scholarly journals Pathways to and Consequences of Surrogate Decision-Making for Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 702-702
Author(s):  
Pamela Teaster ◽  
Cory Bolkan ◽  
Shawn Meyers
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Elder Abuse ◽  
Decision Makers ◽  
Surrogate Decision Making ◽  
Protective Services ◽  
Older Americans ◽  
Adult Protective Services ◽  
Surrogate Decision Makers ◽  
Surrogate Decision

Abstract With a burgeoning aging population, there is a growing need for surrogate decision makers, yet oversight of and guidance for them remains inadequate. People needing surrogate decision makers are an especially vulnerable population because they rely on others for care and/or are unable to advocate for themselves. Their vulnerability leaves them susceptible to elder abuse (e.g., physical, sexual, psychological abuse; active and passive neglect; financial exploitation), which affects approximately five million older Americans each year. Personal, financial, and societal impacts can be devastating and are estimated to cost billions annually. The issue of abuse, neglect and exploitation by surrogates has been highly visible nationally, evidence indicates that some surrogate decision makers perpetrate abuse. One purpose of this symposium is to discuss ways in which surrogates do and do not make decisions for older adults. Ramsey-Klawsnik and Burnett present data at the systemic level to illustrate how self-neglect sequelae can result in placement under surrogate decision-making authority of either well-intended or opportunistic others. Bolkan, Teaster, Ramsey-Klawsnik, and Gerow present findings from a six-state study on surrogate decision maker victims and perpetrators who were substantiated in Adult Protective Services cases. Zhao, Katz, and Teaster show, using a survey of M-Turk participants, how a general population makes and is comfortable with surrogate decisions. Discussant Shawn Meyers will pull together the findings by exploring their translation to judicial best practices for making determinations regarding surrogate decision makers and the effects of their decisions on the surrogate as well as collaterals.

scholarly journals PRELIMINARY FINDINGS ON FAMILY PERPETRATORS AS DESIGNATED SURROGATE DECISION MAKERS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S383-S383
Author(s):  
Cory Bolkan ◽  
Pamela Teaster ◽  
Holly Ramsey-Klawsnik ◽  
Kenneth Gerow
Keyword(s):  
Older Adults ◽  
Decision Makers ◽  
Policy Recommendations ◽  
Community Settings ◽  
Protective Services ◽  
Adult Protective Services ◽  
Surrogate Decision Makers ◽  
Surrogate Decision ◽  
Vulnerable Adults ◽  
Process Level

Abstract Vulnerable older adults needing surrogate decision makers typically rely upon others for care and are unable to advocate for themselves. The issue of EFFE perpetrated by family members designated as surrogates has become highly visible nationally, yet no reliable, empirical documentation exists on the nature or extent of exploitation by surrogate perpetrators. In collaboration with the National Adult Protective Services Association (NAPSA), we prospectively gathered APS data from six geographically diverse counties on 450 substantiated cases of abuse by POAs, representative payees, and guardians of vulnerable adults 65+ living in community settings. This presentation will highlight how family member surrogates perpetuated abuse and the outcomes on elder victims. These findings elucidate person and process-level factors (e.g., characteristics of victims, perpetrators, and their relationships) within the context of the APS system and can inform practice and policy recommendations for better prevention, detection, investigation, and intervention in these challenging cases.

scholarly journals Abuse of Vulnerable Older Adults by Designated Surrogate Decision Makers

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 702-703
Author(s):  
Cory Bolkan ◽  
Pamela Teaster ◽  
Holly Ramsey-Klawsnik ◽  
Kenneth Gerow
Keyword(s):  
Older Adults ◽  
Reliable Data ◽  
Decision Makers ◽  
Community Settings ◽  
Power Of Attorney ◽  
Protective Services ◽  
Adult Protective Services ◽  
Surrogate Decision Makers ◽  
Surrogate Decision ◽  
Vulnerable Adults

Abstract Abuse perpetrated by designated surrogates has become highly visible nationally, yet no reliable data exist on its nature or extent. Because vulnerable older adults needing surrogate decision makers typically rely upon others for care, they may be unable to advocate for themselves and are susceptible to abuse. We prospectively gathered Adult Protective Services (APS) data from six geographically diverse counties on over 400 substantiated cases of abuse by perpetrators (53% non-surrogates; 47% documented or claimed surrogate) of vulnerable adults 65+ living in community settings. Most perpetrators (85%) were designated power of attorney, while approximately 8% were guardians, and 7% were representative payees; most perpetrators were family members. Polyabuse occurred frequently. Almost 25% of cases involved a prior substantiated APS report. This presentation highlights how surrogates perpetuate abuse and outcomes on older adult victims. Our findings inform practice and policy for better prevention, detection, investigation, and intervention in these challenging cases.

