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In this updated position statement, the term \u201cunbefriended\u201d is replaced by \u201cunrepresented\u201d as a term that is more value\u2010neutral, more accurately describes the circumstance in which a person without medical decision\u2010making capacity does not have recognized surrogate representation, and better aligns with increasingly preferred terminology as reflected in recent medical literature. We define unrepresented older adults as those who (1) lack decisional capacity to provide informed consent for a particular medical treatment, (2) have not executed an advance directive that addresses the medical treatment at hand and lack capacity to do so, and (3) lack representation from a surrogate decision\u2010maker (i.e., family, friend, or legally authorized surrogate). Making medical decisions on behalf of unrepresented older adults is exceptionally challenging and, given demographic trends, is likely to become increasingly common in the years ahead. The process of arriving at treatment decisions for this population should follow standards of procedural fairness and include capacity assessment, search for potential surrogates, team\u2010based efforts to determine the patient's values and preferences, and steps to guard against bias. Proactive measures are needed to identify older adults at risk for becoming unrepresented. This position statement also calls for national efforts to reduce state\u2010to\u2010state variability in legal approaches for unrepresented patients.<\/jats:p>","DOI":"10.1111\/jgs.19288","type":"journal-article","created":{"date-parts":[[2024,11,30]],"date-time":"2024-11-30T06:54:34Z","timestamp":1732949674000},"page":"1353-1364","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["American Geriatrics Society position statement: Making medical treatment decisions for unrepresented older adults"],"prefix":"10.1111","volume":"73","author":[{"given":"Joseph D.","family":"Dixon","sequence":"first","affiliation":[{"name":"Division of Geriatric &amp; Palliative Medicine University of Michigan  Ann Arbor Michigan USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aruna V.","family":"Josyula","sequence":"additional","affiliation":[{"name":"Central Texas Veterans Health Care System  Temple Texas USA"},{"name":"Texas A&amp;M University School of Medicine  Bryan Texas USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noelle Marie","family":"Javier","sequence":"additional","affiliation":[{"name":"Brookdale Department of Geriatrics and Palliative Medicine Icahn School of Medicine at Mount Sinai  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yael","family":"Zweig","sequence":"additional","affiliation":[{"name":"Division of Geriatric Medicine and Palliative Care, Department of Medicine  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-3337-7207","authenticated-orcid":false,"given":"Mriganka","family":"Singh","sequence":"additional","affiliation":[{"name":"Division of Geriatrics &amp; Palliative Medicine Warren Alpert School of Medicine at Brown University  Providence Rhode Island USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2396-4868","authenticated-orcid":false,"given":"Luke","family":"Kim","sequence":"additional","affiliation":[{"name":"Center for Geriatric Medicine Cleveland Clinic  Cleveland Ohio USA"},{"name":"Cleveland Clinic Lerner College of Medicine Case Western Reserve University  Cleveland Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niranjan","family":"Thothala","sequence":"additional","affiliation":[{"name":"Good Samaritan Hospital  Vincennes Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0070-8757","authenticated-orcid":false,"given":"Timothy W.","family":"Farrell","sequence":"additional","affiliation":[{"name":"Division of Geriatrics, Department of Internal Medicine Spencer Fox Eccles School of Medicine at the University of Utah  Salt Lake City Utah USA"},{"name":"VA Geriatric Research, Education, and Clinical Center  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,11,30]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"65 and Older Population Grows Rapidly as Baby Boomers Age.United States Census Bureau. 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