As the population ages, the healthcare industry must step up its attention to geriatric and palliative care--and that includes preparing for patients who cannot voice their own wishes and have no family or advocates to do it for them.
Numerous states prohibit healthcare providers from serving as patient surrogates, according to The New York Times, leaving numerous patients "unbefriended," or without any family members or friends available to act as a proxy. The publication cited two separate studies from 2007 that found 5 percent to 16 percent of intensive care unit patients were unbefriended or unrepresented.
While in the past such patients largely came from already marginalized or high-risk populations, such as mentally ill or homeless patients, the aging population combined with baby boomers' rates of divorce and childlessness create an influx of unbefriended patients who have simply outlived their support networks, according to the article. The shifting profile of such a patient has led 24 states and the District of Columbia to add close friends to the list of people allowed to consent to or decline a medical procedure for a patient, The New York Times reports. Traditionally, this has been reserved for spouses, siblings and adult children.
These steps are part of a broader move within healthcare to rethink palliative and end-of-life care as the population ages, amid widespread acknowledgement that the current system is failing patients and trepidation about discussing end-of-life wishes. For example, the Vancouver Clinic in Washington recently appointed Lynda Tang, M.D., a Cleveland Clinic fellow, to lead its multidisciplinary palliative care team, the Columbian reports. Tang will work with social workers, care managers, and specialists and primary care providers. While palliative care is typically inpatient-focused, the clinic seeks to take a more proactive approach by tailoring it to outpatient settings.
But there are concerns that the medical profession is largely unprepared for the aging population, according to a second Times article. Not only are there fewer than 8,000 geriatricians nationwide, the United States will have 19 million people over the age of 85 by 2050, with an estimated 1 to 3,798 ratio of geriatricians to seniors by 2030.