Although there is a good deal of evidence for supported self-care for older people with long-term conditions in general, to date there is little specific evidence concerning self-care in people with frailty.
However, the concept of frailty as a long-term condition in its own right is becoming increasingly well established, and therefore the sort of approaches to self-care that have been shown to be of benefit in other long-term conditions might also be helpful for people with frailty.
The evidence for supported self-care in long-term conditions shows that integrating education about the condition into routine care is the most effective approach to supporting self-care. It also shows that the benefits of supported self-care include increased knowledge and understanding of the condition, leading to greater confidence and a better ability for individuals to cope with their condition.
The fact is also that many people with frailty will also be living with other long-term conditions. Evidence about supported self-care in people living with multiple, rather than single, long-term conditions are likely to be more relevant to the consideration of people living with frailty. Although there is less evidence available concerning self-care in people with multiple, rather than single, long-term conditions, the evidence does show that self-care can result in small but significant improvements in quality of life and reductions in hospital use for this group.
Evidence concerning self-care in people with dementia is also likely to be relevant for people living with frailty, as many people with frailty will also have a diagnosis of dementia or some degree of recognisable cognitive impairment. This evidence shows that there is a need for information and support not just for those people with the diagnosis of dementia, but also for their carers. It shows that psychological and social support for both patients and carers is important and that coping based strategies for carers can help people with the condition to be supported at home and improve their quality of life.
For people with dementia, evidence also shows the importance of supporting self-care for other problems, for example, physical health, alongside consideration of needs relating to their cognitive impairment. Again this is likely to be relevant for people living with the multi-dimensional condition of frailty.
For long-term conditions in general, the effectiveness of supported self-care depends upon, amongst other things, clearly identifying the target “patient” group for self-care support. This means being clear about both the diagnosis of the long-term conditions and understanding at what point in the individual’s care pathway self-care is likely to be most helpful. The best approaches to self-care for people with frailty are therefore likely to vary according to the stage or severity of the person’s frailty and according to different points along their journey of care.
At the moment there is no specific evidence regarding self-care interventions for frailty in general or for different stages of the condition or at different places of care or points in the pathways of care. However, through our evolving understanding of the multi-dimensional and dynamic nature of frailty, we can begin to understand and build opportunities to support self-care throughout the course of the condition.
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