Frailty, a geriatric syndrome, affects 5% to 17% of older adults and is expected to rise alongside rapid growth in the ageing population. Symptoms include generalized weakness, exhaustion, slow gait, poor balance, decreased physical activity, cognitive impairment, and weight loss. Having frailty places an individual at an increased risk of adverse outcomes including falls, hospitalization, and possible mortality. Studies have shown a clear pattern of increased healthcare costs and utilization associated with frailty. 

All older adults are at risk of developing frailty, although risk levels are substantially higher among those with comorbidities, low socioeconomic position, poor diet, and sedentary lifestyles. Researcher has shown a severe impact of frailty on older adults, their caregivers, and on society as a whole. While specific treatments for frailty are yet to be developed and the existing clinical measures of frailty provide useful for identifying high risk individuals.  Identifying frailty early on can lead to improved treatment decision making and management of care by taking into account individual vulnerabilities and propensity for adverse health outcomes. 

Recognizing frailty and understanding its progression will help care teams develop treatment plans and better discuss prognosis with patients and their families.  As individuals age, cognitive decline as well as any life-changing diagnoses such as frailty may make it difficult for them to take an active role in their own healthcare choices. 

Advance care planning (ACP) can help individuals identified with frailty who still have decision-making capacity. ACP discussions can allow individuals to guide healthcare providers and family members in their future healthcare decisions in the event they become unable to make decisions for themselves. ACP allows them to outline their wishes, values, and preferences before these decisions are necessary to ensure they are honored. 

Why Is ACPs Beneficial for Individuals with Frailty? 

ACP is not just about the end of life goals. To be effective and helpful to an individual and their care teams, the process needs to begin as early as possible. 

The goal of ACP is to give an individual autonomy in decision making before those decisions are required due to the possibility of an incapacitating injury or illness. In the event that the individual is no longer capable of participating in their own care or making decisions, ACPs help to do the following: 

  • Increase the likelihood that the individual's preferences are known and respected 
  • Minimize the burden of decision making on family or friends
    • Reduce stress and anxiety for family members in making decisions
    • Improve psychological outcomes for survivors 
  • Reduce the likelihood of conflicts between an advocate, family members, and healthcare providers
  • Improve quality of care received
  • Minimize the likelihood of over or undertreatment 
  • Reduce inappropriate transfers from residential care to a hospital setting

Where to begin ACP Discussions

Early ACP discussion with an individual and their family, especially as their frailty is exacerbated, approaches and restores personhood as it explores their physical, psychological, social, spiritual and cultural self and, where appropriate, the environmental needs and wishes they have. The ACP conversation should be driven by what matters to the person and is best done over several sessions.

The following questions can be used to steer the conversation: 

  • Should current preferences be strictly applied to future situations or serve as a general guide? 
  • In the event of a medical emergency, where do they prefer to receive care? 
  • Are there any life-sustaining treatments that they would want to receive regardless of circumstances or would not want to receive regardless of circumstances? 
  • What are the goals for care? Should the goal of care be to prolong life, improve or maintain function and/or quality of life, provide comfort care, etc.?
  • Who should speak on their behalf if they cannot speak for themselves? 

The ideal ACP gives a sense of the person’s values and beliefs, but also helps to guide medical decisions in particular circumstances (e.g. infection, stroke, fall and hip pain, or cardiac arrest), is easy to update, and is accessible to all healthcare professionals who might need to view it across care settings.

Health plans and at-risk healthcare organizations who are interested in providing this beneficial intervention to their members who are at risk of frailty or other serious illnesses can partner with Iris. We provide an effective way to scale ACP across member populations and provide universal access to Advance Care Planning. To learn more about how we can serve your member population with tailored ACP, contact us today.