Components and classification of frailty and palliative care

BACKGROUND: Globally, the number of people aged 65 years and older is expected to double by 2050. With increasing age, the risk of frailty and the need for palliative care also rise. A shared understanding of how to assess frailty and determine the need for palliative care could support interprofessional collaboration in clinical practice. The transition from a frail condition to palliative care is a dynamic and individualized process. Although frailty and palliative care are distinct concepts, they may overlap. The present study aimed to examine the components of frailty and palliative care in community-dwelling older people. Early recognition by healthcare professionals of the components that contribute to severe frailty can enable the timely initiation of palliative care. Our second aim was to gain insight into whether an individual should be classified as frail or in need of palliative care according to healthcare professionals. METHODS: We presented fifteen case studies to respondents who were selected based on their specific expertise in the Netherlands and Belgium. Each respondent was asked to identify, for each case study, the components that indicated frailty, palliative care needs, or both. Additionally, they were asked to rate their level of certainty regarding each indication. Wilcoxon tests were employed to assess differences, and regression analyses were conducted to identify the components most strongly associated with frailty and in need of palliative care. RESULTS: In most cases, differences were observed between the identification of frailty and palliative care needs, with par-ticipants indicating that a patient could exhibit components of frailty without necessarily having palliative care needs (p-value < 0.05). In no case were palliative components recognized with greater certainty than components of frailty. The case in our study with the highest certainty score for frailty components showed a significant difference compared to the corresponding certainty score for palliative care needs. Conversely, the case with the highest certainty score for palliative care needs did not differ significantly from the certainty score for frailty components. CONCLUSIONS: Our study showed that healthcare professionals use different components to classify individuals as frail or in need of palliative care. In addition, these professionals were more certain in identifying frailty than in identifying palliative care needs, and may be less likely to recognize palliative care needs in their patients, who may already be quite frail. Improved understanding of the progression from frailty to the need for palliative care may support patient-centered care and increase enhance the quality of life for individuals requiring support.