level features (e.g., health literacy, adequate financial compensation). Respondents also highlighted that life changes affected their frailty balance, including changes in health, finances, personal relationships, and living situation.
CONCLUSION
The findings indicate that frailty among older individuals can be considered as a dynamic state and, regardless of frailty, balancing factors are important in maintaining a good QoL. The study investigated not only the deficits, but also the abilities, and resources of frail, older adults. Public policymakers and healthcare organizations are encouraged to include these abilities, supplementary or even complementary to the usual focus on deficits.
背景
关于老年人脆弱性的争论主要集中在缺陷及其与不良（健康）结果的关联上。除了缺陷，考虑老年人的能力和资源也可能很重要。本研究旨在深入了解老年人脆弱性的生活体验，以确定哪些优势可以平衡影响脆弱性的缺陷。
方法
使用混合方法从比利时佛兰芒语区和布鲁塞尔的 121 名潜在脆弱的社区居住老年人中收集数据。使用综合脆弱性评估工具（CFAI）、蒙特利尔认知评估（MoCA）和生活质量（QoL）、护理和支持、生活意义和掌握的数字评分量表（NRS）收集定量数据。进行了双变量分析、配对样本 t 检验和均值。使用半结构化访谈收集关于脆弱性体验、脆弱性平衡、QoL、护理和支持、生活意义和掌握的定性数据。访谈进行了主题内容分析。
结果
“无至轻度脆弱”组的 QoL、护理和支持、生活意义和掌握得分均高于“重度脆弱”组。然而，定性结果表明，尽管被归类为脆弱，但许多老年人仍经历着较高的 QoL、护理和支持、生活意义和掌握水平。受访者提到了多个脆弱性的平衡因素，包括个体层面的情况（例如，个性特征、应对策略、韧性）、环境影响（例如，护理人员、社区、社会参与）和宏观层面的特征（例如，健康素养、充足的财务补偿）。受访者还强调，生活变化会影响他们的脆弱性平衡，包括健康、财务、人际关系和生活状况的变化。
结论
研究结果表明，老年人的脆弱性可以被视为一种动态状态，无论是否脆弱，平衡因素对于维持良好的 QoL 都很重要。该研究不仅调查了缺陷，还调查了脆弱老年人的能力和资源。鼓励公共政策制定者和医疗保健组织将这些能力纳入考虑范围，作为对通常关注缺陷的补充甚至替代。
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