Members of the American Geriatrics Society,

We request your participation in a brief online survey about your experiences working with socially isolated and vulnerable elderly patients.

Purpose:  The “AGS Position Statement: Making Medical Treatment Decisions for Unbefriended Older Adults”¹ hich proposed policy and practice guidelines for patients who are “unbefriended” or at risk for becoming so.  We want to learn more about your experiences working with such patients and the strategies you have developed.

Information about the survey:

• It’s completely voluntary.
• Your answers will remain anonymous – no identifying information will be collected about your or your patients.  Your IP address will not be collected. 
• It will take about 15 minutes to complete. 
• The survey is being distributed to the AGS membership nationwide (approx. 5,000 members).
• At the end of the survey, if you are interested, you may enter a drawing to win a free iPad.
• The project has been reviewed and approved by the Research and Institutional Review Board Committees of VA Boston Healthcare System and the Ethics Committee and executive board of the American Geriatrics Society.
• The project received funding from the Guardianship Policy Institute.

We are eager to gain your valuable perspective on these important issues.

Sincerely, 

Timothy Farrell, M.D., AGSF

University of Utah School of Medicine

VA Salt Lake City Geriatric Research, Education, and Clinical Center

Eric Widera, M.D.

University of California, San Francisco

San Francisco VAMC

Aanand Naik, M.D.

Baylor College of Medicine

Michael E. DeBakey VAMC

Jennifer Moye, Ph.D., ABPP

New England Geriatric Research Education and Clinical Center

Harvard Medical School

Casey Catlin, M.A.

Boston VA Research Institute, Inc.

Boston VAMC

¹Farrell, T., Widera, E., Rosenberg, L., Rubin, C.D., Naik, A.D., Braun, U., Torke, A., Li, I., Vitale, C., Shega, J.; Ethics, Clinical Practice and Models of Care, and Public Policy Committees of the AGS.

AGS Position Statement: Making Medical Treatment Decisions for Unbefriended Older Adults. Journal of the Am Geriatr Soc. 2016 Nov 22; doi: 10.1111/jgs.14586. PMID:27874181.

DEFINITIONS:

An "unbefriended older adult" is a person who: 

(a) lacks decisional capacity to provide informed consent;

(b) has not executed an advance directive;

(c) lacks a legal surrogate (e.g., is without a family / friends - isolated, estranged, bereaved - and there is not a professional acting in that role)

An "adult orphan" is an older adult at risk of becoming unbefriended who: 

     (a) currently retains decisional capacity;

     (b) has not executed an advance directive;

     (c) lacks a legal surrogate (e.g. is without a family / friends - isolated, estranged, bereaved - and there is not a professional acting in that role)

Therefore, both a person considered "unbefriended" and an "adult orphan" are isolated and lack advance directives.  The difference is that the term "unbefriended" is used to describe a person who currently lacks capacity, whereas an "adult orphan" retains capacity.