The model of frailty used in this toolkit helps to highlight the importance of looking for opportunities to support self-care across all domains of frailty, at every stage of the condition, and in all settings along the pathways of care.

It is important to continue to seek opportunities to support self-care for people living with frailty as the condition progresses and an individual’s functional dependency increases. This is equally important whether the person is in their home or in another environment, such as a care home or hospital. In more dependent care settings attempts to support self-care have a tendency to focus upon activities of daily living, such as feeding, washing, dressing and taking medication, but it is important to remember that supporting self-care, to promote psychological wellbeing and maintain motivation, remain equally important.

The National Voices ‘I’m Still Me’ report identified that older people, including those with advancing with frailty, want the opportunity to build relationships with the people involved in their care. Building these positive relationships can play a very important part in supporting self-care as frailty progresses.

The core principles of supported self-care remain important in every setting and at every level of dependency. Every effort should continue to be made to provide people with as much information as possible regarding their condition and to support them to take make their own decisions regarding the care they receive. People with advancing frailty might need greater support in accessing the relevant information, due to increasing sensory or cognitive impairments or worsening fatigue. When making decisions, they might also sometimes wish to have more support from their family or the professionals involved in their care, or require more time for explanation or reflection before making such decisions. The professionals involved in their care must recognise and respond to these changing needs and continue to work in partnership with the person, despite these increasing challenges.

The focus of supported self-care in advancing frailty is to continue helping the person to be as independent as possible and to be able to continue,as far as possible, to do the things that are important to them. The National Voices ‘I’m Still Me’ report identified very clearly that older people, including those with advancing frailty, want to be recognised for what they can do rather than having assumptions made about what they cannot do. They also want the people they are close to, usually their families, to be recognised as key to their independence and quality of life.

People also want to have control over their community and social interactions, and this is important for their psychological status. This needs to be given particular consideration for people who are in a care home setting, where it is easy for the individual’s personal needs or preferences to be overlooked or overruled by the routines or actions of others. Equally, it is important to understand that people in such settings can also experience loneliness and social isolation, despite having people around them.

It is important for everyone involved in the person’s care to recognise that there might be changes in a person’s goals or priorities of care as their condition of frailty advances, and this might have an impact upon the choices they make. This can be particularly true regarding their feelings about the relative risks and benefits associated with certain options, which might include medical treatments or interventions, or might simply concern their daily activities. Supporting self-care means continuing to support and respect the person’s choices, helping them and their carers realistically assess the risks that might be associated with their preferred goals and actions, and helping them to reduce these risks wherever possible.

Understanding the potential to support self-care across the different domains of frailty in different ways, according to the extent of a person’s frailty, the degree of their dependency and their place of care offers opportunities to improve the quality of life for people with frailty at every stage.

What can health and care professionals do to support this self-care?

  1. Continue to seek opportunities to build resilience across all domains, focusing on what the individual can do;
  2. Be particularly mindful of a person’s psychological status and the interaction with their social environment;
  3. Involve families in decision making, particularly regarding changing levels of care needs;
  4. Promote activity.

 

Further information

National Voices “I’m still me” report
PCCJ Plus Article “Supported Self-Management for People with Frailty”
PCCJ Plus “Living with Frailty” issue – all sections