Palliative and Therapeutic Harmonization:: A Model for Appropriate Decision-Making in Frail Older Adults

• Autores: Paige Moorhouse, Laurie H. Mallery
• Localización: Journal of the American Geriatrics Society, ISSN 0002-8614, Vol. 60, Nº. 12, 2012, págs. 2326-2332
• Idioma: inglés
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• Resumen

  • 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.