AGS Position Statement: Making Medical Treatment Decisions for Unbefriended Older Adults

Area of Science:

• Geriatrics
• Bioethics
• Health Law

Background:

• Unbefriended older adults are vulnerable patients lacking capacity and surrogates for medical decisions.
• Existing legal and ethical frameworks present challenges in decision-making for this population.
• This statement updates the 1996 American Geriatrics Society (AGS) position on unbefriended patients.

Purpose of the Study:

• To define "unbefriended older adults" and outline ethical and procedural standards for their medical care.
• To advocate for a standardized, fair process in medical decision-making for this vulnerable group.
• To address variability in legal approaches and promote proactive identification of at-risk individuals.

Main Methods:

• Defining criteria for identifying unbefriended older adults.
• Recommending a procedural fairness standard for treatment decisions.
• Emphasizing capacity assessment, surrogate searches, and team-based preference ascertainment.

Main Results:

• A clear definition of unbefriended older adults is provided.
• A multi-step process for medical decision-making is proposed, ensuring patient preferences are considered.
• The need for national efforts to standardize legal approaches and identify at-risk individuals is highlighted.

Conclusions:

• A systematic, fair process is essential for medical decision-making for unbefriended older adults.
• National collaboration is required to reduce legal inconsistencies and improve care for this population.
• Proactive identification and alternative decision-making models are needed for vulnerable older adults.