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In 1988, Cruzan’s parents requested that her feeding tube be removed, arguing that she would not want to continue in this state. On the one hand, this was unfortunate, as it meant Nancy Cruzan could not be disconnected from the feeding tube immediately. For example, I had another patient in the ICU who she was on a ventilator.
For a trial to have value, it should not exclude patients over age 80, or those with dementia, or patients residing in nursinghomes. Additional links mentioned in the podcast: Recent JGIM article on POLST in California nursinghomes, hospitalization, and nursinghome care Karl’s GeriPal post on appropriate use of POLST Enjoy!
And Lauren Ferrante has found in a study published in JAMA Internal Medicine that trajectories of disability in the year prior to ICU admission were highly predictive of disability post-ICU, on the same order of magnitude as mechanical ventilation. He, his Twitter feed though is brilliant. Eric: Yeah. Alex: Yeah. Lauren: Shock.
A lot has changed, but what motivated the study was a recognition that most advanced care planning interventional research had been undertaken in nursinghomes. So intubation, cpr, feeding tubes. Eric 19:31 So it was interventions like feeding tubes, mechanical ventilation, dialysis at the very end of life.
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