When frailty should mean palliative care

Pialoux, Tanneguy; Goyard, Jean; Hermet, R

doi:10.5430/jnep.v3n7p75

Cited by 7 publications

(4 citation statements)

References 14 publications

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“…However, 11.6% of people with moderate dementia also displayed severe frailty. O'Bryant et al (2010) and Pialoux, Goyard, and Herme (2013) state that the care provided in the advanced stage of dementia is often fragmented; many patients may die experiencing considerable suffering (Jones et al, 2016) as a result of unrecognized and untreated symptoms. A lack of understanding about dementia has been identified as a barrier to providing optimal care to people with advanced dementia (Harris, 2006;Penders, Albers, Deliens, Stichele, & Van den Block, 2015).…”

Section: Frailty Of People With Dementia and The Caregiver's Psycholomentioning

confidence: 99%

A cross-sectional study of family caregiver burden and psychological distress linked to frailty and functional dependency of a relative with advanced dementia

Abreu

Tolson²,

Jackson

et al. 2018

Dementia

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Psychological health of caregivers of people with dementia is a major public concern. This study sought to determine the relationship between caregiver burden, psychological distress, frailty and functional dependency of a relative with advanced dementia. Persons with dementia and their caregivers (102 dyads) participated in this Portuguese community based cross-sectional study. Data were collected using the Clinical Dementia Rating Scale, a sociodemographic questionnaire, the Zarit Burden Interview, the Brief Symptoms Inventory and the Edmonton Frail Scale. Alzheimer's disease was the most common type of dementia among the recipients of care, who showed moderate (42.2%) to severe (52.9%) dementia. Among them 35.3% exhibited moderate and 45.1% severe frailty. Family caregivers reported moderate (76.5%) to severe burden (18.6%). Psychological distress was very high among family caregivers. Results show that people with dementia exhibited moderate (35.3%) or severe frailty (45.1%) and that a severe frailty was found in people with moderate dementia. A one-way ANOVA was conducted between the Global Severity Index and some sociodemographic variables. ANOVA reached p < .01 for employment status of the caregiver, assistance and professional support, and psychiatric history; and p = 0.01 for caregiver age and years of caregiving. Although caregivers reported benefit from the supportive approach offered by the multidisciplinary home care team, high levels of distress and associated burden were found, which might decrease their capacity to care for the person with dementia and their own health and well-being.

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Section: Frailty Of People With Dementia and The Caregiver's Psycholomentioning

confidence: 99%

A cross-sectional study of family caregiver burden and psychological distress linked to frailty and functional dependency of a relative with advanced dementia

Abreu

Tolson²,

Jackson

et al. 2018

Dementia

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“…[6][7][8][9][10] There are few specialist end-of-life services for frailty, despite its high prevalence in older people, and suggestions that frailty should signal a need to adopt a palliative care approach. 11,12 Many established palliative care pathways were designed to meet the needs of people with cancer, and it is unclear how appropriate these are for people with frailty. 13,14 Recent work in England found that older people, carers and other key stakeholders agree that work is needed to develop a model of supportive and palliative care for people with frailty.…”

Section: Introductionmentioning

confidence: 99%

What is the evidence that people with frailty have needs for palliative care at the end of life? A systematic review and narrative synthesis

et al. 2019

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Background: The number of older people living and dying with frailty is rising, but our understanding of their end-of-life care needs is limited. Aim: To synthesise evidence on the end-of-life care needs of people with frailty. Design: Systematic review of literature and narrative synthesis. Protocol registered prospectively with PROSPERO (CRD42016049506). Data sources: Fourteen electronic databases (CINAHL, Cochrane, Embase, EThOS, Google, Medline, NDLTD, NHS Evidence, NICE, Open grey, Psychinfo, SCIE, SCOPUS and Web of Science) searched from inception to October 2017 and supplemented with bibliographic screening and reference chaining. Studies were included if they used an explicit definition or measure of frailty. Quality was assessed using the National Institute for Health tool for observational studies. Results: A total of 4,998 articles were retrieved. Twenty met the inclusion criteria, providing evidence from 92,448 individuals (18,698 with frailty) across seven countries. Thirteen different measures or definitions of frailty were used. People with frailty experience pain and emotional distress at levels similar to people with cancer and also report a range of physical and psychosocial needs, including weakness and anxiety. Functional support needs were high and were highest where people with frailty were cognitively impaired. Individuals with frailty often expressed a preference for reduced intervention, but these preferences were not always observed at critical phases of care. Conclusion: People with frailty have varied physical and psychosocial needs at the end of life that may benefit from palliative care. Frailty services should be tailored to patient and family needs and preferences at the end of life.

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“…Older patients often present comorbidities and other risk factors that probably superimpose, and their absolute mortality risk progressively resembles that of a control population. The old and the frail patient probably will require a different approach and their management imposes different challenges [ 18 , 20 ]. On the contrary, younger patients may need more hospital resources [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

Critically ill patient mortality by age: long-term follow-up (CIMbA-LT)

Pereira

Oliveira

Vieira

et al. 2023

Ann. Intensive Care

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Background The past years have witnessed dramatic changes in the population admitted to the intensive care unit (ICU). Older and sicker patients are now commonly treated in this setting due to the newly available sophisticated life support. However, the short- and long-term benefit of this strategy is scarcely studied. Methods The Critically Ill patients’ mortality by age: Long-Term follow-up (CIMbA-LT) was a multicentric, nationwide, retrospective, observational study addressing short- and long-term prognosis of patients admitted to Portuguese multipurpose ICUs, during 4 years, according to their age and disease severity. Patients were followed for two years after ICU admission. The standardized hospital mortality ratio (SMR) was calculated according to the Simplified Acute Physiology Score (SAPS) II and the follow-up risk, for patients discharged alive from the hospital, according to official demographic national data for age and gender. Survival curves were plotted according to age group. Results We included 37.118 patients, including 15.8% over 80 years old. The mean SAPS II score was 42.8 ± 19.4. The ICU all-cause mortality was 16.1% and 76% of all patients survive until hospital discharge. The SAPS II score overestimated hospital mortality [SMR at hospital discharge 0.7; 95% confidence interval (CI) 0.63–0.76] but accurately predicted one-year all-cause mortality [1-year SMR 1.01; (95% CI 0.98–1.08)]. Survival curves showed a peak in mortality, during the first 30 days, followed by a much slower survival decline thereafter. Older patients had higher short- and long-term mortality and their hospital SMR was also slightly higher (0.76 vs. 0.69). Patients discharged alive from the hospital had a 1-year relative mortality risk of 6.3; [95% CI 5.8–6.7]. This increased risk was higher for younger patients [21.1; (95% CI 15.1–39.6) vs. 2.4; (95% CI 2.2–2.7) for older patients]. Conclusions Critically ill patients’ mortality peaked in the first 30 days after ICU admission. Older critically ill patients had higher all-cause mortality, including a higher hospital SMR. A long-term increased relative mortality risk was noted in patients discharged alive from the hospital, but this was more noticeable in younger patients.

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When frailty should mean palliative care

Cited by 7 publications

References 14 publications

A cross-sectional study of family caregiver burden and psychological distress linked to frailty and functional dependency of a relative with advanced dementia

A cross-sectional study of family caregiver burden and psychological distress linked to frailty and functional dependency of a relative with advanced dementia

What is the evidence that people with frailty have needs for palliative care at the end of life? A systematic review and narrative synthesis

Critically ill patient mortality by age: long-term follow-up (CIMbA-LT)

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