Older people’s goals of care in relation to frailty status—the COOP-study

Author:

van der Klei Veerle M G T H123ORCID,Drewes Yvonne M1234,van Raaij Bas F M123,van Dalsen Maaike D W123,Julien Anneke G123,Festen Jan5,Polinder-Bos Harmke6,Mooijaart Simon P123ORCID,Gussekloo Jacobijn1234,van den Bos Frederiek123, ,Moons Karel G M,van Smeden Maarten,Luijken Kim,Elders Petra

Affiliation:

1. Department of Internal Medicine , Section Gerontology and Geriatrics, , Leiden , the Netherlands

2. Leiden University Medical Center , Section Gerontology and Geriatrics, , Leiden , the Netherlands

3. LUMC Center for Medicine for Older People (LCO), Leiden University Medical Center , Leiden , the Netherlands

4. Department of Public Health and Primary Care, Leiden University Medical Center , Leiden , the Netherlands

5. KBO-PCOB , Nieuwegein , the Netherlands

6. Department of Geriatrics, Erasmus Medical Center , Rotterdam , the Netherlands

Abstract

Abstract Background Literature relating older people’s goals of care to their varying frailty status is scarce. Objective To investigate goals of care in case of acute and/or severe disease in relationship to frailty status among the general older population. Method Older people aged ≥70 in the Netherlands completed a questionnaire. They were divided into three subgroups based on a self-reported Clinical Frailty Scale: fit (CFS 1–3), mildly frail (CFS 4–5) and severely frail (CFS 6–8). Seven goals were graded as unimportant (1–5), somewhat important (6–7) or very important (8–10): extending life, preserving quality of life (QoL), staying independent, relieving symptoms, supporting others, preventing hospital admission and preventing nursing home admission. Results Of the 1,278 participants (median age 76 years, 63% female), 57% was fit, 32% mildly frail and 12% severely frail. Overall, participants most frequently considered preventing nursing home admission as very important (87%), followed by staying independent (84%) and preserving QoL (83%), and least frequently considered extending life as very important (31%). All frailty subgroups reported similar preferences out of the surveyed goals as the overall study population. However, participants with a higher frailty status attached slightly less importance to each individual goal compared with fit participants (Ptrend-values ≤ 0.037). Conclusion Preferred goals of care are not related to frailty status, while the importance ascribed to individual goals is slightly lower with higher frailty status. Future research should prioritise outcomes related to the shared goals of fit, mildly frail and severely frail older people to improve personalised medicine for older patients.

Funder

COOP Study

Netherlands Organisation for Health Research and Development

COVID-19 research programme

Publisher

Oxford University Press (OUP)

Reference41 articles.

1. Aging with multimorbidity: a systematic review of the literature;Marengoni;Ageing Res Rev,2011

2. The geriatric management of frailty as paradigm of “the end of the disease era”;Cesari;Eur J Intern Med,2016

3. Evidence-based medicine in older patients: how can we do better?;Mooijaart;Neth J Med,2015

4. Temporal changes in characteristics and external validity of randomized controlled trials in older people from 2012 to 2019;Eijk;BMC Geriatr,2023

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