Ethical and Legal Implications of Frailty Screening

Abstract

Goals of screening for frailty include (a) promoting healthy aging, (b) addressing frailty with preventive and targeted interventions, (c) better aligning social and medical responses to frailty with the needs of frail older adults and (d) preventing harms to frail older adults from excessive and inappropriate medical interventions that are insensitive to the implications of frailty. However, the medicalization of frailty and outcomes of the screening process also risk harming frail older adults and their autonomy through stereotyping and by legitimizing denial of care. This risk of harm gives rise to ethical and legal questions and considerations that this paper addresses. Frailty screening that is ethically defensible will situate and support healthcare that is consistent with people’s needs, circumstances and capacity to benefit from the care provided. We also call for an informed consent process that incorporates supported or shared decision making in order to protect the autonomy of frail older adults.

Feminist approach to geriatric care: comprehensive geriatric assessment, diversity and intersectionality

“…Similar effects can also be observed in the medicalization of age-associated loss of abilities which are often considered as a form of frailty (Reid et al 2018). Some older people who are assessed as frail consider this as failure or experience stigmatization due to the status (Reid et al 2018;Gallagher and Cox 2019).…”

“…Similar effects can also be observed in the medicalization of age-associated loss of abilities which are often considered as a form of frailty (Reid et al 2018). Some older people who are assessed as frail consider this as failure or experience stigmatization due to the status (Reid et al 2018;Gallagher and Cox 2019). First of all, many older people do not identify with the term frail on an individual level and this may impact their reaction to and in dealing with the status (Reid et al 2018).…”

“…For example, Rockwood argues that frailty is considered as a wasting disorder that is related to weakness, slowness, low physical activity, exhaustion, and weight loss (Rockwood 2005(Rockwood , p. 1069. However, the focus on weight loss (also criticised by Reid et al 2018) obscures the fact that obese older people might suffer from frailty as well, but might not be diagnosed as frail because of the assessment criteria (Rockwood 2005(Rockwood , p. 1069. The focus of certain standardized criteria might also be a problem in the context of other social categories, such as gender, race or education.…”

“…Some older people who are assessed as frail consider this as failure or experience stigmatization due to the status (Reid et al 2018;Gallagher and Cox 2019). First of all, many older people do not identify with the term frail on an individual level and this may impact their reaction to and in dealing with the status (Reid et al 2018). This lack of identification however might not only be based on an individual understanding of aging but can also be rooted in the cultural or social understanding of aging and being old in the patient's (and also the doctor's) community.…”

“…From the beginning, frailty has been a socially influenced status that has become medicalized (Reid et al 2018). The standardized assessment focuses on medical aspects, and the social elements do not receive as much attention as needed.…”