Frailty Recognition by Clinicians and its Impact on Advance Care Planning.

BACKGROUND: Frailty has important implications for the care of the elderly and how their needs are met. OBJECTIVE: To assess clinicians' acknowledgement of frailty in the electronic medical records (EMR) and the impact of frailty recognition on advance care planning (ACP). METHODS: We performed a retrospective study on 119 patients 65 years or older with moderate or severe frailty assessed using a validated frailty scale. We reviewed notes to determine if primary team identified frailty and obtained data regarding ACP planning. We present the characteristics and outcomes of patients who were identified as frail and compared them with patients whose frailty was unrecognized in EMR. RESULTS: Among the 119 frail patients, one third were ≥85 years and one-year mortality was 25.4%. Most patients were taking ≥5 medications and only 14.3% rated their health as excellent or good prior to hospitalization. Only 15 patients (12.6%) were identified as frail in the EMR. The only significant differences between those recognized versus unrecognized frail were body mass index (23.4 vs 28.6, p = 0.02) and reported weight loss in the 3 months prior to admission (93.3% vs 59.6%, p = 0.009). Geriatric or palliative care consults, and changes in code status to do-not resuscitate were more frequent among those recognized vs not. (33.3% vs 11.5%; 13.3% vs 1.9% respectively). CONCLUSION: Documentation of frailty in the EMR was rare and it was associated with a lower likelihood of providing advance care planning. These findings suggest a need for consistent frailty assessment, which might promote patient-centered care.

Update on ocular cicatricial pemphigoid and emerging treatments.

Mucous membrane pemphigoid is a systemic disorder that primarily affects mucous membranes. When localized to the conjunctiva, it is known as ocular cicatricial pemphigoid, a potentially blinding disease. Ocular cicatricial pemphigoid is an indication for systemic immunosuppressive treatment to achieve adequate remission. Immunosuppressive agents are selected with a "stepladder" approach, commencing with medications having the fewest side effects. We provide an update of the literature on immunomodulatory agents since 2011 as additional treatment modalities have been explored in the last 4 years.