Unrepresented Older Adults Face Medical Decision Challenges

Surprising finding: Older adults without family, friends, or legal surrogates to make medical decisions when they lack capacity are now termed "unrepresented" rather than "unbefriended."

The American Geriatrics Society updated its terminology and guidance for a growing population: older adults who can’t make their own medical decisions and have no one authorized to decide for them. These “unrepresented” patients lack decisional capacity, haven’t created relevant advance directives, and have no surrogate decision-maker. The society emphasizes that medical teams should follow procedural fairness standards, including capacity assessment, searching for potential surrogates, and determining patient values through team-based efforts. Given demographic trends, this situation is expected to become increasingly common. The position statement also highlights significant state-to-state legal variability in handling these cases and calls for proactive measures to identify at-risk individuals before they become unrepresented.

Source: PMID 39614758 (Journal of the American Geriatrics Society, 2025)