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Before your loved one has a health scare, it’s important to have these legal documents ready to protect them and your family. Start the conversation early about your loved one’s healthcare wishes and end-of-life care. Learn what legal documents every senior needs by reading on!

1. Last Will and Testament

Having a will ensures your loved one’s wishes for their estate are properly carried out after their death. If a person doesn’t have a will, state law determines what happens to their assets. It’s recommended that your loved one update their will every five years to keep up with changing circumstances in day-to-day life.

2. Advanced Directive

If your loved one is ever unable to make decisions for themselves due to memory loss or a serious health condition, the family is left to make decisions for them which could lead to disagreements about your loved one’s wishes. An advanced directive, also know as a living will, is a document used to specify your loved one’s health care decisions ahead of time. They can accept or refuse certain types of care (e.g. feeding tube, oxygen administration, life support, etc.) depending on what their wishes are.

3. Power of Attorney

By granting power of attorney to a trusted and responsible family member (proxy), this allows them to make decisions on your loved one’s behalf in case they are unable to. A standard power of attorney allows the family member to pay bills and write checks—while a durable power of attorney for medical care can make healthcare decisions for your loved one.

4. Do-Not-Resuscitate Order

A do-not-resuscitate (DNR) is a legal document that instructs health care providers not to provide life sustaining treatment if a patient’s heart stops or they stop breathing. If your loved one is nearing end-of-life care or terminally ill, they may not want to be resuscitated in a medical emergency. Only the patient or their health care proxy can sign a DNR order.

You can download a free starter kit from The Conversation Project to help guide the conversation with your loved one about their end-of-life care. Don’t wait until it’s too late.

About the Author: Peter Kang is a writer for eCaregivers. He is inspired by his caregiver experience with his late grandfather and role model, a Korean War veteran, to help families find affordable care for their loved ones. Follow Peter on Facebook and Twitter.

Background

There are three major types of skin cancer: basal cell, squamous cell, and malignant melanoma (MM). Basal cell carcinoma is the most common skin cancer, accounting for 65–85% of cases (Kennedy-Malone et al., 2000). According to the American Cancer Society (2013), more than 3.5 million cases of basal cell and squamous cell skin cancer are diagnosed every year. Squamous cell carcinoma is more common in African Americans and is also less serious than malignant melanoma. Malignant melanoma accounts for only 3% of all skin cancers, but it is responsible for the majority of deaths from skin cancer. Older adults are 10 times more likely to get MM than adults under age 40 (Johnson & Taylor, 2012). About 8,420 people were estimated to die from malignant melanoma in 2008. The American Cancer Society (2013) estimated that in 2013 there would be over 76,000 new cases of malignant melanoma in the United States.

Risk Factors

Older adults are more susceptible to skin cancers because of a variety of factors. These include exposure to carcinogens over time (such as through sunburn or tanning booths) and immunosenescence, or a decline in immune function. Family history of skin cancers, multiple moles (more than 100), and pale skin also put a person at higher risk. The major risk factor for all types of skin cancer is sun exposure.

Warning Signs

The ABCDE method can help people remember the warning signs of skin cancer:
A = Asymmetry (if a line is drawn down the middle of the lesion, the two sides do not match)
B = Border (the borders of the lesion tend to be irregular)
C = Color (a variety of colors is present; the lesion is not uniform in color)
D = Diameter (MM lesions are usually larger)
E = Evolving (note any changes in shape or size, or any bleeding)

Diagnosis

Annual physical examinations should include inspection of the skin for lesions. Older adults should be taught to report any suspicious areas on their skin to the physician. Persons should particularly look for changes in shape, color, and whether a lesion is raised or bleeds.

Basal Cell Carcinoma

Basal cell carcinoma (BCC) is the most common kind of skin cancer. It is often found on the head or face, or other areas exposed to the sun. Although there are different forms of BCC, the nodular type is most common, and appears as a raised, firm, papule that is pearly or shiny with a rolled edge. (Johnson & Taylor, 2012). Patients often complain that these lesions bleed and scab easily. When treated early, it is easily removed through surgery and is not life threatening, though it is often recurring.

Squamous Cell Carcinoma

Squamous cell carcinoma (SCC) also appears as lesion on areas of the body exposed to the sun, or from other trauma such as radiation. HPV is a risk factor of SCC, and metastasis is more common than with BCC. The lesions of SCC appear scaly, pink, and thicker than BCC. Their borders may be more irregular and the lesions may look more like an ulceration.

Malignant Melanoma

Malignant melanoma MM has a more distinctive appearance than other types of skin cancer. The areas appear asymmetric with irregular borders, a variety of colors (including black, purplish, and pink), and size greater than 6 mm. Malignant melanoma MM is often identified with the ABCDE method and MM accounts for the vast majority of deaths from skin cancer. The good news is that MM is almost always curable when found early. A skin check should be part of an older person’s yearly physical.

Treatment

The best treatment for skin cancer in the elderly is prevention. All older persons, especially those with fair skin who are prone to sunburn, should wear sunblock and protective clothing. Most skin cancers, when treated early, have a good prognosis.

All skin lesions larger than 6 mm, or those with any of the ABCDE signs, should be referred for biopsy. There are many nonsurgical interventions. These include cryotherapy, radiotherapy (for superficial BCC or SCC), electrodessication and curettage, and topical treatments. Topical treatments are generally not as effective as more aggressive interventions, but research is ongoing in this area.

The prognosis for MM depends on the extent and staging of the tumor, but when caught very early, the cure rate is nearly 100%. Malignant melanoma MM presenting in older adults is often more advanced and aggressive. Malignant melanoma MM metastases sites are typically the lymph nodes, liver, lung, and brain (Johnson & Taylor, 2012). Surgical treatment is required in malignant melanoma, with chemotherapy and radiation. Adjuvant treatments for MM are also often used.

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