title: Palliative and therapeutic harmonization: a model for appropriate decision-making in frail older adults.
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.
authors.affiliation: Division of Geriatric Medicine, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. paige.moorhouse@cdha.nshealth.ca
authors.forename: Paige
authors.initials: P
authors.lastname: Moorhouse
authors.forename: Laurie H
authors.initials: LH
authors.lastname: Mallery
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D003704:Dementia / Q000175:diagnosis; D005260:Female; D016330:Frail Elderly; D015577:Geriatric Assessment; D006285:Health Planning; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D010166:Palliative Care