What do we know about nursing practice in relation to functional ability limitations, frailty and models of care among older people in home- and facility-based care: a scoping review

BackgroundNursing practice in long-term care, must support the delivery of safe and evidence-based care, especially for older people with functional ability limitations and frailty, with the competency, knowledge and structured working modes such practice requires. Understanding, detecting and preventing these conditions is important in a context where care is given to a significant number of older people with complex care needs. Our aim was to map published literature on how functional ability limitations and frailty among older people (65 and above) in home-and facility-based care (i.e. long-term care) were described by key stakeholders, and to identify models of care (MoCs) targeting these conditions.MethodsWe followed Arksey and O'Malley's methodological steps and the PRISMA-ScR reporting guidelines. The PubMed, CINAHL and PsycInfo databases were used to identify papers published between June 2002 and June 2022. The search was updated in May 2024. A descriptive analysis was conducted where the identified patterns were organised and categorised with the support of the Pattern, Advances, Gaps, Evidence for practice and research Recommendations framework (PAGER).ResultsA total of 18,875 unique records were identified. Of these, 26 papers were included. The findings implied a discrepancy between the older people's subjective- and the nurses' more objective, 'matter-of-fact' perspective. The older people described both conditions in terms of identity loss and an emotional struggle to remain independent. They also highlighted the importance of positive connotations in relation to their efforts to adapt and accommodate the situation to the conditions. Nursing practice targeting the conditions were predominantly described as being reactive, based on their experiences and guided by 'intuition'. The identified MoCs mainly targeted functional ability limitations while focusing on educating nurses.ConclusionA point of saturation seems to have been reached regarding research focusing on older people's descriptions of frailty in home-based care. The same cannot be said about older people's or nurses' descriptions concerning functional ability limitations or MoCs. Intervention studies focusing on nursing practice and the development of MoCs that target these conditions preferably in a home-based care context could substantially benefit the development of knowledge within nursing and nursing practice.Trial registration: Open Science Frameworkhttps://doi.org/10.17605/OSF.IO/FNHSA.