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Title: Recognising older frail patients near the end of life: What next?
Austin Authors: Cardona-Morrell, Magnolia;Lewis, Ebony;Suman, Sanjay;Haywood, Cilla J ;Williams, Marcella;Brousseau, Audrey-Anne;Greenaway, Sally;Hillman, Ken;Dent, Elsa
Affiliation: South Western Sydney Clinical School, The Simpson Centre for Health Services Research, The University of New South Wales, Liverpool, NSW, Sydney, Australia
Medway NHS Foundation Trust, Elderly Care Service, Medway Maritime Hospital, Gillingham, Kent England, UK
Austin Health, Heidelberg, Victoria, Australia
Department of Medicine, Austin Health, The University of Melbourne, Heidelberg, Victoria, Australia
School of Nursing, Lansing Community College & Sparrow Hospice House, Lansing, MI, USA
Schwartz-Reisman Emergency Medicine Institute, Mount Sinai Hospital, Toronto, Canada
Sydney West Area Palliative Care Service, Westmead Hospital, Westmead, NSW 2145 Sydney, Australia
Intensive Care Unit, Liverpool Hospital and South Western Sydney Clinical School, The University of New South Wales, Intensive Care Unit, Liverpool Hospital, Elizabeth Street, Liverpool, NSW, Sydney, Australia
Torrens University Australia, Adelaide, SA, Australia
Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
Issue Date: Nov-2017 2017-10-06
Publication information: European journal of internal medicine 2017; 45: 84-90
Abstract: Frailty is a state of vulnerability resulting from cumulative decline in many physiological systems during a lifetime. It is progressive and considered largely irreversible, but its progression may be controlled and can be slowed down and its precursor -pre-frailty- can be treated with multidisciplinary intervention. The aim of this narrative review is to provide an overview of the different ways of measuring frailty in community settings, hospital, emergency, general practice and residential aged care; suggest occupational groups who can assess frailty in various services; discuss the feasibility of comprehensive geriatric assessments; and summarise current evidence of its management guidelines. We also suggest practical recommendations to recognise frail patients near the end of life, so discussions on goals of care, advance care directives, and shared decision-making including early referrals to palliative and supportive care can take place before an emergency arises. We acknowledge the barriers to systematically assess frailty and the absence of consensus on best instruments for different settings. Nevertheless, given its potential consequences including prolonged suffering, disability and death, we recommend identification of frailty levels should be universally attempted in older people at any health service, to facilitate care coordination, and honest discussions on preferences for advance care with patients and their caregivers.
DOI: 10.1016/j.ejim.2017.09.026
PubMed URL: 28993099
Type: Journal Article
Subjects: Advanced Care Planning
Frail Elderly
Geriatric Assessment/methods
Terminal Care
Appears in Collections:Journal articles

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