Exploring the lived experience of control and well-being of older people living with frailty within the healthcare service provision in southern England.

Abstract

The high prevalence of frailty among the older population in the UK presents a critical policy challenge. Frailty is characterised by reduced functional capabilities and an increased risk of sudden health decline, resulting in significant personal and social limitations. To address this issue, it is crucial to enhance our understanding of the experiences of older people, as this facilitates a more humanising approach to healthcare. Central to this exploration is the concept of a sense of control—a vital element for older people within health and social care systems. A sense of control is intrinsically linked to their ability to influence their environment and achieve desired outcomes, both of which are fundamental for maintaining agency, dignity and well-being. Yet, there exists a gap in existing literature regarding the lived experiences of a sense of control and well-being among older people living with frailty, particularly in the context of healthcare utilisation. This study employed a hermeneutic phenomenological approach to explore the lived experiences of control and its impact on well-being among older people living with frailty. Additionally, it incorporated perspectives from Day Hospital staff on factors that enhance control and well-being for older people living with frailty within healthcare services. Utilising a lifeworld theoretical framework, the research obtained insights through semi-structured interviews with 20 older people and 10 Day Hospital staff, who were purposefully selected. The analysis of the interviews with older people, guided by van Manen’s principles of hermeneutic phenomenological reflection, revealed essential themes that were further enriched by insights drawn from the staff interviews. The findings indicate that older people living with frailty often experience a gradual decline in bodily function, leading to a diminished sphere of influence. This challenge requires them to seek healthcare services in an effort to maintain a sense of normalcy amid uncertainty. Crucially, the study emphasises that a sense of control is not merely a static attribute but a dynamic experience for older people living with frailty, shaped by their interactions with healthcare providers. Recognising their insiderness can enhance their engagement with healthcare services, promote agency, and foster a greater sense of control. The findings also highlight the emotional aspects of healthcare services, underscoring the importance of often-overlooked existential elements of service provision. Ultimately, this research articulates a language and path toward improving healthcare services and the well-being of older people living with frailty.