Discussion
pain
SECONDARY, RECRUITMENT
The study aimed to assess the feasibility of identifying older frail adults living in the community and pilot subsequent CGA & CSP delivery by ANPs. Of 164 individuals identified at the eFI screening stage, 44.5% (The target recruitment number for this study was 160 participants; however, only 72 patients were recruited. Most patients were recruited from one of the GPs (n = 63). The low-recruiting GP centre had a period of staff shortage and did not progress according to the plan. However, the higher recruiting GP centre had one consistent administrative staff who indicated their use of communication techniques to engage and build a rapport with patients during the recruitment telephone call. This could have been key to this centre's success because frailty can carry a negative stigma associated with the end of life [Fifteen per cent of eFI-eligible individuals were not clinically eligible to enter the study. Even some of those who were diagnosed as frail and entered the study expressed in their interview that they believed they were not ‘frail’ or ‘old’ enough to take part. This contributes to the debate on the conceptual ambiguity of frailty and that when presented as a measure of true discourse, it can be problematic [Although available clinical guidelines consistently recommend frailty identification, assessment and management strategies, implementing these strategies is challenging and dependent upon individual patient characteristics, circumstances and contextual factors and the level of resources and support available [Although the outcomes did not reach statistical significance to show group differences, the health service use (i.e., hospital admissions, GP/999 calls and GP/A&E attendance) was higher in the TAU group compared to the intervention group at the end of the study. The TAU group showed a deterioration in FIM total and motor and cognition subscales post-intervention, though the role limitation due to physical function and pain outcomes improved. In the intervention group, the ITT analysis revealed that the outcome measures did not differ significantly from the baseline. A sample size calculation using SPSS, acquired from the mean (SD) hospital admission of 1.06 (2.09) and 3.00 (5.83) for the intervention and TAU groups, respectively, and power (1 – β) of 0.8, revealed a total of 164 (α = 0.05) or 244 (α = 0.01) participants are needed.The qualitative findings indicate that ANPs provided consistent quality care by spending time to become more aware of the health and care needs and preferences of participants, building a strong relationship with them, signposting to wider services, and acting as a liaison for follow-up care. This would give a more accurate assessment of their needs and further follow-ups. A review of both qualitative and quantitative studies identified the essential components of implementing person-centred care for older adults, including knowing the older patient as a person, building a relationship of trust, working in an interprofessional team with and for the patient, co-creation of tailored health and care plan, and empowering the person [The post-intervention outcome assessments were conducted by a research nurse over the phone in both study groups. However, the bias attributable to the mode of data collection is considered minimal [Sufficiently powered studies with a health economic evaluation are required before the approach proposed in this study is adopted on a larger scale. The intervention was delivered to older adults with mild, moderate, or severe levels of frailty over a period of 6 months, and this may be a reason why the secondary outcomes did not demonstrate significant changes. For a further study, it is recommended to target older adults with moderate or severe levels of frailty who may benefit more from the CGA & CSP. Additionally, extending the intervention delivery time to over 12 months with a 6-month interim review could be beneficial.