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.



We will use the following definitions from the AGS position statement.  Some find these problematic – we’ll ask you more about this later.


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.



What is the clinical setting you work in most often?
5092cdcd720b4f20a982ccf0b15b03a6 Outpatient - home or clinic based 
5092cdcd720b4f20a982ccf0b15b03a6 Outpatient - other 
5092cdcd720b4f20a982ccf0b15b03a6 Inpatient - acute care 
5092cdcd720b4f20a982ccf0b15b03a6 Inpatient - rehab / subacute 
5092cdcd720b4f20a982ccf0b15b03a6 Inpatient - long term care 
5092cdcd720b4f20a982ccf0b15b03a6 Inpatient - other 
What is your panel size (outpatient) or average daily census (inpatient)?

If your primary work setting is INPATIENT, please answer the questions below, #3 - #12.

If your primary work setting is OUTPATIENT or LONG TERM CARE, please skip to question #13.  

If you work in both INPATIENT and OUTPATIENT or LONG TERM CARE, you may answer all questions if you wish.

 

Definition Reminder.  An "unbefriended older adult"

> No decisional capacity

> No advanced directive

> No legal surrogate (family or professional)


Before this survey, had you heard of the term "unbefriended"?

5092cdcd720b4f20a982ccf0b15b03a6 Yes 
5092cdcd720b4f20a982ccf0b15b03a6 No 
In the past year, how often have you cared for an "unbefriended" older adult?
5092cdcd720b4f20a982ccf0b15b03a6 Weekly (>1 time per week) 
5092cdcd720b4f20a982ccf0b15b03a6 Monthly (1-3 times per month) 
5092cdcd720b4f20a982ccf0b15b03a6 Quarterly (3-4 times per year) 
5092cdcd720b4f20a982ccf0b15b03a6 Annually (1 time per year) 
5092cdcd720b4f20a982ccf0b15b03a6 Never 
Have your unbefriended patients/ your team faced any of these problems?
NeverRarelySometimesFrequently
Prolonged hospital stay, past a medically necessary point
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Delay in treatment or surgery
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Delay in appropriately transitioning the patient to hospice or end of life care
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Unable to provide the patient something that may improve quality of life
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Delay in authorizing charges/coverage for care
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Loss of rehabilitation ability/potential in patient
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
We had to continue with what seemed like medically non-beneficial care
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
I experienced personal distress because of an inability to act in my professional role
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
The patient was in physical or psychological distress
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Other: describe below
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
If Other, please describe - also any additional comments?

Please briefly describe a recent example of a situation you encountered with an unbefriended older adult. What was challenging about working with this patient? How did you proceed?

For example:  “An adult with dementia and without known family or friends  lacked consent capacity.  Nursing home placement was recommended to facilitate rehabilitation from a hip fracture.  The nursing home would not accept the patient without a legal surrogate.  The patient remained in the inpatient setting for 68 days.  It was difficult to manage him on the inpatient setting due to his wandering and other dementia-related behaviors.”
What practices, strategies, or resources have you used to meet the needs of unbefriended older adults in your practice/ institution?

Many find the term “unbefriended” to be stigmatizing, undesirable, or not adequately descriptive. Alternatives are often wordy (e.g., “incapacitated, isolated, and unrepresented”).  Do you have suggestions for a different term to describe an older adult who lacks decisional capacity, lacks advance directives, and lacks a legal surrogate?

Below is a list of possible alternative terms for “unbefriended” (adult who lacks decisional capacity, lacks advance directives, and lacks family or friends able to serve as surrogate).

Please rank your top three choices (1-most desirable) for an alternative term.
Top ChoiceSecond ChoiceThird Choice
      1            2            3      
Unrepresented adult
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Incapacitated and alone
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Vulnerable isolated adult
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Unaccompanied adult
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Solitary adult
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Incapacitated adult without advocates
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Surrogate-less
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Proxy-less
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Proxy Vacans (Latin for "vacant proxy")
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Non Advocatus (Latin for "no advocate")
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Non Surrogatus (Latin for "no surrogate")
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Non Amicum (Latin for "no friend")
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Adultum Solum (Latin for "alone adult")
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
None of these - I prefer the term "unbefriended"
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
What is your highest professional degree?
5092cdcd720b4f20a982ccf0b15b03a6 MD/ DO 
5092cdcd720b4f20a982ccf0b15b03a6 PA  
5092cdcd720b4f20a982ccf0b15b03a6 NP 
5092cdcd720b4f20a982ccf0b15b03a6 RN 
5092cdcd720b4f20a982ccf0b15b03a6 PhD 
5092cdcd720b4f20a982ccf0b15b03a6 PharmD 
5092cdcd720b4f20a982ccf0b15b03a6 MSW 
5092cdcd720b4f20a982ccf0b15b03a6 Other 
What U.S. state do you practice in?
Optional: If you would be interested in participating in a future focus group or interview to discuss these topics in greater depth, please leave your name and contact information (email address or phone number) so we may follow up with you.

