1. Making Choice a Reality for our Elders Anna Maria Izquierdo-Porrera MD PhD

2. What is choice? : the act of choosing : the act of picking or deciding between two or more possibilities : the opportunity or power to choose between two or more possibilities : the opportunity or power to make a decision : a range of things that can be chosen

3. What kind of choices do we need to support? Specific Health decisions Style of Health care decisions Life decisions

4. Specific Health Decisions Evidence Based Medicine ◦ “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of the individual patient. It means integrating individual clinical expertise with the best available external clinical evidence from systematic research” ◦ EBM was initially proposed by Dr. David Sackett (1996) and colleagues at McMasters University in Ontario, Canada.

5. Evidence Based Medicine The patient1. Start with the patient -- a clinical problem or question arises out of the care of the patient The question2. Construct a well built clinical question derived from the case The resource3. Select the appropriate resource(s) and conduct a search The evaluation4. Appraise that evidence for its validity (closeness to the truth) and applicability (usefulness in clinical practice) The patient5. Return to the patient -- integrate that evidence with clinical expertise, patient preferences and apply it to practice Self-evaluation6. Evaluate your performance with this patient

6. Evidence of what…? How much of the published information is based on studies conducted on elders? How much of those studies are conducted in elders with multiple conditions?

7. Evidence Based Medicine The patient1. Start with the patient -- a clinical problem or question arises out of the care of the patient The question2. Construct a well built clinical question derived from the case The resource3. Select the appropriate resource(s) and conduct a search The evaluation4. Appraise that evidence for its validity (closeness to the truth) and applicability (usefulness in clinical practice) The patient5. Return to the patient -- integrate that evidence with clinical expertise, patient preferences and apply it to practice Self-evaluation6. Evaluate your performance with this patient

8. Mentorship someone who teaches or gives help and advice to a less experienced and often younger person.

9. Healthcare style Western medicine Herbal medicine Ayurveda medicine Chinese medicine Native medicine Homeopathic medicine El remedio de la abuela

10. How uncomfortable does DIFFERENT make you?

11. Life Decisions End of life decisions Living situation decisions Relationship decisions Trust decisions

12. End-of-life decisions Talking about end-of- life wishes. Asking questions vs giving advice. Sharing with those who are going to be around. Talking to those who are not around.

13. Living situation decision Aging in place Nursing homes and assisted living

14. Relationship decisions Marriage at old age Sex Family relationships Unusual relationships

15. Trust decisions Finances Most important issues.

16. Final thoughts Making choice a reality LISTENING AND UNDERSTANDING Making realistic choices