Promoting well-being in frail elderly people: theory and intervention

In this project, it was investigated if well-being in frail elderly patients (hospital and family practitioners patients) can be increased by means of increasing their Self-Management Ability (SMA). Frail elderly people have suffered interacting losses in physical, social, and psychological domains of functioning. These losses lead to a decreased reserve capacity for dealing with these and new losses. As such, frail elderly people have a risk of declining well-being. To counteract or mitigate these negative consequences of frailty, an intervention was proposed to increase frail elderly people’s adaptive abilities (self-management abilities) to realize well-being. The intervention consisted of six home visits by a geriatric nurse. The visits were psycho-educational and contained information and assignments. Effects of the intervention were tested by comparing an experimental and a control group, both about 50 persons. Besides, some theoretical models about the expected relations between frailty, self-management abilities and well-being were tested in several samples. These samples consisted of elderly people with different levels of frailty. Main results and conclusions: - Using frailty to select older people at risk for interventions may, therefore, be a large improvement compared to selecting people using chronological age. - Both self-management abilities and well-being can be increased in frail elderly hospital patients by means of a general intervention that does not focus on the consequences of specific diseases, but on elderly people’s general capacity for realizing well-being. - The intervention increased overall well-being, which includes physical, social, and psychological well-being. - The intervention increased the self-management abilities and via these, well-being. - The increase in self-management abilities and well-being was found in the short term (directly after the intervention) and in the longer term (4 months after the intervention). - We were able to give our intervention a clear theoretical basis that connected the problem, the working mechanism, and the outcomes. Using the theoretical, we were able to design an intervention that increased the theoretical mechanism of self-management abilities and thereby appeared to lead to the expected outcome (increased well-being). - Most of our theoretical propositions predicted positive well-being well. Other theorizing might be required to capture relevant predictors for negative well-being. Well-being must be considered multidimensionally. - Self-management abilities are mostly related to positive aspects of well-being; frailty is mostly related to negative aspects of well-being. - The SMA intervention can be implemented in transmural care for frail elderly hospital patients, but additional criteria for selecting the patients have to be used.