OUTPATIENT & LONG TERM CARE survey begins here



 

Definition Reminder.  An "unbefriended older adult"

> No decisional capacity

> No advanced directive

> No legal surrogate (family or professional)


Before this survey, had you heard of the term "unbefriended"?
5092cdcd720b4f20a982ccf0b15b03a6 Yes 
5092cdcd720b4f20a982ccf0b15b03a6 No 
In the past year, how often have you cared for an "unbefriended" older adult?
5092cdcd720b4f20a982ccf0b15b03a6 Weekly (>1 time per week) 
5092cdcd720b4f20a982ccf0b15b03a6 Monthly (1-3 times per month) 
5092cdcd720b4f20a982ccf0b15b03a6 Quarterly (3-4 times per year) 
5092cdcd720b4f20a982ccf0b15b03a6 Annually (1 time per year) 
5092cdcd720b4f20a982ccf0b15b03a6 Never 
Which clinical situations have brought a patient’s unbefriended status to your attention?
RarelySometimesFrequentlyN/A
Consent for medical procedure
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Concern re: medication self-management
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Concern re: safety
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Concern re: driving
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Elder Abuse/ Adult Protective issue
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Advance care planning process
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Other: please describe below
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
If other, please describe - also any additional comments?
Please briefly describe a recent example of a situation you encountered with an unbefriended older adult. What was challenging about working with this patient? How did you proceed? (Note: do not include any identifying information).
For example:  “An adult with dementia and without known family or friends lacked consent capacity.  Nursing home placement was recommended to facilitate rehabilitation from a hip fracture.  The nursing home would not accept the patient without a legal surrogate.  The patient remained in the inpatient setting for 68 days.  It was difficult to manage him on the inpatient setting due to his wandering and other dementia-related behaviors.”

What practices, strategies, or resources have you used to meet the needs of unbefriended older adults in your practice/ institution?
Many find the term “unbefriended” to be stigmatizing, undesirable, or not adequately descriptive. Alternatives are often wordy (e.g., “incapacitated, isolated, and unrepresented”). Do you have suggestions for a different term to describe an older adult who lacks decisional capacity, lacks advance directives, and lacks a legal surrogate? 
 
Below is a list of possible alternative terms for “unbefriended” to describe an older adult who lacks decisional capacity, lacks advance directives, and lacks family or friends able to serve as surrogate.

Please rank your top three choices (1-most desirable) for an alternative term.
Top ChoiceSecond ChoiceThird Choice
      1            2            3      
Unrepresented adult
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Incapacitated and alone
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Vulnerable isolated adult
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Unaccompanied adult
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Solitary adult
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Incapacitated adult without advocates
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Surrogate-less
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Proxy-less
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Proxy Vacans (Latin for “vacant proxy”)
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Non Advocatus (Latin for “no advocate”)
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Non Surrogatus (Latin for “no surrogate”)
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Non Amicum (Latin for “no friend”)
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Adultum Solum (Latin for “alone adult”)
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
None of these – I prefer the term “unbefriended”
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6

ADULT ORPHANS:


These final questions seek your input on ways to prevent “adult orphans” from becoming unbefriended. 

 
 

Definition Reminder.  An "adult orphan"

> Has decisional capacity

> No advanced directive

> No legal surrogate (family or professional)


Are there things you do to identify adult orphans in your practice / institution?
5092cdcd720b4f20a982ccf0b15b03a6 Yes 
5092cdcd720b4f20a982ccf0b15b03a6 No 
5092cdcd720b4f20a982ccf0b15b03a6 Unsure 
If you have instituted or could envision a process, please describe:
What would your practice need in order to better identify adult orphans and prevent them from becoming unbefriended? Check all that apply (if any).
84ebff3947934f84a3c48b8a40887751 Time 
84ebff3947934f84a3c48b8a40887751 Advance care planning supported by Medicare reimbursement 
84ebff3947934f84a3c48b8a40887751 Care manager 
84ebff3947934f84a3c48b8a40887751 Social worker 
84ebff3947934f84a3c48b8a40887751 Pathway to partner with community or volunteer agency 
84ebff3947934f84a3c48b8a40887751 Other 
Many find the term “adult orphan” to be stigmatizing, undesirable, or not adequately descriptive. Do you have suggestions for a different term to describe an older adult who retains decisional capacity, has not executed an advance directive, and lacks a legal surrogate?
Below is a list of possible alternative terms for “adult orphan” to describe an older adult who retains decisional capacity, has not executed an advance directive, and lacks a legal surrogate. Please rank your top three choices (1-most desirable) for an alternative term.
Top ChoiceSecond ChoiceThird Choice
      1            2            3      
Elder orphan
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Isolated vulnerable adult
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Lone elder
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Isolated adult at risk
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Adult without advocates
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Unprotected adult
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Companionless
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Solitary adult
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Solo adult
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Proxy Vacans (Latin for “vacant proxy”)
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Non Advocatus (Latin for “no advocate”)
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Non Surrogatus (Latin for “no surrogate”)
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Non Amicum (Latin for “no friend”)
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
Adultum Solum (Latin for “alone adult”)
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
None of these – I prefer the term “adult orphan”
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
5092cdcd720b4f20a982ccf0b15b03a6
What is your highest professional degree?
5092cdcd720b4f20a982ccf0b15b03a6 MD / DO 
5092cdcd720b4f20a982ccf0b15b03a6 NP 
5092cdcd720b4f20a982ccf0b15b03a6 PA 
5092cdcd720b4f20a982ccf0b15b03a6 RN 
5092cdcd720b4f20a982ccf0b15b03a6 PhD 
5092cdcd720b4f20a982ccf0b15b03a6 PharmD 
5092cdcd720b4f20a982ccf0b15b03a6 MSW 
5092cdcd720b4f20a982ccf0b15b03a6 Other: specify: 
What U.S. state do you practice in?
Optional: If you would be interested in participating in a future focus group or interview to discuss these topics in greater depth, please leave your name and contact information (email address or phone number) so we may follow up with you.