Lived Experiences of Elderly Patients with Frailty Attending Public Hospitals in Wolaita Zone, Southern Ethiopia

Lived Experiences of Elderly Patients with Frailty Attending Public Hospitals in Wolaita Zone, Southern Ethiopia | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Lived Experiences of Elderly Patients with Frailty Attending Public Hospitals in Wolaita Zone, Southern Ethiopia Besufikad Yilma Desalegn, Habtamu Hurisa Dadi, Habtamu Bekele Beriso, and 3 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8104094/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 5 You are reading this latest preprint version Abstract Background Frailty is a multidimensional condition associated with aging, characterized by reduced physiological reserve and increased vulnerability to stressors, leading to impaired independence and quality of life. In low-resource settings, frailty’s social, emotional, and economic dimensions are poorly understood. This study explored the lived experiences of frail older adults attending public hospitals in Wolaita Zone, Southern Ethiopia. Objectives To investigate and comprehend the lived experience of frailty among elderly patients in public hospitals of the Wolaita zone, Ethiopia, 2024. Methods A qualitative descriptive-phenomenological study design was employed, and semi-structured, in-depth interviews were conducted with 10 frail elderly patients (≥ 75 years) from October 2 to 30, 2024. Frailty was assessed using the FRAIL-NH scale, with scores ≥ 7 classifying participants as frail. Data were analyzed using Colaizzi’s descriptive phenomenological method, and open code software was employed for this process. Based on data saturation, 10 voluntary elderly patients with frailty were included in the study, of whom six were male. The mean age was 77(range from 75 to 81) The analysis of the studies revealed three main themes: the physical experiences associated with frailty, the multifaceted effects of frailty, and the role of social and family support. Conclusion The study revealed that elderly patients with frailty experienced significant physical, psychological, and social challenges. While many benefited from family and social support, they also emphasized resilience and coping strategies to manage their condition. Healthcare providers should offer holistic, empathetic care by recognizing and addressing the unique needs and experiences of frail older adults. Frailty Elderly Hospitalization Qualitative research lived experience Phenomenology Introduction Frailty is a prevalent condition among older adults, characterized by heightened sensitivity to stressors resulting from the gradual deterioration of multiple physiological systems[ 1 , 2 ]. It is strongly linked to aging, long-term health conditions, and functional restrictions that impact independence, well-being, and quality of life in elderly individuals[ 3 ]. Frailty has become a major public health concern due to the aging population, especially in low- and middle-income nations where health systems are sometimes unprepared to handle the demands of senior citizens[ 4 , 5 ]. By 2050, there will be 2.1 billion people worldwide who are 60 years of age or older, with almost 80% of them residing in developing nations[ 6 ]. As life expectancy rises, more people experience frailty and chronic illnesses, which raises hospitalization, disability, dependency, and mortality rates[ 7 ]. Frailty has an impact on older persons' perceptions of aging, independence, and their roles in families and communities in addition to its biological manifestations. According to recent qualitative research, while some older persons exhibit resilience and adjust to social and physical changes, frailty frequently results in feelings of loss, dread of dependency, and social isolation[ 8 , 9 ]. Frailty is becoming a significant yet little-studied public health concern in sub-Saharan Africa. Few research have examined how weak older persons perceive their health and the aging process, despite the incidence among older adults ranging from 10% to 50%[ 10 ]. An estimated 6% of Ethiopia's population is elderly, and this percentage is predicted to rise sharply over the next several decades[ 11 ]. Geriatric care is still scarce despite this demographic shift, with the health system mostly concentrating on acute treatment, infectious disorders, and maternity and child health[ 12 ]. The vulnerability of older persons with frailty is increased by intersecting issues like poverty, chronic illnesses, limited healthcare services, and weak social safety systems[ 13 ]. Qualitative data from Ethiopia and other African nations demonstrate how cultural norms, intergenerational interactions, and evolving family structures influence aging and frailty[ 14 – 16 ]. Many older persons describe feelings of neglect, loneliness, and diminished social value as traditional support networks deteriorate as a result of urban migration and economic constraints[ 17 ]. Therefore, frailty is not just a medical disease but a lived experience that includes social marginalization, emotional difficulties, and physical deterioration. Despite the growing body of quantitative research on ageing and chronic illness in Ethiopia, limited qualitative studies have been done on the lived experiences of frail elderly patients, particularly those seeking care in public hospitals. Developing person-centered, culturally appropriate therapies requires an understanding of how elderly patients with frailty experience diseases, reliance, and healthcare interactions. Thus, the purpose of this study was to investigate and comprehend the real-life experiences of elderly patients with frailty who visit public hospitals in Southern Ethiopia's Wolaita Zone. The results of this study offer insights that can guide compassionate, all-encompassing care for elderly people in low-resource situations and deepen our understanding of the social, cultural, and emotional dimensions of frailty. Methods and materials Study area and period The South Ethiopia Regional State's Wolaita Zone is where the study was carried out. Wolaita Sodo, its political and administrative center, lies roughly 151 kilometers west of Hawassa and 328 kilometers south of Addis Ababa. The zone covers an estimated 4,511.7 km²[ 18 ]. According to a recent survey, Wolaita Zone's population was estimated at 2.161 million[ 19 ]. The zone's health-service infrastructure consists of about 419 health institutions, including 69 health centers and 8 hospitals, including a comprehensive specialty hospital, according to data from the zonal health department[ 20 ]. The Wolaita Sodo University Comprehensive Specialized Hospital (WSUCSH), Boditi Primary Hospital, Bitena Primary Hospital, and Humbo Primary Hospital were the locations of this study. Data was gathered from October 2 to 30, 2024. Study design A qualitative descriptive phenomenological design was employed to explore and understand the lived experiences of elderly frail patients. This approach enabled an in-depth understanding of participants’ perceptions, meanings, and lived experiences associated with frailty. Frailty assessment Participants’ frailty was assessed using the FRAIL-NH scale[ 21 , 22 ], a validated tool that considers fatigue, mobility, resistance, chronic illnesses, and weight loss. Participants scoring 7 or higher on the FRAIL-NH scale were classified as frail, ensuring that only those meeting the validated criteria were included. This threshold, supported by previous studies in institutional and hospital settings, also enabled the study to examine how varying degrees of frailty influenced participants’ daily experiences and challenges Population The source of the population was all elderly patients who attended public hospitals in the Wolaita Zone. The study population comprised all elderly patients who visited selected Wolaita Zone public hospitals during the data collection period. Sample size determination The sample size determination was based on data saturation, which was 10 individuals. Data saturation was achieved when no new themes or subthemes emerged from the interviews, which occurred after conducting 10 in-depth interviews. Sampling procedure Purposive sampling[ 23 ] was used to choose participants for the in-depth interviews, focusing on those who could offer rich and pertinent details on the lived experience of frailty. Recruitment Eligible participants were elderly patients who: Screened positive for frailty using the FRAIL-NH scale Had attended the hospital more than once, Were aged 75 years or older, and Were able to communicate their experiences effectively Must be mentally competent to provide informed consent and articulate their experiences clearly These requirements guaranteed that the participants could offer in-depth explanations of the phenomenon being investigated. Tools and procedures for data gathering In-depth interviews (IDIs) with a semi-structured interview guide of three open-ended questions with probes were used to gather data. Interviews were done until data saturation was achieved, then the guide was written in English. To reduce interruptions and guarantee the accuracy of participants' answers, the lead investigator conducted interviews in private rooms. Each session began with an explanation of the study's goal and an assurance that the participants' information would remain private. In order to record contextual information and nonverbal clues, field notes were recorded both during and right after each interview. In-depth interviews were used to collect the data, and an observation guide was added. Data collection procedure The questionnaires were translated into Amharic and back into English to maintain consistency. Before main data collection, the tool was pretested with two participants who met the inclusion criteria to test the clarity and relevance of the questions. We conducted in-depth, semi-structured interviews[ 24 ] in a private room with Amharic translations of the interview-guided questions. At the start of each interview, respondents were given a copy of the informed consent agreement form; after they consented to participate and signed it, the interview was considered to have begun. To ensure consistency, a template was used to allow flexibility when exploring new topics. The interviews were recorded using audio with the consent of the participants and transcribed verbatim. All participants had the chance to ask questions for clarification regarding the interview or the study, and the participants were notified during the audio recording. Then the interview was accomplished using the 3-topic guide question (background information, lived experience of frailty-related questions, family and social-related information, and coping and adaptation-related information), which was translated into the Amharic language. The researcher avoided jargon that could confuse the participants, and some questions were probed to provide participants with a clearer picture. The data collections were facilitated by two researchers, who were MSc-qualified nurses, and supervised by two MSc nurses. The estimated duration for the interview was 50–60 minutes. Data quality control Credibility Prolonged engagement was maintained with participants to establish trust and foster open communication, enabling the collection of rich and meaningful data. Member checking was conducted by inviting participants to review and verify their transcribed statements for accuracy and to clarify any ambiguous interpretations. Data were collected through both in-depth interviews and direct observation to ensure a comprehensive understanding of the phenomena under study. Peer debriefing sessions were held with the research supervisor to identify and minimize potential researcher bias and ensure the authenticity of interpretations[ 25 ]. Dependability All methodological decisions, including interview guides, coding procedures, and any adjustments made during the research process, were systematically documented to ensure an auditable trail. A semi-structured interview guide was employed to maintain consistency across interviews while allowing flexibility to explore emerging themes and participant perspectives in depth[ 25 ]. Confirmability To enhance objectivity, the research supervisor independently reviewed the coding framework, thematic structure, and supporting data to confirm that interpretations were grounded in participants’ narratives. Direct quotations and illustrative excerpts from participants were incorporated into the findings to provide transparency and demonstrate the linkage between data and interpretation[ 25 ]. Transferability Comprehensive contextual details were provided regarding the study setting, participant demographics, and socio-cultural background to enable readers to assess the potential