Surrogate Decision Making

May 6, 2014
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A recent study published in “JAMA Internal Medicine” indicated that nearly half of all hospitalized older adults rely on surrogate decision making. This study was conducted among over 1,000 hospitalized patients in 2 different hospitals. The results were as follows:

“According to physician reports, at 48 hours of hospitalization, 47.4% of older adults required at least some surrogate involvement, including 23.0% with all decisions made by a surrogate. Among patients who required a surrogate for at least 1 decision within 48 hours, 57.2% required decisions about life-sustaining care (mostly addressing code status), 48.6% about procedures and operations, and 46.9% about discharge planning. Patients who needed a surrogate experienced a more complex hospital course with greater use of ventilators (2.5% of patients who made decisions and 13.2% of patients who required any surrogate decisions), artificial nutrition (1.7% of patients and 14.4% of surrogates), and length of stay (median, 6 days for patients and 7 days for surrogates). They were more likely to be discharged to an extended-care facility (21.2% with patient decisions and 40.9% with surrogate decisions) and had higher hospital mortality (0.0% patients and 5.9% surrogates). Most surrogates were daughters (58.9%), sons (25.0%), or spouses (20.6%). Overall, only 7.4% had a living will and 25.0% had a health care representative document in the medical record.”

An important piece to take note of is the low percentage of patients who had legal documentation either asserting their end of life wishes (living will) or designating a health care proxy to carry out these wishes on their behalf (health care proxy). Both a living will and a health care proxy are essential documents to create ahead of time as to avoid confusion during a crisis situation when a hospitalization may occur. The high number of patients in this study who needed others to make decisions on their behalf confirms this to be true. A living will and a health care proxy can be created with the assistance of an elder law attorney who can provide you with important information and ensure that your wishes are well documented.

If you wish to learn more about Health Care Proxies, please attend our Alzheimer’s Association Long Island Chapter presentation on Health Care Proxies on May 16, 2014 from 1-3pm at our Melville offices. Seating is limited so please call to register.


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