# data[].attributes.body
I added my notes and key points from the chapter to the portfolio to supplement the notes given to us in the module. I will continue to use these notes to study for the PRAXIS. I added the section from the textbook regarding the role of the SLP because I think it is important to have an understanding of our role in surgeries ( post/pre). I will continue to use this reference during my externship and as I continue on to my fellowship in a medical setting.

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I will use this sheet to understand the acronyms used in our field, especially the medical field which I plan to work in.

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I added these notes for this chapter because they will be relevant while studying for exams and when studying during my externship. I will continue to use these notes as I start my career to refresh on my knowledge about dysphagia.

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These notes were added because I felt that they were helpful when understanding the phases of the swallow and diagnostic information. I plan to refer back to these study points when prepping for the PRAXIS and COMPS and whenever I need a reference for diagnostics while working or completing my externship.

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I added this training video as a reference when interpreting swallowing evaluations results using the penetration-aspiration scale. This tutorial is in-depth and shows examples with MBS. I have continued to use this video while completing assignments and I will use it when completing my medical externship which will require me to use this scale.

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I  have added this lecture because I  will continue to refer back to it when studying for the final. The lecture goes over swallowing disorders following surgery which is a patient population I will be working with next semester, so this is a good reference for when I need extra information. I  have also added because the information will be helpful when studying for the COMPS and PRAXIS

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Video Conferencing, Web Conferencing, Webinars, Screen Sharing

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Zoom is the leader in modern enterprise video communications, with an easy, reliable cloud platform for video and audio conferencing, chat, and webinars across mobile, desktop, and room systems. Zoom Rooms is the original software-based conference room solution used around the world in board, conference, huddle, and training rooms, as well as executive offices and classrooms. Founded in 2011, Zoom helps businesses and organizations bring their teams together in a frictionless environment to get more done.

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This website offers information of the muscles in our body, the points of insertion, what the muscles do and how they move. I added this resource as a reference for when I begin to work in the future. We work with many individuals who may have impairments in their muscles, and as SLPs we should know what those impairments look like in our patients so we can make accurate diagnosis and create treatments plans that suit our patients.

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When you're studying the muscular system, there's a lot of terminology to learn beyond the names of the muscles themselves. Part of becoming familiar with the body's muscles is learning how to describe the locations where they attach to bones, the different kinds of muscle actions that move the body, and what roles muscles play in different movements.

Video footage from Muscles & Kinesiology.

Today, we're going to explore the basics of this terminology using the newest version of our musculoskeletal app for iOS- Muscles & Kinesiology!

What are origins and insertions?

The majority of skeletal muscles wouldn't be very useful to us if they weren't attached to bones-we are able to move our bodies precisely because the muscular and skeletal systems are literally linked to one another.

When skeletal muscles receive electrical signals from the nervous system, they contract, and the force generated by that contraction moves bones relative to the joints that connect them. Essentially, bones act as levers and synovial joints act as fulcrums. The force it takes to move the lever is applied by the contraction of a muscle or series of muscles working together.

Tendons are strong, thick bands of connective tissue that attach muscles to bones. There are two different classifications of skeletal muscle attachment points: origins and insertions. The origin is the location where a muscle attaches to a fixed (or stabilized) bone with respect to the joint the muscle is acting on. The location where the muscle attaches to the bone that is moved by the contraction of the muscle is called the insertion.

It's frequently the case that one muscle has multiple points of attachment. Take the biceps brachii as an example. Its two heads have different points of origin on the scapula-the long head's origin is the supraglenoid tubercle, and the short head's origin is the coracoid process. The point of insertion for both heads of the biceps brachii is the radial tuberosity on the radius bone of the forearm. When muscle fibers in the biceps brachii (and the other muscles it works with) contract, the forearm is pulled towards the upper arm and shoulder joint.

Image from The origin (red pin) and insertion (blue pin) of the long head of the biceps brachii. Muscles & Kinesiology.

Studying origins and insertions with Muscles & Kinesiology

Muscles & Kinesiology makes it easy to visualize origins and insertions using pins and bone paint. This is a great tool for people like me, who use colors to memorize everything!

Let's say you want to look at the attachments for the latissimus dorsi (lats!). First, choose a regional view that contains the latissimus dorsi-like shoulder extension-or select the latissimus dorsi from the muscle index. Fun fact: if you know what muscle you're looking for, you can type its name into the search box below the menu at the top of the screen.