applicability of findings to other contexts. Participants were purposively selected to reflect diverse backgrounds and experiences, thereby enhancing the breadth and contextual relevance of the insights generated[ 25 ]. Data handling procedures All interviews were audio-recorded and transcribed verbatim to ensure the accuracy and integrity of participants’ accounts. Each transcript was cross-checked against the corresponding audio recording to verify fidelity and correct any discrepancies. Transcripts and coding were reviewed multiple times to ensure consistency and accurate representation of participants’ perspectives. Both raw and processed data were securely stored in password-protected digital folders accessible only to the research team, thereby maintaining confidentiality and data security. Researcher reflexivity Reflexivity was applied throughout all stages of the research process to enhance the credibility and trustworthiness of the findings. The researcher acknowledged the potential influence of prior professional experience lived experience of frailty. To minimize bias, bracketing—the deliberate process of setting aside personal assumptions and professional perspectives—was practiced during data collection and analysis. Reflective journaling and supervisory discussions further supported the researcher’s ongoing self-awareness and critical reflection. Data processing and analysis The data were analyzed using Colaizzi’s (1978) descriptive phenomenological approach[ 25 , 26 ] to deeply explore how frail older adults cope with and adapt to the challenges of daily life. This method was chosen because it allows the researcher to stay close to participants lived experiences and to uncover the true meaning behind their stories. All interviews were first transcribed word for word from the audio recordings and then translated from Amharic into English by the primary investigator. Each transcript was read several times to gain a clear and holistic understanding of each participant’s experience of frailty. As the researcher immersed himself in the data, notes and reflections were recorded to capture emerging insights and emotional tones. Using Open Code (version 4.02), the transcripts were carefully coded, breaking the data into small, meaningful pieces that expressed important ideas or feelings. Codes with similar meanings or relationships were then grouped together into broader categories. From these categories, overarching themes were developed that represented the shared essence of participants’ experiences. Throughout this process, the researcher moved back and forth between the data, codes, and themes—refining interpretations until they felt authentic and grounded in participants’ words. Finally, the summarized findings were returned to participants for member checking, allowing them to confirm that their experiences had been accurately understood and represented. Ethical considerations Ethical clearance was obtained from the ethical review committee of the nursing school on behalf of the Institutional Review Board (IRB) of the Wolaita Sodo University with Ref. Number Ref. No/CRCSD 4/1996/2015). A formal cooperation letter was submitted to the selected Wolaita zone public hospitals, and permission was obtained from the hospital administration to conduct the study. Participants were fully informed about the study’s purpose, their right to skip any question, and their freedom to withdraw at any time without consequence. Written informed consent was obtained from all participants prior to data collection. To maintain confidentiality, all information was securely stored and accessible only to the research team, with identifying details removed from transcripts and reports. The study was carried out in accordance with the ethical principles of the Declaration of Helsinki, ensuring respect, autonomy, and the protection of participants’ well-being throughout the research process. Results Sociodemographic characteristics of the study participants A total of ten frail older adults, aged between seventy-five and eighty-one years, participated in the in-depth interviews. Participants were purposively selected based on predefined inclusion criteria to ensure that they represented individuals with diverse experiences of frailty. Of the total participants, six (60%) were male and four (40%) were female. The maximum FRAIL-NH score recorded among participants was twelve, and the highest reported frequency of hospitalization was four times. Focusing on individuals aged seventy-five years and older allowed the study to capture rich, first-hand insights into the lived experiences, coping mechanisms, and daily challenges associated with frailty in later life(Table 1 ). Table 1 Sociodemographic Characteristics of Frail Older Adults Attending Public Hospitals in Wolaita Zone, Southern Ethiopia, 2024 Variables Categories Frequency Percent (%) Sex Male 6 60 Female 4 40 Age Mean age = 77(range from 75 to 81) Residency Urban 2 20 Rural 8 80 Marital status Married 5 50 Single 2 20 Widowed 1 10 Divorced 2 20 Educational status No formal education 2 20 Primary (1–8) school 3 30 Secondary (9–12) school 4 40 College and above 1 10 Employment status Employed 2 20 Unemployed 5 50 Merchant 2 20 House wife 1 10 FRAIL-NH score 7–8 1 10 9–10 2 20 11–12 4 40 > 13 3 30 Hospitalization 2 times/ year 1 10 3 times/year 4 40 > 3 times/year 5 50 Main theme of the study The analysis of the data revealed fifty initial codes, which were grouped into seven subthemes and distilled into three main themes that capture how frail older adults experience and navigate daily life. The first theme, Physical Experience of Frailty, reflects the challenges participants face in their bodies—feeling tired, weak, fatigued, or physically limited—and the ways they adapt, such as resting, eating nourishing food, and praying to maintain their strength and independence. The second theme, Effects of Frailty, highlights how frailty affects not just the body but also emotions, finances, and overall well-being. Participants shared feelings of sadness, loss, and isolation, as well as financial difficulties and struggles with health issues like loss of appetite, illness, and vision problems. The third theme, Social and family Support, emphasizes the importance of relationships and community in shaping their experiences. Participants described the pain of social isolation, dependence on others, and the anxiety or worry that comes with needing support, yet these same connections also offered comfort and guidance. Together, these themes provide a compassionate and holistic understanding of how frail older adults live, adapt, and find meaning amidst the physical, emotional, and social challenges of frailty. Table 2 Themes, Subthemes, and Main Codes Emerged from Qualitative Data Analysis on the Experience of Frailty among Elderly Patients in Wolaita Zone Public Hospitals, Ethiopia, 2023 Themes Sub-themes Main codes Physical experience of frailty Activity limitation Tiredness, Weakness, Fatigue, Inactivity, Reduced Activity, Loss of Stamina, Difficulty, Disablement, Exhaustion, Fatigability, Immobility Coping with physical limitations Resting, Nutrition, Healthy Diet, Praying Effects of frailty Gloomy feeling Lack of Motivation, Feeling Unsupported, Loss of Relatives, Sense of Loss Related to Condition Economical effect Financial Strain, Eating What Is Available, Health-Related Expenses Effect on health Difficulty Eating, Illness, Loss of Appetite, Sight Problems, Diet-Related Problems Social and family support Social isolation Depression, Sadness, Unhappiness, Dependence, Hospitalization, Loneliness, Friendlessness, Attachment Issues, Social Impact Apprehension Anxiety, Distress, Overthinking, Feeling Saddened Theme 1 : P hysical experience of frailty Activity Limitation Participants reported that frailty severely limited their ability to engage in daily activities, which negatively impacted their quality of life and functional independence. Many described difficulties performing routine physical tasks, such as walking, household chores, or work-related activities, noting that their physical capabilities had progressively declined over time. This deterioration reduced their productivity and made it increasingly challenging to manage activities of daily living independently. A 77-year-old participant stated, “ I feel the absence of strength to perform anything else when I walk, and I move slowly. My health has started to decline over time, and I feel weaker than before ” [p.1]. Similarly, a 75-year-old participant explained, “ I feel tired and unable to move alone as I want. It is difficult to walk without stopping because of fatigue ” [p.2]. Another participant from the oncology unit noted, “ I can’t move or walk as I used to. I feel progressively more tired, and my body becomes weaker and fatigued over time, which may be related to my disease as well as aging ” [p.4]. Coping with Physical Limitations The study revealed that participants employed spiritual and religious strategies to cope with the challenges posed by frailty. Many relied on prayer and their faith in God to manage the physical and emotional burdens of their condition. This reliance provided them with a sense of control, hope, and resilience in the face of health limitations. A 77-year-old participant stated, “ I gave all things to my God; all things happen by His will. We can’t handle anything without God’s support ” [p.1]. Another participant shared, “ In my experience, God is always with me. He can heal me with His holy power, so I am not afraid of anything that happens to me. I have God only ” [p.8]. Theme 2: Effects of Frailty The findings indicated that frailty has multifaceted consequences, affecting physical, emotional, and economic aspects of participants’ lives. Emotionally, participants reported feelings of isolation, loneliness, and difficulty interacting with others, which significantly impacted their well-being. Economically, frailty imposed financial burdens due to healthcare-related expenses and the cost of managing their condition. Participants also described the physical toll of frailty, including persistent discomfort, fatigue, frequent hospitalizations, and challenges in carrying out everyday activities. These narratives underscore how frailty extends beyond physical limitations, profoundly shaping the social, emotional, and economic dimensions of older adults’ lives. Gloomy Feeling Participants described experiencing a range of emotional challenges, including feelings of loneliness, depression, and a sense of loss of control over their lives. Many reported that their declining health and reduced ability to engage in social activities contributed to a sense of isolation, despite support from family members who assisted with daily living and provided emotional care. A 78-year-old participant shared, “ I am a housewife, and I lost my husband. This, along with my health concerns, makes me feel more depressed. I spend most of my time alone, and my social life has been disrupted compared to my previous lifestyle ” [p.8]. Another participant noted, “ Different situations make me feel depressed, and my health status along with my family’s issues are the major contributors ” [p.9]. A 76-year-old participant added, “ Depression is unavoidable; it comes from being isolated from social activities and my compromised health condition ” [p.10]. Economic Effect The findings revealed that frail older adults experienced significant financial challenges, largely related to healthcare costs and declining income. Participants emphasized that managing frailty often required spending substantial amounts on medications, diagnostic tests, hospital stays, and other health-related expenses, placing considerable strain on their limited resources. Several participants highlighted the cumulative effect of frequent hospitalizations and ongoing medical care, which further exacerbated their economic burden and affected their overall well-being. A 77-year-old participant shared, “ Becoming frail affects many aspects of my life, particularly unnecessary healthcare costs. I spend a lot of money on medications, diagnostic tests, and even hospital beds, not to mention the time it consumes ” [p.1]. Another participant noted, “ I am frequently hospitalized due to this condition, and I spend a lot of money and time on healthcare. I am often sick, and the costs add up quickly ” [p.5]. Effect on Health The findings indicated that frail older adults experienced a range of health challenges, with nutritional problems being particularly prominent. Participants reported nausea, loss of appetite, and a diminished desire to eat, which negatively affected their overall health and quality of life. Many described the compounded impact of chronic illnesses, vision problems, and other