scholarly journals Self-Neglect: One Pathway to Surrogate Decision-Making

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 703-703
Author(s):  
Holly Ramsey-Klawsnik ◽  
Jason Burnett
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Nursing Home ◽  
Mental Capacity ◽  
Early Mortality ◽  
Surrogate Decision Making ◽  
Protective Services ◽  
Adult Protective Services ◽  
Cognitive Limitations ◽  
Surrogate Decision

Abstract Self-neglect, the most frequently reported allegation to Adult Protective Services (APS), involves profoundly harmful behaviors often due to functional or cognitive limitations, health problems, and insufficient resources that result in older adults insufficiently meeting their basic needs. Outcomes include high risk of illness, hospitalization and readmission, hospice and nursing home use, early mortality, and placement under surrogate decision-making authority of either well-intended or opportunistic others. APS staff are charged with assessing self-neglect and intervening to reduce client danger. A nationwide APS survey revealed program policies, procedures, resources, and needs affecting the client welfare. For example, 92% of APS programs have provisions for seeking guardianship for self-neglecting individuals, in 25% of programs staff serve as court-appointed guardians, and a wide variety of tools are used within APS programs to assess clients’ mental capacity. Key study findings, implications, and recommendations will be presented.

scholarly journals A Scenario-Based Investigation of Surrogate Decision Making for Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 703-703
Author(s):  
Yuxin Zhao ◽  
Benjamin Katz ◽  
Pamela Teaster
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Financial Management ◽  
Self Efficacy ◽  
Decision Makers ◽  
Surrogate Decision Making ◽  
Insurance Company ◽  
Surrogate Decision ◽  
Critically Ill Adults ◽  
Amazon's Mechanical Turk

Abstract Surrogate decisions involve complex, challenging choices; surrogate decision-makers make treatment decisions for approximately 40% of hospitalized adults and 70% of older adults, and up to 95% of critically ill adults of any age. The purpose of our study was to understand how people make decisions for others and how surrogate decision making is linked to people’s cognition, self-efficacy, and demographics, especially differences in acute (e.g., health and medical care, financial management, and end of life) versus general scenarios (spending time with family, contacting an insurance company on behalf of a family member). Participants were recruited through Amazon’s Mechanical Turk. We collected data from 290 adult participants aged 18 years or older. On average, people reported a higher level of confidence in general versus acute scenario. The differences of confidence in scenario-based surrogate decision-making links to decision-makers’ cognition, self-efficacy, the experience of decision-making, the experience of caregiving, and demographic factors.

Financial Surrogate Decision Making: Lessons from Applied Experimental Philosophy

2016 ◽  
Vol 19 ◽  
Author(s):  
Adam Feltz
Keyword(s):  
Decision Making ◽  
Experimental Philosophy ◽  
Decision Makers ◽  
Surrogate Decision Making ◽  
Financial Decisions ◽  
Financial Decision Making ◽  
Recent Debate ◽  
Surrogate Decision Makers ◽  
Financial Decision ◽  
Surrogate Decision

AbstractAn estimated 1 in 4 elderly Americans need a surrogate to make decisions at least once in their lives. With an aging population, that number is almost certainly going to increase. This paper focuses onfinancialsurrogate decision making. To illustrate some of the empirical and moral implications associated with financial surrogate decision making, two experiments suggest that default choice settings can predictably influence some surrogate financial decision making. Experiment 1 suggested that when making hypothetical financial decisions, surrogates tended to stay with default settings (OR = 4.37, 95% CI 1.52, 12.48). Experiment 2 replicated and extended this finding suggesting that in a different context (OR = 2.27, 95% CI 1.1, 4.65). Experiment 2 also suggested that those who were more numerate were less likely to be influenced by default settings than the less numerate, but only when the decision is whether to “opt in” (p= .05). These data highlight the importance of a recent debate about “nudging.” Defaults are common methods to nudge people to make desirable choices while allowing the liberty to choose otherwise. Some of the ethics of using default settings to nudge surrogate decision makers are discussed.

scholarly journals The judgment grounds in surrogate decision-making in Japanese clinical practice: A qualitative survey

