Midlands Regional Hospital, Tullamore, County Offaly, Republic of Ireland.
School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.
Int J Older People Nurs. 2024 May;19(3):e12611. doi: 10.1111/opn.12611.
The objective of this study was to synthesise the evidence of older persons' experiences of frailty.
The world's population is ageing with those aged over 60 years expected to total 2 billion by 2050. Although not exclusive to ageing, there is a higher prevalence of frailty in older adults, with corresponding demand for related healthcare. While definitions of frailty are debated, there is emerging consensus that sole reliance on biomedical conceptualisations is inadequate to capture the complex needs of older persons living with frailty. In addition, the voices of older persons have largely been excluded from frailty discourses. There is a consequent need for an expanded approach.
A meta-synthesis was conducted of the literature on older persons' experiences of frailty. CINAHL, Medline, Embase and ASSIA databases were systematically searched up to January 2024. Reference lists of retrieved sources and grey literature were also searched. Studies were independently evaluated for inclusion by two reviewers using predetermined inclusion criteria. Included studies were quality appraised using a standardised tool, and extracted data were thematically analysed and synthesised.
Eight hundred and thirteen studies were identified as potentially relevant. Following title and abstract review, 52 studies were selected for full-text review. Thirty-four studies were subsequently excluded as they did not address the systematic review question, leaving 17 included in the final review. An additional two studies were identified via grey literature sources. Older persons' experiences of frailty were synthesised with reference to three themes: (i) living with frailty: a multidimensional experience; (ii) living with frailty: acceptability and associations; and (iii) living with frailty: resisting and adapting and losing control.
Older persons' experiences of frailty revealed a resistance to the biomedical use of the term generally used in clinical practice. Instead, a more nuanced and multidimensional understanding of frailty was identified in the experiences of older persons.
Health and social care personnel should therefore consider an expanded approach in practice that incorporates the perspective of older people who strive to maintain independence and control when living with frailty. Doing so may enhance shared understanding and person-centred care planning between older persons and professionals.
本研究旨在综合老年人虚弱体验的证据。
世界人口正在老龄化，预计到 2050 年，60 岁以上人口将达到 20 亿。虽然虚弱并非仅限于老龄化，但老年人中虚弱的患病率更高，相应地对相关医疗保健的需求也更高。虽然虚弱的定义存在争议，但越来越多的共识认为，仅依靠生物医学概念不足以捕捉到患有虚弱的老年人的复杂需求。此外，老年人的声音在很大程度上被排除在虚弱的讨论之外。因此，需要一种扩展的方法。
对老年人虚弱体验的文献进行了元综合。系统检索了 CINAHL、Medline、Embase 和 ASSIA 数据库，截至 2024 年 1 月。还检索了检索来源的参考文献列表和灰色文献。两名审查员独立评估纳入标准，使用预定纳入标准评估研究的纳入情况。使用标准化工具对纳入的研究进行质量评估，并对提取的数据进行主题分析和综合。
确定了 813 项可能相关的研究。在标题和摘要审查后，选择了 52 项进行全文审查。随后，有 34 项研究因未解决系统审查问题而被排除在外，最终有 17 项研究被纳入审查。通过灰色文献来源又确定了另外两项研究。老年人虚弱的体验被综合为三个主题：（一）虚弱的生活：多维体验；（二）虚弱的生活：可接受性和关联；以及（三）虚弱的生活：抵抗和适应以及失去控制。
老年人对虚弱的体验揭示了他们对临床实践中普遍使用的生物医学术语的抵制。相反，在老年人的体验中，发现了对虚弱的更细致和多维的理解。
因此，卫生和社会保健人员在实践中应考虑采用更广泛的方法，该方法应纳入努力在虚弱时保持独立和控制的老年人的观点。这样做可以增强老年人和专业人员之间的共同理解和以人为本的护理计划。
