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?
be29ce550bd44e00b37074e7494af7a4 Outpatient - home or clinic based 
be29ce550bd44e00b37074e7494af7a4 Outpatient - other 
be29ce550bd44e00b37074e7494af7a4 Inpatient - acute care 
be29ce550bd44e00b37074e7494af7a4 Inpatient - rehab / subacute 
be29ce550bd44e00b37074e7494af7a4 Inpatient - long term care 
be29ce550bd44e00b37074e7494af7a4 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"?

be29ce550bd44e00b37074e7494af7a4 Yes 
be29ce550bd44e00b37074e7494af7a4 No 
In the past year, how often have you cared for an "unbefriended" older adult?
be29ce550bd44e00b37074e7494af7a4 Weekly (>1 time per week) 
be29ce550bd44e00b37074e7494af7a4 Monthly (1-3 times per month) 
be29ce550bd44e00b37074e7494af7a4 Quarterly (3-4 times per year) 
be29ce550bd44e00b37074e7494af7a4 Annually (1 time per year) 
be29ce550bd44e00b37074e7494af7a4 Never 
Have your unbefriended patients/ your team faced any of these problems?
NeverRarelySometimesFrequently
Prolonged hospital stay, past a medically necessary point
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Delay in treatment or surgery
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Delay in appropriately transitioning the patient to hospice or end of life care
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Unable to provide the patient something that may improve quality of life
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Delay in authorizing charges/coverage for care
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Loss of rehabilitation ability/potential in patient
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
We had to continue with what seemed like medically non-beneficial care
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
I experienced personal distress because of an inability to act in my professional role
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
The patient was in physical or psychological distress
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Other: describe below
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
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
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Incapacitated and alone
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Vulnerable isolated adult
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Unaccompanied adult
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Solitary adult
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Incapacitated adult without advocates
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Surrogate-less
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Proxy-less
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Proxy Vacans (Latin for "vacant proxy")
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Non Advocatus (Latin for "no advocate")
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Non Surrogatus (Latin for "no surrogate")
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Non Amicum (Latin for "no friend")
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Adultum Solum (Latin for "alone adult")
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
None of these - I prefer the term "unbefriended"
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
What is your highest professional degree?
be29ce550bd44e00b37074e7494af7a4 MD/ DO 
be29ce550bd44e00b37074e7494af7a4 PA  
be29ce550bd44e00b37074e7494af7a4 NP 
be29ce550bd44e00b37074e7494af7a4 RN 
be29ce550bd44e00b37074e7494af7a4 PhD 
be29ce550bd44e00b37074e7494af7a4 PharmD 
be29ce550bd44e00b37074e7494af7a4 MSW 
be29ce550bd44e00b37074e7494af7a4 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"?
be29ce550bd44e00b37074e7494af7a4 Yes 
be29ce550bd44e00b37074e7494af7a4 No 
In the past year, how often have you cared for an "unbefriended" older adult?
be29ce550bd44e00b37074e7494af7a4 Weekly (>1 time per week) 
be29ce550bd44e00b37074e7494af7a4 Monthly (1-3 times per month) 
be29ce550bd44e00b37074e7494af7a4 Quarterly (3-4 times per year) 
be29ce550bd44e00b37074e7494af7a4 Annually (1 time per year) 
be29ce550bd44e00b37074e7494af7a4 Never 
Which clinical situations have brought a patient’s unbefriended status to your attention?
RarelySometimesFrequentlyN/A
Consent for medical procedure
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Concern re: medication self-management
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Concern re: safety
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Concern re: driving
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Elder Abuse/ Adult Protective issue
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Advance care planning process
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Other: please describe below
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
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
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Incapacitated and alone
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Vulnerable isolated adult
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Unaccompanied adult
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Solitary adult
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Incapacitated adult without advocates
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Surrogate-less
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Proxy-less
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Proxy Vacans (Latin for “vacant proxy”)
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Non Advocatus (Latin for “no advocate”)
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Non Surrogatus (Latin for “no surrogate”)
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Non Amicum (Latin for “no friend”)
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Adultum Solum (Latin for “alone adult”)
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
None of these – I prefer the term “unbefriended”
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4

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?
be29ce550bd44e00b37074e7494af7a4 Yes 
be29ce550bd44e00b37074e7494af7a4 No 
be29ce550bd44e00b37074e7494af7a4 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).
ddf583f935eb44b6b8bf00ac5fed47ce Time 
ddf583f935eb44b6b8bf00ac5fed47ce Advance care planning supported by Medicare reimbursement 
ddf583f935eb44b6b8bf00ac5fed47ce Care manager 
ddf583f935eb44b6b8bf00ac5fed47ce Social worker 
ddf583f935eb44b6b8bf00ac5fed47ce Pathway to partner with community or volunteer agency 
ddf583f935eb44b6b8bf00ac5fed47ce 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
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Isolated vulnerable adult
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Lone elder
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Isolated adult at risk
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Adult without advocates
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Unprotected adult
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Companionless
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Solitary adult
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Solo adult
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Proxy Vacans (Latin for “vacant proxy”)
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Non Advocatus (Latin for “no advocate”)
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Non Surrogatus (Latin for “no surrogate”)
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Non Amicum (Latin for “no friend”)
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
Adultum Solum (Latin for “alone adult”)
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
None of these – I prefer the term “adult orphan”
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
be29ce550bd44e00b37074e7494af7a4
What is your highest professional degree?
be29ce550bd44e00b37074e7494af7a4 MD / DO 
be29ce550bd44e00b37074e7494af7a4 NP 
be29ce550bd44e00b37074e7494af7a4 PA 
be29ce550bd44e00b37074e7494af7a4 RN 
be29ce550bd44e00b37074e7494af7a4 PhD 
be29ce550bd44e00b37074e7494af7a4 PharmD 
be29ce550bd44e00b37074e7494af7a4 MSW 
be29ce550bd44e00b37074e7494af7a4 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.