Exploring Frailty: Community Physical and Occupational Therapists’ Perspectives

ABSTRACT

Frailty is prevalent among community-dwelling older adults. Community physical and occupational therapists provide at-home care to older adults, yet little is known about their ability to identify frailty, specifically the early development (pre-frailty). Objectives: To explore therapists’ perspectives on frailty, and develop a definition of how they view and manage frailty in their practice. Eleven therapists (17.3 ± 12.0 years of experience) completed repertory grid-guided interviews. Principal component analysis identified relationships in data and highlighted themes, and constant comparative analysis built upon emerging themes. Therapists recognized frailty as self-imposed isolation due to reduced motivation, lack of safe judgment, and declining physical fitness resulting in functional dependence. Therapists’ image of frailty included deterioration of physical, mental, and social capacities, leading to an inability to thrive. Therapists recognized that the underlying comorbidities contributed to the unique expression of frailty within individual clients. Therapists’ distinct perspectives of frailty add to current proposed definitions by establishing early identifiers to enable an effective and useable definition of “what is frail?”     

Sick-listing habits among general practitioners in a Swedish county

Objective - To describe sick-listing habits in general practice, how common it is and for how long and for what diagnoses it is granted. Design - Medical audit study. Setting - Primary health care. Subjects - 53 general practitioners (GPs) registering all cases during a 2-week period when sick-listing was considered. Main outcome measures - Percentage of GP consultations that involved sick-listing, number of days of certified sick-leave, percentage of partial sick-listing, GP sex differences. Results - 9% of all consultations included a consideration about sick-listing, and in only 6% of these instances was a certificate not issued. The median length of the certified sickness period was 14 days. Musculoskeletal problems were by far the most common diagnosis. Female patients were more often partially sick-listed than males. Female GPs sick-listed a larger proportion of their patients than male GPs. Risk factors for long certification periods were in fact associated with long certification periods. Even in cases where the GP would not recommend sick-listing a certificate was issued in 87%. Conclusions - Patients appear to have a strong influence on sick-listing practice, and there are important sex differences among GPs in this practice.     

General practitioners' reactions to non-compliant patients

Objective - To examine how general practitioners (GPs) respond to patients who are non-compliant with medical advice and who doctors believe act irresponsibly towards their health. Design - Quantitative analysis of responses to questionnaire with case histories. Setting and subjects - 93 questionnaires completed by a random stratified sample of Norwegian GPs. Main outcome measures - Scores relating to GPs' feelings and choice of main and sub-strategies for further treatment of patients. Results - The respondents typically felt discouraged or unaffected by non-compliant patients, younger doctors more often felt helpless while older ones were more content, and female doctors more often than male doctors felt irritated or angry. The main strategy preferred was to give the patient a new appointment. The young, the inexperienced, and females tended more often to ask a colleague for advice or refer to a specialist. Patient-centred sub-strategies were generally preferred, especially by younger doctors. Conclusion - GPs' feelings towards and strategies for dealing with non-compliant patients vary, and the doctor's age, sex and clinical experience are central variables.     

Prevention of cardiovascular disease within the primary health care system: Feasibility of a prevention programme within the Sollentuna primary health care catchment area

Objective - To integrate prevention of cardiovascular disease within the primary health care.

Design - A prevention programme which combines population and individual high-risk strategy.

Setting - The Primary Health Care in Sollentuna, Stockholm, Sweden.

Main outcome measure - Characteristics of, and risk factor prevalence among, persons registered in the prevention programme.

Results - During the first year more than 2000 persons, representing every tenth visitor and 6% of the population aged 15–60 years, were registered in the prevention programme. 90% were ?60 years and 62% were women. A large proportion (70%) had risk factors that required advice, treatment, and follow up. 24% of the men and 27% of the women were smokers, 68% and 62% respectively, had serum cholesterol ?5.2 mmol/1, and 33% and 22% had a diastolic blood pressure ?90 mmHg.

Conclusion - The present study implies that it is possible to integrate a large scale prevention programme in the existing primary health care organization. The prevalence of risk factors in those who enter the prevention programme is high, which places great demands for treatment and follow up.     

Entering a World with No Future: A phenomenological study describing the embodied experience of time when living with severe incurable disease

Scand J Caring Sci; 2013; 27; 165–174 A phenomenological study describing the embodied experience of time when living with severe incurable disease This article presents findings from a phenomenological study exploring experience of time by patients living close to death. The empirical data consist of 26 open‐ended interviews from 23 patients living with severe incurable disease receiving palliative care in Norway. Three aspects of experience of time were revealed as prominent: (i) Entering a world with no future; living close to death alters perception of and relationship to time. (ii) Listening to the rhythm of my body, not looking at the clock; embodied with severe illness, it is the body not the clock that structures and controls the activities of the day. (iii). Receiving time, taking time; being offered – not asked for – help is like receiving time that confirms humanity, in contrast to having to ask for help which is like taking others time and thereby revealing own helplessness. Experience of time close to death is discussed as an embodied experience of inner, contextual, relational dimensions in harmony and disharmony with the rhythm of nature, environment and others. Rhythms in harmony provide relief, while rhythms in disharmony confer weakness and limit time.