Adult daughter speaking with elderly parents

No one wants to imagine a future where a loved one becomes sick or incapacitated. But unfortunately, accidents and critical illnesses are among the most unpredictable and distressing parts of life. If an elderly member of your family became incapacitated--and wasn't able to speak or make their own decisions--would you know what level of medical intervention they would choose?

It's a difficult discussion, but talking about it now could help you manage the burden in a crisis. Learning about "advance directives" is the first step towards approaching the discussion.

What Are Advance Directives?
Advance directives are legal documents. These documents allow someone to direct what medical care they would like to receive if they are unable to express their wishes due to sickness or incapacity. Advanced directives allow people to make certain choices ahead of time, while they're still in good health.

Since serious accidents can happen at any age, anyone over 18-years-old may want to consider creating an advance directive. However, advanced directives are particularly important for elderly people--especially if they are in poor health.

What Are the Different Types of Advance Directives?
There are several kinds of advance directives, and the laws that govern them differ by state.

  • Living will. This legal document describes the kind of medical treatments you would want if you were seriously or terminally ill. However, it doesn't allow you to designate another person to make decisions for you.
  • Durable power of attorney for healthcare (DPA). A DPA for healthcare allows you to select a particular person to make medical decisions on your behalf. The DPA comes into effect whenever you are unconscious or unable to direct your own medical care.
  • Do not resuscitate (DNR) order. A DNR is a request that your medical team not use cardiopulmonary resuscitation in the event that your heart stops or you stop breathing.

While it isn't required, you and your loved one may want to seek the advice of an attorney to assist in creating a legally binding advance directive. Even if you know your loved one's wishes, you may not be in the position to put those wishes into effect without a legally valid document. You may also consider consulting the website of the National Hospice and Palliative Care Organization (nhpco.org/), which offers free advance directives forms and instructions for every state.

How Can You Start the Discussion?
It can feel difficult to raise the topic of advance directives with older family members. You may worry that the conversation will be too emotional. Or worse, that your elder relative will become confused or upset. Despite these worries, it is important to broach this serious topic to ensure that your elder loved one understands their options.

To start the discussion, find a time to talk to your family member when there will be no distractions (like TV) or interruptions (like kids playing in the room). Explain the importance of knowing your loved one's wishes in advance. Then, share the options available for different types of advance directives. Remind your loved one that it may not be enough for you to know their wishes. It is important to have a legally valid advance directive in place if they want their wishes to be carried out in a health crisis.

Helping Your Loved One to Plan Ahead
It may make you uncomfortable to think about a senior family member needing advance directives. Nevertheless, if you want your loved one's wishes to be honored, it's important to plan ahead. Even if your elder relative gets admitted to the hospital prior to advance directives being written, you can help make their wishes known, according to the American Academy of Family Physicians (AAFP). However, while you and your relative have time, the better approach is to create advance directives now. You can be an advocate for your senior family member, and help them through the process. In the long run, you will be helping to ensure that your loved one has the freedom, and the dignity, to make their own decisions.