The following is a summary of “Palliative Care Needs of Physically Frail Community-Dwelling Older Adults With Heart Failure,” published in the JUNE 2023 issue of Pain Management by DeGroot, et al.

Physical frailty is increasingly recognized as a potential trigger for palliative care (PC) consultation. However, the specific palliative care needs of physically frail individuals with heart failure (HF) in the outpatient setting have yet to be extensively studied. Therefore, for a study, researchers sought to describe the palliative care needs of community-dwelling, physically frail individuals with HF.

The study included individuals ≥50 years or older with HF who had been hospitalized at least once the previous year. Participants with moderate/severe cognitive impairment, hospice patients, or non-English speakers were excluded. The FRAIL scale (ranging from 0 to 5, with 0 representing robust health, 1-2 indicating prefrailty, and 3-5 indicating frailty) and the Integrated Palliative Outcome Scale (IPOS) (17 items, scoring from 0 to 68, with higher scores indicating greater palliative care needs) were used as measures. Multiple linear regression analysis examined the association between the frailty group and palliative care needs.

The study included 286 participants with a mean age of 68 (ranging from 50 to 92). Most participants were male (63%) and White (68%); on average, they experienced two hospitalizations annually. Most participants were physically frail (44%) or prefrail (41%). The mean palliative care needs (IPOS) score was 19.7 (ranging from 0 to 58). On average, participants reported 5.86 (SD 4.28) moderate, severe, or overwhelming palliative care needs in the past week. The most prevalent needs reported were family/friend anxiety (58%), weakness/lack of energy (58%), and shortness of breath (47%). Frail participants had a significantly higher mean score for palliative care needs (26) compared to prefrail (16, P < 0.001) and robust participants (11, P < 0.001). Frail individuals reported an average of 8.32 (SD 3.72) moderate/severe/overwhelming needs, while prefrail and robust participants reported 4.56 (SD 3.77) and 2.39 (SD 2.91) needs, respectively (P < 0.001). Frail participants also reported a higher prevalence of weakness/lack of energy (83%), shortness of breath (66%), and family/friend anxiety (69%) compared to prefrail (48%, 39%, 54%) and robust (13%, 14%, 35%) participants (P < 0.001).

Physically frail individuals with HF had higher unmet palliative care needs than their non-frail counterparts. Implementing palliative care needs and frailty assessments may help identify vulnerable patients with unmet needs who require further evaluation and follow-up.

Source: jpsmjournal.com/article/S0885-3924(23)00042-8/fulltext