On November 9, 2006,1 authors Kenneth S. Boockvar and Diane E. Meier introduced a frail older patient, Mrs K, an 89-year-old woman with frailty characterized by multiple medical problems and several years of declining physical condition. Throughout, she was cared for by her long-time physician, Dr T. The core clinical features of frailty include loss of strength, weight loss, low levels of activity, poor endurance, and fatigue. The presence of 3 or more of these characteristics is associated with adverse outcomes including falls, new or worsened functional impairment, hospitalization, and death. Using Mrs K's course, the authors described the challenges of recognizing frailty in clinical practice and identified it as a condition for which palliative care would be appropriate. They also provided approaches to common problems and symptoms that frail older adults experience. Advance care planning, patient-clinician communication, and appropriate palliative care and hospice referral were highlighted. The authors recommend the application of multidisciplinary, team-based palliative approaches, with up-to-date geriatrics knowledge, to treat these patients' coexisting social, psychological, and medical needs. Dr T continued to see Mrs K regularly, making home visits when she was no longer able to come to his office.
Markowitz AJ, Pantilat SZ. Palliative Care for Frail Older Adults: “There Are Things I Can't Do Anymore That I Wish I Could”. JAMA. 2006;296(24):2967. doi:10.1001/jama.296.24.2967