Medical decision making for older adults: an international perspective comparing the United States and India.
There has been a significant decline in cardiovascular morbidity and mortality amidst pervasive advances in care, including percutaneous revascularization, mechanical circulatory support, and transcatheter valvular therapies. While advancing therapies may add significant longevity, they also bring about new end-of-life decision-making challenges for patients and their families who also must weigh the advantages of reduced mortality to the possibility of longer lives consisting of high morbidity, frailty, pain, and poor quality of living. Advance care entails options of withholding or withdrawing therapies, and has become a familiar part of cardiovascular care for older patients in Western countries. However, as advanced cardiovascular practices extend to developing countries, the interrelated concept of advance care is rarely straight forward as it is affected by local cultural traditions and mores, and can lead to very different inferences and use. This paper discusses the concepts of advance care planning, surrogate decision-making, orders for resuscitation and futility in patients with cardiac disease with comparisons of West to East, focusing particularly on the United States versus India.
Division of Interventional Cardiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA ; Division of Cardiology, Department of Medicine, Kalra Hospital SRCNC Pvt. Ltd., New Delhi, India.
Ankur
A
Kalra
Section of Geriatric Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA ; Geriatrics Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
Daniel E
DE
Forman
Department of Medicine-Geriatrics, Oregon Health & Sciences University and Veterans Affairs Portland Health Care System, Portland, Oregon, USA.
Sarah J
SJ
Goodlin
Advance care planning; Advance directive; End-of-life; India; Surrogate decision-making