incurable conditions, which further limited their ability to maintain adequate nutrition and general well-being. Health education and support regarding nutrition were emphasized as critical for vulnerable older adults. A 75-year-old participant shared, “ I lost my appetite and desire for food, and I feel severe pain inside my body, which increases progressively every day. It’s important to get good nutrition regularly, but due to economic issues, it is not easily affordable ” [p.5]. Another participant noted, “ Mostly, I can’t eat food regularly because of loss of appetite and financial limitations. This condition affects my overall health and quality of life, and I have lost weight as a result ” [p.7]. Theme 3: Social Support The findings highlighted that frailty not only affects physical and emotional well-being but also has profound social implications. Participants described psychological instability, sadness, and a sense of disengagement from social life. These experiences contributed to feelings of apprehension and anxiety, reflecting the broader impact of frailty on social relationships and daily interactions. Social Isolation Participants reported that social isolation was a significant consequence of frailty, often exacerbating their physical and emotional challenges. Many described feeling alone and disconnected from family, friends, and community activities. Physical limitations, cognitive decline, and dependence on others for daily care contributed to reduced social engagement, leaving participants vulnerable to loneliness and loss of autonomy. A 76-year-old participant stated, “ Most of the time I spend alone and isolate myself from any social activities. My abilities have decreased over time, which separates me from social interactions and relationships, and I depend on others for support in moving around ” [p.7]. Another participant shared, “ No one reassures me or supports me. Although I have children, there is no one nearby like my parents or family members to help me cope with this health condition and depression ” [p.8]. A further participant noted, “ Most of the time I spend my days alone. This makes me stressed because I have lost my children, and now no one can help me. I have God only ” [p.6]. Apprehension The findings revealed that frail older adults experienced a range of psychological challenges, with anxiety being particularly prominent. Participants described feelings of worry and apprehension related to their dependence on others, declining health, and fear of hospitalization. These psychological difficulties not only affected their emotional well-being but also limited their ability to manage daily tasks and cope with stress. A 76-year-old participant shared, “ Anxiety is unavoidable; it comes from isolation and compromised health conditions, and I have lost my ability to resist challenges and external stress over time ” [p.10]. Another participant explained, “ Different situations make me anxious about my health, and family issues are major contributors ” [p.9]. A further participant noted, “ Sometimes, I feel depressed due to obstacles in my life, economic issues, and not being able to do my work as I want. This makes me feel very low ” [p.3]. Discussion This study explored the lived experiences of frail older adults in Wolaita Zone, Southern Ethiopia, offering an in-depth view of how physical decline, emotional distress, and social change intersect to shape everyday life in later years. The findings highlight that frailty is not merely a medical condition but a deeply personal and multifaceted experience that touches every aspect of life such as physical, psychological, social, and economic. The three overarching themes: physical experience of frailty, effects of frailty, and social and family support—together illustrate how older adults navigate vulnerability and dependence while striving to adapt and preserve dignity. Their experiences are framed within a setting characterized by limited resources but also by a strong cultural reliance on faith, family, and community as vital sources of resilience and meaning. Our findings is in line with the notion of frailty as a syndrome of vulnerability arising from the cumulative decline in multiple physiological systems[ 27 , 28 ]. Participants described profound physical instability, reporting reduced mobility, fatigue, and diminished muscle strength. These limitations impeded their capacity to perform activities of daily living and threatened their independence—findings consistent with the literature showing that frailty correlates strongly with functional decline and reduced autonomy[ 29 ]. Participants reported about how their physical strength and stamina had gradually declined over time, making everyday tasks increasingly difficult and affecting their sense of independence. This gradual loss of physical ability was not just a practical challenge but also an emotional one, as many felt frustrated by their growing reliance on others. Similar patterns have been observed in other studies from both low- and high-income countries, where frailty has been closely linked to reduced mobility, functional decline, and a poorer quality of life[ 2 , 30 ]. Participants’ accounts of fatigue, immobility, and exhaustion revealed how the gradual decline in physical ability eroded their confidence and sense of independence. Many found themselves needing to reorganize their daily routines to cope with these limitations, adapting to a new way of living that balanced their physical challenges with a desire to remain as self-reliant as possible. A notable finding in this study was the central role of spiritual coping in participants’ lives. Many described prayer and faith in God as their main sources of comfort and strength, helping them manage both the emotional and physical challenges that come with frailty. These strategies are consistent with other studies showing how spirituality and religion aid in adaptability in older persons dealing with long-term health issues[ 31 ]. For these individuals, spirituality offered a sense of hope, meaning, and acceptance amid uncertainty. This finding aligns with evidence from other studies in sub-Saharan Africa and beyond, which consistently highlight spirituality as a vital coping mechanism for older adults living with chronic illness and functional decline[ 32 ]. Frailty touched many aspects of participants’ lives, extending far beyond physical limitations to include emotional strain and financial hardship. Many described feelings of sadness, loneliness, and a loss of motivation as their physical strength declined and daily activities became more challenging. These emotional experiences echo findings from international studies that have linked frailty with depression, anxiety, and reduced life satisfaction, emphasizing that the impact of frailty reaches well beyond the body to affect overall well-being and quality of life[ 33 , 34 ]. Sadness, loneliness, and a decrease in social interaction were prevalent, which is consistent with research that links frailty to social isolation and psychological discomfort[ 35 ]. Frequent expressions such as “feeling unsupported” and “spending most of my time alone” reveal how physical dependence often leads to emotional strain and social withdrawal. This sense of isolation not only affects mental well-being but can also intensify physical symptoms, creating a self-perpetuating cycle of decline in which emotional and physical health are closely intertwined. Frailty often brings significant economic challenges, as frequent healthcare needs, medication costs, and reduced earning ability increase financial strain. This loss of independence can heighten feelings of helplessness, highlighting the need for stronger social protection and accessible healthcare for older adults in low-resource settings[ 36 ]. Economic vulnerability was a key consequence of frailty. Participants described how medical expenses, reduced income, and limited work capacity created financial strain, which in turn restricted access to nutritious food, healthcare, and assistive devices, worsening their condition. These findings highlight the strong connection between poverty and health and emphasize the importance of social protection measures, such as subsidized care and community-based insurance, to support frail older adults and their families. The study participants reported that they faced a lot of nutrition related problems. The impact on nutritional health and associated physical decline was another key finding. Participants described loss of appetite, losing weight, and experiencing more physical discomfort, which is in line with the idea that nutritional deficiency is a modifiable risk factor for frailty[ 37 ]. Health-related effects were also significant, especially those connected to chronic comorbidities and nutritional difficulties. Participants' exhaustion, appetite loss, and weight loss are in line with research showing that malnutrition is both a cause and an effect of frailty[ 38 ]. For many older adults, getting enough nutritious food was a daily struggle, made harder by both limited availability and tight finances. This often meant going without a balanced diet, which could worsen their frailty over time. Programs that teach practical ways to eat well using affordable, familiar foods, along with community nutrition initiatives, could make a real difference in helping older adults maintain strength and health in Ethiopia. Participants reported that social isolation was a significant consequence of frailty, often exacerbating their physical and emotional challenges. Social isolation and anxiety were closely connected to how participants experienced frailty. As their physical abilities declined, many found it harder to take part in social activities, leaving them feeling lonely and emotionally drained. These experiences highlight how isolation can deepen vulnerability and undermine well-being, a pattern that has been observed in other studies exploring the social impacts of frailty[ 39 ]. Similar studies have reported, social support came to be seen as a compromised and protecting realm. While some found strength in networks and relationships, others felt helpless, nervous, and alone. This dual nature highlights the intricate relationship between the development of frailty and social connectivity[ 40 , 41 ]. Many participants shared that their feelings of disconnection grew stronger after losing a spouse or child, when family members moved away, or as community gatherings and social activities became less frequent. Support from family and the community was a double-edged experience for many participants. While they deeply appreciated help from relatives and neighbors, they also worried about becoming a burden. This mix of gratitude and unease reflects what other studies have found in collectivist societies, where older adults often feel both comforted and conflicted when depending on family for care[ 42 , 43 ]. Strength and Limitation of the study One of the main strengths of this study is the rich qualitative insight it provides, giving frail older adults a platform to share their own experiences and perspectives on aging in Ethiopia. Conducting in-depth interviews allowed participants to express their challenges, coping strategies, and daily realities in detail, while including both urban and rural residents ensured a diversity of viewpoints. However, the study has some limitations. The small number of participants and focus on a single zone may limit how well the findings apply to other settings. Older adults with cognitive impairments were not included, leaving the experiences of those with dementia—who are particularly vulnerable to frailty—unexplored. In addition, the study relied on participants’ own accounts, which could be affected by memory lapses or the desire to present themselves in a certain way. Conclusion This study highlights that frailty in older adults is not just about physical decline, it touches every aspect of their lives, including emotional well-being, financial security, and social connections. In Wolaita Zone, frail older adults navigate daily challenges that go beyond medical care, relying on family, community, and their faith to cope with limitations. Spirituality and personal belief systems emerged as important sources of strength and resilience, emphasizing the need for care approaches that respect local culture and values. The findings suggest that addressing frailty requires a comprehensive approach that combines healthcare, nutrition support, mental health services, and social engagement. Interventions that strengthen family involvement, encourage early recognition of frailty, and provide accessible community-based support could make a meaningful difference in improving the daily lives and