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Daughters Make More Decisions on Parents’ Care, Study Finds

Family members are making decisions for nearly half of elderly patients who end up in the hospital, and in most cases daughters are the ones who must make the tough choices, a new study finds.

Because elderly hospital patients are frequently too impaired to make their own medical decisions, many need a surrogate decision maker. Daughters step in for almost 60 percent of those cases, according to the report published Monday in JAMA Internal Medicine.

And that's a big problem because hospitals aren't organized to include family members in the care of older patients, said the study's lead author, Dr. Alexia Torke, an associate professor of medicine at Indiana University.

"Physicians talk to patients during daily bedside rounds when the family isn't there," Torke said. She said this research suggests they should be calling family members on a daily basis.

Torke and her colleagues interviewed physicians caring for 1,083 elderly adults who needed to make at least one major medical decision within the first 48 hours of being admitted to one of two Midwestern hospitals. More than 47 percent of those patients needed a surrogate to help make choices, while 23 percent had all decisions made by a surrogate. Daughters were the ones most commonly tapped, at 59 percent, followed by sons at 25 percent and spouses at 21 percent.

Few patients had written their wishes down prior to hospitalization: Only 7.4 percent had a living will and just 25 percent had a health care representative documented in their medical record.

Torke's message to families: If you have an elderly parent, talk to them about what kinds of care they would want and who they would want to be making decisions for them if they become incapacitated.

The new numbers didn't surprise Jennifer Wolff, an associate professor at the Johns Hopkins Bloomberg School of Public Health, who called it valuable for documenting a common, hidden problem.

"It's highlighting how the system, as it's currently structured, is failing families, patients and physicians," Wolff said.