Older Adults' Perceptions of Frailty and Advance Care Planning (ACP)

Introduction

Advanced care planning (ACP) is particularly relevant for those living with frailty, who are at heightened risk of sudden health changes and loss of cognitive ability. The concepts of frailty and ACP are understood differently by older adults and health care professionals (HCPs). This abstract represents the qualitative component of a mixed methods study aiming to evaluate older people’s perspectives of frailty, including how and why they build self-perceptions of frailty, and their perceptions of ACP.

Method

Ten community dwelling, older adults, (aged seventy years plus), registered with a single GP practice, were interviewed, alongside a ‘close person’ if they wished. Participants were purposively sampled from a pool of survey respondents. Semi structured interviews were analysed using reflexive thematic analysis.

Results

Four themes were identified: ‘Focus on the familiar first’, ‘Dependency: the good, the bad and the ugly’, “If you don’t use it, you will lose it”; don’t give in to frailty – keep going, ‘Attitudes towards frailty matter; you need to have mental grit’. ACP is not familiar to most older people and family is often consulted before HCPs. What people want to plan for may not be health related. Being independent and able to keep going were key to many older people’s frailty identity. Some older adults feel there is a choice in how one responds to frailty, placing great importance on having a positive mental attitude.

Conclusions

Understanding older people’s priorities for future planning can help HCPs to engage in ACP conversations with an open mind. Knowing that families have often already been involved in future planning discussions may allow a ‘way in’. Insights into how older people construct their frailty identity, and the importance placed on positive attitudes, keeping going and independence, may allow for conversations to be more aligned with their values.