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Surrogate Decision Making for Older Hospitalized Adults

Surrogate Decision Making for Older Hospitalized Adults

The aging population has led to a greater number of older adults being hospitalized with various conditions, but many of these individuals have impaired cognition. “These patients often face major decisions about their medical care at a time when they can’t communicate their preferences or have trouble with decision making,” explains Alexia M. Torke, MD. Surrogate decision makers can be used when patients are unable to make their own medical decisions. These individuals are often close family members or friends who, in some cases, have been chosen by the patient as a healthcare power of attorney. “The presence of surrogates requires fundamental changes in the way that clinicians communicate and make decisions,” Dr. Torke says. Much of the research on surrogates has focused on how accurately they make decisions based on hypothetical situations or has looked at the burden and distress experienced by surrogates. Few studies, however, have assessed how often surrogates are called upon to make decisions. Research is also lacking on the types of decisions surrogates must make. Taking a Closer Look In a study published in JAMA Internal Medicine, Dr. Torke and colleagues described the scope of surrogate decision making, the hospital course, and outcomes for adults aged 65 and older in a prospective, observational analysis. The study was conducted in medicine and medical ICU services of two hospitals and involved 1,083 patients who were identified by their physicians as requiring major medical decisions. “Our goal was to better understand the issues facing surrogates,” says Dr. Torke. This data may help redesign hospital care so that clinicians can more effectively fulfill the needs of aging patients...
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