Perspectives on palliative care - frailty Jacqueline Thompson, Nurse Consultant Older People DHSCP jacquelinethompson2@nhs.net

Frailty and palliative care What do we mean by frail (elderly)? Why is frailty an issue for palliative care? What are the challenges in providing ‘good’ palliative care in our frail (elderly) population.

A Greying Nation

Frailty - defined Frailty is not a disease but a combination of the natural ageing process and a variety of medical problems. • It focuses on the loss of reserve, energy and wellbeing. • A useful definition is: “Multidimensional loss of reserves - energy, physical ability, cognition and health” Rockwood et al (2005)

Frailty and end of life Frailty is: Common Quantifiable Predictor of morbidity + mortality Progressive (5 -10 years) Episodic deterioration Preventable components Longer need for palliative care Can be unpredictable - sudden death Expensive

The challenges of frailty & palliative care

‘Disease Apartheid’ (Prof Thomas) Different disease trajectory Increasing demand Multiple co morbidities Mental capacity issues Resources/service modelling Time for complex, sensitive discussions These challenges are a compelling reason for not getting involved in frailty

A different ending Identify frailty using validatated tools (use frailty pathways) Skilled generalists Provide information - prognosis, options, benefits, burdens ie shared decision making Well timed and documented person centered, advance care planning Care which can rapidly respond to a change in circumstances and offer choices Open, honest communication with patients, families and carers An adequately resourced integrated health and social care system