Who Needs POLST?

           POLST (Physician Orders for Life Sustaining Treatment) is meant for people who have a life expectancy of less than two years. Primarily, POLST is used for the elderly; those not necessarily who are actively dying but have a number of medical problems with declining health. 

 Some examples 

Think about the 90 year old living in a nursing home that has had a couple of strokes, lung disease from years of smoking, and perhaps had a heart attack in the past. This person may no longer be able to get up and walk, do most of his basic care on his own. Adding to the medical problems, may now be some dementia. The dementia may cause this person to forget to eat and drink leading to a common bladder infection that can easily spread systemically. Another common scenario is this same person, who is no longer able to be physically active, not breathing deeply, then gets pneumonia. 

Another example would be someone who has been diagnosed twenty years with diabetes. Often diabetes goes uncontrolled; early on in the diagnosis, a person may say, “Well, I take the pill the doctor gives me”.  Yet, that person knows little about diabetes, what his HbA1C levels are (hemoglobin A1C measures the extra glucose in the blood). Ideally, that level should be 5 percent, that of a non-diabetic person. However, typically it is much higher, placing this person at risk for heart attacks, strokes, blindness, kidney failure and dialysis, as well as amputations. Many times this person is not physically active nor is eating a diet rich in fiber and low in fat. During the course of years, this person may experience enough of the complications that will land him in a nursing home. Now, this person with one leg amputated, having had a heart attack, stroke, and on kidney dialysis with loss of vision has a very poor quality of life. 

How would they benefit from POLST?

          By ensuring that those with complicated medical problems, limited mobility, and increased aging, have their end of life decisions addressed, those of us in healthcare can honor those decisions. 

            At some point, we all die. While someone involved in a trauma can recover, the likelihood of someone like we discussed above recovering from yet another stroke or heart attack is very slim. As the body ages, each vital organ loses some function, the more the disease processes on board, the more function is lost. Then, when the body is additionally stressed, that person really cannot recover, even to bring that person back to his lower level of functioning. 

            Through discussions with the patient and family, with input from whomever the patient and family think would help, such as the pastor or other spiritual advisor and healthcare provider, decisions can be made. These end of life decisions are then put in writing, signed by the physician, patient, and family. This way, everyone knows ahead of time what level of treatment healthcare providers will give.