Aging & Advance Care Planning

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Aging & Planning
for (Possible) End-of-Life:
Tips for Older Adults & Family Caregivers
Leslie Kernisan, MD MPH
Geriatricia...

These Slides Will Cover
• Overview of advance care planning for end-of-
life
– What it means & how to approach
– Tools to ...

“Advance care planning is about
planning for the ‘what ifs’ that
may occur across the entire
lifespan.”
— Joanne Lynn, MD
...

What I tell patients & families
We always want to hope for the
best.
 And, we should prepare for the
likely, as well as ...

A more technical (wordy) definition
“Advance care planning (ACP) is an ongoing process in
which patients, their families, ...

In other words…
• There is more to health planning than a legal
statement regarding “end-of-life wishes”
• Advance care pl...

Caveats
Preparing for health crises and end-of-life is NOT
just about medical issues.
Emotional & spiritual & relationshi...

What‘s the Likely to Prepare For?
Includes:
• Being so sick or impaired that you can’t make
your own medical decisions
• B...

What‘s the Likely to Prepare For?
Complexities that come up in real life:
• Being so sick or impaired that you can’t make ...

Key Thing to Know
• Many older adults experience health crises
that *could* be terminal
– Common in advanced heart failure...

www.BetterHealthWhileAging.net
Source: End of life care: definitions & decisions. Re-used with permission from
Leslie Blac...

Advance Care Planning Involves:
• Learning what types of decisions often come
up if one is too sick to make decisions for
...

Advance Care Planning Involves
(slide 2)
• Choosing a surrogate decision-maker
– Who will make decisions on your behalf?
•...

Tips on Thinking of “End-of-Life”
• Consider planning for “last stages” rather than
last moments of life.
• Many people ex...

Benefits of Advance Care Planning
• Helps a very ill person get the preferred care:
– For those who prefer this: can incre...

Challenges in Planning
• Reluctance of aging adult, & of caregivers
• Can be hard to understand health conditions
and what...

4 steps for advance care planning
1. Understand health conditions and how they
are likely to progress
– Hope for best, pre...

Step 1: Understanding Health
Conditions
• Understanding any chronic conditions is key:
– Ex: heart failure, heart disease,...

Understanding Medical “Big Picture”
• Tips for discussing the medical “big picture”
with a health provider:
– Schedule a v...

Example: Alzheimer’s & COPD
Mrs. A has been diagnosed with early
Alzheimer’s. Mrs. A also has advanced COPD,
uses home oxy...

Step 2: Preferences & Values for
Future Care
• What does the aging person value?
– What matters most in life?
– What makes...

Tools to help consider preferences
• PrepareForYourCare.org
– Great easy-to-use online resource with videos, creates an
ac...

Tips to Remember
• You don’t have to sort out just what you’d
want for every – or any – future medical
decision.
– Just re...

Step 3: Document Preferences in
Writing
• Print or hand-write key points from the
process of reflecting & discussing
– Thi...

Documenting Preferences (Cont)
• Consider POLST/MOLST (Physician/Medical
Orders for Life-Sustaining Care)
– Bright-colored...

www.BetterHealthWhileAging.net

Preferences addressed in POLST
• POLST focuses on these key issues:
– If heart stopped & no breathing:
• Allow natural dea...

Step 4: Reassess preferences & plans
periodically
• Preferences will change over time, as health
evolves.
• Consider revie...

Reassessing Preferences (cont)
• Realize that benefits & burdens of certain
medical interventions change as people
decline...

Key Points on Advance Care Planning
• Hope for the best but prepare for the quite
possible
– Learn what kinds of health cr...

The Role of Palliative Care
• Palliative Care:
– Care focused on symptoms and quality of life
– Providers have special tra...

Tips for Managing End-of-Life
• Educate yourself as to what to expect
• Consider palliative care consultation
– Can help m...

Resources
Recommended Reading:
–Knocking on Heaven’s Door, by Katy
Butler
–Handbook for Mortals, by Dr. Joanne
Lynn & Jani...

Advance Care Planning Resources
• PrepareForYourCare.org
– Great easy-to-use online resource with videos, creates an
actio...

About Leslie Kernisan, MD MPH
and BetterHealthWhileAging.net
Dr. Kernisan is a practicing geriatrician who
believes it sho...

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