Research Article
“There’s More to Frail than That”: Older New Zealanders and
Health Professionals Talk about Frailty
Susan B. Gee ,
1
Gary Cheung,
2
Ulrich Bergler ,
1
and Hamish Jamieson
1
1
University of Otago, Christchurch New Zealand, Canterbury District Health Board, Christchurch 8083, New Zealand
2
University of Auckland, Auckland 1023, New Zealand
Correspondence should be addressed to Susan B. Gee; susan.gee@cdhb.health.nz
Received 25 June 2019; Revised 15 October 2019; Accepted 26 October 2019; Published 1 December 2019
Academic Editor: F. R. Ferraro
Copyright © 2019 Susan B. Gee et al. is is an open access article distributed under the Creative Commons Attribution License,
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
ere is general agreement that frailty is common and important in later life, but there is less agreement about what frailty is. Little
is known about the extent to which practicing health professionals and older people hold a mutual understanding of frailty. Focus
groups were held to engage older people and health professionals in discussion about what made them think that someone was
frail. Eighteen older people took part across three focus groups, and se’venteen health professionals took part across another three
focus groups. Both the health professionals and the older people talked about the experience of frailty as an interplay of physical,
psychological, and social dimensions. Older people with frailty were seen as needing help and being vulnerable to adverse
outcomes, but accepting help was positioned by older people as an adaptive choice. e experience of frailty was described as being
mediated by the individual’s psychological mindset, highlighting the importance of approaches that recognise strengths and
resilience. A broader and more balanced understanding of frailty may help create more rounded and appropriate approaches to
assessment and management.
1. Introduction
Frailty has variously been described in the medical field as “a
syndrome in desperate need of description” ([1], p. 134) and
in the social sciences as “one of those complex terms...with
multiple and slippery meanings” ([2], p. 48). How frailty is
conceptualised and understood is not merely an academic
exercise: it will shape policies and access to services, care
practices, and social responses and in turn the experience of
frailty [3].
Within the health sector, there is a common underlying
understanding of frailty as an elevated state of risk or vul-
nerability [4]. Older people with frailty are more vulnerable
to a sudden decline in health and negative outcomes (such as
hospitalisation, entry to residential care, or death) in re-
sponse to seemingly small trigger events or changes—from a
bout of influenza to a hip replacement [5–7]. e rates of
frailty are recognised as increasing with age as a consequence
of age-related physiological declines, with estimates that a
quarter to a half of people aged 85 are considered frail [6].
Identifying frailty is seen as clinically useful to more ef-
fectively and appropriately target and facilitate access to care
pathways, interventions, and individualised treatment plans
to prevent or delay adverse outcomes [5, 8, 9].
While clinicians generally agree that they can recognise
frailty and it is useful to do so, there is no consensus as to the
operational definition of frailty in everyday clinical practice.
One common approach is that frailty is a unidimensional
medical syndrome (or phenotype) with an underlying bi-
ological cause. Frailty can therefore be measured by simple
criteria-based screening tools that commonly include
shrinking, weakness, exhaustion, slowness, and low activity
[5, 10]. In some models, this is linked to a defining char-
acteristic of a loss of independent capacity to carry out
practical and social activities of daily living [11]. A second
approach gaining popularity is that frailty represents an
accumulation of a range of deficits, so that the more things a
person has wrong with them, the more likely that person is
to be frail. Frailty, from this perspective, is best measured
using a broad index [12]. Research has found that both
Hindawi
Journal of Aging Research
Volume 2019, Article ID 2573239, 13 pages
https://doi.org/10.1155/2019/2573239