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Frailty-Informed Decision Making During Acute Health Crises: A Competency-Based Framework for Person-Centered Care.

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This review presents a framework to help clinicians align medical decisions with the values of frail individuals, ensuring dignity and personhood are prioritized during acute care. It guides distinguishing beneficial treatments from those unlikely to help as frailty progresses.

Keywords:
advance care planningdignity-conserving carefrailtygoals-of-care discussionsshared decision makingsubstitute decision making

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Area of Science:

  • Geriatrics
  • Clinical Medicine
  • Bioethics

Background:

  • Frailty significantly impacts medical care risks, benefits, and outcomes.
  • Acute care decisions often lack a holistic view of patient values and prognosis.
  • Current practices may not adequately preserve personhood in frail individuals.

Purpose of the Study:

  • To introduce a competency-based framework for clinical decision-making in frail patients.
  • To align treatment choices with individual patient values and priorities.
  • To guide clinicians in distinguishing medically reasonable interventions.

Main Methods:

  • Review of current clinical decision-making paradigms for frail individuals.
  • Development of a practical, competency-based framework.
  • Emphasis on structured clinical tasks for goal-concordant care.

Main Results:

  • A framework is proposed to guide clinicians in aligning treatment decisions with patient values.
  • The approach differentiates interventions based on medical reasonableness and potential benefit.
  • It acknowledges the evolving nature of appropriate treatments as frailty advances.

Conclusions:

  • Skillful application of the framework can reduce low-value interventions.
  • The approach supports patient autonomy and promotes compassionate, goal-concordant care.
  • Prioritizing dignity and personhood is central to managing aging with frailty.