Medical decision making for unbefriended older adults: an AGS position statement

From the document:

Policy Recommendations

1.National stakeholders should work together to create legal standards regarding unbefriended older adults that could be considered for adoption by all states.

2.Clinicians, health care organizations, and other stakeholders should work proactively to prevent older adults without potential surrogates from becoming unbefriended.

3.Clinicians, health care organizations, communities, and other stakeholders should develop innovative, efficient and accessible approaches to promote adequate protections and procedural fairness in decision making for unbefriended older adults.

Clinical Practice Recommendations

4.Medical decision making for unbefriended older adults should include adequate safeguards against ad hoc approaches and ensure procedural fairness.

5.Clinicians should consider non-traditional surrogate decision makers for unbefriended older adults.

6.Clinicians should assess medical decision-making capacity in a systematic fashion.

7.Clinicians and healthcare institutions should develop and standardize/systematize methods to make decisions for unbefriended older adults in urgent, life-threatening situations.

8.Clinicians and healthcare institutions should ensure that patients with long-term incapacity have longitudinal access to a decision-making surrogate who is familiar with the patient's medical condition and specific circumstances.

9.When applying the best interest standard to unbefriended older adults, institutional committees (such as an ethics committee) should synthesize all available evidence, including cultural and ethnic factors, during deliberations about treatment decisions.