The ‘Balance’ of Frailty: A Case Study Analysis of Occupational Therapy Practice

This research was conducted within a single integrated acute and community healthcare trust to explore the role of Occupational Therapists (OTs) with frail older people across acute, intermediate and primary care settings. A group of local and national stakeholders were interviewed as a preliminary stage of this study. A constructionist position with an interpretivist epistemological perspective aligned with the utilisation of case study methodology in this qualitative study. An individual Occupational Therapy (OT) case study was purposefully selected in each of the acute, intermediate and secondary care settings, and four members of their multi-disciplinary team were selected by each case study OT to provide additional perspectives on the role of the OT in that specific setting. The stakeholder and three OT case study interviews were recorded, transcribed and thematically analysed. This analysis informed a cross case analysis of the three OT cases from which a ‘balance of frailty’ conceptual framework was constructed. OT practice is described across three main themes of ‘precarious balance’, ‘the ‘tipping point’ and ‘restoring the balance’ The long term condition of frailty is a transitional multi-component state which can be missed in the early stages. The study findings indicate that OTs were well placed to identify silent or ‘hidden’ social and cognitive triggers for an older person who may become frail. Through occupational analysis OTs were able to contribute to the early diagnosis of this condition. In the acute setting OTs were able to detect silent triggers and provide solutions to prevent future admissions. In-depth assessment and intervention were most appropriate in the home or community environment where assessment of normal habituation, effort levels and risk factors were considered in providing an accurate and client orientated assessment. OTs have an ‘occupational lens’ across the transitional levels of frailty within acute and community contexts. They can enhance living well in the early stages of frailty and promote ageing well when increased levels of support are required in more advanced levels of frailty.