Background Improved understanding of how to provide palliative care to the growing number of people living and dying with frailty is an international priority. Appropriate models of care may have similarities and differences to existing specialist palliative care (SPC) provision. Patients who currently access SPC may subjectively be described as frail; however, there is limited data on actual frailty prevalence and how frailty is associated with demographics, diagnoses and outcomes.
Methods Specific measures of frailty are not routinely recorded in SPC; therefore, measures of performance that are consistently collected were mapped to frailty level. Hospices North East (a collaborative of independent hospices) have an established dataset detailing the care they provide for whom. Analysis of this dataset established levels of frailty and its relationships.
Results The Australia-Modified Karnofsky Performance Status (AKPS) can be mapped to Rockwood’s Clinical Frailty Scale to provide a proxy measure of frailty. 520 discharges or deaths (from 455 patients) occurred in three independent hospices in the Northeast of England from April 1st 2017 to March 31st 2018. Admission AKPS was available on 420 discharges or deaths (from 407 patients). On admission to the hospice the prevalence of very severe frailty (AKPS 10–20) was 26.4%; severe frailty (AKPS 30) was 11.4%; moderate frailty (AKPS 40–50) was 35.5% and mild frailty (AKPS 60) was 17.6%. One-off high levels of frailty and progressively increasing frailty are detrimentally related to prognosis and length of stay.
Conclusions There is a significant burden of frailty in the current hospice in-patient population. Therefore, much may be learned from contemporary service provision when considering applicable future palliative care models for those with frailty. As with current patients a two-tier in-patient model comprising of both intensive medically led short stay units and nurse led longer stay units or community beds may be useful.
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