Supportive and palliative care for people with chronic respiratory disease and frailty

Curr Opin Support Palliat Care. 2020 Sep;14(3):206-212. doi: 10.1097/SPC.0000000000000523.

Abstract

Purpose of review: Frailty is a multidimensional syndrome associated with increased risk of poor outcomes. It is estimated that at least one in five people with chronic respiratory disease is also living with frailty. In this review, we consider recent advances in how frailty can be recognized, and its associated impact on people with chronic respiratory disease. We then discuss advances in supportive and palliative care for those with both chronic respiratory disease and frailty.

Recent findings: The interconnectedness of chronic respiratory disease and frailty is being better understood. An increasing number of factors associated with frailty in respiratory disease have been identified, from increased symptom burden (e.g. breathlessness, fatigue) to increased exacerbations and higher mortality. These contribute to accumulating multidimensional losses in reserve, and unpredictable health. Recent advances in respiratory research, while not always with people with frailty, may inform supportive and palliative care to address frailty in chronic respiratory disease. These include rehabilitation interventions to strengthen reserves, advance care planning interventions to help manage unpredictable trajectories, and integrated models of care (e.g. incorporating respiratory, geriatric, and palliative care) to address multidimensional needs.

Summary: Recent evidence supporting the role of rehabilitation, advance care planning, and early palliative care, may be of benefit to people living with chronic respiratory disease and frailty. Models showing integration across multiple specialities and professionals may have the most potential to meet the multidimensional needs of this group. Future research should develop and test models of care that address frailty and/or explore the role of frailty in triggering integrated multidisciplinary input.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Advance Care Planning
  • Chronic Disease
  • Frailty / diagnosis*
  • Frailty / epidemiology*
  • Frailty / therapy
  • Humans
  • Palliative Care / organization & administration*
  • Respiration Disorders / epidemiology*
  • Respiration Disorders / therapy
  • Severity of Illness Index
  • Systems Integration