9 The identification of older people living with frailty approaching the end of their life in acute care settings

<h3></h3> Frailty is a leading cause of death in older people and yet it is often not considered at end of life. This can lead to inappropriate interventions and sub-optimal treatment of palliative care symptoms and concerns. Recognising when older people living with frailty are approaching the end of their life is important and yet problematic. This is mainly due to the uncertainty associated with the unpredictable trajectory of decline in this patient population. Although tools exist to help with this, there are no studies evaluating the effectiveness of these in frail populations. Acute care settings offer a period of interdisciplinary assessment and an opportunity to discuss prognosis, care needs and patient preferences. Within one of our elderly care wards, as part of a QI project, we have developed a tool to identify progressive frailty (Pro-FiT) as a proxy identifier for people approaching the end of their life. The Progressive Frailty Tool (Pro-FiT) includes several interlinked factors key to wellbeing such as nutritional intake, energy levels, cognition and social engagement. The clinician’s holistic assessment determines to what extent the level and combination of these factors inform the prognosis. Those with a score of greater than 7 are considered progressively frail and likely to be approaching the end of their life. Advance care discussions are prioritised in this group. At 12 months 275 patients’ electronic records were reviewed. Of these, 174 (63%) were identified as progressively frail, 76 (28%) had a documented discussion regarding prognosis and 74 (27%) had died. The Progressive Frailty Tool is useful in identifying older people living with frailty likely to be in the last year of life in an acute care setting. Once identified timely discussions regarding prognosis and goals of care can be initiated with the aim of meeting patients’ needs, and preferences.