Frailty is the loss of resources in several domains leading to the inability to respond to physical or psychological stress. The evaluation of frailty is generally carried out using the Comprehensive Geriatric Assessment. For this evolving and potentially reversible syndrome, screening and early intervention are a priority in primary health care, and general practitioners require a simple screening tool. The aim of the present work was to review the literature for validated screening instruments for frailty in primary health care setting. A search was carried out on PubMed and Cochrane Central in June 2011. A total of 10 instruments screening for frailty in primary health care were listed, analysed and compared. It is difficult to show which tool today is the best for screening for frailty in the elderly in primary care settings. Two instruments are potentially suitable - the Tilburg Frailty Indicator and the SHARE Frailty Index. In addition, these instruments require validation in larger studies in primary health care settings and with more quality criteria.

There is difficulty for practitioners in recognising frailty and in establishing palliative care. This clinical entity is the sum of several illnesses or syndromes that are curable if taken separately. Practitioners have difficulty integrating the inevitably fatal nature of the situation. The aim of this work is to assist physicians in providing proper care for the frail elderly. It consists in a systematic review of the literature available, intended answer the following questions: Is frailty an appropriate indication for the instatement of palliative care? When is the right moment to instate palliative care for the frail elderly subject? What tools are available to assist care teams? Are there efficient organisational models that integrate the frail elderly into palliative care? A consensus was reached on 12 articles. There are answers to these questions. But the level of evidence is low. It can be concluded that frailty is an indication for the instatement of palliative care. It is possible to envisage a three-stage procedure: First; identification of the frail elderly presenting characteristics that makes them candidates for palliative care. This is the most delicate phase. Then evaluation of symptoms and needs. Here again the GCGA is very useful. Finally, the drafting of a care plan.

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