overall well-being of older adults in Ethiopia and similar contexts. Implication of the study One important implication of this study is the need for comprehensive, person-centered interventions that consider the full scope of frailty—physical, psychological, social, and economic. Routine frailty assessments should go beyond medical evaluation to include functional limitations, access to spiritual and social support, and financial stress. Care models must be sensitive to local culture, particularly in contexts like Ethiopia where religious faith plays a central role in coping. The negative effects of frailty can be alleviated by strengthening social networks, enhancing financial and community support systems, and providing practical interventions such as mobility aids, nutritional guidance, and therapies tailored to older adults’ needs. Abbreviations ADL: Activities of Daily Living FRIAL: F atigue, R esistance, A mbulation, I llnesses, L oss of weight NH = Nursing Home IDI: In-Depth Interview OPD: Outpatient Department QoL: Quality of Life WHO: World Health Organization IRB: Institutional review board Declarations Author contribution B.Y.D conceptualized the study and led the methodology design. H.H.D., B.M., H.B., Y.N and B.D wrote the original draft and Writing – review & editing. H.B.B., B.D, and Y.A. reviewed the manuscript and provided critical revisions, and B.M., and Y.N.T, supervised the work. All authors read and approved the final manuscript. Acknowledgment The authors would like to express their sincere gratitude to the elderly participants who generously shared their lived experiences. We also thank the Wolaita Sodo university and Wolaita Zone Health Department and the management and staff of the participating public hospitals for their cooperation Ethics Approval and Consent to Participate Ethical approval for this study was obtained from the Institutional Review Board (IRB) of Wolaita Sodo University . Permission to conduct the study was also secured from the Wolaita Zone Health Department and the administrations of participating public hospitals. All participants were informed about the aims of the study, the voluntary nature of participation, the right to withdraw at any time, and measures taken to ensure confidentiality. Written informed consent was obtained from all participants prior to data collection. Consent for Publication Written informed consent for publication of anonymized data was obtained from the all participants. Availability of data and materials The dataset(s) supporting the conclusions of this article is (are) included within the manuscript. Competing interests The authors declare that they have no competing interests. Funding The author has no specific fund for this work. Clinical trial number Not applicable References Clegg A, et al. Frailty Elder people. 2013;381(9868):752–62. Fried LP et al. Frailty in older adults: evidence for a phenotype. 2001. 56(3): pp. M146–57. Kojima G, et al. Transitions between frailty states among community-dwelling older people: A systematic review and meta-analysis. Ageing Res Rev. 2019;50:81–8. Beard JR, et al. The World report on ageing and health: a policy framework for healthy ageing. Lancet. 2016;387(10033):2145–54. Hoogendijk EO, et al. Frailty: implications for clinical practice and public health. Lancet. 2019;394(10206):1365–75. Organization WH. WHO clinical consortium on healthy ageing 2021: report of consortium meeting held virtually, 5–6 November 2021. World Health Organization; 2022. Warmoth K et al. ‘Thinking you're old and frail’: a qualitative study of frailty in older adults. 2016. 36(7): pp. 1483–500. Grenier A, Lloyd L, Phillipson C. Precarity and frailty in later life: Reframing the lived experience. Gerontologist. 2021;61(2):228–36. Nicholson C et al. The experience of living at home with frailty in old age: a psychosocial qualitative study. 2013. 50(9): pp. 1172–9. Wandera SO, Kwagala B, Ntozi J. Frailty and health outcomes among older adults in Uganda: A population-based study. BMC Geriatr, 2022(22(1)): p. 563.*. Ababa A. Central statistical agency . 2011. Melaku T, Alemu T, Teklu M. Health service utilization and associated factors among older adults in Ethiopia: A cross-sectional study. BMC Health Serv Res. 2021;21(1):1–10. Gebremariam G, Habte A, Adane M. It is part of life to grow old: Perceptions and experiences of ageing among older adults in northern Ethiopia: A qualitative study. PLoS ONE, 2022(17(8)). Degu G, Woldie M, Yitayal M. Social support and health status among the elderly in Ethiopia. Ethiop J Health Dev. 2018;32(3):164–71. Nyirenda M, Sitali DC. Experiences of ageing and frailty among older adults in Zambia: A qualitative exploration. Afr J Ageing Stud, 2021(3(1)): pp. 25–36.*. Aboderin I, Beard J. Older people’s health in sub-Saharan Africa: Lessons from global ageing research. Lancet Healthy Longev 2020(1(1)): p. e2–e4.*. Wondimagegn D, Teklu A. We are left alone: The lived experiences of elderly people in southern Ethiopia. J Cross-Cult Gerontol. 2021;36(4):321–38. Mengistu B, et al. Progress in controlling the transmission of schistosome parasites in Southern Ethiopia: the Geshiyaro Project in the Wolaita Zone. Volume 17. Parasites & Vectors; 2024. p. 113. 1. Bolado GN, et al. Informed consent practice and associated factors among healthcare professionals in public hospitals of Southern Ethiopia, 2023: a mixed-method study. BMC Nurs. 2024;23(1):77. (CSA)., C.S.A. Population projections of zones and woredas as of July 2023; Addis Ababa. CSA; July 2023. Ga H et al. Use of the frailty index and FRAIL-NH scale for the assessment of the frailty status of elderly individuals admitted in a long-term care hospital in Korea. 2018. 22(1): p. 20. Liau SJ et al. The FRAIL-NH scale: systematic review of the use, validity and adaptations for frailty screening in nursing homes. 2021. 25(10): pp. 1205–16. Moriarty J. Qualitative methods overview. 2011. S., K., Interviews: Learning the craft of qualitative research interviewing . Sage, 2009. J., G., Ensuring trustworthiness in qualitative research. Belitung Nurs J 2015 Dec 7(1(1)): pp. 10–1. Morrow R, King RA. Colaizzi’s descriptive phenomenological method. Psychol. 2015;28(8):643–4. Clegg A, Iliffe YJ, Rikkert S, Rockwood MO. K., Frailty in elderly people. The lancet., 2013 Mar 2(381(9868)): pp. 752 – 62. Su H et al. The lived experience of frailty in patients aged 60 years and older with heart failure: A qualitative study. 2023. 17(4): pp. 191–9. Dent E, Martin FC, Bergman H, Woo J, Romero–Ortuno R, Walston JD. Management of frailty: Opportunities, challenges, and future directions. Lancet. 2016;388(10058):1376–86. Dent E et al. Management of frailty: opportunities, challenges, and future directions. 2019. 394(10206): pp. 1376–1386. Koenig HG. Religion, spirituality, and health: The research and clinical implications. ISRN Psychiatry, 2012. 278730. Idler EL, et al. Relig Qual life last year life. 2009;64(4):528–37. Gale CR et al. Social isolation and loneliness as risk factors for the progression of frailty: the English Longitudinal Study of Ageing. 2018. 47(3): pp. 392–7. Mezuk B et al. Depression and frailty in later life: a synthetic review. 2012. 27(9): pp. 879–92. Peng S, Luo HH, Kang X, Wang J, Tan X. Real experiences and care needs of frail older patients: a systematic review of qualitative studies. Front Public Health. 2025 Oct;1:1679832. Aboderin IA, Beard JRJTL. Older people's health in sub-Saharan Africa. 2015. 385(9968): pp. e9-e11. Lee H, Lee E, I.-Y. .J.J.o.K.m.s. Jang. Frailty Compr geriatric Assess. 2020;35(3):e16–16. Lorenzo-López L et al. Nutritional determinants of frailty in older adults: a systematic review. 2017. 17(1): p. 108. Courtin E, Knapp MJH. and s.c.i.t. community, Social isolation, loneliness and health in old age: a scoping review. 2017. 25(3): pp. 799–812. Liu S et al. Understanding frailty: a qualitative study of older heart failure patients’ frail experience and perceptions of healthcare professionals with frailty. 2024. 24. NR N. A review of social isolation: an important but underassessed condition in older adults. J Prim Prev. 2012;33(2):137–52. Gureje O, Kola L, Afolabi EJTL. Epidemiology of major depressive disorder in elderly Nigerians in the Ibadan Study of Ageing: a community-based survey. 2007. 370(9591): pp. 957–64. Puts MTE et al. Interventions to prevent or reduce the level of frailty in community-dwelling older adults: a scoping review of the literature and international policies. 2017. 46(3): pp. 383–392. Additional Declarations No competing interests reported. Supplementary Files Frailtymeasurement.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviewers invited by journal 12 Dec, 2025 Editor assigned by journal 08 Dec, 2025 Editor invited by journal 20 Nov, 2025 Submission checks completed at journal 20 Nov, 2025 First submitted to journal 20 Nov, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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condition among older adults, characterized by heightened sensitivity to stressors resulting from the gradual deterioration of multiple physiological systems[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. It is strongly linked to aging, long-term health conditions, and functional restrictions that impact independence, well-being, and quality of life in elderly individuals[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Frailty has become a major public health concern due to the aging population, especially in low- and middle-income nations where health systems are sometimes unprepared to handle the demands of senior citizens[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eBy 2050, there will be 2.1\u0026nbsp;billion people worldwide who are 60 years of age or older, with almost 80% of them residing in developing nations[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. As life expectancy rises, more people experience frailty and chronic illnesses, which raises hospitalization, disability, dependency, and mortality rates[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Frailty has an impact on older persons' perceptions of aging, independence, and their roles in families and communities in addition to its biological manifestations. According to recent qualitative research, while some older persons exhibit resilience and adjust to social and physical changes, frailty frequently results in feelings of loss, dread of dependency, and social isolation[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Frailty is becoming a significant yet little-studied public health concern in sub-Saharan Africa. Few research have examined how weak older persons perceive their health and the aging process, despite the incidence among older adults ranging from 10% to 50%[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. An estimated 6% of Ethiopia's population is elderly, and this percentage is predicted to rise sharply over the next several decades[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Geriatric care is still scarce despite this demographic shift, with the health system mostly concentrating on acute treatment, infectious disorders, and maternity and child health[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. The vulnerability of older persons with frailty is increased by intersecting issues like poverty, chronic illnesses, limited healthcare services, and weak social safety systems[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eQualitative data from Ethiopia and other African nations demonstrate how cultural norms, intergenerational interactions, and evolving family structures influence aging and frailty[\u003cspan additionalcitationids=\"CR15\" citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Many older persons describe feelings of neglect, loneliness, and diminished social value as traditional support networks deteriorate as a result of urban migration and economic constraints[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. Therefore, frailty is not just a medical disease but a lived experience that includes social marginalization, emotional difficulties, and physical deterioration.\u003c/p\u003e \u003cp\u003eDespite the growing body of quantitative research on ageing and chronic illness in Ethiopia, limited qualitative studies have been done on the lived experiences of frail elderly patients, particularly those seeking care in public hospitals. Developing person-centered, culturally appropriate therapies requires an understanding of how elderly patients with frailty experience diseases, reliance, and healthcare interactions.