title: [Living and dying with frailty : Qualitative interviews with elderly people in the domestic environment].
abstract: BACKGROUND
  Frail older people are becoming an increasingly more important target group in healthcare provision. Little is known about patients' views on frailty and its various impacts, especially towards the end of life. This study was carried out to analyze the needs of frail elderly people at the end of life.
  
  
  METHODS
  A qualitative, longitudinal case study design was applied and included 31 frail older patients (≥ 70 year) with a Canadian study of health and aging (CSHA) clinical frailty scale (CFS) grade 6/7 from urban and rural areas within the region of Lower Saxony. The analysis was based on guided interviews and followed the principles of grounded theory.
  
  
  RESULTS
  From the patients' perspective frailty is perceived as a process of increasing complexity of health problems, increased vulnerability and reduced ability to perform tasks. Frailty is experienced as various deficits including the physical, psychological, social and existential dimensions. Living and dying in a familiar environment and maintaining autonomy was identified as a core category. Key determinants were access to and quality of healthcare services as well as various individual and social resources.
  
  
  CONCLUSIONS
  A palliative biopsychosocial care approach should be established early in the process of frailty, including advance care planning in order to meet the patients' needs of staying in a familiar environment. General practitioners as well as home care nursing personnel have to collaborate in order to balance issues of autonomy with increased care needs and the support of informal carers as key partners towards the end of life.
authors.affiliation: Institut für Allgemeinmedizin, Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
authors.forename: Katharina
authors.initials: K
authors.lastname: Klindtworth
authors.affiliation: Institut für Allgemeinmedizin, Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
authors.forename: Karin
authors.initials: K
authors.lastname: Geiger
authors.affiliation: Institut für Pflegewissenschaft und -praxis, Paracelsus Medizinische Privatuniversität Salzburg, Strubergasse 21, 5020, Salzburg, Österreich.
authors.forename: Sabine
authors.initials: S
authors.lastname: Pleschberger
authors.affiliation: Institut für Allgemeinmedizin, Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
authors.forename: Jutta
authors.initials: J
authors.lastname: Bleidorn
authors.affiliation: Institut für Allgemeinmedizin, Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland. schneider.nils@mh-hannover.de.
authors.forename: Nils
authors.initials: N
authors.lastname: Schneider
authors.affiliation: Institut für Allgemeinmedizin, Medizinische Hochschule Hannover (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Müller-Mundt
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology*; D000368:Aged; D000369:Aged, 80 and over; D001293:Attitude to Death; D001294:Attitude to Health; D005260:Female; D016330:Frail Elderly / Q000523:psychology* / Q000706:statistics & numerical data*; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007407:Interviews as Topic; D008137:Longitudinal Studies; D008297:Male; D026684:Personal Autonomy; D011788:Quality of Life / Q000523:psychology*; D012424:Rural Population / Q000706:statistics & numerical data; D014505:Urban Population / Q000706:statistics & numerical data; D035862:Vulnerable Populations / Q000523:psychology* / Q000706:statistics & numerical data
keywords: Family practice; Health services research; Independent living; Needs assessment; Palliative care