Authors
Esther Nafula
Second Author
Keywords
goals of care
frailty
advance care planning
Introduction
Advances in medicine have significantly improved survival rates among high-risk populations. However, in frail patients—characterized by reduced physiological reserve and increased vulnerability to stressors—survival may come at the cost of functional decline, prolonged suffering, or diminished quality of life. This raises an important question: are we truly benefiting frail patients, or inadvertently creating survivors with poor outcomes?
Objectives
1. To evaluate outcomes in frail patients admitted to critical care units
2. To assess the integration of goals-of-care discussions into care of the frail
Methods
Literature review
Results
Frail patients had higher postoperative complications, ICU admissions, and longer hospital stays. Many experienced functional decline despite survival. Goals-of-care discussions were inconsistently documented, with less than half having formal preoperative ACP. Clinicians cited time constraints and discomfort as barriers, while families desired clearer communication on prognosis and expected outcomes.
Discussion
Findings reveal a gap between survival-focused care and outcome quality in frail patients. Anesthesia enables complex interventions but places anesthesiologists at the center of ethical decisions. Without meaningful goals-of-care discussions, care may not align with patient values. Integrating frailty assessment and structured communication into preoperative evaluation helps shift focus from “can we intervene?” to “should we?”.
Conclusion
In frail patients, survival alone is an insufficient marker of success. Care should align with patient goals, prioritizing quality of life and dignity. Moving from a survival-centric model to a goal-concordant care approach is essential to avoid creating “survivors”.
References
McIsaac DI, et al. Frailty as a predictor of death or new disability after surgery. Ann Surg. 2020.
