The meaning of confidence from the perspective of older people living with frailty: a conceptual void within intermediate care services.

Background Confidence is a cornerstone concept within health and social care's intermediate care policy in the UK for a population of older people living with frailty. However, these intermediate care services delivering the policy, tasked to promote and build confidence, do so within an evidence vacuum. Objectives To explore the meaning of confidence as seen through the lens of older people living with frailty and to re-evaluate current literature-based conceptual understanding. Design A phenomenological study was undertaken to bring real world lived-experience meaning to the concept of confidence. Methods Seventeen individual face-to-face interviews with older people living with frailty were undertaken and the data analysed using van Manen's approach to phenomenology. Results Four themes are identified, informing a new conceptual model of confidence. This concept consists of four unique but interdependent dimensions. The four dimensions are: social connections, fear, independence and control. Each is ever-present in the confidence experience of the older person living with frailty. For each dimension, identifiable confidence eroding and enabling factors were recognised and are presented to promote aging well and personal resilience opportunities, giving chance to reduce the impact of vulnerability and frailty. Conclusions This new and unique understanding of confidence provides a much needed evidence-base for services commissioned to promote and build confidence. It provides greater understanding and clarity to deliver these ambitions to an older population, progressing along the heath-frailty continuum. Empirical referents are required to quantify the concept's impact in future interventional studies.