Advance Directives: 3 Case Studies of Older Adults with Different Views on the End of Life

When I was the Director of Social Services at a long-term care facility, every new patient we admitted was asked if they had an advance directive. Often this question would be met with furrowed brows and confusion. “What’s an advance directive?” “Do I really need one?” “Isn’t that the thing you’re supposed to fill out before you die?”
Simply put, an advance directive is a document that details what type of end-of-life care you prefer, if any.[1. “Advance Directives,” https://www.nlm.nih.gov/medlineplus/advancedirectives.html] No, individuals don’t need to have one (there’s no law saying one must) and completing one does not imply that death is imminent. In fact, there are a number of different scenarios in which one can use advance directives. Below, we examine three examples of (fictional) patients with three very different end-of-life preferences and requests.

Case #1: Mr. Jones

Mr. Jones, a widower, is a 78-year-old terminal cancer patient. Over the last several months his health has deteriorated to the point where he is confined to a hospital bed. Although he receives hospice care at home, including a visiting nurse, he can no longer voice coherent thoughts about his health care. However, Mr. Jones previously made out an advance directive which names his son as a medical proxy. The advance directive also outlines his wishes not to be kept alive via artificial means. When doctors suggest putting Mr. Jones on a ventilator to extend his life, his son informs them that this is not what his father would have wanted. Mr. Jones passes away peacefully without the ventilator, surrounded by his son and other loved ones.

Case #2: Mrs. Patel

Mrs. Patel is a 90-year-old woman who has still been able to drive until recently. A few weeks back, she was in a car accident which left her in a coma. Her doctors say she can come home with a 24-7 home health aide, but the coma left her at risk for cardiac failure. Mrs. Patel’s husband has dementia and has been declared legally incompetent.[2. “Incompetence,” https://www.law.cornell.edu/wex/incompetence] Although he is her next-of-kin, he cannot make legal decisions for her.
However, Mrs. Patel filled out an advance directive prior to her accident, stating she wanted to be resuscitated under any circumstances—even if there was no chance of her regaining consciousness. Before her discharge from the hospital, Mrs. Patel goes into cardiac failure. The staff resuscitates her per her wishes, and she remains in her comatose state.

Case #3: Mr. Suarez

Mr. Suarez is a 73-year-old man who is estranged from his wife. Since he prefers that she doesn’t make any medical decisions for him should the need arise, he has filled out an advance directive naming his daughter as his health care proxy. He has suffered from diabetes for many years and is adamant that he does not want dialysis—even if it would sustain his life. He does, however, wish to have tube feeding for however long it will sustain him (if necessary).
One evening while his overnight aide is caring for him, Mr. Suarez has a seizure. He is taken to the hospital immediately, but never regains consciousness and doctors do not expect him to do so. They want to put him on dialysis (as his diabetes is worsening) and a feeding tube (as there is no other way for him to receive nutrients). His daughter informs the doctors of her father’s end-of-life wishes. The doctors warn her that without dialysis her father will pass away more quickly, even with the feeding tube. Mr. Suarez’s daughter says that although she is aware, she wants them to carry out her father’s wishes. They do so and the feeding tube gives Mr. Suarez a few more days of life, though not as many as he would have had by adding dialysis.

Start a Conversation about Advance Directives

As mentioned, advance directives are by no means mandatory. However, evidenced by the three examples above, almost everyone benefits from having one. As long as you’re over the age of 18 and mentally competent, you can complete this important document and have the most control possible over your health care.
If you are unsure of how to best help an aging loved one, the trained and compassionate staff at the Institute on Aging is here to help you make that decision and gain the best in at-home care for older adults. Contact us to find out more.