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Psychological frailty adds most to overall feelings of frailty, but is often neglected, although meaning in life is important for psychological well-being. The purpose of this paper is to explore the sources of meaning in life within psychologically frail older people.

Data (n= 16,872) generated from the Belgian Ageing Studies were collected, using the Comprehensive Frailty Assessment Instrument and the Sources of Meaning Profile (SOMP-R) instrument. Psychometric properties of the SOMP-R were explored using factor and reliability analysis and one-way-ANOVA analysis were used to asses mean differences.

Financial security, meeting basic needs and personal relations play an important role as sources of meaning in life. Moreover, the SOMP-R showed excellent psychometric properties.

Due to the cross-sectional design of this study, evolution in time and causal links could not be assessed.

The findings of this study emphasize that sources of meaning in life are relevant and can be assessed using the SOMP-R upon which individually tailored care plans can be developed. The results show that, meaning in life as such plays an important role for psychologically frail older people. As a consequence, this offers insights to support these older people. Caregivers and policymakers might therefore take these results into account. Guarantee and/or follow up a frail individual’s financial security, assessing and enabling one’s personal relationships and meeting their basic needs are very important when taking care of psychologically frail older individuals.

Besides the practical implications, the social inclusion of psychologically frail older people seems to be relevant.

To the best of the authors’ knowledge, the association between meaning in life and psychological frailty in later life is not yet investigated. Further the findings of this study emphasize that sources of meaning in life are relevant and can be assessed using the SOMP-R upon which individually tailored care plans can be developed.

In the context of early detection of frail older people, prior research found several risk factors of multidimensional frailty. The current study aims to validate these risk factors.

Two data sets, Belgian Ageing Studies and Detection, Support and Care for older people: Prevention and Empowerment (BAS and D-SCOPE), in three Belgian municipalities (Ghent, Knokke-Heist and Thienen) were used and compared. The BAS data set (N = 1496) is a representative sample of community-dwelling older adults (60+), while the recruitment of the D-SCOPE sample (validation sample, N = 869) is based on risk factors (e.g. age, marital status, moved in the past 10 years). Frailty was measured with the comprehensive frailty assessment instrument (CFAI). The validity was examined by means of prevalence rates, distribution and the odds rates within both data sets.

The validation sample had an increase in the percentage of elderly who were mildly and highly frail for physical frailty (men: +17.0 percent point, women: +20.7 percent point), for psychological frailty (men: +13.4 percent point, women: +13.7 percent point), for social frailty (men: +24.8 percent point, women: +4.8 percent point) and environmental frailty (men: +24.2 percent point, women: +6.8 percent point). The present results indicate that the risk of being mildly or highly frail was higher in the validation sample in comparison with the BAS data.

The present study proved the validity of aforementioned risk factors. Selecting older people based on these risk factors proved to be an effective strategy for detecting frail older people.

An intervention “Continuum of care for frail elderly people” was designed to create an integrated care from the hospital emergency department (ED) to home. The purpose of this paper is to evaluate longitudinal effects in terms of self-determination in daily life for community-living frail older persons.

A non-blinded, controlled trial with participants randomised to the intervention group or a control group with follow-ups at three, six and 12 months. The intervention involved collaboration between a nurse with geriatric competence at the ED, the hospital wards and a multi-professional team in the community with a case manager as the hub. The intervention’s person-centred approach involved the older persons in all decisions. Inclusion criteria: 80 years and older or 65-79 years with at least one chronic disease and dependent in at least one daily activity. Analyses were made on the basis of the intention-to-treat principle and outcome measure experienced self-determination in daily life measured by Impact on Participation and Autonomy for Older persons (IPA-O). The analysis was made using Svenssons’ statistical method.

There were significant differences in favour of the intervention at three months in self-determination concerning activities at home and at three and six months concerning social relationships.

Self-determination seems to deteriorate over time in both groups, and the intervention “Continuum of care for frail elderly people” seemed to slow the rate of decline in two dimensions; activities in and around the house at three-month follow-up, and at three and six months concerning social relationship. Thus, the intervention has the means to support them in exercising self-determination and aging in place, a valuable benefit both for the individual and for society.

Self-determination is governed by ethical and legal rights in western society. In spite of that, older people are still restricted by others in their decision-making processes. The purpose of this paper is to explore older persons’ different conceptions of self-determination.

A qualitative phenomenographic interview study on frail older persons (n=15).

Three categories emerged, showing the variations of conception of self-determination as experienced by frail older people: first, self-determination changes throughout life; second, self-determination is being an agent in one's own life; and third, self-determination is conditional. In summary, while self-determination is changeable throughout life, and older persons want to be their own agents, and struggle to be that, certain conditions must be met to make it possible for them to be able to exercise self-determination.

Suggestions for supporting and strengthening frail older persons’ self-determination, and indirectly their well-being and health: to have a person-centered approach, treat them with dignity and respect and give them opportunities to influence and to feel involved; to improve their health literacy by, for example, supporting them with enough knowledge to be able to exercise self-determination; to make them feel safe and secure in relationships, such as with family and caregivers.

This study explores frail older persons’ own conceptions of self-determination to be able to gain knowledge of how professionals can support them so that they may experience self-determination in life.