The Muscle Index and search bar in Muscles & Kinesiology.

Once you've got the 3D model on the screen, tap or click the latissimus dorsi to highlight it. In the info box, you'll see a red pin icon-tap it and you'll be taken to the pins and paint view, where you can explore the origins and insertions of the latissimus dorsi by tapping the red and blue pins you see on the model. You can also move through them quickly by tapping the arrow icons on the pin label, as I do in the video below.

The attachments of the latissimus dorsi. Video footage from Muscles & Kinesiology.

What are the roles muscles play during muscle actions?

In any muscle action, there are several key players. The first, and arguably the most important, is the role of agonist, or prime mover. An agonist is a muscle that does the bulk of the work during a muscle action. There can be multiple agonists working together, as well. For an example, think back to the biceps brachii. It's a prime mover in elbow flexion, along with the brachialis and brachioradialis.

In literature, an antagonist works against the hero and stands in the way of their goals. A muscle working as an antagonist does something similar: it works in opposition to the action of the agonist. In fact, it's usually a prime mover of the opposite action in a pair like flexion and extension (more on those later). Why is it important to have an antagonist? They help maintain the position of the body or limb during muscle actions, and they also keep muscle movements controlled.

In the elbow example, the triceps brachii would be the antagonist for elbow flexion, but it's the agonist for the opposing action, elbow extension. The hamstrings and quadriceps femoris muscle groups have a similar agonist/antagonist relationship for the flexion and extension of the knee joint.

Now, sometimes agonists need a little help. This is where synergists and stabilizers come in. Synergists provide direct assistance to the agonists. For example, the pronator teres is a synergist in elbow flexion. Stabilizers help the agonist by stabilizing the bone that the prime mover's origin attaches to (that is, the bone that's not being moved).

The pronator teres acts as a synergist in elbow flexion. Image from Muscles & Kinesiology.

Using Muscles & Kinesiology to study muscle roles and interactions

To see which actions a particular muscle is involved in, select that muscle and read the definition of that muscle in the info box.

You can also select a muscle action and check the info box to see which muscles act as prime movers and synergists in that action. Then you can select individual muscles to find out more about them.

The info box for scapula elevation in Muscles & Kinesiology.

What are the different types of muscle actions?

Although we've started by talking about flexion and extension, there's a lot more to muscle actions than just those two! Let's take a look at the different types of paired muscle actions you can explore in Muscles & Kinesiology.
Abduction and adduction
Abduction and adduction occur at ball-and-socket joints like the shoulder and hip. Thinking about the midline of the body and the meaning of Latin prepositions-turned-prefixes are key to remembering the difference between these two movements. ABduction is movement away from the midline of the body (in Latin, the preposition a/ab roughly means "from").

Hip abduction.

ADduction is movement towards the midline of the body (ad is another Latin preposition which means "to" or "toward").

Hip adduction.

Elevation and depression
Elevation and depression are what they sound like: moving a part of the body up or down. The most obvious example of these actions is the elevation and depression of the mandible, which closes and opens the mouth, respectively. The scapulae can also be moved in this way-think of a shoulder shrug and you've got scapula elevation.

Scapula elevation.

Pressing the shoulder(s) down is scapula depression.

Scapula depression.
Flexion and extension
The technical definition of flexion and extension has to do with the angle between two bones. A movement that decreases the angle between bones is flexion.

Knee flexion.

A movement that increases the angle between bones is extension.

Knee extension.

Flexion and extension occur at hinge joints like the knee, elbow, and digits; ball-and-socket joints like the shoulder and hip; and gliding joints in the spine. Lateral flexion (right-left direction of movement vs. forward-backward) also occurs in the joints of the spine.
Inversion and eversion
Inversion and eversion, like abduction and adduction, make reference to the midline of the body. Turning the sole of the foot inward (towards the midline) is inversion.

Foot inversion.

Turning the sole of the foot outward (away from the midline) is eversion. Once again, you can see this in the prefixes-in Latin, the preposition in means "into" or "against," and e/ex means "from" or "out from."

Foot eversion.
Plantarflexion and dorsiflexion
The trick to remembering the difference between plantarflexion and dorsiflexion is thinking about which part of the foot is decreasing its angle with respect to the leg.

