The impact of palliative care on the frailty-stroke continuum: from theoretical concepts to practical aspects

ABSTRACT

With a constant increase in prevalence and incidence worldwide, stroke remains a public health issue in the 21^st century. Additionally, population aging inevitably leads to increased vulnerability in the general population, a clinical state known as frailty. While there are adequate guidelines on the treatment of stroke in the acute setting, there are a lot of gaps regarding the chronic management of stroke patients, particularly the frail ones. From the therapeutic point of view, palliative care could be the key to offering complex and individualized treatment to these frail chronic stroke patients. In the context of the heterogeneous data and incomplete therapeutic guidelines, this article provides a new and original perspective on the topic, aiming to increase awareness and understanding and improve palliative care management in stroke patients. Based on current knowledge, the authors describe a new concept called the frailty-stroke continuum and offer a detailed explanation of the intricate stroke-frailty connection in the first part. After understanding the role of palliative care in managing this kind of patients, the authors discuss the most relevant practical aspects aiming to offer an individualized framework for daily clinical practice. The novel approach consists of developing a four-step scale for characterizing frail stroke patients, with the final aim of providing personalized treatment and correctly evaluating prognosis. By pointing out the limitations of current guidelines and the challenges of new research directions, this article opens the pathway for the better evaluation of frail stroke patients, offering a better perception of patients’ prognosis.

KEYWORDS:

• Ederly
• disability frailty
• functional status
• palliative care
• prognosis
• stroke

Abbreviation list

CGA	=	Comprehensive Geriatric Assessment
DALY	=	Disability-Adjusted Life Year
FFI	=	Fried Frailty Index
NIHSS	=	National Institutes of Health Stroke Scale
PC	=	Palliative Care
WHO	=	World Health Organization

Declaration of financial/other relationships

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

All authors were involved in review conceptualization and writing and S Antoniu was also involved in the critical check of the draft till production of the final draft.

Additional information

Funding

I Chirap is funded with a PhD Grant [2297/2022] provided by the University of Medicine and Pharmacy Grigore T Popa Iasi. Romania.