|Home | About | Journals | Submit | Contact Us | Français|
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.