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Logo of brjgenpracRCGP homepageJ R Coll Gen Pract at PubMed CentralBJGP at RCGPBJGP at RCGP
Br J Gen Pract. 2009 August 1; 59(565): 613.
PMCID: PMC2714786

Frailty in old age

Jan De Lepeleire et al1 have highlighted a very important area in the assessment of older patients. I fully endorse their emphasis on the ways that frailty may be reversed. However, frailty can be a prognostic indicator that should alert us to other issues, such as effective planning for end-of-life care. Frailty can be useful as a component in the identification of an irreversible decline.

Patients and relatives often need clear information about this state, that is also crucial for carers (professional or laypersons). At the end of life, frailty increases and may alert us to:

  • the need to stop active or inappropriate interventions;
  • to plan the place of end-of-life care;
  • to ensure proper symptom control;
  • to stop the revolving door cycle of fruitless admissions that can mar the final days/weeks of some older patients;
  • to prepare relatives and carers that death is approaching; and
  • to help relatives/carers prepare for death and appropriate grieving.

I was a little disappointed that the paper did not discuss this area in more detail. We are already moving away from the idea that palliative care/terminal care only applies to malignant conditions. Death is, at some point, inevitable. Part of our duty to patients and carers is to ensure that death is managed appropriately and with dignity. We need better understanding of when frailty is irreversible as well as an optimistic and rehabilitative approach to reversible factors.


1. De Lepeleire J, Iliffe S, Mann E, Degryse JM. Frailty: an emerging concept for general practice. Br J Gen Pract. 2009;59(562):e177–e182. [PMC free article] [PubMed]

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