[Advance Directives in Geriatrics: Proposed Management Algorithm]

This work encompasses both a review article and the proposal of an operational model for the implementation of advance directives in older adults with terminal or end-stage illnesses within the Geriatrics Department, conceived as an ethical and clinical strategy aimed at promoting autonomy at the end of life. Through a comprehensive regulatory, bioethical, and epidemiological review, as well as an analysis of institutional barriers, we developed an algorithm that includes candidate identification, provision of information to patients and their families, obtaining informed consent, formalization of the document, registration, and ongoing follow-up. The methodology was grounded in the integration of national and international evidence, the clinical experience of the team, and current Mexican legislation. Our proposal seeks to foster shared anticipatory decision-making, reduce futile interventions, and humanize the dying process. We conclude that the institutionalization of clear protocols regarding advance directives enhances the quality of palliative care, facilitates proactive planning, decreases family conflicts, and strengthens respect for the dignity of older adults.