Senior living team can help clarify older adults' end-of-life wishes
Brian Clemency, D.O.
Physicians' Orders for Life-Sustaining Treatments, or POLST, forms often are seen as a way to honor the end-of-life wishes of frail elderly individuals when they no longer can speak for themselves.
A study published last week in the Journal of the American Medical Directors Association, however, finds that these medical order forms often are incomplete or ambiguous, leaving healthcare professionals uncertain of an older adult's preferences.
“Any form that is incomplete or contradictory may cause patents to receive unintended or unwanted advanced and/or invasive interventions,” first author Brian Clemency, D.O., told McKnight's Senior Living.
The study was conducted in the emergency department of Erie County Medical Center in Buffalo, NY, where Clemency is an emergency medicine attending physician. One hundred POLST forms (in New York called Medical Orders for Life Sustaining Treatment, or MOLST, forms) were collected from individuals arriving in the ED.
Information requested on the form includes whether a person desires cardiopulmonary resuscitation, a do not resuscitate order, intubation, hospitalization, intravenous fluids, feeding tubes or antibiotics. Of the 100 forms collected, 69% were incomplete, with at least one section of the form having been left blank.
Although it is part of a primary care physician's job to guide their senior patients through the POLST form and clarify their answers before the form is needed — and the study authors recommend additional training for physicians toward that end — others working in senior living can play a role in the process, said Clemency, who is an associate professor in the Department of Emergency Medicine in the Jacobs School of Medicine and Biomedical Sciences at the University of Buffalo.
“While a physician is needed to sign the final copy of the MOLST form, the entire interdisciplinary team can help residents with the completion of a form that accurately reflects their wishes,” he said. “This begins with care team members identifying residents who would benefit from a MOLST form but do not have one in place.
“Next, team members can explain the process and/or meet with residents and their families ahead of the physician visit,” he continued. “This will allow the residents and their families time to discuss and reflect on their options ahead of time.
“Finally, team members who see a resident on a more frequent basis may be the first to realize when a completed MOLST form no longer reflects the realities of a patient's conditions or wishes,” Clemency said.
Clarity on the forms will help adult children of the sick, too, he added.
“You already have many stressors when an elderly parent is ill,” Clemency said, “but if the parent's wishes aren't clearly articulated, you might have multiple children, all of whom have the best of intentions, each of whom has a different understanding of what that parent wanted. Patients and their families can only benefit when the patient's wishes are clearly articulated.”