Nontraditional Surrogate Decision Makers for Hospitalized Older Adults

Background: Without advanced preparation of legal documents, state law determines who may serve as a surrogate decision maker for patients in hospitals. Objectives: To examine the relationship characteristics associated with traditional versus nontraditional health care surrogates who are making medical decisions for patients in hospitals. Research Design: Secondary analysis of a baseline cross-sectional survey of a larger prospective observational study. Subjects: In total, 364 patient/surrogate dyads consisting of patients aged 65 years and older admitted to the medical or medical intensive care unit services who lacked decision-making capacity based on a physician assessment and also had a surrogate available. Results: This study of surrogate decision makers for hospitalized older adults found that the relationships of nontraditional surrogates such as, nieces, nephews, and friends serving in the surrogate role is nearly identical to those of traditional, first degree relatives serving as a surrogate. Over two-thirds (71.2%) of nontraditional surrogates saw the patient in-person at least weekly compared with 80.8% of legal surrogates (P-value, 0.9023). Almost all traditional and nontraditional surrogates discussed the patient's medical preferences with the patient (96.9% of legal surrogates and 89.2% of nontraditional surrogates; P= 0.0510). Conclusions: This study shows that both traditional and nontraditional surrogates, who are a patient's primary care giver have similar relationships with patients. The findings of this study suggest that requiring family members such as grandchildren to take the extra step of formal appointment through a legal channel may not be necessary to protect patients. Therefore, broader state laws expanding the list of surrogates authorized by state statute to include more nontraditional surrogates may be necessary.