2020 ◽  
Author(s):  
Masashi Tanaka ◽  
Kayoko Ohnishi ◽  
Aya Enzo ◽  
Taketoshi Okita ◽  
Atsushi Asai
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Decision Makers ◽  
Best Interests ◽  
Current Status ◽  
Surrogate Decision Making ◽  
Surrogate Decision Makers ◽  
Surrogate Decision ◽  
Family Preference ◽  
Made In

Abstract Background Surrogate decision-making is expected to become more prevalent in Japanese clinical practice. In recent years, activities to promote advanced care planning (ACP) have gathered momentum ,which may potentially affect the ways in which judgments are made in surrogate decision-making. The purpose of this study is to clarify the current judgment grounds on which surrogate decisions are made in Japan. Methods We adopted a qualitative research method that was based on semi-structured interviews to reveal the judgement grounds in surrogate decision-making involving critical, life-related choices in acute hospitals. Results We interviewed 15 participants. We analyzed the content of the 14 transcribed texts, eliminating one text that does not meet the inclusion criteria. We extracted a total of 4 core categories, 17 categories, 35 subcategories, and 55 codes as an analysis results of interviews regarding the judgment grounds in surrogate decision-making. The four categories are as follows: type 1“Patient preference-oriented factor”, type2“Patient interest-oriented factor”, type3“Family preference-oriented factor”,and type4 “Balanced patient/family preference-oriented factor”. Conclusions This study revealed the current status of surrogate decision-making in Japan: when making decisions about important matters related to a patient’s life, surrogate decision-makers base their decisions not only on the preferences and best interests of the patient, but on their own preferences as well. Included in the preferences of surrogate decision-makers were their own views of life and death, their values, and care burden. Given the cultural and social backgrounds in Japan, it remains unclear whether ACP can be properly reflected in judgment grounds in surrogate decision-making. It would be undesirable to base judgments solely on the principle of respect for autonomy or the principles of surrogate decision-making. In the future, we believe that surrogate decisions-makers will be required to consider the judgment grounds from a more diverse perspective and that such attitudes should be ethically accepted.

scholarly journals Grounds for surrogate decision-making in Japanese clinical practice: a qualitative survey

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Masashi Tanaka ◽  
Kayoko Ohnishi ◽  
Aya Enzo ◽  
Taketoshi Okita ◽  
Atsushi Asai
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Decision Makers ◽  
Best Interests ◽  
Surrogate Decision Making ◽  
Inclusion Criteria ◽  
Surrogate Decision Makers ◽  
Surrogate Decision ◽  
Factor Type ◽  
Family Preference

Abstract Background In the coming years, surrogate decision-making is expected to become highly prevalent in Japanese clinical practice. Further, there has been a recent increase in activities promoting advance care planning, which potentially affects the manner in which judgements are made by surrogate decision-makers. This study aims to clarify the grounds on which surrogate decision-makers in Japan base their judgements. Methods In this qualitative study, semi-structured interviews were conducted to examine the judgement grounds in surrogate decision-making for critical life-sustaining treatment choices in acute care hospitals. Results A total of 228 participants satisfied the inclusion criteria, and 15 were selected for interviews. We qualitatively analysed the content of 14 interview transcripts, excluding one that did not meet the inclusion criteria. Based on this analysis, we extracted 4 core categories, 17 categories, 35 subcategories, and 55 codes regarding judgement grounds in surrogate decision-making. The four core categories were as follows: patient preference-oriented factor (Type 1), patient interest-oriented factor (Type 2), family preference-oriented factor (Type 3), and balanced patient/family preference-oriented factor (Type 4). The Type 4 core category represented attempts to balance the preferences of the patient with those of the surrogate decision-maker. Conclusions Surrogate decision-makers based their decisions on important aspects related to a patient’s life, and they considered not only the patient’s preferences and best interests but also their own preferences. As the need for surrogate decisions will increase in the future, decision-makers will need to consider judgement grounds from a more diverse perspective.

Family and Physicians' Views of Surrogate Decision-Making: The Roles and How to Choose

1996 ◽  
Vol 8 (4) ◽  
pp. 589-596 ◽  
Author(s):  
Michel Silberfeld ◽  
Rivka Grundstein-Amado ◽  
Derek Stephens ◽  
Raisa Deber
Keyword(s):  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Decision Making ◽  
Shared Decision Making ◽  
Family Members ◽  
Decision Makers ◽  
Surrogate Decision Making ◽  
Shared Decision ◽  
Surrogate Decision Makers ◽  
Surrogate Decision

