A qualitative study regarding older people's goals of care in relation to frailty status: finding meaning in 'smaller things' in life.

Abstract

Background: Increasingly frailty assessment is part of the shared decision-making process of older patients. However, little is known of the role of frailty in goals of care among the diverse group of older persons.

Objective: To explore the role of frailty in older people's perspectives on goals of care in case of acute and/or severe disease.

Methods: We conducted semi-structured interviews with people aged ≥70 years in the Netherlands (n = 26), which were purposively sampled based on a self-reported Clinical Frailty Scale. The interviews were analysed using thematic content analysis to compare frailty subgroups.

Results: Three themes regarding goals of care emerged: (1) preserving well-being in one's lifeworld through life goals; (2) goals related to care, as access to appropriate care, good contact with care professionals and a dignified end-of-life; (3) differences in attainment and adaptation of goals of care according to frailty status. The first two themes appeared to be independent of frailty status. However, differences were seen in theme 3, as fit older people primarily strengthened their capacity to attain goals of care, while frail older people primarily adapted the meaning ascribed to goals of care and had higher acceptance of the life cycle.

Conclusion: Goals of care that older people want to attain are driven by life goals, independent of frailty. Therefore, older people with varying frailty status could be treated similarly in goal-setting and life goals. However, different support may be needed for the attainment and adaptation of their goals of care.