\u003c/p\u003e \u003cp\u003eThus, the purpose of this study was to investigate and comprehend the real-life experiences of elderly patients with frailty who visit public hospitals in Southern Ethiopia's Wolaita Zone. The results of this study offer insights that can guide compassionate, all-encompassing care for elderly people in low-resource situations and deepen our understanding of the social, cultural, and emotional dimensions of frailty.\u003c/p\u003e"},{"header":"Methods and materials","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy area and period\u003c/h2\u003e \u003cp\u003eThe South Ethiopia Regional State's Wolaita Zone is where the study was carried out. Wolaita Sodo, its political and administrative center, lies roughly 151 kilometers west of Hawassa and 328 kilometers south of Addis Ababa. The zone covers an estimated 4,511.7 km\u0026sup2;[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. According to a recent survey, Wolaita Zone's population was estimated at 2.161 million[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe zone's health-service infrastructure consists of about 419 health institutions, including 69 health centers and 8 hospitals, including a comprehensive specialty hospital, according to data from the zonal health department[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The Wolaita Sodo University Comprehensive Specialized Hospital (WSUCSH), Boditi Primary Hospital, Bitena Primary Hospital, and Humbo Primary Hospital were the locations of this study. Data was gathered from October 2 to 30, 2024.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy design\u003c/h3\u003e\n\u003cp\u003eA qualitative descriptive phenomenological design was employed to explore and understand the lived experiences of elderly frail patients. This approach enabled an in-depth understanding of participants\u0026rsquo; perceptions, meanings, and lived experiences associated with frailty.\u003c/p\u003e\n\u003ch3\u003eFrailty assessment\u003c/h3\u003e\n\u003cp\u003eParticipants\u0026rsquo; frailty was assessed using the FRAIL-NH scale[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e], a validated tool that considers fatigue, mobility, resistance, chronic illnesses, and weight loss. Participants scoring 7 or higher on the FRAIL-NH scale were classified as frail, ensuring that only those meeting the validated criteria were included. This threshold, supported by previous studies in institutional and hospital settings, also enabled the study to examine how varying degrees of frailty influenced participants\u0026rsquo; daily experiences and challenges\u003c/p\u003e\n\u003ch3\u003ePopulation\u003c/h3\u003e\n\u003cp\u003eThe source of the population was all elderly patients who attended public hospitals in the Wolaita Zone. The study population comprised all elderly patients who visited selected Wolaita Zone public hospitals during the data collection period.\u003c/p\u003e\n\u003ch3\u003eSample size determination\u003c/h3\u003e\n\u003cp\u003eThe sample size determination was based on data saturation, which was 10 individuals. Data saturation was achieved when no new themes or subthemes emerged from the interviews, which occurred after conducting 10 in-depth interviews.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eSampling procedure\u003c/h2\u003e \u003cp\u003ePurposive sampling[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] was used to choose participants for the in-depth interviews, focusing on those who could offer rich and pertinent details on the lived experience of frailty.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eRecruitment\u003c/h3\u003e\n\u003cp\u003eEligible participants were elderly patients who:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eScreened positive for frailty using the FRAIL-NH scale\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eHad attended the hospital more than once,\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eWere aged 75 years or older, and\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eWere able to communicate their experiences effectively\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eMust be mentally competent to provide informed consent and articulate their experiences clearly\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThese requirements guaranteed that the participants could offer in-depth explanations of the phenomenon being investigated.\u003c/p\u003e\n\u003ch3\u003eTools and procedures for data gathering\u003c/h3\u003e\n\u003cp\u003eIn-depth interviews (IDIs) with a semi-structured interview guide of three open-ended questions with probes were used to gather data. Interviews were done until data saturation was achieved, then the guide was written in English. To reduce interruptions and guarantee the accuracy of participants' answers, the lead investigator conducted interviews in private rooms. Each session began with an explanation of the study's goal and an assurance that the participants' information would remain private. In order to record contextual information and nonverbal clues, field notes were recorded both during and right after each interview. In-depth interviews were used to collect the data, and an observation guide was added.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eData collection procedure\u003c/h2\u003e \u003cp\u003eThe questionnaires were translated into Amharic and back into English to maintain consistency. Before main data collection, the tool was pretested with two participants who met the inclusion criteria to test the clarity and relevance of the questions. We conducted in-depth, semi-structured interviews[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e] in a private room with Amharic translations of the interview-guided questions. At the start of each interview, respondents were given a copy of the informed consent agreement form; after they consented to participate and signed it, the interview was considered to have begun. To ensure consistency, a template was used to allow flexibility when exploring new topics. The interviews were recorded using audio with the consent of the participants and transcribed verbatim. All participants had the chance to ask questions for clarification regarding the interview or the study, and the participants were notified during the audio recording. Then the interview was accomplished using the 3-topic guide question (background information, lived experience of frailty-related questions, family and social-related information, and coping and adaptation-related information), which was translated into the Amharic language. The researcher avoided jargon that could confuse the participants, and some questions were probed to provide participants with a clearer picture. The data collections were facilitated by two researchers, who were MSc-qualified nurses, and supervised by two MSc nurses. The estimated duration for the interview was 50\u0026ndash;60 minutes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eData quality control\u003c/h2\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003ch2\u003eCredibility\u003c/h2\u003e \u003cp\u003eProlonged engagement was maintained with participants to establish trust and foster open communication, enabling the collection of rich and meaningful data. Member checking was conducted by inviting participants to review and verify their transcribed statements for accuracy and to clarify any ambiguous interpretations. Data were collected through both in-depth interviews and direct observation to ensure a comprehensive understanding of the phenomena under study. Peer debriefing sessions were held with the research supervisor to identify and minimize potential researcher bias and ensure the authenticity of interpretations[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eDependability\u003c/h2\u003e \u003cp\u003eAll methodological decisions, including interview guides, coding procedures, and any adjustments made during the research process, were systematically documented to ensure an auditable trail. A semi-structured interview guide was employed to maintain consistency across interviews while allowing flexibility to explore emerging themes and participant perspectives in depth[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eConfirmability\u003c/h2\u003e \u003cp\u003eTo enhance objectivity, the research supervisor independently reviewed the coding framework, thematic structure, and supporting data to confirm that interpretations were grounded in participants\u0026rsquo; narratives. Direct quotations and illustrative excerpts from participants were incorporated into the findings to provide transparency and demonstrate the linkage between data and interpretation[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eTransferability\u003c/h2\u003e \u003cp\u003eComprehensive contextual details were provided regarding the study setting, participant demographics, and socio-cultural background to enable readers to assess the potential applicability of findings to other contexts. Participants were purposively selected to reflect diverse backgrounds and experiences, thereby enhancing the breadth and contextual relevance of the insights generated[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eData handling procedures\u003c/h2\u003e \u003cp\u003e All interviews were audio-recorded and transcribed verbatim to ensure the accuracy and integrity of participants\u0026rsquo; accounts. Each transcript was cross-checked against the corresponding audio recording to verify fidelity and correct any discrepancies. Transcripts and coding were reviewed multiple times to ensure consistency and accurate representation of participants\u0026rsquo; perspectives. Both raw and processed data were securely stored in password-protected digital folders accessible only to the research team, thereby maintaining confidentiality and data security.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eResearcher reflexivity\u003c/h2\u003e \u003cp\u003eReflexivity was applied throughout all stages of the research process to enhance the credibility and trustworthiness of the findings. The researcher acknowledged the potential influence of prior professional experience lived experience of frailty. To minimize bias, bracketing\u0026mdash;the deliberate process of setting aside personal assumptions and professional perspectives\u0026mdash;was practiced during data collection and analysis. Reflective journaling and supervisory discussions further supported the researcher\u0026rsquo;s ongoing self-awareness and critical reflection.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eData processing and analysis\u003c/h2\u003e \u003cp\u003eThe data were analyzed using Colaizzi\u0026rsquo;s (1978) descriptive phenomenological approach[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e, \u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e] to deeply explore how frail older adults cope with and adapt to the challenges of daily life. This method was chosen because it allows the researcher to stay close to participants lived experiences and to uncover the true meaning behind their stories.\u003c/p\u003e \u003cp\u003eAll interviews were first transcribed word for word from the audio recordings and then translated from Amharic into English by the primary investigator. Each transcript was read several times to gain a clear and holistic understanding of each participant\u0026rsquo;s experience of frailty. As the researcher immersed himself in the data, notes and reflections were recorded to capture emerging insights and emotional tones.\u003c/p\u003e \u003cp\u003eUsing Open Code (version 4.02), the transcripts were carefully coded, breaking the data into small, meaningful pieces that expressed important ideas or feelings. Codes with similar meanings or relationships were then grouped together into broader categories. From these categories, overarching themes were developed that represented the shared essence of participants\u0026rsquo; experiences.\u003c/p\u003e \u003cp\u003e Throughout this process, the researcher moved back and forth between the data, codes, and themes\u0026mdash;refining interpretations until they felt authentic and grounded in participants\u0026rsquo; words. Finally, the summarized findings were returned to participants for member checking, allowing them to confirm that their experiences had been accurately understood and represented.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eEthical considerations\u003c/h2\u003e \u003cp\u003e Ethical clearance was obtained from the ethical review committee of the nursing school on behalf of the Institutional Review Board (IRB) of the Wolaita Sodo University with Ref. Number Ref. No/CRCSD 4/1996/2015). A formal cooperation letter was submitted to the selected Wolaita zone public hospitals, and permission was obtained from the hospital administration to conduct the study. Participants were fully informed about the study\u0026rsquo;s purpose, their right to skip any question, and their freedom to withdraw at any time without consequence. Written informed consent was obtained from all participants prior to data collection. To maintain confidentiality, all information was securely stored and accessible only to the research team, with identifying details removed from transcripts and reports. The study was carried out in accordance with the ethical principles of the Declaration of Helsinki, ensuring respect, autonomy, and the protection of participants\u0026rsquo; well-being throughout the research process.