Palliative Care Needs of Physically Frail Community-Dwelling Older Adults With Heart Failure

Abstract

Context: Physical frailty is emerging as a potential "trigger" for palliative care (PC) consultation, but the PC needs of physically frail persons with heart failure (HF) in the outpatient setting have not been well described.

Objectives: This study describes the PC needs of community dwelling, physically frail persons with HF.

Methods: We included persons with HF ≥50 years old who experienced ≥1 hospitalization in the prior year and excluded those with moderate/severe cognitive impairment, hospice patients, or non-English speaking persons. Measures included the FRAIL scale (0-5: 0 = robust, 1-2 = prefrail, 3-5 = frail) and the Integrated Palliative Outcome Scale (IPOS) (17 items, score 0-68; higher score = higher PC needs). Multiple linear regression tested the association between frailty group and palliative care needs.

Results: Participants (N = 286) had a mean age of 68 (range 50-92) were majority male (63%) and White (68%) and averaged two hospitalizations annually. Most were physically frail (44%) or prefrail (41%). Mean PC needs (IPOS) score was 19.7 (range 0-58). On average, participants reported 5.86 (SD 4.28) PC needs affecting them moderately, severely, or overwhelmingly in the last week. Patient-perceived family/friend anxiety (58%) weakness/lack of energy (58%), and shortness of breath (47%) were the most prevalent needs. Frail participants had higher mean PC needs score (26) than prefrail (16, P < 0.001) or robust participants (11, P < 0.001). Frail participants experienced an average of 8.32 (SD 3.72) moderate/severe/overwhelming needs compared to prefrail (4.56, SD 3.77) and robust (2.39, SD 2.91) participants (P < 0.001). Frail participants reported higher prevalence of weakness/lack of energy (83%), shortness of breath (66%), and family/friend anxiety (69%) than prefrail (48%, 39%, 54%) or robust (13%, 14%, 35%) participants (P < 0.001).

Conclusion: Physically frail people with HF have higher unmet PC needs than those who are nonfrail. Implementing PC needs and frailty assessments may help identify vulnerable patients with unmet needs requiring further assessment and follow-up.

Keywords: Palliative care; heart failure; older adults; physical frailty.

Figure 1:

Conceptual Framework

Figure 2:

Radar chart of Unmet Palliative Care Needs by Frailty Group Corners represent each item of the IPOS subscale. Concentric radiating axes represent the continuum of percent responded from 0% (at the center) to 100% (at the exterior). Points (dots) represent the percentage of participants responding with higher need on that item. Lines connecting these dots provide a visual “shape” of the average pattern of responses to all the items in the subscale by frailty group (robust, prefrail, or frail).

Figure 2:

Radar chart of Unmet Palliative Care Needs by Frailty Group Corners represent each item of the IPOS subscale. Concentric radiating axes represent the continuum of percent responded from 0% (at the center) to 100% (at the exterior). Points (dots) represent the percentage of participants responding with higher need on that item. Lines connecting these dots provide a visual “shape” of the average pattern of responses to all the items in the subscale by frailty group (robust, prefrail, or frail).

Figure 2:

Radar chart of Unmet Palliative Care Needs by Frailty Group Corners represent each item of the IPOS subscale. Concentric radiating axes represent the continuum of percent responded from 0% (at the center) to 100% (at the exterior). Points (dots) represent the percentage of participants responding with higher need on that item. Lines connecting these dots provide a visual “shape” of the average pattern of responses to all the items in the subscale by frailty group (robust, prefrail, or frail).