Feature Article Health despite frailty: Exploring influences on frail older adults’ experiences of health Zahra Ebrahimi, RN, PhD(C) a, b, * , Katarina Wilhelmson, MD, PhD a, b , Kajsa Eklund, OTR, PhD b, c , Crystal Dea Moore, MSW, MA, PhD d , Annika Jakobsson, RN, PhD a a Sahlgrenska Academy, Institute of Medicine, Unit of Social Medicine, Department of Public Health and Community Medicine, University of Gothenburg, Sweden b The Swedish Institute for Health Sciences, Sweden c Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Sweden d Skidmore College, Saratoga Springs, NY, USA article info Article history: Received 4 June 2012 Received in revised form 9 April 2013 Accepted 15 April 2013 Available online 10 May 2013 Keywords: Frail older adults Perceptions of health Feel assured Promoting health and well-being abstract The aim of this study was to explore and identify influences on frail older adults’ experience of health. A sample of older adults,11 men and 11 women aged 67e92, with diverse ratings of self-perceived health ranging from poor to excellent were selected through a purposeful strategic sampling of frail older adults taken from a broader sample from a quantitative study on health. In total, 22 individual qualitative interviews were analyzed using qualitative content analysis in which themes were developed from raw data through a systematic reading, categorization of selected text, theme development and interpreta- tion. To feel assured and capable was the main theme, which consisted of five subthemes: managing the unpredictable body, reinforcing a positive outlook, remaining in familiar surroundings, managing everyday life, and having a sense of belonging and connection to the whole. The importance of sup- porting frail older adults in subjective resilience in their context is emphasized. Ó 2013 Mosby, Inc. All rights reserved. 1. Introduction Maintenance of health in old age is both a challenge and goal of the health care system. The proportion of people aged 65 and older is expected to increase worldwide in the coming decades. 1 Reserve capacity decreases, and the risk of morbidity and frailty increases by aging. 2 There is a close link between ill health and frailty in older adults; a combination of multimorbidity, impairment of reserve and functional capacity, and dependency on others in daily activities is associated with frailty. 3e5 Although there is no strong consensus as to its definition, frailty as a multi-factorial syndrome is a concept often used to understand aging and health among older adults. 3 Distinct from aging, 6 frailty is preventable. 7 Knowledge of frail older adults’ descriptions and perceptions of their health and how they experience health despite frailty is scarce. To fully understand frailty, individuals’ subjective perceptions of health in their unique context should be taken into account. 8 Eriksson 9 links health to suffering and posits “health is endurable suffering.” Unendurable suffering hinders human development, and therefore care is inten- ded to alleviate it. Eriksson defines health as physical and mental soundness and feelings of well-being and wholeness. This definition of health is holistic and multidimensional, relative, and subjective. 10 Healthy and successful aging have been associated with the older adults’ ability to constantly modify, reassess, and redefine oneself. 11 Older people perceive healthy and active aging as main- taining physical health and function, leisure and social activity, and social relationships and contacts. 12 This has been conceptualized as a balance among life habits and activities in order to bring harmony and well-being. 13 There are different theories on successful aging but no consensus on definition. Successful aging from a public health perspective is defined as an optimal state of overall func- tioning and well-being (objective perspective), while older adults define successful aging as a process of adaptation within a specific context, 14 as a social experience, a coping strategy and a way to have fun to achieve and maintain a subjective feeling of well- being. 15 Older adults, who were independent in activities of daily living and rated their health as good to excellent, defined successful aging as multidimensional phenomenon encompassing physical, functional, psychological and social health. 16 Declaration of conflicting interests: The authors declared no conflicts of interest with respect to authorship and/or publication of this article. Funding: The authors disclosed receipt of following financial support for the research and/or authorship of this article: Vårdalinstitutet, The Swedish Institute for Health Sciences. * Corresponding author. Department of Public Health and Community Medicine, Unit of Social Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 453, 405 30 Gothenburg, Sweden. E-mail address: zahra.ebrahimi@socmed.gu.se (Z. Ebrahimi). Contents lists available at SciVerse ScienceDirect Geriatric Nursing journal homepage: www.gnjournal.com 0197-4572/$ e see front matter Ó 2013 Mosby, Inc. All rights reserved. http://dx.doi.org/10.1016/j.gerinurse.2013.04.008 Geriatric Nursing 34 (2013) 289e294