Timothy W. Farrell, MD, AGSF

Q: The American Geriatrics Society recently unveiled guidance for the term “unbefriended” for older adults. What does that term mean?

A: These patients are highly vulnerable older adults who have no one to speak for them. They not only lack capacity to make decisions but lack decision-makers or advance directives. 

Q: How does this situation cause problems in nursing homes?

A: In our position statement there’s a section about long-term care. End-of-life decisions become paramount. These folks may have cognitive impairments and providers may not know when or how to improve decision-making related to palliative care or hospice.

Q: How can providers help improve this for residents?

A: It’s really kind of thinking outside the box and looking at those who may be close to the patient — it may not be family. 

Q: How do you protect residents against family members who arrive out of the blue?

A: I encounter this often. Resist the urge to change the treatment plan because of one person. Step back and use procedural fairness in a way that takes into account the big picture.