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


Address correspondence to Paige Moorhouse, Division of Geriatric Medicine, Dalhousie University, QEII Health Sciences Centre, 5955 Veterans' Memorial Lane, Suite 1308, Halifax, NS, B3H 2E1, Canada. E-mail:


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.