Surrogate Decision Making in Elder Care

Your elderly father has cardiovascular disease and has trouble getting around on his own. He sometimes needs help with cleaning, eating and dressing himself. A recent visit to his doctor resulted in a diagnosis of stage IV bladder cancer. The doctor recommends surgery to remove the tumor as well as chemotherapy.

Surgery and chemo present foreseeable problems for your father and chances of him living longer than six months are slim, even with the treatment.

While it is already painful to watch your father succumb to the cardiovascular disease, treating the cancer would drag him down to an all-time low.

This is a dilemma faced by many caregivers and their elderly loved ones. So what’s the best course of action to take?

Many adults age 65 and older require decision-making assistance from family members or other surrogates because they are too impaired to make decisions independently. The vast majority of surrogates are children or spouses. In some instances, a surrogate may have been previously designated on a Health Care Power of Attorney form, but in many cases the surrogate is not fully informed about the patient’s wishes.

Surrogates will commonly face decisions about life-sustaining care, such as whether to revive a loved one if his or her heart were to stop, as well as decisions about medical procedures like in the scenario previously mentioned. Surrogates are asked to make decisions in critical areas including code status, ventilators and other life-prolonging therapies and surgery options Many surrogate decision-making discussions that involve the elderly center around end-of-life care—whether a person wants to aggressively treat, go into palliative care, or, if the timing is appropriate, enter hospice care.

So it is important to talk to your elderly loved ones and determine if and how they want you to be involved in the decision-making process. Not every health care decision needs to be addressed with lengthy discussions about patient goals and values, but many of the medical issues facing older adults are complex enough to warrant a sit-down dialogue. This situation might be made easier if a caregiver and their elderly loved one have an honest and serious discussion with one another as well as with the senior’s primary care provider before a serious medical issue crops up.

Though end-of-life discussions can be difficult, it’s never too early to start planning for the future.