Palliative Care and End-of-Life Considerations for the Frail Patient

Abstract

Patients with frailty experience substantial physical and emotional distress related to their condition and face increased morbidity and mortality compared with their nonfrail peers. Palliative care is an interdisciplinary medical specialty focused on improving quality of life for patients with serious illness, including those with frailty, throughout their disease course. Anesthesiology providers will frequently encounter frail patients in the perioperative period and in the intensive care unit (ICU) and can contribute to improving the quality of life for these patients through the provision of palliative care. We highlight the opportunities to incorporate primary palliative care, including basic symptom management and straightforward goals-of-care discussions, provided by the primary clinicians, and when necessary, timely consultation by a specialty palliative care team to assist with complex symptom management and goals-of-care discussions in the face of team and/or family conflict. In this review, we apply the principles of palliative care to patients with frailty and synthesize the evidence regarding methods to integrate palliative care into the perioperative and ICU settings.

Figure 1.

Indications and key components of each of the three categories of palliative care.

Figure 2.

The illness trajectory of a frail patient with surgical needs. Purple = opportunities for primary palliative care; yellow= opportunities for specialty palliative care; blue = consideration of hospice, if in line with goals and values. Adapted from Lynn and Adamson, 2003.