Dr. Alexia Torke, an associate professor of medicine at Indiana University School of Medicine and Regenstrief Institute investigator, said often the hospitalized patient is too impaired to make decisions independently and hospitals turn to family and other surrogates -- mostly children or spouses.
These patient surrogates commonly face decisions about life-sustaining care, such as whether to revive a loved one if his or her heart were to stop, as well as decisions about medical procedures and whether to send the patient to a nursing facility upon discharge.
"As the population ages, family members of older adults should prepare for the crucial role they may play when their loved ones are hospitalized," Torke said in a statement.
Torke and colleagues at the Indiana University Center for Aging Research tracked 1,083 hospitalized older adults in either a medical intensive care unit or on the medical service of two large urban hospitals. The care of all patients required major medical decisions.
When patients cannot make decisions for themselves due to dementia, delirium or other types of cognitive impairment, physicians turn to surrogate decision-makers, most commonly a close family member. In some instances, a surrogate may have been previously designated by the patient who completed a Health Care Power of Attorney form, but in many cases the individual is not fully informed about the patient's wishes, Torke said.
Surrogates are asked to make decisions in critical areas including code status, ventilators and other life-prolonging therapies, surgery options and post-hospital placement. All are vital to the patient's care and outcome.
"Many hospitals treat family members as visitors rather than as members of the patient's health care team," Torke said. "In-depth interviews with surrogates conducted as part of my ongoing research has found that surrogates often have trouble contacting hospital staff and struggle for information about the patient. Clinicians also frequently report making decisions with surrogates to be highly stressful."
The presence of a surrogate requires fundamental changes in the way clinicians communicate and make decisions for the patient, the researchers said.
Torke and colleagues said this change requires the redesign of hospital functions to account for the large and growing role of surrogates and to provide support for surrogates as they make healthcare decisions.
The findings were published online in advance of print publication in the March issue of JAMA Internal Medicine.
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