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Sally Hardwick, MS Chair, Nevada POLST – A Nevada Non-Profit

Nevada POLST for Alzheimer Patients Application and Challenges. Sally Hardwick, MS Chair, Nevada POLST – A Nevada Non-Profit. Nevada POLST Non-Profit. Established specifically to: Educate and train the public and health care providers throughout NV regarding the Nevada POLST Program

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Sally Hardwick, MS Chair, Nevada POLST – A Nevada Non-Profit

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  1. Nevada POLST for Alzheimer Patients Application and Challenges Sally Hardwick, MS Chair, Nevada POLST – A Nevada Non-Profit

  2. Nevada POLST Non-Profit Established specifically to: • Educate and train the public and health care providers throughout NV regarding the Nevada POLST Program • Provide state approved Nevada POLST forms…bright pink, 65# stock • Support other organizations in providing compassionate end-of-life care For more information visit www.nevadapolst.org

  3. HISTORY • Currently all but 5 states have a POLST program • 1991: Oregon • 2003: Needs analysis by Nevada Center for Ethics & Health Policy (NCEHP) • 2004: Statewide Nevada Task Force formed - • 2009: Coalition formed by NCEHP • 2013: NRS 449.691- 697 • 2016: Revisions proposals

  4. The Nevada POLST Program • The frail elderly, those near the end of a life-limiting illness and not expected to survive a year • Treatment preferences are elicited, documented, communicated and honored in all settings: home, acute care, nursing home • Reflects current state of health – may require updating as status changes • Completed with and signed by patient, DPOA or legal guardian • Signed and validated by physician

  5. Journal of the American Geriatric Association (JAG) SUPPORTING RESEARCH • Association Between Physician Orders for Life-Sustaining Treatment for Scope of Treatment and In-Hospital Death in Oregon • Published Online June 9, 2014 – Available soon in June issue of JAG • 17,902 subjects – largest study to date

  6. RESEARCH – POLST Preferences and Hospital Deaths POLST Preferences Comfort Measures Only – 66.1% Full Treatment – 6.4% Association between POLST Choices and Hospital Deaths: Comfort Measures Only – 6.4% Full Treatment – 44.2% For those without a POLST – 34.2% were hospitalized

  7. RESEARCH – POLST Preferences and Hospital Deaths • Take Away Message • Vastly more who complete a POLST choose CMO • Those with POLSTs for CMO were significantly LESS likely to die in a hospital • Those with orders for full treatment were MORE likely to die in the hospital than those without a POLST • This holds for each of the top 10 causes of death. • Results repeated in W. Virginia with very different demographics “Comparable Pattern for POLST Registry Decedents: Oregon vs West Virginia 2012-2013” J Am Geriatr Soc 2016,

  8. ACP Methods for AD • Those with mild & moderate AD were able to express a reasonable treatment choice • When asked to provide “rational” reasons, almost none of those with Alzheimer patients could • When asked to discuss an emotional reason & consequences, 40% of Alzheimer patients could Marson DC, Alz Dis Assoc Disord, 1994;8:5

  9. ACP Methods for AD • Written description of advanced AD (Stage 7) • 50% desired comfort care • 21% desired life-prolonging care • 18% something in-between • 2 minute Video of a person in Stage 7 • http://www.bmj.com/content/338/bmj.b2159 • 89% comfort care • None want life-prolongation • 8% limited care http://www.acpdecisions.org/videos/advanced-dementia/

  10. Choosing Wisely • Initiative of the American Board of Internal Medicine • Avoiding wasteful or unnecessary medical tests, treatments and procedures • “Don’t recommend percutaneous feeding tubes in patients with advanced dementia; instead offer oral assisted feeding.” • American Geriatrics Society • American Academy of Hospice and Palliative Medicine

  11. Recommendations for AD Task Force • Support NRS revision to allow NPs and PAs to sign POLST medical orders • Physician access is challenging in rural counties • Hospice patients at home • Encourage use of Volante video for ACP sessions • Support Next-of-Kin statute to allow decisional authority for incompetent patients if there is no designated DPOA-HC or legal guardian • Patient must be competent or have a DPOA, but many do not have DPOAs

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