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J Frailty Aging. 2018;7(4):240-246. doi: 10.14283/jfa.2018.33.

Improving End-of-Life Care and Advance Care Planning for Frail Older Adults in Canad.

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James Downar, MDCM, MHSc, Interdepartmental Division of Critical Care Medicine and Palliative Care, Department of Medicine, University of Toronto, 200 Elizabeth St. 9N-926, Toronto, ON, M5G 2C4, canada, T. (416) 340-4800 x2674, F. (416) 340-4823. E.


We present five Key Concepts that describe priorities for improving end-of-life care for frail older adults in Canada, and recommendations based on each Key Concept. Key Concept #1: Our end-of-life care system is focused on cancer, not frailty. Key Concept #2: We need better strategies to systematically identify frail older adults who would benefit from a palliative approach. Key Concept #3: The majority of palliative and end-of-life care will be, and should be, provided by clinicians who are not palliative care specialists. Key Concept #4: Organizational change and innovative funding models could deliver far better end-of-life care to frail individuals for less than we are currently spending. Key Concept #5: Improving the quality and quantity of advance care planning for frail older adults could reduce unwanted intensive care and costs at the end of life, and improve the experience for individuals and family members alike.


Frailty; advance care planning; end-of-life care; health policy; health professional education; palliative care

[Indexed for MEDLINE]

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