Uncertainty and advance care planning in older adults living with frailty. A collection and commentary on theme of advanced care planning.

Older people often live with multiple serious illnesses and frailty with a reduced biological reserve (O’Caoimh et al 2021). People living with frailty face an inherently uncertain future with the unpredictable dying trajectory of frailty being widely recognised (Murray et al 2005). Uncertainty can also result from healthcare systems, from fragmented care due to multiple illnesses, or patchy communication between services. It can leave patients, carers, and health professionals distressed and overwhelmed (Etkind et al 2022). Advance care planning seeks to help individuals articulate their preferences and priorities for care in the face of an uncertain future (Box 1). Advance care planning is thus intertwined with and inseparable from uncertainty, yet the relationship between the two is relatively under-recognised and under-investigated. The papers in this themed collection explore aspects of this relationship in the context of frailty. Some of the included papers discuss uncertainty explicitly, while in others, uncertainty is implicit in discussions of advance care planning, reflecting that uncertainty is often an important undercurrent in these situations. We discuss how uncertainty is commonly conceptualised as a barrier to advance care planning, but advance care planning can also be seen as an opportunity to help people live well by supporting them to make sense of ongoing and irreducible uncertainty.