THE CONCEPT OF CONFIDENCE OF OLDER PEOPLE LIVING WITH FRAILTY AND IMPLICATIONS FOR PRACTICE
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Background Our human world is aging. The prevalence of older people living with syndromes of frailty is growing too. Frailty syndromes, such as falls, immobility, delirium, incontinence and susceptibility to medication side effects, are leading causes of acute hospitalisation of older people. Confidence is recognised to impact on individuals’ physical health and mental well-being, despite it not being clearly expressed in the literature. Health and social care policy and practice now focus on frailty interventions to reduce long-term demands of this growing population. Understanding the relationship of the concept of confidence and its associated impact on the physical health and mental well-being of older people living with frailty is important. It is fundamental that opportunities are identified for interventional practice-based developments that address confidence-related issues. Aim To explore and develop a concept of ‘confidence’ in the context of older people living with frailty and to consider implications for practice. Method The Knowledge-to-Action Framework’s knowledge creation funnel informed a four-stage interpretivist study design to explore and develop the concept of confidence. This sequential approach to knowledge growth included: qualitative systematic review meta-aggregation of the literature; primary concept construction; an interpretive phenomenological enquiry; and method triangulation to inform a final conceptual outcome. Findings Method triangulation identified convergence across the three studies to present a final concept of confidence from the perspectives of older people living with frailty. Four interdependent paradigms form this construct of confidence: social connectedness, fear, independence and control. This new concept connects the contemporary frailty care through the biopsychosocial and environmental cornerstones of Comprehensive Geriatric Assessment commonly adopted to manage frailty syndromes. It enables clearer understanding and opportunity for intervention along the continuums of health and frailty and of resilience and vulnerability. Conclusion Confidence is a word that can often be dismissed or misused. This research raises its status as a credible force in the lives of older people. The newly defined concept of confidence in older people living with frailty compellingly associates this with frailty models exposing assets as it does deficits. The new concept of confidence now needs empirical referents developing to measure and quantify impact across new interventional opportunities in practice.