alexa Palliative and therapeutic harmonization: a model for appropriate decision-making in frail older adults.


Journal of Gerontology & Geriatric Research

Author(s): Moorhouse P, Mallery LH

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Abstract 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. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society. This article was published in J Am Geriatr Soc and referenced in Journal of Gerontology & Geriatric Research

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