Making Critical Health Care Decisions for Older Adults: Consensus among Family Members

Abstract

Making Critical Health Care Decisions for Older Adults: Consensus Among Family Members* Sixty-tvo older adults and their family members responded to 45 hypothetical health care scenarios. At least 70% of the dyads reached agreement for half of the scenarios. Health status and level of treatment influenced their responses. Family members used multiple approaches for resolving different views on a particular procedure or treatment for their older relatives. The results support the normative-affect model of decision making that postulates that people make decisions based on emotionallyladen values and commitments. Key Words: family decision making, health care, life sustaining treatments, old-old. Family involvement in the health care of older adults is the rule rather than the exception. Before going to a health care provider and upon returning home, most older individuals consult their family about their health problems, concerns, and treatment options (Hickey, 1988; Stein, 1989). Family members react to the medical problems of their older relatives by giving them advice and emotional support, providing direct care for them when necessary, and frequently interacting with the health care system on their behalf. In instances where older adults are in poor health, and unable to make decisions for themselves, family members often become their health care decision makers. Individuals may legally appoint a family member (or anyone else they choose) as their surrogate health care decision maker by completing an advanced directive such as a living will or a durable power of attorney for health care (DPAHC). The purpose of appointing a surrogate decision maker is to have someone to serve in case of incapacity who can speak as the person would have spoken (Loewy, 1992). If no such document exists, physicians often turn to the immediate family for input on major treatment decisions. Many states now have statutes stating priority lists of family members who may make decisions for relatives who are incapacitated but lack advanced directives (O'Conner, 1996). Family Decision Makers The systematic study of the health care decision making of older adults and their family members is in its early stages. Most investigations rely on small convenience or volunteer samples of older adults derived from either hospital and medical center populations or easily accessible groups (e.g., senior centers, retirement communities, AARP chapters). Two findings consistently reported across studies are that older adults want family members involved in the decision making process and family members are not necessarily prepared to take on this role. Older persons use a hierarchical pattern in choosing surrogate decision makers (High, 1988; 1989). Married older adults give primary preference to a competent spouse but frequently also want their adult children to be included in the decision making process. The 40 community dwelling elders (M = age 74) selected from a volunteer research pool at the Center for Aging at the University of Kentucky resisted the idea of appointing a single surrogate to make health care decisions, especially if they had several close relatives (High & Turner, 1987). When the 26 women and 14 men were asked who they would trust to make health care decisions for them in the event they could not and who they would want to make the final decision if they were too sick to make their own decisions about their health care, 60% of the study participants favored surrogate decision making by a family group. Geographical location of the children was not a primary factor in the older adults, preference for surrogate decision makers. They often expressed that if there was a crisis, their family members should come together and make decisions as a unit. High's findings are corroborated by Shawler and colleagues (1992). In their qualitative study, 43 decisionally capable older hospital patients (M = age 74) were asked who they would want to make the final health care decision if they were too sick to make their own decisions. …