Aging & Social Change: Eleventh Interdisciplinary Conference

Abstract

Patients with advanced dementia generally lose capacity to make decisions for themselves, along with their sense of time, even if they can still make small day-to-day decisions for themselves. When an adverse health event occurs, responsible clinicians, along with multi-disciplinary team members and patient representatives such as a relative with power of attorney, are tasked with trying to determine the best interests of the patient. This is not an exact science, and it is easy for clinicians to make assumptions based on previous experience and a patient’s age and appearance. But these are not reliable indicators of needs and preferences, and while some decisions are of limited consequence, others are more serious, such as Do Not Attempt Resuscitation (DNARs) and whether to try drug treatments that could have adverse effects. Based on findings from a multi-professional workshop held at Royal Stoke University Hospital (UK) in 2019, we suggest that whenever possible, determining best interests should involve wide consultation and ethical discussion. Factors for discussion should not be limited to purely clinical criteria and we recommend a structured approach to best interests decision-making for an increasingly common category of aging, vulnerable patients.