Advance Care Planning
We have wrapped up our series on the 4Ms of a age-friendly health system, so now let’s deep dive a little more into specific topics in all these categories!
Let’s start today with Advance Care Planning (ACP). Advance Care Planning is the medical term for end of life care plans. This is a critical topic to the appropriate care of any adult and especially with the aging adult. As one of my patients has said, “No one gets out of this life alive,” so to know your parents, grandparents, aunts, uncles, as well as your own values, beliefs, and goals for end of life care is vital before that time arrives. I have been in ICU rooms with patients on ventilators, multiple tubes running in and out of their bodies and heard family members say, “S/He never would have wanted this.” As a (now) geriatrician, I look back on these situations and think that they may be one of the most heartbreaking scenarios in healthcare; the trauma experienced by the patient and their family in these end of life situations is avoidable by open and honest communication with each other and with the healthcare team.
However, this is a very complex topic and not easily broached with anyone, let alone the important and loved people in our lives. Acknowledging mortality is healthy and knowing the issues surrounding a loved one’s end of life and what matters to that person can alleviate anxieties and worries. Not only for caregivers but for those cared for! Having these discussions communicates a care that extends beyond a person’s mortal span of years. It is a way of saying, “I care for you now and I always will.”
But what tools are available to make certain someone’s wishes are respected? The first and most important is communication. A person may not wish to be resuscitated if their heart stops beating, but if that person never tells anyone it’s almost a guarantee that a resuscitation attempt will occur. The next are specific tools that can guide these discussions, a commonly used one is Five Wishes. I have a lot of personal experience with the Colorado MOST form and find it to be an excellent scaffold for having these conversations as values and beliefs are explored with each box. Most states have a similar form that is a legal document, and once filled out are regarded as medical directives in the event that a person is unable to express their wishes. Another essential form is a document that appoints a medical power of attorney. This is a document that appoints a specific person as a medical decision maker if the person creating the document becomes incapacitated. If you or a loved one appoints a medical power of attorney please notify the person you are appointing and have these conversations with them! The person appointed needs to be aware of the gravity of their responsibility, and needs to be a person trustworthy of upholding a person’s wishes in the face of adversity and tragedy.
Most of these documents are available at doctors’ offices, and if not they are easily retrievable. The next time you are at your or your loved one’s doctors’ office please ask for them and have these hard conversations! And finally be sure to circle back and have these conversations with your physician. These documents need to be stored in an easily retrievable location, I highly recommend a scanned copy on a computer and hard copy in your house. If you live in a state that has a MOST (or POLST) form, then keep it on the refrigerator in a highly visible area! Remember, we all will have these conversations with our loved ones and their healthcare teams. Let’s have them in calm and peaceful environments, not in the hospital or intensive care unit.
For more details regarding Advance Care Planning check out the NIH website!
Key Points:
Advance Care Planning is a critical portion of elder care
Discussing What Matters can guide end of life care and increases quality of life