Many social services departments have successfully developed services which meet older people's physical survival needs so that they can continue living in their own homes despite serious disabilities. An emerging priority is to support the morale and quality of life of the same individuals.Assisted by the Social Policy Research Unit (SPRU), a team of social services managers conducted a programme of interviews designed to obtain the views of very old, frail home care clients about their services and their lives in general. A few interviewees expressed very low morale and this seemed to reduce substantially their ratings of satisfaction with the help they received. While it is well established that disability and isolation are linked to depression in older people, it is rare that service providers systematically address these problems. Some practical strategies for this purpose are proposed as a result of this survey.

The purpose of this paper is to explore the association between level of physical activity (PA) and perception of quality of life (QOL) and physical health in frail and non-frail older adults.

Volunteer participants in this quantitative cross-sectional study were a convenience sample of 236 independent residents (120 frail, 116 non-frail) in an assisted living facility in Israel. Frailty was measured by Fried et al.’s phenotype; QOL and physical health were measured using the World Health Organization Quality of Life Instruments (WHOQOL-BREF) questionnaire. PA level was ascertained from attendance lists completed by exercise class instructors in each class during the eight-week study.

Frail older adults who engaged in regular PA (at least 2.5 h/week) reported the same physical health as non-frail older individuals performing a similar level.

Unsupervised PA performed independently was not taken into consideration; exercise class attendance may be a less reliable criterion of PA than collection of objective data, i.e. calories burned; participants were selected from an economically homogeneous population of a specific assisted living facility with easy access to a variety of PA.

The level of PA performed by frail older adults impacts their perceived QOL and physical health. The logs were an incentive to attend PA classes.

A minimum of 2.5 h a week of regular PA can be a protective factor that improves perceived QOL and physical health in frail older adults.

Discharging frail older people from acute hospital settings has been an issue of concern for over 40 years and recent studies suggest that enduring problems remain. This paper explores the experiences of discharge from three different units: an acute surgical ward, an acute medical ward and a specialist ward for older people. Based on extensive data from interviews with older people, their family carers and ward‐based staff, a grounded theory of the discharge experience is presented. This suggests that the quality of discharge hinges largely on whether the focus of efforts is on ‘pace’ (the desire to discharge older people as rapidly as possible) or ‘complexity’ (where due account is taken of the complex interaction of medical and wider social issues). When pace is the focus, ‘pushing’ and ‘fixing’ are the main processes driving discharge. However, when attention is given to complexity, far more subtle processes of ‘informing’ and ‘brokering’ are in evidence. These latter processes are conceived of as forms of ‘relational practice’ and it is argued that such practices lie at the heart of high quality care for older people.

Although there is substantial evidence about the association between frailty and mental illnesses in older people, there is currently little evidence about how this is integrated into psychiatric clinical practice. The purpose of this paper is to explore the attitudes of a sample of psychiatrists in the UK about the concept and assessment of frailty in their clinical practice.

This research used a qualitative approach with semi-structured interviews. Interview schedules and transcripts were analysed using thematic analysis. NVivo software and an audit trail were used for the data analysis.

There were ten respondents (all psychiatrists) in this study. From the interviews, it appeared that some respondents were not be fully familiar with existing concepts of frailty. However, from their perspectives, frailty appeared to be multidimensional, reversible and for some could be enhanced by older people’s ability. Negative stereotypes of being frail could undermine the accessibility to appropriate assessment and care. Existing multidisciplinary assessments, with some adjustments to the particular needs of psychiatric patients, can be used to establish a frailty index.

The concept of frailty, especially those concerning its multidimensional and homeostatic nature, should be further examined to make it more applicable to psychiatric practice. Without much more effort, frailty could be assessed within current psychiatric practices. This could constitute a care plan tailored for frail people with a psychiatric illness, so as to improve the outcomes of their treatment and quality of life.

This article reports an important multi‐centre practice‐based review that identifies good practice and an ideal pathway for the healthcare of frail older people, which, if replicated nationally, could result in improved quality of care and better value for money for the NHS. Data on healthcare resource groups (HRGs) in England were examined as a marker for the management of elderly people through the healthcare system. Care pathways in several different NHS trusts were explored via staff interviews. A high variation in treatment outcomes across centres was found. Principles of best practice were identified and include: comprehensive geriatric assessment; the availability of specialist geriatric teams and wards; and shared assessment and co‐ordination between care agencies.

Re-abling care of frail older people is highly on the agenda in several countries. The purpose of this paper is to have a closer look at the argumentation used for its establishment by local policy actors in the field and the kind of expectations towards the behaviour of frail older people it entails.

The empirical material consists of qualitative interviews with 17 local policy actors in two Danish municipalities. The interviews have been analysed with the help of argumentative discourse analysis.

The most important argument for re-abling care appears to be grounded in economic reasons. However, a second, moral argument was found revolving around the older peoples’ activity, which contributes to the establishment of moral expectations towards frail older people to be active.

As the goal of the study was to analyse understandings and values of key local actors, the implementation of re-ablement programmes and the users’ perspective were not studied.

The paper contributes to the investigation of the shift from universal entitlement as a right to towards market rationalities in Danish elder care.