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?
676c7ab3e0d44f169a7f4892d615149a Outpatient - home or clinic based 
676c7ab3e0d44f169a7f4892d615149a Outpatient - other 
676c7ab3e0d44f169a7f4892d615149a Inpatient - acute care 
676c7ab3e0d44f169a7f4892d615149a Inpatient - rehab / subacute 
676c7ab3e0d44f169a7f4892d615149a Inpatient - long term care 
676c7ab3e0d44f169a7f4892d615149a 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"?

676c7ab3e0d44f169a7f4892d615149a Yes 
676c7ab3e0d44f169a7f4892d615149a No 
In the past year, how often have you cared for an "unbefriended" older adult?
676c7ab3e0d44f169a7f4892d615149a Weekly (>1 time per week) 
676c7ab3e0d44f169a7f4892d615149a Monthly (1-3 times per month) 
676c7ab3e0d44f169a7f4892d615149a Quarterly (3-4 times per year) 
676c7ab3e0d44f169a7f4892d615149a Annually (1 time per year) 
676c7ab3e0d44f169a7f4892d615149a Never 
Have your unbefriended patients/ your team faced any of these problems?
NeverRarelySometimesFrequently
Prolonged hospital stay, past a medically necessary point
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Delay in treatment or surgery
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Delay in appropriately transitioning the patient to hospice or end of life care
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Unable to provide the patient something that may improve quality of life
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Delay in authorizing charges/coverage for care
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Loss of rehabilitation ability/potential in patient
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
We had to continue with what seemed like medically non-beneficial care
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
I experienced personal distress because of an inability to act in my professional role
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
The patient was in physical or psychological distress
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Other: describe below
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
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
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Incapacitated and alone
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Vulnerable isolated adult
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Unaccompanied adult
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Solitary adult
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Incapacitated adult without advocates
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Surrogate-less
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Proxy-less
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Proxy Vacans (Latin for "vacant proxy")
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Non Advocatus (Latin for "no advocate")
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Non Surrogatus (Latin for "no surrogate")
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Non Amicum (Latin for "no friend")
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Adultum Solum (Latin for "alone adult")
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
None of these - I prefer the term "unbefriended"
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
What is your highest professional degree?
676c7ab3e0d44f169a7f4892d615149a MD/ DO 
676c7ab3e0d44f169a7f4892d615149a PA  
676c7ab3e0d44f169a7f4892d615149a NP 
676c7ab3e0d44f169a7f4892d615149a RN 
676c7ab3e0d44f169a7f4892d615149a PhD 
676c7ab3e0d44f169a7f4892d615149a PharmD 
676c7ab3e0d44f169a7f4892d615149a MSW 
676c7ab3e0d44f169a7f4892d615149a 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"?
676c7ab3e0d44f169a7f4892d615149a Yes 
676c7ab3e0d44f169a7f4892d615149a No 
In the past year, how often have you cared for an "unbefriended" older adult?
676c7ab3e0d44f169a7f4892d615149a Weekly (>1 time per week) 
676c7ab3e0d44f169a7f4892d615149a Monthly (1-3 times per month) 
676c7ab3e0d44f169a7f4892d615149a Quarterly (3-4 times per year) 
676c7ab3e0d44f169a7f4892d615149a Annually (1 time per year) 
676c7ab3e0d44f169a7f4892d615149a Never 
Which clinical situations have brought a patient’s unbefriended status to your attention?
RarelySometimesFrequentlyN/A
Consent for medical procedure
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Concern re: medication self-management
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Concern re: safety
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Concern re: driving
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Elder Abuse/ Adult Protective issue
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Advance care planning process
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Other: please describe below
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
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
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Incapacitated and alone
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Vulnerable isolated adult
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Unaccompanied adult
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Solitary adult
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Incapacitated adult without advocates
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Surrogate-less
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Proxy-less
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Proxy Vacans (Latin for “vacant proxy”)
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Non Advocatus (Latin for “no advocate”)
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Non Surrogatus (Latin for “no surrogate”)
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Non Amicum (Latin for “no friend”)
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Adultum Solum (Latin for “alone adult”)
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
None of these – I prefer the term “unbefriended”
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a

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?
676c7ab3e0d44f169a7f4892d615149a Yes 
676c7ab3e0d44f169a7f4892d615149a No 
676c7ab3e0d44f169a7f4892d615149a 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).
d87fb8aae25042b8a54b917c5980c9ff Time 
d87fb8aae25042b8a54b917c5980c9ff Advance care planning supported by Medicare reimbursement 
d87fb8aae25042b8a54b917c5980c9ff Care manager 
d87fb8aae25042b8a54b917c5980c9ff Social worker 
d87fb8aae25042b8a54b917c5980c9ff Pathway to partner with community or volunteer agency 
d87fb8aae25042b8a54b917c5980c9ff 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
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Isolated vulnerable adult
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Lone elder
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Isolated adult at risk
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Adult without advocates
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Unprotected adult
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Companionless
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Solitary adult
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Solo adult
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Proxy Vacans (Latin for “vacant proxy”)
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Non Advocatus (Latin for “no advocate”)
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Non Surrogatus (Latin for “no surrogate”)
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Non Amicum (Latin for “no friend”)
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
Adultum Solum (Latin for “alone adult”)
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
None of these – I prefer the term “adult orphan”
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
676c7ab3e0d44f169a7f4892d615149a
What is your highest professional degree?
676c7ab3e0d44f169a7f4892d615149a MD / DO 
676c7ab3e0d44f169a7f4892d615149a NP 
676c7ab3e0d44f169a7f4892d615149a PA 
676c7ab3e0d44f169a7f4892d615149a RN 
676c7ab3e0d44f169a7f4892d615149a PhD 
676c7ab3e0d44f169a7f4892d615149a PharmD 
676c7ab3e0d44f169a7f4892d615149a MSW 
676c7ab3e0d44f169a7f4892d615149a 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.