Recognising transition
Repeated deterioration, worsening function, reduced reserve, recurrent urgent care and diminishing recovery may signal increasing palliative need.
Palliative frailty is a transition, not a single threshold
Frailty trajectories are uncertain. Some people stabilise or recover after acute illness; others experience recurrent episodes with progressively incomplete recovery. A palliative approach can begin before the final days of life and can coexist with treatment and rehabilitation.
Three questions to keep returning to
What is reversible? What is burdensome? What matters most to the person now?
Core areas
Goals & escalation
Discuss priorities, acceptable burdens, treatment escalation, DNACPR in its proper context and where care should be delivered.
Symptom burden
Pain, breathlessness, fatigue, agitation, secretions, nutrition, hydration and medicines require proportionate, person-centred review.
Family & carers
Uncertainty, expectations, disagreement, practical support, communication and bereavement all require attention.
Place of care
Community teams, care homes, community hospitals, hospices and acute hospitals should form a coordinated network rather than disconnected destinations.
Parallel rehabilitation
Comfort and palliative goals do not automatically exclude mobility, function, therapy or reablement where these remain meaningful.
Last days of life
When a person may be entering the last days of life, assessment should include physiological, psychological, social and spiritual needs, current signs and symptoms, clinical context, goals and the views of people important to them. Improvement may indicate stabilisation or recovery, so uncertainty must be acknowledged and reviewed.
NICE NG31 · Care of dying adults in the last days of lifeOpen NICE guidance ↗
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