SHARED DECISION-MAKING AND THERAPEUTIC PROPORTIONALITY IN THE CARE OF FRAIL ELDERLY: EXPERIENCE REPORT IN A MEDIUM-SIZED HOSPITAL

Abstract

This article aims to synthesize scientific evidence on frailty screening in the emergency department (ED) and integrate these findings with the clinical experience of Internal Medicine residents in Goiás, Brazil. Hybrid study comprising a qualitative experience report and a systematic literature review (PRISMA and GRADE guidelines) involving 11 observational cohort studies (N=24,107). The report details the clinical management of an 86-year-old patient (CFS 8) in pulmonary septic shock; rapid frailty assessment halted futile intubation, directing care to low-flow oxygen, morphine, and family comfort. The systematic review validated this clinical path, showing a strong dose-response correlation between the Clinical Frailty Scale (CFS) and acute mortality (in-hospital mortality up to 38.3% in CFS 8 vs. 1.3% in robust patients). High frailty also predicted increased documentation of treatment ceilings (DNR/POLST rates up to 57.1% in CFS 8). Biological frailty must override chronological age, providing robust grounds for proportional care and dignified orthothanasia.