Palliative Pearls with Dr. Kelly Little

Since beginning clinical practice in 2014 I’ve done house calls for frail and home bound elders in Vancouver. Throughout this time, I’ve taught medical students, residents and fellows which has encouraged me to refine and distill my approach to frailty to ensure, wherever a learner ends up in the medical system, they can diagnose, stage and know why frailty matters to a patient’s care. I tend to teach in 3’s because that’s all I can keep in my brain! Here is my TL;DR approach that I hope you can use in your practice:

1. I diagnose and stage frailty using the Rockwood Clinical Frailty Scale

• Data suggests that case finding is the best approach which means family doctors (you!) are key in identifying these patients
• I list frailty in my problem list as its own diagnosis and stage it so changes are monitored over time
• I schedule regular appointments with patients identified as frail instead rather than relying only on episodic care for acute issues

2. It matters: frailty predisposes patients to negative outcomes and death

• Frail patients have a significantly increased risk for loss of function, hospitalization, falls, fractures and death
• The frailer a patient the more likely they are to experience these adverse outcomes
• I use this as a moment of pause before continuing down any algorithm of care

3. I use this Frailty Roadmap for Families to have hard but important conversations

• I print this and walk through step by step with families and patients (if appropriate)
• I consider whether a specific care plan might help the patient and family using tools such as the BC Guideline or Path Frailty App
• I share my plan with all members in the circle of care when able: family/caregivers, allied staff and other specialist colleagues

I would like to thank my colleagues with HomeViVE for over a decade of support, learning and inspiration. This Palliative Pearl is dedicated to you and the patients you serve.