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Perspectives on palliative care - frailty

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?

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Perspectives on palliative care - frailty

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

  2. 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.

  3. A Greying Nation

  4. 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)

  5. 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

  6. The challenges of frailty & palliative care

  7. ‘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

  8. 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

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