References
Ethical principles and challenges in end-of-life care for frail older adults
Abstract
Providing end-of-life care to frail, older adults with multiple comorbidities can be ethically complex. As frailty differs from single terminal illness, end-of-life care requires a carefully considered, ethically informed approach. The four core ethical principles of autonomy, beneficence, nonmaleficence and justice need to be applied within this context; they involve challenges specific to frail patients, including fluctuating mental capacity, the risks of aggressive interventions and equitable access to resources. Key ethical issues include do not attempt cardiopulmonary resuscitation orders, confidentiality, mental capacity assessments and palliative sedation. Health professionals require a structured framework for decision-making. By balancing patient dignity, quality of life and legal considerations, practitioners can understand ethical obligations and practical decision-making strategies. For frail, older adults, a compassionate, patient-centred approach that prioritises comfort and dignity, especially as people approach the end of life, ensures care is provided in line with both ethical and legal standards.
The global ageing population is expanding rapidly, with the UK experiencing a substantial increase in the number of older adults, many of whom experience complex end-of-life (EoL) circumstances (British Geriatrics Society, 2023). According to the most recent data from the Office for National Statistics (ONS, 2025), the population aged ≥65 years is expected to grow by approximately 13.8% over the next decade, from 12.0 million in mid-2022 to 13.7 million by mid-2032. In addition, the number of people aged ≥85 years is projected to almost double by mid-2047, further intensifying demands on health and social care systems and increasing the complexity of EoL care (ONS, 2025).
EoL care for frail older adults, who are often living with multiple comorbidities, is significantly different from the care provided to individuals with a single terminal illness (National Institute for Health and Care Excellence (NICE), 2019). Frailty in advanced stages encompasses a range of decline trajectories, which may include gradual deterioration, as observed in advanced dementia, sudden life-limiting events such as stroke or hip fracture, and periods marked by unpredictable fluctuations, often precipitated by acute episodes such as delirium or functional decline (British Geriatrics Society, 2023).
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