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Palliative and Therapeutic Harmonization: A Model for Appropriate Decision‐Making in Frail Older Adults
Author(s) -
Moorhouse Paige,
Mallery Laurie H.
Publication year - 2012
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2012.04210.x
Subject(s) - medicine , dementia , palliative care , confidence interval , odds ratio , psychological intervention , randomized controlled trial , gerontology , population , medline , disease , nursing , surgery , environmental health , political science , law , pathology
Frail older adults face increasingly complex decisions regarding medical care. The Palliative and Therapeutic Harmonization ( PATH ) model provides a structured approach that places frailty at the forefront of medical and surgical decision‐making in older adults. Preliminary data from the first 150 individuals completing the PATH program shows that the population served is frail (mean Clinical Frailty Score = 6.3), has multiple comorbidities (mean 8), and takes many medications (mean = 9). Ninety‐two percent of participants were able to complete decision‐making for an average of three current or projected health issues, most often (76.7%) with the help of a substitute decision‐maker ( SDM ). Decisions to proceed with scheduled medical or surgical interventions correlated with baseline frailty level and dementia stage, with participants with a greater degree of frailty (odds ratio ( OR ) = 3.41, 95% confidence interval ( CI ) = 1.39–8.38) or more‐advanced stage of dementia ( OR = 1.66, 95% CI = 1.06–2.65) being more likely to choose less‐aggressive treatment options. Although the PATH model is in the development stage, further evaluation is ongoing, including a qualitative analysis of the SDM experience of PATH and an assessment of the effectiveness of PATH in long‐term care. The results of these studies will inform the design of a larger randomized controlled trial.