Selected free-text comments from the questionnaire
| Frailty:
Using ‘frailty of old age’ conflates two separate terms. Frailty is not age specific and old age can end up being a surrogate for frailty. Frailty can occur in those younger than 80 [years] and not every person over the age of 80 [years] has frailty, so the terminology is inaccurate at present. ‘Frailty of old age’ is an appropriate term that can be used in death certification. I hate the word ‘frailty’. When we write [it] in the death certificate, then we are missing an important and treatable underlying medical condition. ‘Frailty of old age’ is a potentially useful descriptor for a small group of patients who are extremely frail with an associated general decline but no obvious reversible final cause ‘Advanced frailty’ should also be included as an acceptable cause of death. I had concerns raised from the deceased's family on use of the term ‘frailty’ in [the] MCCD as the family was not aware that their relative was ‘frail’ and this condition was never mentioned to them by any other clinician before. I do think that ‘frailty of old age’ is a useful term, particularly when it denotes a slow decline [to] death without a clear pathology. Frailty is not age related. Frailty depends on comorbidities, physiological reserve, disease burden and support. Debility and senility: I don't like debility as this may be a reversible condition and is not necessarily progressive with appropriate intervention. Senility/debility is less acceptable to families and could be considered ageist. ‘Senility of old age’ is a term that means little. Debility and, definitely, senility are not acceptable. Senility sounds pejorative. Sarcopenia is such a specialist word it will be misinterpreted and misused. Debility sounds vague and probably doesn't have the supporting evidence base (unlike frailty). General comments: We should not use any terms linked to old age. This gives a wrong impression that old age causes the condition. ‘Old age’ [can be used] if [the] patient is biologically older and has no other cause of death. ‘Old age’ alone can be used; it is what I want written on my death certificate. I would prefer the term ‘older’ age. Your questions feel weighted or biased towards the negative view of the term. As the geriatric population is ever increasing and 80 [years] is no longer old in a relative sense, we should refrain from age-related descriptions, if possible. Before formal decisions are taken on this topic, it should be discussed with a group of patient representatives (and/or their families). [It's a] very emotive issue as [the] family sees the death certificate, we can't deny that old age exists and this does not make us ageist to say this but have to ensure what we put is not going to upset the family. I think the aim is to steer away from defining any disability on grounds of chronological ‘age’ alone. [I'm] interested to see results of this. |
MCCD = medical certificate of cause of death.