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?
a9d2a28f32774b4ab38d946471f686d2 Outpatient - home or clinic based 
a9d2a28f32774b4ab38d946471f686d2 Outpatient - other 
a9d2a28f32774b4ab38d946471f686d2 Inpatient - acute care 
a9d2a28f32774b4ab38d946471f686d2 Inpatient - rehab / subacute 
a9d2a28f32774b4ab38d946471f686d2 Inpatient - long term care 
a9d2a28f32774b4ab38d946471f686d2 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"?

a9d2a28f32774b4ab38d946471f686d2 Yes 
a9d2a28f32774b4ab38d946471f686d2 No 
In the past year, how often have you cared for an "unbefriended" older adult?
a9d2a28f32774b4ab38d946471f686d2 Weekly (>1 time per week) 
a9d2a28f32774b4ab38d946471f686d2 Monthly (1-3 times per month) 
a9d2a28f32774b4ab38d946471f686d2 Quarterly (3-4 times per year) 
a9d2a28f32774b4ab38d946471f686d2 Annually (1 time per year) 
a9d2a28f32774b4ab38d946471f686d2 Never 
Have your unbefriended patients/ your team faced any of these problems?
NeverRarelySometimesFrequently
Prolonged hospital stay, past a medically necessary point
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Delay in treatment or surgery
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Delay in appropriately transitioning the patient to hospice or end of life care
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Unable to provide the patient something that may improve quality of life
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Delay in authorizing charges/coverage for care
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Loss of rehabilitation ability/potential in patient
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
We had to continue with what seemed like medically non-beneficial care
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
I experienced personal distress because of an inability to act in my professional role
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
The patient was in physical or psychological distress
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Other: describe below
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
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
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Incapacitated and alone
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Vulnerable isolated adult
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Unaccompanied adult
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Solitary adult
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Incapacitated adult without advocates
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Surrogate-less
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Proxy-less
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Proxy Vacans (Latin for "vacant proxy")
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Non Advocatus (Latin for "no advocate")
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Non Surrogatus (Latin for "no surrogate")
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Non Amicum (Latin for "no friend")
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Adultum Solum (Latin for "alone adult")
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
None of these - I prefer the term "unbefriended"
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
What is your highest professional degree?
a9d2a28f32774b4ab38d946471f686d2 MD/ DO 
a9d2a28f32774b4ab38d946471f686d2 PA  
a9d2a28f32774b4ab38d946471f686d2 NP 
a9d2a28f32774b4ab38d946471f686d2 RN 
a9d2a28f32774b4ab38d946471f686d2 PhD 
a9d2a28f32774b4ab38d946471f686d2 PharmD 
a9d2a28f32774b4ab38d946471f686d2 MSW 
a9d2a28f32774b4ab38d946471f686d2 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"?
a9d2a28f32774b4ab38d946471f686d2 Yes 
a9d2a28f32774b4ab38d946471f686d2 No 
In the past year, how often have you cared for an "unbefriended" older adult?
a9d2a28f32774b4ab38d946471f686d2 Weekly (>1 time per week) 
a9d2a28f32774b4ab38d946471f686d2 Monthly (1-3 times per month) 
a9d2a28f32774b4ab38d946471f686d2 Quarterly (3-4 times per year) 
a9d2a28f32774b4ab38d946471f686d2 Annually (1 time per year) 
a9d2a28f32774b4ab38d946471f686d2 Never 
Which clinical situations have brought a patient’s unbefriended status to your attention?
RarelySometimesFrequentlyN/A
Consent for medical procedure
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Concern re: medication self-management
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Concern re: safety
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Concern re: driving
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Elder Abuse/ Adult Protective issue
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Advance care planning process
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Other: please describe below
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
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
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Incapacitated and alone
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Vulnerable isolated adult
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Unaccompanied adult
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Solitary adult
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Incapacitated adult without advocates
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Surrogate-less
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Proxy-less
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Proxy Vacans (Latin for “vacant proxy”)
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Non Advocatus (Latin for “no advocate”)
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Non Surrogatus (Latin for “no surrogate”)
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Non Amicum (Latin for “no friend”)
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Adultum Solum (Latin for “alone adult”)
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
None of these – I prefer the term “unbefriended”
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2

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?
a9d2a28f32774b4ab38d946471f686d2 Yes 
a9d2a28f32774b4ab38d946471f686d2 No 
a9d2a28f32774b4ab38d946471f686d2 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).
91f05fd817fc4f80b4e477e3320bfd7f Time 
91f05fd817fc4f80b4e477e3320bfd7f Advance care planning supported by Medicare reimbursement 
91f05fd817fc4f80b4e477e3320bfd7f Care manager 
91f05fd817fc4f80b4e477e3320bfd7f Social worker 
91f05fd817fc4f80b4e477e3320bfd7f Pathway to partner with community or volunteer agency 
91f05fd817fc4f80b4e477e3320bfd7f 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
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Isolated vulnerable adult
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Lone elder
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Isolated adult at risk
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Adult without advocates
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Unprotected adult
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Companionless
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Solitary adult
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Solo adult
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Proxy Vacans (Latin for “vacant proxy”)
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Non Advocatus (Latin for “no advocate”)
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Non Surrogatus (Latin for “no surrogate”)
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
a9d2a28f32774b4ab38d946471f686d2
Non Amicum (Latin for “no friend”)
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Adultum Solum (Latin for “alone adult”)
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None of these – I prefer the term “adult orphan”
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What is your highest professional degree?
a9d2a28f32774b4ab38d946471f686d2 MD / DO 
a9d2a28f32774b4ab38d946471f686d2 NP 
a9d2a28f32774b4ab38d946471f686d2 PA 
a9d2a28f32774b4ab38d946471f686d2 RN 
a9d2a28f32774b4ab38d946471f686d2 PhD 
a9d2a28f32774b4ab38d946471f686d2 PharmD 
a9d2a28f32774b4ab38d946471f686d2 MSW 
a9d2a28f32774b4ab38d946471f686d2 Other: specify: 
What U.S. state do you practice in?
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