EP-08 Understanding Frailty: Assessment, Goals of Care, and the PATH Program

In this episode, hosts Drs. Peter Gregory and Meredith Chiasson sit down with Dr. Alethea Lacas – geriatrician, family physician, and member of the Division of Geriatrics at Dalhousie University and Nova Scotia Health – about frailty, the Clinical Frailty Scale (CFS), and the Palliative and Therapeutic Harmonization (PATH) Program. Dr. Lacas explains how frailty differs from simply appearing frail, why understanding a patient's baseline function is essential, and how the Clinical Frailty Scale can help clinicians make more informed decisions about prognosis, treatment, and goals of care. She also explores the concept of the frailty cycle, discusses practical strategies for minimizing frailty progression during hospital admissions, and highlights the importance of integrating frailty-informed thinking into everyday clinical practice. Importantly, the conversation also examines the PATH Program, including when referrals may be appropriate, how comprehensive frailty assessments can support shared decision-making, and why understanding "what matters most" to patients is central to delivering person-centred care. Listeners of this episode will gain insights into: How to accurately assess frailty using the Clinical Frailty Scale Why baseline function and collateral history are critical when evaluating frailty The relationship between frailty, prognosis, and goals-of-care conversations Practical strategies to reduce frailty progression during hospitalization Appropriate referrals to the PATH Program and how it supports decision-making The 5Ms framework for caring for older adults: Multi-complexity, Medications, Mobility, Mind, and Matters Most Timestamps 04:36 – Understanding frailty and the Clinical Frailty Scale 11:14 – Frailty and goals-of-care conversations 11:37 – The frailty cycle explained 21:33 – Introduction to the PATH Program 29:49 – The 5Ms framework 30:09 – "What Matters Most" in clinical decision-making 37:23 – Measuring success in frailty-informed care 40:00 – Key takeaways Resources mentioned in this episode: • Canadian Geriatrics Society 5Ms Poster and Clinical Resources: The Canadian Geriatrics Society - Geriatric 5Ms • Clinical Frailty Scale (Dalhousie University / Dr. Kenneth Rockwood): Clinical Frailty Scale - Geriatric Medicine Research - Dalhousie University • PATH (Palliative and Therapeutic Harmonization) Program information: Palliative & Therapeutic Harmonization Clinic (PATH clinic) | Nova Scotia Health Clinical Currents is produced by the Dalhousie Department of Medicine for internal medicine physicians across the Maritimes. This podcast is for professional education only and should not be taken as personal medical advice. Content reflects Canadian practice unless otherwise noted.