Walking the frailty tightrope : exploring the construction of identity in older people with frailty within an NHS Day Hospital

People with frailty are less likely to recover from illness and are at greater risk of falls, institutionalisation and death. Rates of frailty are increasing and expected to rise as the population ages putting great pressure on the NHS. Over the last 20 years frailty has been explored in terms of biomedical assessment and intervention however authors report that older people do not necessary value or want to take part in 'frailty' services. Focusing on identity and sense of self, this study set out to determine how a Day Hospital providing frailty services; which were highly regarded by older people, supported people to engage in services. This ethnographic study aims to contribute to this gap in knowledge through exploration of the socio-cultural experiences of older people undergoing treatment in an NHS Day Hospital. Through approximately 100 hours of participant observations and additional focus group discussions, the cultural practices and processes, interactions and experiences of care within the Day Hospital were documented and analysed. The findings of the study contribute knowledge in three main areas firstly; that sense of self-identity in people with frailty is constructed through numerous losses and social perceptions that shape their social roles. This can create a sense of ontological insecurity, or disruption to the order of their lives as they know them. Secondly humanising processes within the Day Hospital, supported people with frailty to feel more secure in their daily activities, social roles and identities. This was achieved through fostering a hospitable environment and building a culture of humanising relationships on embodied relational knowledge. These cultural processes contributed to older people with frailty engaging more fully in their rehabilitative journey. Finally, the study revealed that the construction of a nurturing and accepting work culture, is an essential foundation to support humanising and embodied practice for older people with frailty. Fostering a culture where positive sense of self for both patients and staff is supported is key to continued therapeutic engagement. Changes in personal identity in people with frailty and the responses needed to address them need to be considered by policy makers and healthcare providers to provide appropriate and effective care services.