Does it Matter Who Decides? Outcomes of Surrogate Decision-Making for Community-Dwelling, Cognitively Impaired Older Adults Near the End of Life

2021 ◽  
Author(s):  
Micah Y. Baum ◽  
Joseph J. Gallo ◽  
Marie T. Nolan ◽  
Kenneth M. Langa ◽  
Scott D. Halpern ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
End Of Life ◽  
Community Dwelling ◽  
Cognitively Impaired ◽  
Surrogate Decision Making ◽  
Surrogate Decision

scholarly journals Religion and Spirituality in Surrogate Decision Making for Hospitalized Older Adults

2015 ◽  
Vol 55 (3) ◽  
pp. 765-777 ◽  
Author(s):  
Kristin N. Geros-Willfond ◽  
Steven S. Ivy ◽  
Kianna Montz ◽  
Sara E. Bohan ◽  
Alexia M. Torke
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Surrogate Decision Making ◽  
Religion And Spirituality ◽  
Hospitalized Older Adults ◽  
Surrogate Decision

scholarly journals A Scenario-Based Investigation of Surrogate Decision Making for Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 703-703
Author(s):  
Yuxin Zhao ◽  
Benjamin Katz ◽  
Pamela Teaster
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Financial Management ◽  
Self Efficacy ◽  
Decision Makers ◽  
Surrogate Decision Making ◽  
Insurance Company ◽  
Surrogate Decision ◽  
Critically Ill Adults ◽  
Amazon's Mechanical Turk

Abstract Surrogate decisions involve complex, challenging choices; surrogate decision-makers make treatment decisions for approximately 40% of hospitalized adults and 70% of older adults, and up to 95% of critically ill adults of any age. The purpose of our study was to understand how people make decisions for others and how surrogate decision making is linked to people’s cognition, self-efficacy, and demographics, especially differences in acute (e.g., health and medical care, financial management, and end of life) versus general scenarios (spending time with family, contacting an insurance company on behalf of a family member). Participants were recruited through Amazon’s Mechanical Turk. We collected data from 290 adult participants aged 18 years or older. On average, people reported a higher level of confidence in general versus acute scenario. The differences of confidence in scenario-based surrogate decision-making links to decision-makers’ cognition, self-efficacy, the experience of decision-making, the experience of caregiving, and demographic factors.

scholarly journals Scope and Outcomes of Surrogate Decision Making Among Hospitalized Older Adults

2014 ◽  
Vol 174 (3) ◽  
pp. 370 ◽  
Author(s):  
Alexia M. Torke ◽  
Greg A. Sachs ◽  
Paul R. Helft ◽  
Kianna Montz ◽  
Siu L. Hui ◽  
...  
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Surrogate Decision Making ◽  
Hospitalized Older Adults ◽  
Surrogate Decision

scholarly journals Same, same, but different? A longitudinal, mixed-methods study of stability in values and preferences for future end-of-life care among community-dwelling, older adults

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Malin Eneslätt ◽  
Gert Helgesson ◽  
Carol Tishelman
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Mixed Methods ◽  
End Of Life ◽  
End Of Life Care ◽  
Community Dwelling ◽  
Life Care ◽  
T1 And T2 ◽  
Community Dwelling Older Adults ◽  
Over Time

Abstract Background End-of-life preferences may change over time, e.g. due to illness progression or life events. Research on stability of end-of-life preferences has largely focused on life-sustaining treatments in seriously ill patients or medical decision-making based on hypothetical illness scenarios and possible treatment options. Few studies focus on community-dwellers in natural settings. The aim of this study was thus to explore if and how community-dwelling, older adults’ prioritizations and reasoning about values and preferences for future end-of-life care change over time. Methods Using a mixed-methods design, we explored stability of end-of-life preferences in older community-dwelling adults without imminent end-of-life care needs. At two timepoints (T1 and T2), 5.5–12 months apart, 52 individuals discussed what would be important to them at the end-of-life, through open conversations and while using DöBra cards, a Swedish version of GoWish cards. Participants ranked their most important card statements from 1 to 10. Stability in card rankings, i.e. a card recurring in the top-10 ranking at T2 regardless of position, was explored using descriptive statistics and non-parametric analyses. Participants’ reasoning about card choices were explored with longitudinal qualitative analysis. Results Stability between T1 and T2 in the top-10 priorities ranged from 20 to 80%, median 60%. Stability in cards rankings could not be explained by changes in participants’ health status, extent of card use (no/little/frequent use) between interviews, or days between T1 and T2, nor was it related to demographic variables. Qualitative analysis showed that consistent reasoning was not always paired with consistency in card choices and changed card choices were not always related to changes in reasoning. Conclusions Longitudinal exploration combining DöBra card rankings with underlying reasoning about end-of-life preferences over time furthers knowledge on the dynamics between values and preferences in end-of-life decision-making. Individuals’ end-of-life preferences in form of card choices were relatively stable over time albeit with large variation between different individuals. However, the values and underlying reasoning that participants used to motivate their choices appeared more stable than ranking of card choices. We thus conclude that concurrent conversation-based exploration is a more comprehensive indicator of end-of-life values and preferences over time than ranking of cards alone.

scholarly journals FAMILY CAREGIVERS’ ADVANCE CARE PLANNING FOR COGNITIVELY IMPAIRED OLDER ADULTS: SERVICE PROVIDERS’ PERSPECTIVES

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S237-S237
Author(s):  
Hyunjin Noh ◽  
Temilade A Aladeokin
Keyword(s):  
Older Adults ◽  
End Of Life ◽  
Family Caregivers ◽  
Advance Care Planning ◽  
Service Providers ◽  
Cognitively Impaired ◽  
Care Planning ◽  
Barriers To Access ◽  
Advance Care ◽  
Surrogate Decision

Abstract An increasing number of family caregivers face challenges of advance care planning (ACP) for their cognitively impaired older adults. The purpose of this study was to understand service providers’ views of ACP knowledge and needs among such family caregivers. Purposive sampling was used to recruit 10 service providers who serve older adults and their family caregivers in community settings of West Alabama. Individual, face-to-face interviews were conducted guided by a semi-structured questionnaire, asking about their experiences with and views of family caregivers’ ACP for their older adults. Thematic analysis of the qualitative data revealed several findings: family caregivers’ lack of knowledge about ACP and end-of-life care, discomfort in end-of-life discussions, uncertainty about their older adult’s end-of-life preferences, frustration with the surrogate decision-making role, family conflicts in ACP process, and logistical barriers to access ACP resources. Tailored services should be developed to address these barriers to promote ACP among this population.

Sign in / Sign up

Export Citation Format

Share Document