The POLST program is intended for specific patients: those near the end of a life-limiting illness or condition and the frail elderly. We frequently receive questions about what actually constitutes frailty.
Frailty is a state of loss of physiological reserve and resilience. To the already frail, exposure to a stressor increases the risk of developing further disability or death. But, frailty is progressive. At what stage should a POLST medical order be considered?
Following are two instruments to assess frailty. Following each is a recommendation for the stage at which a POLST conversation should be initiated.
Kenneth Rockwood, Professor of Geriatric Medicine, developed this scale validated many times for clinical use.
The Clinical Frailty Scale:
Using the Clinical Frailty Scale, patients at levels 7 – 9 should be considered for a POLST conversation. Those at levels 5 – 6 should be monitored for the development of additional deficits and should have an Advance Directive designating a Durable Power of Attorney for Health Care.
The FRAIL Scale:
For the purposes of POLST, a patient with three (3) or more deficits on the FRAIL Scale should be considered a candidate for a POLST medical order.
In addition to these two instruments, you may want to view this review of various frailty scales and the references provided on each instrument that is presented.
Remember, the POLST is appropriate for those with several accumulated deficits, those who you would not expect to survive another year. Those with fewer deficits should have Advance Directives with a Durable Power of Attorney for Health Care appointment and be followed closely.