What is your approach to counseling severely frail older adults regarding their planning for invasive life-sustaining therapy?  

My approach is pragmatic, evidence-based, and bi-directional. Patients/family make the decision, but I ensure they are fully informed about the pros and cons and provide them time to think through.

I have three tips: the first is to have a direct, honest, and clear discussion with the patient, who has definitely thought about death already. I avoid euphemisms and say "when you die, or are dying, meaning your heart and lungs stop working." Sometimes I have to press a little for someone who does...