Older, sicker adults might want an additional end-of-life document
In today's "Minding Our Elders" column, Carol says there's another document that tells emergency personnel exactly how far they can go to save your life.
Dear Carol: Even though I’m an older adult myself, I read your column regularly and like your balanced responses. I know that you’ve addressed the problem of getting older adults to talk about future planning and I agree. My children know my preferences and I have the traditional legal work in place. In your opinion, has COVID changed anything about how we should approach our legal work? — AR
Dear AR: Thank you for your kind words. I appreciate hearing from people of all ages.
I’ve covered end-of-life documents before, of course, but here I’m adding information about another form because, well, times have changed. Please bear with me as I first provide some tips for those who may want a refresher.
Basic legal work: All adults of legal age should consider setting up end-of-life documents, with ongoing updates as years go by. These documents should include a last will and testament and at least two powers of attorney, one for health and one for finances. The following websites can lead you to free, state-specific downloads, but they also provide useful information for people who may be consulting an attorney to draw up the paperwork.
- End-of-life paperwork: https://theconversationproject.org/
- Emergency advocacy: www.preparetocare.com
Now for the newer information: In my opinion, it’s important for people who are older and/or may have life-limiting health issues to not only let your loved ones know how you feel about extreme measures, but make your choices legal with a POLST.
The POLST, or physician's order for life-sustaining treatment (or "medical order for life-sustaining treatment" in some states), might be a consideration for older adults in poor health who have strong views about end-of-life choices. While you can download these documents, they must be signed by your physician to be legal. A POLST tells emergency personnel and attending physicians exactly how far they can go to save your life.
Older adults have been especially interested in this document during COVID because intubation has happened more frequently than was the case prior to the pandemic. Understand that some older people do survive being intubated and recover enough to live a normal life, but many others, should they survive, may live a much-diminished life. Therefore, as an older adult, allowing oneself to be put on a ventilator should be a personal decision made after obtaining full information from trusted medical sources, including your own doctor.
The POLST form is specific about what you do or do not want, though state forms may vary. In general, you choose whether or not to allow or reject CPR; allow, limit or reject tube feeding; and allow or reject intubation. This form can be withdrawn or updated at any time. These choices are separate, so you can say yes to some, and no to others.
AR, your attention to these end-of-life issues is one of the most important gifts that you can give to your children. May their need to put these documents to use be far into the future.
Carol Bradley Bursack is a veteran caregiver and an established columnist. She is also a blogger, and the author of “Minding Our Elders: Caregivers Share Their Personal Stories.” Bradley Bursack hosts a website supporting caregivers and elders at www.mindingourelders.com. She can be reached through the contact form on her website.