Perspectives on Care at the Close of Life Section Editor: Margaret A. Winker, MD, Deputy Editor, JAMA.
Author Affiliations: James J. Peters Veterans Affairs Medical Center, Bronx, NY (Dr Boockvar); Mount Sinai School of Medicine, New York, NY (Drs Boockvar and Meier); The Jewish Home and Hospital, New York, NY (Dr Boockvar).
Frailty in older adults is increasingly a recognized syndrome of decline, sometimes subtle, in function and health that may be amenable to available approaches to care. Frailty manifests the following core clinical features: loss of strength, weight loss, low levels of activity, poor endurance or fatigue, and slowed performance. The presence of 3 or more of these features is associated with adverse outcomes including falls, new or worsened function impairment, hospitalization, and death. In this article, we use the case of Mrs K to describe the challenges of recognizing frailty in clinical practice, common problems and symptoms that frail older adults experience, and approaches to these issues that clinicians may incorporate into their practices. We discuss the importance of advance care planning, provider-patient communication, and appropriate palliative care and hospice referral for frail older adults. Frailty is associated with symptomatic long-term disease, decline in function, and abbreviated survival. Therefore, when frailty is severe, delivery of palliative care focused on relief of discomfort and enhancement of quality of life is highly appropriate. The application of multidisciplinary, team-based palliative approaches and of up-to-date geriatrics knowledge is beneficial for treating these patients because of the complexity of their coexisting social, psychological, and medical needs.
Kenneth S. Boockvar, Diane E. Meier. Palliative Care for Frail Older Adults“There Are Things I Can't Do Anymore That I Wish I Could . . . ”. JAMA. 2006;296(18):2245–2253. doi:10.1001/jama.296.18.2245