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Textbook of Palliative Care pp 1191–1207Cite as

Palliative Care, Frailty, and Older People

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Abstract

This chapter provides an overview of the symptoms of frailty, the tools used to recognize and assess older people living with frailty such as the frailty phenotype and frailty index, and some of their common palliative care needs. Further, it details some of the perceived challenges of frailty to current palliative care practice, namely, recognizing dying, multiple morbidities and symptom burden, and the focus or goals of care. Palliative care for older people with frailty requires a broader disability rather than a single disease focus. Coordination and interdependencies with other care providers become as important as the discrete patient/professional clinical encounter. The centrality of the older person with frailty and their “family” living and dying over time means the social environment becomes paramount local resources; support and the interplay between services and community are vital. While evidence on the best ways to provide palliative care to this population is still developing, the chapter offers some examples of current services and suggests key elements derived from the literature and practice. The authors suggest there is a moral and clinical imperative for palliative care services to engage with older people with frailty and their caregivers, both lay and professional. This imperative brings opportunities and challenges, including revaluing living and dying rather than an overemphasis on care in the last days of life and remodeling palliative care services to focus more on need than diagnosis and the reorientation of palliative care, so that it can be integrated with older people’s services.

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Authors and Affiliations

  1. King’s College London, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, London, UK

    Caroline Nicholson & Sarah Combes

  2. St Christopher’s Hospice, London, UK

    Caroline Nicholson & Sarah Combes

  3. King’s College London, Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, London, UK

    Catherine Evans

  4. Sussex Community NHS Foundation Trust, Brighton General Hospital, Brighton, UK

    Catherine Evans

  5. Supportive and End of Life Care (Nursing), St. Christopher’s Hospice/King’s College, London, UK

    Caroline Nicholson

Authors
  1. Caroline Nicholson
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  2. Catherine Evans
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  3. Sarah Combes
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Corresponding author

Correspondence to Caroline Nicholson .

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Editors and Affiliations

  1. School of Medicine,Palliative Care, HammondCare, The University of Sydney School of Medicine, Sydney, Australia

    Roderick Duncan MacLeod

  2. VUB-UGhent End-of-Life Care Research Group, Department of Family Medicine and Chronic Care and Department of Clinical Sciences, Vrije Universiteit Brussel (VUB), Brussels, Belgium

    Lieve Van den Block

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Nicholson, C., Evans, C., Combes, S. (2019). Palliative Care, Frailty, and Older People. In: MacLeod, R., Van den Block, L. (eds) Textbook of Palliative Care. Springer, Cham. https://doi.org/10.1007/978-3-319-77740-5_66

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