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eSociodemographic characteristics of the study participants\u003c/h2\u003e \u003cp\u003eA total of ten frail older adults, aged between seventy-five and eighty-one years, participated in the in-depth interviews. Participants were purposively selected based on predefined inclusion criteria to ensure that they represented individuals with diverse experiences of frailty. Of the total participants, six (60%) were male and four (40%) were female. The maximum FRAIL-NH score recorded among participants was twelve, and the highest reported frequency of hospitalization was four times. Focusing on individuals aged seventy-five years and older allowed the study to capture rich, first-hand insights into the lived experiences, coping mechanisms, and daily challenges associated with frailty in later life(Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic Characteristics of Frail Older Adults Attending Public Hospitals in Wolaita Zone, Southern Ethiopia, 2024\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eMean age\u0026thinsp;\u003cb\u003e=\u003c/b\u003e\u0026thinsp;77(range from 75 to 81)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eResidency\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eMarital status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eWidowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDivorced\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eEducational status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo formal education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary (1\u0026ndash;8) school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary (9\u0026ndash;12) school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCollege and above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eEmployment status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMerchant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHouse wife\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cb\u003eFRAIL-NH score\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u0026ndash;8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u0026ndash;10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u0026ndash;12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eHospitalization\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 times/ year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 times/year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;3 times/year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eMain theme of the study\u003c/h2\u003e \u003cp\u003eThe analysis of the data revealed fifty initial codes, which were grouped into seven subthemes and distilled into three main themes that capture how frail older adults experience and navigate daily life. The first theme, Physical Experience of Frailty, reflects the challenges participants face in their bodies\u0026mdash;feeling tired, weak, fatigued, or physically limited\u0026mdash;and the ways they adapt, such as resting, eating nourishing food, and praying to maintain their strength and independence. The second theme, Effects of Frailty, highlights how frailty affects not just the body but also emotions, finances, and overall well-being. Participants shared feelings of sadness, loss, and isolation, as well as financial difficulties and struggles with health issues like loss of appetite, illness, and vision problems. The third theme, Social and family Support, emphasizes the importance of relationships and community in shaping their experiences. Participants described the pain of social isolation, dependence on others, and the anxiety or worry that comes with needing support, yet these same connections also offered comfort and guidance. Together, these themes provide a compassionate and holistic understanding of how frail older adults live, adapt, and find meaning amidst the physical, emotional, and social challenges of frailty.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThemes, Subthemes, and Main Codes Emerged from Qualitative Data Analysis on the Experience of Frailty among Elderly Patients in Wolaita Zone Public Hospitals, Ethiopia, 2023\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eThemes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSub-themes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMain codes\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003ePhysical experience of frailty\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eActivity limitation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTiredness, Weakness, Fatigue, Inactivity, Reduced Activity, Loss of Stamina, Difficulty, Disablement, Exhaustion, Fatigability, Immobility\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCoping with physical limitations\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eResting, Nutrition, Healthy Diet, Praying\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cb\u003eEffects of frailty\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGloomy feeling\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLack of Motivation, Feeling Unsupported, Loss of Relatives, Sense of Loss Related to Condition\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEconomical effect\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFinancial Strain, Eating What Is Available, Health-Related Expenses\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEffect on health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDifficulty Eating, Illness, Loss of Appetite, Sight Problems, Diet-Related Problems\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003eSocial and family support\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSocial isolation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDepression, Sadness, Unhappiness, Dependence, Hospitalization, Loneliness, Friendlessness, Attachment Issues, Social Impact\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eApprehension\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAnxiety, Distress, Overthinking, Feeling Saddened\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eTheme 1\u003c/b\u003e: P\u003cb\u003ehysical experience of frailty\u003c/b\u003e\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eActivity Limitation\u003c/h2\u003e \u003cp\u003eParticipants reported that frailty severely limited their ability to engage in daily activities, which negatively impacted their quality of life and functional independence. Many described difficulties performing routine physical tasks, such as walking, household chores, or work-related activities, noting that their physical capabilities had progressively declined over time. This deterioration reduced their productivity and made it increasingly challenging to manage activities of daily living independently.\u003c/p\u003e \u003cp\u003eA 77-year-old participant stated, \u0026ldquo;\u003cem\u003eI feel the absence of strength to perform anything else when I walk, and I move slowly. My health has started to decline over time, and I feel weaker than before\u003c/em\u003e\u0026rdquo; [p.1]. Similarly, a 75-year-old participant explained, \u0026ldquo;\u003cem\u003eI feel tired and unable to move alone as I want. It is difficult to walk without stopping because of fatigue\u003c/em\u003e\u0026rdquo; [p.2]. Another participant from the oncology unit noted, \u0026ldquo;\u003cem\u003eI can\u0026rsquo;t move or walk as I used to. I feel progressively more tired, and my body becomes weaker and fatigued over time, which may be related to my disease as well as aging\u003c/em\u003e\u0026rdquo; [p.4].\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eCoping with Physical Limitations\u003c/h2\u003e \u003cp\u003eThe study revealed that participants employed spiritual and religious strategies to cope with the challenges posed by frailty. Many relied on prayer and their faith in God to manage the physical and emotional burdens of their condition. This reliance provided them with a sense of control, hope, and resilience in the face of health limitations.\u003c/p\u003e \u003cp\u003eA 77-year-old participant stated, \u0026ldquo;\u003cem\u003eI gave all things to my God; all things happen by His will. We can\u0026rsquo;t handle anything without God\u0026rsquo;s support\u003c/em\u003e\u0026rdquo; [p.1]. Another participant shared, \u0026ldquo;\u003cem\u003eIn my experience, God is always with me. He can heal me with His holy power, so I am not afraid of anything that happens to me. I have God only\u003c/em\u003e\u0026rdquo; [p.8].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003eTheme 2: Effects of Frailty\u003c/h2\u003e \u003cp\u003eThe findings indicated that frailty has multifaceted consequences, affecting physical, emotional, and economic aspects of participants\u0026rsquo; lives. Emotionally, participants reported feelings of isolation, loneliness, and difficulty interacting with others, which significantly impacted their well-being. Economically, frailty imposed financial burdens due to healthcare-related expenses and the cost of managing their condition. Participants also described the physical toll of frailty, including persistent discomfort, fatigue, frequent hospitalizations, and challenges in carrying out everyday activities. These narratives underscore how frailty extends beyond physical limitations, profoundly shaping the social, emotional, and economic dimensions of older adults\u0026rsquo; lives.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section3\"\u003e \u003ch2\u003eGloomy Feeling\u003c/h2\u003e \u003cp\u003eParticipants described experiencing a range of emotional challenges, including feelings of loneliness, depression, and a sense of loss of control over their lives. Many reported that their declining health and reduced ability to engage in social activities contributed to a sense of isolation, despite support from family members who assisted with daily living and provided emotional care.\u003c/p\u003e \u003cp\u003eA 78-year-old participant shared, \u0026ldquo;\u003cem\u003eI am a housewife, and I lost my husband. This, along with my health concerns, makes me feel more depressed. I spend most of my time alone, and my social life has been disrupted compared to my previous lifestyle\u003c/em\u003e\u0026rdquo; [p.8]. Another participant noted, \u0026ldquo;\u003cem\u003eDifferent situations make me feel depressed, and my health status along with my family\u0026rsquo;s issues are the major contributors\u003c/em\u003e\u0026rdquo; [p.9]. A 76-year-old participant added, \u0026ldquo;\u003cem\u003eDepression is unavoidable; it comes from being isolated from social activities and my compromised health condition\u003c/em\u003e\u0026rdquo; [p.10].\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003eEconomic Effect\u003c/h2\u003e \u003cp\u003eThe findings revealed that frail older adults experienced significant financial challenges, largely related to healthcare costs and declining income. Participants emphasized that managing frailty often required spending substantial amounts on medications, diagnostic tests, hospital stays, and other health-related expenses, placing considerable strain on their limited resources. Several participants highlighted the cumulative effect of frequent hospitalizations and ongoing medical care, which further exacerbated their economic burden and affected their overall well-being.\u003c/p\u003e \u003cp\u003eA 77-year-old participant shared, \u0026ldquo;\u003cem\u003eBecoming frail affects many aspects of my life, particularly unnecessary healthcare costs. I spend a lot of money on medications, diagnostic tests, and even hospital beds, not to mention the time it consumes\u003c/em\u003e\u0026rdquo; [p.1]. Another participant noted, \u0026ldquo;\u003cem\u003eI am frequently hospitalized due to this condition, and I spend a lot of money and time on healthcare. I am often sick, and the costs add up quickly\u003c/em\u003e\u0026rdquo; [p.5].