Coping with frailty

A new study offers a more holistic understanding of the complex interplay between frailty, resilience and self-efficacy, and their impact on patient care and recovery in older adults in an acute care context.

Physical and mental well-being — fitness and health, state of mind, and willpower — can and do influence a patient’s ability to cope with illness and loss. At the same time, knowing how these factors play a role in overall well-being helps nurses and caregivers to provide better care.

To understand better how older hospitalised patients experience and perceive frailty, which can affect their resilience and coping abilities, a group of Singapore General Hospital (SGH) nurses interviewed 24 SGH inpatients who were aged 65 years and above and 10 caregivers of inpatients between September 2020 and July 2021.

“We came to understand that frailty encompassed physical elements as well as manifestations of psychological traits, fear of the unknown, and being in control,” said Clinical Assistant Professor (Dr) Siewhoon Lim , Nurse Clinician, Division of Nursing, SGH.

“Older adults and family caregivers shared that a considerable decline in physical health with age and level of perseverance can determine the level of frailty. They felt that one would be less frail when he or she had a better mental state and stronger willpower.”

In the study, led by Dr Lim, patients, relatives and caregivers were asked for their understanding of the terms ‘frailty’, ‘resilience’ and ‘self-efficacy’. The group comprising patients was also asked specifically whether they considered themselves to be frail, what helped them cope with health issues, and what their health goals were. Meanwhile, the other group, comprising relatives and caregivers, was asked about their perceptions of the patient’s health status, whether the patient was frail, and how they helped the patient to cope and attain their health goals.

The mean age of the 24 older adults was 70.4 years old, comprising mostly females (92 per cent) and Chinese (96 per cent). The mean age of the 10 family caregivers was 51.4 years; 50 per cent were female and 80 per cent were Chinese.

Dr Lim had observed that, after years of working in SGH’s colorectal surgery unit, older patients were increasingly being admitted to hospital, often with complex medical conditions. “This raises the importance of understanding how frailty and resilience impact their care and recovery in acute care settings. Investigating how older adults and caregivers perceive their own self-efficacy in the acute care setting could also shed light on areas where interventions may improve patient outcomes and caregiver burden,” she said.

She had wanted to gain a more holistic understanding of the complex interplay between frailty, resilience and self-efficacy as a way of examining how the quality of care and support for older patients and their caregivers can be enhanced. Earlier studies had focused on the individual factors in isolation.

Participants discussed frailty in association with their health beliefs and personal fears. For instance, both the older adults and family caregivers described frailty as being closely related to physical condition, was inevitable as people age, and would be accompanied by mental frailty. However, some also believed that a better mental state and greater willpower could to some extent mitigate growing frailty.

Many participants highlighted concerns about the unknown. Becoming frail and sick unexpectedly can lead to a loss of independence, thus becoming a burden to their families. “Hence, being in control appeared to be a common coping response of these older adults, through active involvement in the management of their own health,” said Dr Lim.

Nurses can help patients to be more involved in their own care during hospitalisation and in the community, and enhance their independence in response to coping with frailty, she added. “It’s important to understand the diverse conceptualisation of frailty, across psychological and social dimensions, which differed from the physical definitions of frailty. Resilience and self-efficacy play a pivotal role in the context of frailty in the older adults,” said Dr Lim. “Understanding resilience in this context will assist nurses to facilitate the use of individual and sociocultural resources that may improve how resilience is experienced by older adults. Nurses can provide guidance on coping strategies for older adults to help them be more involved in their own care and enhance their independence in response to coping with frailty.”

Findings from the study were shared at professional healthcare conferences, including the SingHealth Duke-NUS Conference 2023 and 5th SingHealth Nursing and APN Conference 2023.

This article was first published in Singapore Health Mar-Apr 2025 issue.