Frailty in older adults: Implications for end-of-life care
ABSTRACTFrailty has important implications for the care needs of older adults and how those needs are met. By recognizing frailty and measuring it objectively, clinicians can better engage patients and their loved ones in difficult discussions about treatment plans and prognosis, and ultimately deliver better palliative care.
KEY POINTS
- Frail older adults are more susceptible to delirium, functional decline, impaired mobility, falls, social withdrawal, and death.
- Evaluating the health care needs of people who are frail requires assessment of their cognition, function, mobility, balance, and social circumstances, in addition to understanding their medical problems.
- When people are so frail that they cannot withstand interventions that can cause significant injury, such as surgery or chemotherapy, then appropriate end-of-life care should focus on maintaining their highest-order functions.
- End-of-life care can include curative treatments of some episodes if they threaten cognition, mobility, or function or cause pain and suffering, even in the context of an overall palliative care plan.
BETTER PALLIATIVE CARE FOR ALL
Palliative care, developed initially to provide holistic and timely symptom-based care for patients with noncurable cancer, should also be available and offered to patients with nonmalignant, life-limiting diseases.23,36,37 Meeting this standard of geriatric care is not easy, given the burden of frailty in this population. Needed are multimodal palliative efforts across the spectrum of settings, from the home to the hospital and nursing home.23
To do this, we need to embrace the complexity posed by each person’s presentation and view care through the frailty lens. This will give us a common language in which to engage in a conversation with the same goal in mind: optimizing quality of life.
Furthermore, quantifying frailty can help minimize interventions that are futile or burdensome, that are not expected to ease symptoms, and that can worsen cognition and function. At the end of a patient’s life, we do not want to add to his or her frailty burden but rather minimize the morbidity associated with it.
The concept of frailty assessment is therefore essential for the timely delivery of holistic palliative care in geriatric patients who have progressive and ultimately terminal conditions.
