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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:
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.