Ways To Support Health Decisions

Solutions that support the older adult's health decisions include:

• Discussing the older adult's wishes
• Encouraging the older adult to make arrangements
• Involving others

Discussing the Older Adult's Wishes

Ask how the older adult would want any health emergencies or end-of-life care handled.

For example, does the older adult:

• Worry about getting enough care or about getting overly aggressive care
• Want to do everything possible to live independently
• Want to live for as long as possible
• Have strong feelings about emergency treatments towards the end of life like ventilator support (breathing machine), artificial nutrition (feeding tube), or artificial hydration (intravenous fluids)
• Want people close to them to be contacted and updated about health emergencies
• Want to honor family, religious or spiritual traditions

Ask the older adult what you, others close to them and health professionals should know about the older adult's care preferences.

Ask who the older adult thinks best understands their wishes. Ask if the older adult has discussed how to handle health emergencies with them.

Ask how involved the older adult would want you to be in a health emergency. Say that you want to make sure to understand and respect the older adult's wishes.

Encouraging the Older Adult To Make Arrangements

Ask who the older adult wants to make medical decisions, if the older adult isn't able to. Check if the older adult has discussed care preferences with that person.

You should also ask if the older adult has any of these documents:

• An advance directive describes what care the person wants if they are seriously ill or dying, and may include a living will, power of attorney for healthcare and do not resuscitate (DNR) order.
• A living will describes which treatments the person does and does not want, in different situations.
• A power of attorney for healthcare names who the person wants to make healthcare decisions for them if they're not able to.
• Other documents include do not resuscitate (DNR) and do not intubate (DNI) orders and instructions regarding organ and tissue donations.

If the older adult doesn't have these documents - and if you don't have them, either - look into drawing up the documents at the same time as the older adult does. This will give you more opportunity to discuss the older adult's wishes and can help avoid the feeling that you're focused on the older adult becoming seriously ill or dying. Look to see if the older adult's state has fill-in forms or talk to legal professionals.

If the older adult has these documents, ask if someone else has copies or know where to find them, in case of an emergency. If the older adult had the documents made long ago, ask if they should be updated.

Ask if the older adult has shared copies with their primary health professional, local hospital and health care power of attorney. Health professionals use this information to provide care that reflects patients' priorities.

Involving Others

Ask who the older adult would want to share information with during health emergencies.

Ask who the older adult would want to be included in discussions before major decisions.

Ask if the older adult is open to bringing together some or all of these people, to discuss the older adult's wishes. Explain that the stress of medical emergencies often leads to disagreement, unless the people involved understand the older adult's wishes beforehand.

Discussion topics could include:

• How important independence, control and comfort are to the older adult
• How the older adult feels about treatments like kidney dialysis, cardiopulmonary resuscitation (CPR), ventilator support (breathing machine), artificial nutrition (tube feeding) or artificial hydration (intravenous fluids)
• What treatments the older adult would and would not want in case of a terminal illness, persistent vegetative state or worsening untreatable condition like dementia
• How the older adult's beliefs and practices affect healthcare decisions
• Where and how the older adult wants to die

Ask what topics the older adult wants to discuss and which to avoid. Contact others to decide when and how to have the discussion - in person, by phone or online.

Before the discussion, ask if the older adult wants to set ground rules. At the beginning of the discussion, share the older adult's ground rules and ask if anyone want to suggest others. Take and share notes to remind everyone what was discussed and agreed to.

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