Frailty in independently living elderly; the physiotherapists vision

Abstract

BACKGROUND The Dutch population is ageing, a process that is associated with frailty. About 48,5% of the independently living elderly is frail. A condition that increases the change of negative health outcomes. There is a need to identify and treat frailty in an early stage to sustain the quality of life of independently living elderly and prevent an increasing burden on the healthcare system. Physiotherapists can play an important role in the assessment and treatment of frailty in independently living elderly. However, it is unknown how much physiotherapists know of frailty and how they assess and treat frailty.

AIM To explore and describe the knowledge of physiotherapist about the concept of frailty in independently living elderly, how they assess and prevent frailty in their patients and what they recommend to optimize the assessment and treatment of frailty.

METHODS An exploratory qualitative study using semi-structured interviews among physiotherapists that treat independently living elderly was performed. Data was analysed with Atlas.ti 8.3.1. using a narrative approach.

RESULTS Twelve physiotherapists (aged 26-57 years) were interviewed. Four main categories emerged; the concept frailty, recognition of frailty, treatment of frailty, recommendations. Physical functioning is seen as an important factor in relation to frailty. The recognition of frailty by physiotherapists is mostly based upon gut feeling in a relatively late stadium of the treatment. Tools to assess frailty are barely used. Treatment consists of reducing fall incidence and muscle strength training. Physiotherapists believe that preventive and or multidisciplinary treatment would be beneficial for the patient, but is often impossible because of limiting conditions.

CONCLUSION The knowledge of physiotherapists with regard to frailty is variable. Frailty or problems in other domains than physical functioning are often treated as being of minor importance and attended relatively late. Physiotherapists feel that frailty should be treated multidisciplinary, but accomplishing multidimensional collaborating is difficult and time consuming. CLINICAL RELEVANCE Physiotherapists should be more aware of frailty and use a multifactorial assessment tool. They should be more proactive in communication and collaboration with other health care professionals.