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Why Advance Directives Are Crucial for Aging Parents
Interviewer: How do you have the conversation with your parents who are over 65 about advanced directives? It could be a difficult conversation, but it doesn't necessarily need to be. And it's one that you should absolutely have with your parents especially if they're over 65. That conversation is about advanced directives.
We're with Dr. Anna Beck from Huntsman Cancer Institute. Dr. Beck, let's say that I don't know if my parents have advanced directives. I feel that they should because I know that it's a good idea. How do I bring that conversation up to them? It feels a little strange saying, "You guys are getting close to dying." When you do... What's your advice there?
Dr. Beck: Well, that's a very good question. There has actually been recent data that has now shown that roughly 50% of people over the age of 65 who get admitted to the hospital for an unplanned admission, because they're sick for some reason, 50% of those patients need some help making their decision. So a surrogate is asked to be a part of that decision-making process.
So I think that's a good warning sign to all of us that any of our family members who are reaching the age of 65, if you don't know who their surrogate is or if they haven't picked a surrogate, there is a reason for them to start thinking about that whole process.
What Are Advance Directives and When Do They Apply?
Interviewer: So advanced directive, just to be clear, is it if they're unconscious and can't make decisions or when does that actually come into play?
Dr. Beck: So it comes into play if they become impaired, if they're not able to think clearly or be an active participant in the decision. So for example, suppose your father gets admitted to the hospital with pneumonia and because of that he's short of breath, he's not able to speak clearly, or he's not able to understand. Maybe he's got some hearing impairment or maybe he's got a little bit of dementia and just can't quite think through the process. That's where a surrogate could step in and say, "These are the kinds of things that are appropriate and these are not the things that he would want to have done."
Interviewer: And it comes back to after 65, 50% of people, that's a lot, need that kind of help.
Dr. Beck: Who get admitted to the hospital because they're ill. Yes, exactly.
Initiating the Conversation About Advance Directives
Interviewer: So if I bring that up with my parents and find out that they do not, and they don't even want to have this conversation at this point, but I know it's a good idea that they should. How do you push forward?
Dr. Beck: I would probably pick the process of saying, "I know that you don't want to be a burden and I know that the reason you don't want to talk about this is because it's unpleasant, but it would be really stressful for me to try to figure out what you want to have done without knowing about it. Can we at least talk about things that are important to you?"
Interviewer: Yeah.
Dr. Beck: And I also suggest putting a time limit on it so that people don't feel like this is a conversation that's going to go on for hours.
Interviewer: Sure.
Dr. Beck: And that's your initial expectation. It's like, "Oh, no! We're going to talk about that." If you say, "Can we just spend ten minutes? Give me some important things that you want to make sure never happened to you." Or maybe it's, "I don't want to be in pain. I want you to always make sure that I'm comfortable. I never want to do a prolonged death or anything like that." Or just talk about stuff that you want me to know about, or tell me who your surrogate is. Maybe they have picked a surrogate and you don't know who it is.
Interviewer: Yeah.
Dr. Beck: So again, kind of putting a time frame on it, "Let's just spend ten minutes, Dad, and go through this so that I don't have to be stressed and I'll know what's important to you."
Interviewer: And I like the framing of it, more big picture. Instead of, "If you're on life support." "Do you want to be on it or not?" It's more what's important to you in your life as your life ends. I like that.
Dr. Beck: Exactly. That's another point that you raise is a lot of times people can't say, "Well, yeah, I want to be on life support, or I don't want to be on life support, or I want to get fluids, or I don't want to get fluids."
Interviewer: Because that's what those forms look like.
Dr. Beck: Yes, right.
Interviewer: Those are the questions those forms ask.
Dr. Beck: Yeah, and I have a problem with that on the forms as well too. So I think it's important as people get older and they get more frail that you have that conversation with the doctor about what kinds of things might be potential options or might happen to you potentially.
But I think if you can phrase it more in terms of general goals, like playing with grandkids, being able to interact with my family, being able to toilet myself... trying to help them figure out what are the important things that they want to try to preserve in order to make their life worthwhile. And if that doesn't happen, then don't prolong my death, if you will.
Resources for Creating Advance Directives
Interviewer: Yeah, so if I want to help my parents through this process, what would be my next step? Do I need to go to a lawyer? Are there forms online? Could I contact their doctor? Would they have something?
Dr. Beck: Yes.
Interviewer: Yes, yes, and yes.
Dr. Beck: Yes, the answer is yes to all of those. There are forms that are available online that you can download. It's also a good idea to make an appointment with their physician because their physician needs to be aware of their wishes as well.
Interviewer: Okay.
Dr. Beck: But it's really a triad. It's the patient, it's the surrogate, and the physician. All three of those people need to be on the same page and need to be regularly updating that document so that everybody knows what everybody's wishes are.
Interviewer: All right. Any final thoughts on talking to your older parents about an advanced directive?
Dr. Beck: I think you may be surprised at how unstressful that conversation can be because they generally are thinking about it and sometimes just being able to share their thoughts they'll feel better afterward. And I would encourage you after you have that conversation to kind of do a gut check and maybe ask them as well. Was that difficult? Was that hard for you to talk about? And I think you may be surprised at the answer.
updated: January 16, 2025
originally published: April 16, 2015