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003eEffect on Health\u003c/h2\u003e \u003cp\u003eThe findings indicated that frail older adults experienced a range of health challenges, with nutritional problems being particularly prominent. Participants reported nausea, loss of appetite, and a diminished desire to eat, which negatively affected their overall health and quality of life. Many described the compounded impact of chronic illnesses, vision problems, and other incurable conditions, which further limited their ability to maintain adequate nutrition and general well-being. Health education and support regarding nutrition were emphasized as critical for vulnerable older adults.\u003c/p\u003e \u003cp\u003eA 75-year-old participant shared, \u0026ldquo;\u003cem\u003eI lost my appetite and desire for food, and I feel severe pain inside my body, which increases progressively every day. It\u0026rsquo;s important to get good nutrition regularly, but due to economic issues, it is not easily affordable\u003c/em\u003e\u0026rdquo; [p.5]. Another participant noted, \u0026ldquo;\u003cem\u003eMostly, I can\u0026rsquo;t eat food regularly because of loss of appetite and financial limitations. This condition affects my overall health and quality of life, and I have lost weight as a result\u003c/em\u003e\u0026rdquo; [p.7].\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eTheme 3: Social Support\u003c/h3\u003e\n\u003cp\u003eThe findings highlighted that frailty not only affects physical and emotional well-being but also has profound social implications. Participants described psychological instability, sadness, and a sense of disengagement from social life. These experiences contributed to feelings of apprehension and anxiety, reflecting the broader impact of frailty on social relationships and daily interactions.\u003c/p\u003e \u003cdiv id=\"Sec31\" class=\"Section2\"\u003e \u003ch2\u003eSocial Isolation\u003c/h2\u003e \u003cp\u003eParticipants reported that social isolation was a significant consequence of frailty, often exacerbating their physical and emotional challenges. Many described feeling alone and disconnected from family, friends, and community activities. Physical limitations, cognitive decline, and dependence on others for daily care contributed to reduced social engagement, leaving participants vulnerable to loneliness and loss of autonomy.\u003c/p\u003e \u003cp\u003eA 76-year-old participant stated, \u0026ldquo;\u003cem\u003eMost of the time I spend alone and isolate myself from any social activities. My abilities have decreased over time, which separates me from social interactions and relationships, and I depend on others for support in moving around\u003c/em\u003e\u0026rdquo; [p.7]. Another participant shared, \u0026ldquo;\u003cem\u003eNo one reassures me or supports me. Although I have children, there is no one nearby like my parents or family members to help me cope with this health condition and depression\u003c/em\u003e\u0026rdquo; [p.8]. A further participant noted, \u0026ldquo;\u003cem\u003eMost of the time I spend my days alone. This makes me stressed because I have lost my children, and now no one can help me. I have God only\u003c/em\u003e\u0026rdquo; [p.6].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec32\" class=\"Section2\"\u003e \u003ch2\u003eApprehension\u003c/h2\u003e \u003cp\u003eThe findings revealed that frail older adults experienced a range of psychological challenges, with anxiety being particularly prominent. Participants described feelings of worry and apprehension related to their dependence on others, declining health, and fear of hospitalization. These psychological difficulties not only affected their emotional well-being but also limited their ability to manage daily tasks and cope with stress.\u003c/p\u003e \u003cp\u003eA 76-year-old participant shared, \u0026ldquo;\u003cem\u003eAnxiety is unavoidable; it comes from isolation and compromised health conditions, and I have lost my ability to resist challenges and external stress over time\u003c/em\u003e\u0026rdquo; [p.10]. Another participant explained, \u0026ldquo;\u003cem\u003eDifferent situations make me anxious about my health, and family issues are major contributors\u003c/em\u003e\u0026rdquo; [p.9]. A further participant noted, \u0026ldquo;\u003cem\u003eSometimes, I feel depressed due to obstacles in my life, economic issues, and not being able to do my work as I want. This makes me feel very low\u003c/em\u003e\u0026rdquo; [p.3].\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study explored the lived experiences of frail older adults in Wolaita Zone, Southern Ethiopia, offering an in-depth view of how physical decline, emotional distress, and social change intersect to shape everyday life in later years. The findings highlight that frailty is not merely a medical condition but a deeply personal and multifaceted experience that touches every aspect of life such as physical, psychological, social, and economic. The three overarching themes: physical experience of frailty, effects of frailty, and social and family support\u0026mdash;together illustrate how older adults navigate vulnerability and dependence while striving to adapt and preserve dignity. Their experiences are framed within a setting characterized by limited resources but also by a strong cultural reliance on faith, family, and community as vital sources of resilience and meaning. Our findings is in line with the notion of frailty as a syndrome of vulnerability arising from the cumulative decline in multiple physiological systems[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e, \u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. Participants described profound physical instability, reporting reduced mobility, fatigue, and diminished muscle strength. These limitations impeded their capacity to perform activities of daily living and threatened their independence\u0026mdash;findings consistent with the literature showing that frailty correlates strongly with functional decline and reduced autonomy[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eParticipants reported about how their physical strength and stamina had gradually declined over time, making everyday tasks increasingly difficult and affecting their sense of independence. This gradual loss of physical ability was not just a practical challenge but also an emotional one, as many felt frustrated by their growing reliance on others. Similar patterns have been observed in other studies from both low- and high-income countries, where frailty has been closely linked to reduced mobility, functional decline, and a poorer quality of life[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Participants\u0026rsquo; accounts of fatigue, immobility, and exhaustion revealed how the gradual decline in physical ability eroded their confidence and sense of independence. Many found themselves needing to reorganize their daily routines to cope with these limitations, adapting to a new way of living that balanced their physical challenges with a desire to remain as self-reliant as possible.\u003c/p\u003e \u003cp\u003eA notable finding in this study was the central role of spiritual coping in participants\u0026rsquo; lives. Many described prayer and faith in God as their main sources of comfort and strength, helping them manage both the emotional and physical challenges that come with frailty. These strategies are consistent with other studies showing how spirituality and religion aid in adaptability in older persons dealing with long-term health issues[\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. For these individuals, spirituality offered a sense of hope, meaning, and acceptance amid uncertainty. This finding aligns with evidence from other studies in sub-Saharan Africa and beyond, which consistently highlight spirituality as a vital coping mechanism for older adults living with chronic illness and functional decline[\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFrailty touched many aspects of participants\u0026rsquo; lives, extending far beyond physical limitations to include emotional strain and financial hardship. Many described feelings of sadness, loneliness, and a loss of motivation as their physical strength declined and daily activities became more challenging. These emotional experiences echo findings from international studies that have linked frailty with depression, anxiety, and reduced life satisfaction, emphasizing that the impact of frailty reaches well beyond the body to affect overall well-being and quality of life[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e, \u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Sadness, loneliness, and a decrease in social interaction were prevalent, which is consistent with research that links frailty to social isolation and psychological discomfort[\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Frequent expressions such as \u0026ldquo;feeling unsupported\u0026rdquo; and \u0026ldquo;spending most of my time alone\u0026rdquo; reveal how physical dependence often leads to emotional strain and social withdrawal. This sense of isolation not only affects mental well-being but can also intensify physical symptoms, creating a self-perpetuating cycle of decline in which emotional and physical health are closely intertwined.\u003c/p\u003e \u003cp\u003eFrailty often brings significant economic challenges, as frequent healthcare needs, medication costs, and reduced earning ability increase financial strain. This loss of independence can heighten feelings of helplessness, highlighting the need for stronger social protection and accessible healthcare for older adults in low-resource settings[\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Economic vulnerability was a key consequence of frailty. Participants described how medical expenses, reduced income, and limited work capacity created financial strain, which in turn restricted access to nutritious food, healthcare, and assistive devices, worsening their condition. These findings highlight the strong connection between poverty and health and emphasize the importance of social protection measures, such as subsidized care and community-based insurance, to support frail older adults and their families.\u003c/p\u003e \u003cp\u003eThe study participants reported that they faced a lot of nutrition related problems. The impact on nutritional health and associated physical decline was another key finding. Participants described loss of appetite, losing weight, and experiencing more physical discomfort, which is in line with the idea that nutritional deficiency is a modifiable risk factor for frailty[\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Health-related effects were also significant, especially those connected to chronic comorbidities and nutritional difficulties. Participants' exhaustion, appetite loss, and weight loss are in line with research showing that malnutrition is both a cause and an effect of frailty[\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e]. For many older adults, getting enough nutritious food was a daily struggle, made harder by both limited availability and tight finances. This often meant going without a balanced diet, which could worsen their frailty over time. Programs that teach practical ways to eat well using affordable, familiar foods, along with community nutrition initiatives, could make a real difference in helping older adults maintain strength and health in Ethiopia.\u003c/p\u003e \u003cp\u003eParticipants reported that social isolation was a significant consequence of frailty, often exacerbating their physical and emotional challenges. Social isolation and anxiety were closely connected to how participants experienced frailty. As their physical abilities declined, many found it harder to take part in social activities, leaving them feeling lonely and emotionally drained. These experiences highlight how isolation can deepen vulnerability and undermine well-being, a pattern that has been observed in other studies exploring the social impacts of frailty[\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Similar studies have reported, social support came to be seen as a compromised and protecting realm. While some found strength in networks and relationships, others felt helpless, nervous, and alone. This dual nature highlights the intricate relationship between the development of frailty and social connectivity[\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e, \u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e]. Many participants shared that their feelings of disconnection grew stronger after losing a spouse or child, when family members moved away, or as community gatherings and social activities became less frequent. Support from family and the community was a double-edged experience for many participants. While they deeply appreciated help from relatives and neighbors, they also worried about becoming a burden. This mix of gratitude and unease reflects what other studies have found in collectivist societies, where older adults often feel both comforted and conflicted when depending on family for care[\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e, \u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec34\" class=\"Section2\"\u003e \u003ch2\u003eStrength and Limitation of the study\u003c/h2\u003e \u003cp\u003eOne of the main strengths of this study is the rich qualitative insight it provides, giving frail older adults a platform to share their own experiences and perspectives on aging in Ethiopia. Conducting in-depth interviews allowed participants to express their challenges, coping strategies, and daily realities in detail, while including both urban and rural residents ensured a diversity of viewpoints. However, the study has some limitations. The small number of participants and focus on a single zone may limit how well the findings apply to other settings. Older adults with cognitive impairments were not included, leaving the experiences of those with dementia\u0026mdash;who are particularly vulnerable to frailty\u0026mdash;unexplored. In addition, the study relied on participants\u0026rsquo; own accounts, which could be affected by memory lapses or the desire to present themselves in a certain way.