When frailty should mean palliative care

Abstract

There is difficulty for practitioners in recognising frailty and in establishing palliative care. This clinical entity is the sum of several illnesses or syndromes that are curable if taken separately. Practitioners have difficulty integrating the inevitably fatal nature of the situation. The aim of this work is to assist physicians in providing proper care for the frail elderly. It consists in a systematic review of the literature available, intended answer the following questions: Is frailty an appropriate indication for the instatement of palliative care? When is the right moment to instate palliative care for the frail elderly subject? What tools are available to assist care teams? Are there efficient organisational models that integrate the frail elderly into palliative care? A consensus was reached on 12 articles. There are answers to these questions. But the level of evidence is low. It can be concluded that frailty is an indication for the instatement of palliative care. It is possible to envisage a three-stage procedure: First; identification of the frail elderly presenting characteristics that makes them candidates for palliative care. This is the most delicate phase. Then evaluation of symptoms and needs. Here again the GCGA is very useful. Finally, the drafting of a care plan.