Frailty-Informed Decision Making During Acute Health Crises: A Competency-Based Framework for Person-Centered Care

Frailty profoundly influences the risks, benefits, and outcomes of medical care, yet clinical decision making during an acute health crisis is often driven by single-system treatment paradigms rather than a holistic understanding of patient values, prognosis, and personhood. This review outlines a practical, competency-based framework to guide clinicians through key clinical tasks that reliably align treatment decisions with what matters most to individuals living with frailty. The approach distinguishes between interventions that remain medically reasonable versus those that are unlikely to provide benefit and acknowledges that appropriate treatments evolve as frailty progresses. Anchoring the framework is an emphasis on dignity and the preservation of personhood through every stage of care. Much like a clinical procedure, these clinical tasks require defined intent, structured steps, and practice to ensure competence. When performed skillfully, these tasks may reduce low-value interventions, support autonomy, and promote compassionate, goal-concordant care during the most challenging moments of aging.