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?
c898e15de4ee4fddacba596736485cb7 Outpatient - home or clinic based 
c898e15de4ee4fddacba596736485cb7 Outpatient - other 
c898e15de4ee4fddacba596736485cb7 Inpatient - acute care 
c898e15de4ee4fddacba596736485cb7 Inpatient - rehab / subacute 
c898e15de4ee4fddacba596736485cb7 Inpatient - long term care 
c898e15de4ee4fddacba596736485cb7 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"?

c898e15de4ee4fddacba596736485cb7 Yes 
c898e15de4ee4fddacba596736485cb7 No 
In the past year, how often have you cared for an "unbefriended" older adult?
c898e15de4ee4fddacba596736485cb7 Weekly (>1 time per week) 
c898e15de4ee4fddacba596736485cb7 Monthly (1-3 times per month) 
c898e15de4ee4fddacba596736485cb7 Quarterly (3-4 times per year) 
c898e15de4ee4fddacba596736485cb7 Annually (1 time per year) 
c898e15de4ee4fddacba596736485cb7 Never 
Have your unbefriended patients/ your team faced any of these problems?
NeverRarelySometimesFrequently
Prolonged hospital stay, past a medically necessary point
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Delay in treatment or surgery
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c898e15de4ee4fddacba596736485cb7
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Delay in appropriately transitioning the patient to hospice or end of life care
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c898e15de4ee4fddacba596736485cb7
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Unable to provide the patient something that may improve quality of life
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c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
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Delay in authorizing charges/coverage for care
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c898e15de4ee4fddacba596736485cb7
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Loss of rehabilitation ability/potential in patient
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
We had to continue with what seemed like medically non-beneficial care
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
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I experienced personal distress because of an inability to act in my professional role
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
The patient was in physical or psychological distress
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
Other: describe below
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
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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
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
Incapacitated and alone
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
Vulnerable isolated adult
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
Unaccompanied adult
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
Solitary adult
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
Incapacitated adult without advocates
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
Surrogate-less
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
Proxy-less
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
Proxy Vacans (Latin for "vacant proxy")
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
Non Advocatus (Latin for "no advocate")
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
Non Surrogatus (Latin for "no surrogate")
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
Non Amicum (Latin for "no friend")
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
Adultum Solum (Latin for "alone adult")
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
None of these - I prefer the term "unbefriended"
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
What is your highest professional degree?
c898e15de4ee4fddacba596736485cb7 MD/ DO 
c898e15de4ee4fddacba596736485cb7 PA  
c898e15de4ee4fddacba596736485cb7 NP 
c898e15de4ee4fddacba596736485cb7 RN 
c898e15de4ee4fddacba596736485cb7 PhD 
c898e15de4ee4fddacba596736485cb7 PharmD 
c898e15de4ee4fddacba596736485cb7 MSW 
c898e15de4ee4fddacba596736485cb7 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"?
c898e15de4ee4fddacba596736485cb7 Yes 
c898e15de4ee4fddacba596736485cb7 No 
In the past year, how often have you cared for an "unbefriended" older adult?
c898e15de4ee4fddacba596736485cb7 Weekly (>1 time per week) 
c898e15de4ee4fddacba596736485cb7 Monthly (1-3 times per month) 
c898e15de4ee4fddacba596736485cb7 Quarterly (3-4 times per year) 
c898e15de4ee4fddacba596736485cb7 Annually (1 time per year) 
c898e15de4ee4fddacba596736485cb7 Never 
Which clinical situations have brought a patient’s unbefriended status to your attention?
RarelySometimesFrequentlyN/A
Consent for medical procedure
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c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
Concern re: medication self-management
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c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
Concern re: safety
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
Concern re: driving
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
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Elder Abuse/ Adult Protective issue
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
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Advance care planning process
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
Other: please describe below
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
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
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
Incapacitated and alone
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
Vulnerable isolated adult
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
Unaccompanied adult
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
Solitary adult
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
Incapacitated adult without advocates
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
Surrogate-less
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
Proxy-less
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
Proxy Vacans (Latin for “vacant proxy”)
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
Non Advocatus (Latin for “no advocate”)
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
Non Surrogatus (Latin for “no surrogate”)
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
Non Amicum (Latin for “no friend”)
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
Adultum Solum (Latin for “alone adult”)
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
None of these – I prefer the term “unbefriended”
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
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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?
c898e15de4ee4fddacba596736485cb7 Yes 
c898e15de4ee4fddacba596736485cb7 No 
c898e15de4ee4fddacba596736485cb7 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).
cecdfd3bc60a416492b56dc5efac5a8f Time 
cecdfd3bc60a416492b56dc5efac5a8f Advance care planning supported by Medicare reimbursement 
cecdfd3bc60a416492b56dc5efac5a8f Care manager 
cecdfd3bc60a416492b56dc5efac5a8f Social worker 
cecdfd3bc60a416492b56dc5efac5a8f Pathway to partner with community or volunteer agency 
cecdfd3bc60a416492b56dc5efac5a8f 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
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
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Isolated vulnerable adult
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
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Lone elder
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
Isolated adult at risk
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
Adult without advocates
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
Unprotected adult
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
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Companionless
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
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Solitary adult
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
Solo adult
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
Proxy Vacans (Latin for “vacant proxy”)
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
Non Advocatus (Latin for “no advocate”)
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
Non Surrogatus (Latin for “no surrogate”)
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
Non Amicum (Latin for “no friend”)
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
Adultum Solum (Latin for “alone adult”)
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
None of these – I prefer the term “adult orphan”
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
c898e15de4ee4fddacba596736485cb7
What is your highest professional degree?
c898e15de4ee4fddacba596736485cb7 MD / DO 
c898e15de4ee4fddacba596736485cb7 NP 
c898e15de4ee4fddacba596736485cb7 PA 
c898e15de4ee4fddacba596736485cb7 RN 
c898e15de4ee4fddacba596736485cb7 PhD 
c898e15de4ee4fddacba596736485cb7 PharmD 
c898e15de4ee4fddacba596736485cb7 MSW 
c898e15de4ee4fddacba596736485cb7 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.