Proxy indicators to support independent ageing-in-place in older people with frailty: a Delphi-style expert...

Frailty is a clinical syndrome associated with greater risk of functional limitations and dependency. However, older people with or at risk of frailty who live at home can still lead fulfilling lives, engage with their community, and maintain a good quality of life, that is, age in place well. To support this and prevent resource-intensive care use, this expert consultation survey aimed to identify proxy indicators that capture ageing-in-place experiences in community-dwelling older people with frailty.

Using a modified Delphi approach, two survey rounds were conducted to build consensus on proxy ageing-in-place indicators in relation to frailty. Eighty-nine indicators were extracted from a rapid literature review and grouped into five themes: Personal Characteristics of Older People, Place, Social Networks, Support, and Technology. Eighteen experts in geriatric care and gerontology rated indicators for importance for ageing-in-place and feasibility of routine measurement. Consensus for importance and feasibility was defined as mean scores ≥ 4.0 (scale 1-5), suggesting indicators were extremely/very important for ageing-in-place and extremely/very feasible to measure routinely. Public contributors, who were experts by lived experiences of frailty and ageing-in-place, also reviewed the indicators and survey findings.

Only four proxy indicators reached consensus for importance and feasibility: "physical performance and mobility", "multimorbidity", "sensory function", and "pressure ulcers" (all Personal Characteristics). Twenty-seven indicators were extremely/very important for ageing-in-place but not as feasible to measure routinely (17 related to Personal Characteristics, 4 to Social Networks, and 3 to Place and Support). Only five indicators (the four consensus indicators and "polypharmacy") were extremely/very feasible to measure routinely. No technology-related indicators were extremely/very important or feasible to measure routinely. Mean scores of few indicators differed by experts' occupations and areas of expertise. Public contributors generally agreed with the survey results but highlighted the importance of technology-related indicators (particularly "digital literacy") and more integrated care records to support targeted care.

This study lays the foundation for developing standardised proxy ageing-in-place indicators to monitor how older people with or at risk of frailty are living in their homes and communities. Future directions include assessing feasibility of capturing non-clinical indicators routinely; applying these indicators to guide personalised targeted interventions; and leveraging technology-related indicators to improve digital inclusion and literacy in older people to support ageing-in-place.