Age Stereotypes and Their Potential Relationship to Frailty Risk in Older Adults A Literature Review to Improve Understandings and Orient a Nurse Practitioner Response

Abstract

The older adult population is growing in Canada. This is accompanied by increasing rates of frailty, making it a healthcare priority. A nurse practitioner (NP) approach emphasizing holism, health promotion and illness/injury prevention may be particularly well-positioned to lead this challenge. NP practice experience identified older adult reluctance to engage in evidence-based frailty mitigating recommendations because of beliefs that they are unlikely to be of benefit or are too risky and generated the questions: Where might these beliefs come from? How powerful is their impact on the progression and outcomes of frailty? And how might frailty be mitigated by addressing them? Frailty concepts and best practice guidelines have yet to explore systemic factors, such as age stereotypes, as potential reversible risk factors and sources of health inequity for older adults. This literature review aims to explore (a) the existing literature on the relationship between age stereotypes and frailty, (b) the underlying assumptions and objectives of this knowledge base, (c) the gaps and limitations for informing NP knowledge and practice development, and (d) the implications for NP practice. 

Methodology and methods: This literature review was designed to inform a future interpretive description study to develop understanding and inform disciplinary action. 

Results: Studies exploring the potential relationship between age stereotypes and frailty, wholly and directly, are few and inconsistent in their findings. There is significantly more research suggestive of a relationship between age stereotypes and singular frailty factors, across multiple domains, and associated outcomes. 

Discussion: The literature exploring the relationship between age stereotypes and frailty appears to justify concern and warrant further inquiry and action. To orient and inform future knowledge development for NPs, the existing knowledge is examined and critiqued to reveal its underpinnings and gaps for disciplinary knowledge development. Until such knowledge is available, NPs can lead an initiative to embrace the opportunities inherent in existing knowledge and create practice change through critical self-reflection, a shift in approach with older adult clients, disruption of social systems, and re-consideration of engagement with the concept of frailty. 

Conclusion: NPs will increasingly provide healthcare for older adults. Experience in NP practice generated the concern about a potential relationship between frailty and age stereotypes, which appears supported by the existing, but limited, literature base. There remains an intriguing space for future NP research and an emerging awareness that is a call to action to prevent harm and health inequity for older adults.