Risk Management

2019 May Bulletin: Older Patients

May 2019 Risk Management Bulletin

Older Patients and Surrogates

The U.S. Census Bureau confirmed that by 2030, all baby boomers will be older than age 65. That means that 1 in every 5 residents will be retirement age.

Older patients make up a significant portion of the patient population of most ophthalmologists. Many older patients suffer from co-morbities like diabetes, dementia, and heart disease. Some patients lose their ability to make the informed consent decision before surgery due to poor management of medications or signs of dementia.

How should you protect yourself in the event that you do not believe that your patient understands the risks, benefits, and alternatives to surgery? If a patient lacks decision- making capability, a surrogate decision maker must be found to make the informed consent decision before surgery is allowed to proceed. States recognize that some patients may temporarily or permanently lose their ability to make decisions on their own behalf and have developed mechanisms for determining who may decide in the patient’s stead. A relative or guardian with power of attorney (POA) status is ultimately what you hope to have in place for older patients who require assistance with medical decisions. Check state law regarding who may act as a surrogate and the limitations of the types of decisions the surrogate is empowered to make.

RESOURCES

• Census Bureau
• Surrogate Consent Laws in the U.S.
• OMIC Digest Article on Older Patients