January 1, 2017

AGS Position Statement: Making Medical Treatment Decisions for Unbefriended Older Adults

Farrell, T.W., et al, J Am Ger Soc 65(1):14, January 2017

METHODS: The authors present an official position statement from the American Geriatrics Society (AGS) on decision making for unbefriended older adults (also known as “adult orphans”), which represents an update of the 1996 statement. Unbefriended adults are defined as patients who are unable to exercise informed consent for treatment decisions, do not have a preexisting advance directive or capacity to complete one, and have no family members or legal surrogate decision maker.

RESULTS: Because states vary in their legal approaches to decision making on behalf of unbefriended patients, consistent policies are needed to reduce confusion and allow timely care decisions. Ideally, providers would identify older adults at risk of becoming unbefriended and urge them to complete advance directives and/or choose a health care surrogate. For the population that is already unbefriended, the AGS makes several policy and clinical practice recommendations directed at providers, health care organizations, and other stakeholders. Foremost is the need to formulate legal policies on the issue for adoption by all states, while working to prevent older adults from becoming unbefriended and developing procedures for making safe and fair decisions for this population. Providers must assess each patient’s decision-making capacity; have standardized policies in place for decision-making in urgent-care scenarios; allow the participation of non-traditional surrogate decision makers; ensure that patients with long-term incapacity have access to a surrogate decision maker; and involve health care teams and/or ethics committees to weigh all the evidence (e.g., medical, cultural, and patient’s preferences if known) when making decisions. 39 references

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