Physicians and family members were compared on the roles played in surrogate decision-making and their views as to how choices should be made by surrogate decision-makers. Thirty-six family members of patients with Alzheimer's disease, 35 family members of patients with schizophrenia, and 34 physicians from a diversity of specialties were the respondents. There was general agreement that shared decision-making was preferred. Physicians seem to make surrogate decisions in accordance with contemporary views about their roles. Families believed they had a strong subjective appreciation of the patient's overall good. The burden of decision-making was geater for families, but that depended to some degree on the diagnosis of the patient.

scholarly journals Cross-sectional survey of surrogate decision-making in Japanese medical practice

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Masashi Tanaka ◽  
Seiji Bito ◽  
Aya Enzo ◽  
Takethoshi Okita ◽  
Asai Atsushi
Keyword(s):  
Decision Making ◽  
Large Scale ◽  
Healthcare Professionals ◽  
Decision Makers ◽  
Decision Making Process ◽  
Surrogate Decision Making ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Surrogate Decision Makers ◽  
Surrogate Decision

Abstract Background Instances of surrogate decision-making are expected to increase with the rise in hospitalised older adults in Japan. Few large-scale studies have comprehensively examined the entire surrogate decision-making process. This study aimed to gather information to assess the current state of surrogate decision-making in Japan. Methods A cross-sectional survey was conducted using online questionnaires. A total of 1000 surrogate decision-makers responded to the questionnaire. We examined the characteristics of surrogate decision-makers and patients, content of surrogate decision-making meeting regarding life-sustaining treatment between the doctors and surrogate decision-makers, extent of involvement of the various parties in the surrogate decision-making process, judgement grounds for surrogate decision-making, and frequency of involvement in the surrogate decision-making process. Results Of the participants, 70.5% were male and 48.3% were eldest sons. Only 7.6% of the patients had left a written record of their preferences and 48.8% of the surrogates reported no knowledge of the patient having expressed their prior intentions regarding medical care in any form. Respondents indicated that their family meetings with healthcare professionals mostly included the information recommended by guidelines in a surrogate decision-making meeting in Japan. Most participants reported a good understanding of the meeting content. Although many participants based their decisions on multiple grounds, surrogates’ considerations may not adequately reflect respect for patient autonomy in Japan. Specifically, the eldest son considered his own preference more frequently than that of the other surrogate decision-makers. In 26.1% of the cases, either zero or one family meeting with healthcare professionals was held. In these cases, significantly fewer decisions involved the participation of healthcare professionals other than the doctor compared to cases with multiple meetings. Conclusions Surrogate decisions in Japan are most commonly made by eldest sons and may not frequently consider the perspectives of other surrogates. The finding that patient preferences were rarely known suggests a role for increased advance care planning.

scholarly journals Grounds for surrogate decision-making in Japanese clinical practice: A qualitative survey

2021 ◽  
Author(s):  
Masashi Tanaka ◽  
Kayoko Ohnishi ◽  
Aya Enzo ◽  
Taketoshi Okita ◽  
Atsushi Asai
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Decision Makers ◽  
Best Interests ◽  
Surrogate Decision Making ◽  
Inclusion Criteria ◽  
Surrogate Decision Makers ◽  
Surrogate Decision ◽  
Factor Type ◽  
Family Preference

Abstract Background In the coming years, surrogate decision-making is expected to become highly prevalent in Japanese clinical practice. Further, there has been a recent increase in activities promoting advance care planning, which potentially affects the manner in which judgements are made by surrogate decision-makers. This study aims to clarify the grounds on which surrogate decision-makers in Japan base their judgements.Methods In this qualitative study, semi-structured interviews were conducted to examine the judgement grounds in surrogate decision-making for critical life-sustaining treatment choices in acute care hospitals.Results A total of 228 participants satisfied the inclusion criteria, and 15 were selected for interviews. We qualitatively analysed the content of 14 interview transcripts, excluding one that did not meet the inclusion criteria. Based on this analysis, we extracted 4 core categories, 17 categories, 35 subcategories, and 55 codes regarding judgement grounds in surrogate decision-making. The four core categories were as follows: patient preference–oriented factor (Type 1), patient interest–oriented factor (Type 2), family preference–oriented factor (Type 3), and balanced patient/family preference–oriented factor (Type 4). The Type 4 core category represented attempts to balance the preferences of the patient with those of the surrogate decision-maker.Conclusions Surrogate decision-makers based their decisions on important aspects related to a patient’s life, and they considered not only the patient’s preferences and best interests but also their own preferences. As the need for surrogate decisions will increase in the future, decision-makers will need to consider judgement grounds from a more diverse perspective. 

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