Apr 16, 2015 — You don’t know if your parents have advance directives. You feel that they should. It can be a difficult conversation, but it doesn’t necessarily need to be, and it’s one that you should absolutely have with your parents. Dr. Anna Beck from Huntsman Cancer Institute offers advice on how to bring up the conversation, and why it’s so important, especially if your parents are over the age of 65.

Interview

Interviewer: How to have the conversation to your parents that are over 65 about advanced directives. That's next on The Scope.

Recording: Medical news and research from University Utah physicians and specialists you can use for a happier and healthier life. You are listening to The Scope.

Interviewer: 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. Anna 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, so because they're sick for some reason that again, 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 reason for them to start thinking about that whole process.

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. Anna 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. Anna Beck: Who get admitted to the hospital because they're ill. Yes, exactly.

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. Anna 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. Anna 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. Anna 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. Anna 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. Anna 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 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. Anna Beck: Yes, right.

Interviewer: Those are the questions those forms ask.

Dr. Anna 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.

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. Anna Beck: Yes.

Interviewer: Yes, yes, and yes.

Dr. Anna Beck: Yes, the answer is yes to all of those. There are forms that are available online that you can download. And 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 too.

Interviewer: Okay.

Dr. Anna 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. Anna 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 afterwards. 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.

Recording: We're your daily dose of science, conversation, medicine. This is The Scope, University of Utah Health Sciences Radio.


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