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study highlights that frailty in older adults is not just about physical decline, it touches every aspect of their lives, including emotional well-being, financial security, and social connections. In Wolaita Zone, frail older adults navigate daily challenges that go beyond medical care, relying on family, community, and their faith to cope with limitations. Spirituality and personal belief systems emerged as important sources of strength and resilience, emphasizing the need for care approaches that respect local culture and values. The findings suggest that addressing frailty requires a comprehensive approach that combines healthcare, nutrition support, mental health services, and social engagement. Interventions that strengthen family involvement, encourage early recognition of frailty, and provide accessible community-based support could make a meaningful difference in improving the daily lives and overall well-being of older adults in Ethiopia and similar contexts.\u003c/p\u003e\n\u003ch3\u003eImplication of the study\u003c/h3\u003e\n\u003cp\u003eOne important implication of this study is the need for comprehensive, person-centered interventions that consider the full scope of frailty\u0026mdash;physical, psychological, social, and economic. Routine frailty assessments should go beyond medical evaluation to include functional limitations, access to spiritual and social support, and financial stress. Care models must be sensitive to local culture, particularly in contexts like Ethiopia where religious faith plays a central role in coping. The negative effects of frailty can be alleviated by strengthening social networks, enhancing financial and community support systems, and providing practical interventions such as mobility aids, nutritional guidance, and therapies tailored to older adults\u0026rsquo; needs.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eADL: Activities of Daily Living\u003cbr\u003eFRIAL: \u003cstrong\u003eF\u003c/strong\u003eatigue, \u003cstrong\u003eR\u003c/strong\u003eesistance, \u003cstrong\u003eA\u003c/strong\u003embulation, \u003cstrong\u003eI\u003c/strong\u003ellnesses,\u0026nbsp;\u003cstrong\u003eL\u003c/strong\u003eoss of weight\u003cbr\u003e\u003cstrong\u003eNH\u003c/strong\u003e = \u003cstrong\u003eNursing Home\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;IDI: In-Depth Interview\u003cbr\u003e\u0026nbsp;OPD: Outpatient Department\u003cbr\u003e\u0026nbsp;QoL: Quality of Life\u003cbr\u003e\u0026nbsp;WHO: World Health Organization\u003c/p\u003e\n\u003cp\u003eIRB: Institutional review board\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eB.Y.D conceptualized the study and led the methodology design. H.H.D., B.M., H.B., Y.N and B.D wrote the original draft and Writing \u0026ndash; review \u0026amp; editing. H.B.B., B.D, and Y.A. reviewed the manuscript and provided critical revisions, and B.M., and Y.N.T, supervised the work. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to express their sincere gratitude to the elderly participants who generously shared their lived experiences. We also thank the Wolaita Sodo university and Wolaita Zone Health Department and the management and staff of the participating public hospitals for their cooperation\u003cstrong\u003e\u003cbr\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003ch3\u003e\u003cstrong\u003eEthics Approval and Consent to Participate\u003c/strong\u003e\u003c/h3\u003e\n\u003cp\u003eEthical approval for this study was obtained from the Institutional Review Board (IRB) of \u003cem\u003eWolaita Sodo University\u003c/em\u003e. Permission to conduct the study was also secured from the Wolaita Zone Health Department and the administrations of participating public hospitals. All participants were informed about the aims of the study, the voluntary nature of participation, the right to withdraw at any time, and measures taken to ensure confidentiality. Written informed consent was obtained from all participants prior to data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for Publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent for publication of anonymized data was obtained from the all participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe dataset(s) supporting the conclusions of this article is (are) included within the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author has no specific fund for this work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eClegg A, et al. 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K., \u003cem\u003eFrailty in elderly people.\u003c/em\u003e The lancet., 2013 Mar 2(381(9868)): pp. 752\u0026thinsp;\u0026ndash;\u0026thinsp;62.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSu H et al. The lived experience of frailty in patients aged 60 years and older with heart failure: A qualitative study. 2023. 17(4): pp. 191\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDent E, Martin FC, Bergman H, Woo J, Romero\u0026ndash;Ortuno R, Walston JD. Management of frailty: Opportunities, challenges, and future directions. Lancet. 2016;388(10058):1376\u0026ndash;86.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDent E et al. \u003cem\u003eManagement of frailty: opportunities, challenges, and future directions.\u003c/em\u003e 2019. 394(10206): pp. 1376\u0026ndash;1386.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKoenig HG. Religion, spirituality, and health: The research and clinical implications. ISRN Psychiatry, 2012. 278730.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eIdler EL, et al. Relig Qual life last year life. 2009;64(4):528\u0026ndash;37.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGale CR et al. Social isolation and loneliness as risk factors for the progression of frailty: the English Longitudinal Study of Ageing. 2018. 47(3): pp. 392\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMezuk B et al. Depression and frailty in later life: a synthetic review. 2012. 27(9): pp. 879\u0026ndash;92.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePeng S, Luo HH, Kang X, Wang J, Tan X. Real experiences and care needs of frail older patients: a systematic review of qualitative studies. Front Public Health. 2025 Oct;1:1679832.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAboderin IA, Beard JRJTL. \u003cem\u003eOlder people's health in sub-Saharan Africa.\u003c/em\u003e 2015. 385(9968): pp. e9-e11.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLee H, Lee E, I.-Y. .J.J.o.K.m.s. Jang. Frailty Compr geriatric Assess. 2020;35(3):e16\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLorenzo-L\u0026oacute;pez L et al. Nutritional determinants of frailty in older adults: a systematic review. 2017. 17(1): p. 108.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCourtin E, Knapp MJH. and s.c.i.t. community, \u003cem\u003eSocial isolation, loneliness and health in old age: a scoping review.\u003c/em\u003e 2017. 25(3): pp. 799\u0026ndash;812.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu S et al. Understanding frailty: a qualitative study of older heart failure patients\u0026rsquo; frail experience and perceptions of healthcare professionals with frailty. 2024. 24.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNR N. A review of social isolation: an important but underassessed condition in older adults. J Prim Prev. 2012;33(2):137\u0026ndash;52.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGureje O, Kola L, Afolabi EJTL. Epidemiology of major depressive disorder in elderly Nigerians in the Ibadan Study of Ageing: a community-based survey. 2007. 370(9591): pp. 957\u0026ndash;64.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePuts MTE et al. \u003cem\u003eInterventions to prevent or reduce the level of frailty in community-dwelling older adults: a scoping review of the literature and international policies.\u003c/em\u003e 2017. 46(3): pp. 383\u0026ndash;392.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Frailty, Elderly, Hospitalization, Qualitative research, lived experience, Phenomenology","lastPublishedDoi":"10.21203/rs.3.rs-8104094/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8104094/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eFrailty is a multidimensional condition associated with aging, characterized by reduced physiological reserve and increased vulnerability to stressors, leading to impaired independence and quality of life. In low-resource settings, frailty\u0026rsquo;s social, emotional, and economic dimensions are poorly understood. This study explored the lived experiences of frail older adults attending public hospitals in Wolaita Zone, Southern Ethiopia.\u003c/p\u003e\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eTo investigate and comprehend the lived experience of frailty among elderly patients in public hospitals of the Wolaita zone, Ethiopia, 2024.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA qualitative descriptive-phenomenological study design was employed, and semi-structured, in-depth interviews were conducted with 10 frail elderly patients (\u0026ge;\u0026thinsp;75 years) from October 2 to 30, 2024. Frailty was assessed using the FRAIL-NH scale, with scores\u0026thinsp;\u0026ge;\u0026thinsp;7 classifying participants as frail. Data were analyzed using Colaizzi\u0026rsquo;s descriptive phenomenological method, and open code software was employed for this process. Based on data saturation, 10 voluntary elderly patients with frailty were included in the study, of whom six were male. The mean age was 77(range from 75 to 81) The analysis of the studies revealed three main themes: the physical experiences associated with frailty, the multifaceted effects of frailty, and the role of social and family support.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe study revealed that elderly patients with frailty experienced significant physical, psychological, and social challenges. While many benefited from family and social support, they also emphasized resilience and coping strategies to manage their condition. Healthcare providers should offer holistic, empathetic care by recognizing and addressing the unique needs and experiences of frail older adults.\u003c/p\u003e","manuscriptTitle":"Lived Experiences of Elderly Patients with Frailty Attending Public Hospitals in Wolaita Zone, Southern Ethiopia","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-18 05:45:46","doi":"10.21203/rs.3.rs-8104094/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewersInvited","content":"","date":"2025-12-12T12:06:27+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-08T18:34:18+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-11-20T14:08:51+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-11-20T13:56:09+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Geriatrics","date":"2025-11-20T13:53:04+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-geriatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bgtc","sideBox":"Learn more about [BMC Geriatrics](http://bmcgeriatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bgtc/default.aspx","title":"BMC Geriatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1db15213-95d3-44c0-acd9-4423bae3d873","owner":[],"postedDate":"December 18th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-12-18T05:45:46+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-18 05:45:46","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8104094","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8104094","identity":"rs-8104094","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}