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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: PMC2714787

Authors' response

Jan de Lepeleire
Katholieke Universiteit Leuven, General Practice, Kapucijnenvoer 33 — blok j — bus 7001, Leuven, 3000 Belgium. E-mail: eb.nevueluk.dem@erielepeled.naj
Steve Illffe
University College London, Department of Primary Care, London
Jean Marie Degryse
Université Catholique de Louvain, CAMG, Brussels, 1200 Belgium

We agree with Avril Danczak that palliative care for frail older people is an important issue, but our purpose was different. We wanted to reframe frailty and pre-frailty as tractable problems, even if temporary reversal of frailty is difficult in the current environment in many countries in primary care. The challenge is then to think about interventions to increase capability and function rather than provide prosthetic replacements for them.

Nevertheless, it is important to know when frailty becomes intractable. This is problematic, especially when cognitive impairment is severe and impedes communication. The predictions that practitioners make about the course of frailty are often wrong, with both underestimation and overestimation of mortality risk.

End-of-life care for frail older people has also tended to focus on what should be withheld, rather than on what should be done.1 As Danczak says, the lack of clarity about prognosis and best practice in palliation can result in care that can easily fall below acceptable standards, and inappropriate emergency admissions to hospital.


1. Goodman C, Evans C, Wilcock J, et al. End of life care for community dwelling older people with dementia: an integrated review. Int J Geriatric Psychiatr. 2009 (in press) [PubMed]

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