Understanding Frailty in Older Adults and its Relationship with Ageing Perceptions

Frailty in older adults is characterised as a vulnerable state, which predicts a range of health outcomes (e.g., injurious falls, institutionalisation, and mortality). The physiological and practical outcomes of frailty are recognised, but the psychosocial processes are largely unexplored so they were the focus the thesis. The overall aim of the thesis was to advance the understanding of frailty in older adults and its relationship with ageing perceptions. Three studies were conducted to achieve this aim. The first piece of work was a systematic review that investigated the association between older adults’ perceptions of ageing, broadly defined, and their health and functioning. The review showed that negative ageing perceptions were associated with poor health and functioning across a variety of health domains relevant to understanding frailty including: self-rated health; comorbidities; disability; memory; quality of life; mortality. However, conclusions from the review were limited by the quality and cross-sectional nature of the studies. Consequently, the second piece of work analysed data from a large longitudinal sample to test the relationship between older adults’ ageing perceptions and frailty explicitly. Older adults with more negative perceptions of ageing were more likely to be frail after adjusting for age, sex, depression symptoms, and socioeconomic status. However, ageing perceptions were found to be a weak predictor of frailty six years later. To investigate the mechanisms of the relationship between ageing perceptions and frailty, a qualitative exploration of older adults’ understanding of frailty and their beliefs concerning its progression and consequences was conducted as the third piece of work. Twenty-nine participants participated in semi-structured interviews, which were analysed using a Grounded Theory approach. An understanding of frailty as a negative identity and the strategies by which self-identification “as frail” occurs and is resisted were developed. Participants believed that the consequences of self-identifying as frail were poor health and functioning, disengagement from physical and social activities, depressive thoughts, negative affect, stigmatisation, and discrimination. Most participants actively resisted the identity, and they used a variety of resistance strategies. Collectively, the findings from this project indicate that older adults’ ageing perceptions are related to the development and progression of frailty. Ageing perceptions are associated with older adults’ health and how they view themselves – whether they identify as frail and the different strategies they may use to resist identification. Whilst additional research is needed, the results of this research suggest an influential psychosocial aspect to frailty. Accordingly, a new model of frailty and its relationship with older adults’ ageing perceptions is offered. The model has implications for the way frailty is identified, supported and treated.National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) for the South West Peninsul