Do people with frailty have palliative and end of life care needs?

Problem

The number of older adults living and dying with frailty is rising. Frailty has been defined as a state of increased vulnerability to stressors, characterized by an accumulation of deficits, diminished strength, endurance, and reduced physiologic function. Slow trajectories of decline in frailty may mean that primary care professionals do not recognise the need for a palliative care approach or specialist palliative care. The aim of this study was to summarise evidence on the end of life care needs of people with frailty, to inform care provision.

Approach

Systematic review of nine electronic databases, grey literature and reference lists. The population of interest was adults with frailty, nearing the end of life in any setting. Studies were excluded where older adults were only described as frail, or the term frailty was used without being defined using: phenotypic frailty measures; cumulative deficit measures; other operational definitions of frailty; or without providing a specific measure of frailty for the sample. Studies were included where they reported quantitative data relating to palliative/end of life care. A narrative synthesis was carried out to account for heterogeneity in the definitions of frailty used, outcome measures and results reported. Quality assessment was conducted using National Institute for Health tool for observational and cohort studies

Findings

4474 papers were identified by the searches. Eighteen studies met the inclusion criteria, providing data on 17,738 individuals with frailty from six countries. The majority of studies were from North America (US=5, Canada=6), and Europe (N=4). Eleven different measures or definitions of frailty were used. Patients with frailty reported a range of physical and psychosocial needs, including weakness, weight loss and drowsiness. Pain and emotional distress were experienced at levels similar to populations of cancer patients. Functional support needs were highest for people with cognitive frailty.

Consequences

People with frailty do have specific physical and psychosocial needs at the end of life that may benefit from a palliative care approach or specialist palliative care. Palliative care for this group needs to accommodate high levels of functional dependence. End of life research with older adults should measure frailty, to address the paucity of information available for service provision.