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Frailty and palliative care
  1. M E Hamaker1,
  2. Frederiek van den Bos2 and
  3. Siri Rostoft3
  1. 1Geriatric Medicine, Diakonessenhuis, Utrecht, The Netherlands
  2. 2Geriatric Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
  3. 3Department of Geriatric Medicine, Oslo University Hospital; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
  1. Correspondence to Dr M E Hamaker, Geriatric Medicine, Diakonessenhuis, Utrecht 3582KE, The Netherlands; mhamaker{at}diakhuis.nl

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Introduction

Frailty is a syndrome evident when a threshold number of regulatory systems required to maintain human body homoeostasis are compromised by intercurrent and chronic diseases and physiological ageing. As a result, someone with frailty becomes vulnerable to adverse outcomes when exposed to stressors like an acute illness or treatment(s).1 2 Frailty can also have significant personal impact, including care dependence and loneliness.

Many different concepts of frailty exist3 and consequently prevalence data shows huge variation.4 It is not simply present or absent but a spectrum that encompasses cognitive, functional, psychosocial and somatic domains. With greater vulnerability, seemingly insignificant stressors like a urinary tract infection can cause significant incremental morbidity, like delirium or functional decline and ultimately death. Frailty may fluctuate, but over time patients usually exhibit slowly progressive decline, sometimes interspersed with disease episodes or exacerbations and (partial) recovery, with only a slight acceleration of decline as death approaches.

People with frailty have physical, psychosocial and support needs amenable to palliative interventions, but studies reveal they are less likely to access palliative care than those with advanced cancer.5 We will focus on two questions. First, why is palliative care relevant to patients with frailty and what hinders them from receiving it? Second, why is awareness of frailty and its components relevant for provision of palliative care?

The relevance of palliative care to frailty

Much end of life care is organised based on terminal illnesses like cancer,6 where the disease trajectory is somewhat predictable and prognostication is difficult but feasible.7 This is relevant, because palliative care access is generally restricted to those with cancer or a disease with similarly limited remaining life-expectancy.8 However, initiating palliative care in patients who are frail due to illnesses like chronic obstructive pulmonary disease, dementia, end-stage renal disease and heart failure (or a combination), is less …

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Footnotes

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Commissioned; internally peer reviewed.

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