Plantarflexion deals with the sole of the foot (the plantar surface). The angle between the sole of the foot and the calf decreases-think of this as bringing that angle from 270° to 180°.

Plantarflexion.

Dorsiflexion is when the foot moves such that the toes come closer to the shin. That is to say, the angle between the top of the foot (dorsum) and the shin decreases.

Dorsiflexion.
Pronation & supination
With pronation and supination, it helps to think about the prone and supine positions of the body. A prone position is one in which a person is lying stomach and face down, and a supine position is one in which a person is lying stomach and face up. If we think about pronation and supination of the forearm as if the palm of the hand is the stomach, pronation would be a rotation of the forearm ending with the palm facing backward or down.

Forearm pronation.

Supination would be a rotation of the forearm ending with the palm facing forward or up.

Forearm supination.
Protraction and retraction
Protraction and retraction are also pretty much what they sound like. They involve moving a part of the body forward (protraction) or backward (retraction). In addition to being moved up and down, the mandible can also be moved forward or backward. When the mandible moves forward, ending in an underbite, that's mandible protraction.

Mandible protraction.

When the mandible moves backwards, ending in an overbite, that's mandible retraction.

Mandible retraction.

Studying muscle actions in Muscles & Kinesiology

With its muscle actions menu, enhanced muscle action animations, and related content options, Muscles & Kinesiology makes it easy to integrate muscle actions into your studies!

You can view the full library of muscle action animations by looking at the muscle actions menu. Within the menu, the actions are organized by body region.

The muscle actions menu in Muscles & Kinesiology.

As you've seen in the video clips above, the new muscle action animations in Muscles & Kinesiology (as well as the newest version of Human Anatomy Atlas) feature fading as the muscles involved in an action relax. This fading makes it easier to distinguish between paired actions.

Let's look at scapula elevation and depression as an example. First, we'll go to the muscle actions menu and look in the shoulder section. We'll select scapula elevation, and then watch the animation and take a look at the info box.

From here, there are two ways you can get to the scapula depression animation-you can either return to the muscle actions menu by tapping the icon in the lower left hand corner of the screen, or you can select the scapula depression animation from the Related Content section of the info box.

Selecting an animation from the Related Content in Muscles & Kinesiology.

All in all, Muscles & Kinesiology ( available now for iOS and coming soon to Android!) gives you the tools you need to study how muscles move, how they interact with one another, and where they attach to the skeleton.

You can also visit the Visible Body Learn Site and check out these related blog posts to learn more about how the muscular, nervous, and skeletal systems interact and what happens when injuries occur:

Be sure to subscribe to the Visible BodyBlog for more anatomy awesomeness!

Are you an instructor? We have award-winning 3D products and resources for your anatomy and physiology course! Learn more here.

Additional Sources:

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A Visual Guide to Muscle Terminology with Muscles & Kinesiology

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When you're studying the muscular system, there's a lot of terminology to learn beyond the names of the muscles themselves. Part of becoming familiar with the body's muscles is learning how to describe the locations where they attach to bones, the different kinds of muscle actions that move the body, and what roles muscles play in different movements.

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I  added this to my portfolio because I am interested in working with this population in the future. It has a lot of helpful information on diagnosing infants and cranial nerves anamolies in infants. I would use this as a reference when studying for the PRAXIS and while continuing on to my externship.

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Im adding this into the portfolio because it is a quick guide to swallow tests. It shows the evidence and description of each test and how to administer the tests which will be useful when assessing patients in the future. I will use this when studying for the COMPS and PRAXIS and while interning in the hospital

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I have added the chapter 6 notes as a supplement to my personal notes from this chapter. These notes outline an instrumental evaluation and the how each instrument is used. I think this is a very important lecture because Dr. Hidgon details the evaluation process and I continue to refer back to these slides while completing my workbook and studying for COMPS and PRAXIS. Next semester, I will continue to refer back to these notes while working with patients in the hospital.

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I have added this dysphagia report outline as a reference for how to write a report. Each section breaks down the phases of the swallow and what you observed during each swallow phase which will allow me to write a detailed report. I will continue to refer back to this guide as I continue to study for the COMPS and PRAXIS.

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I have added these key points from the chapter to my portfolio as a supplement to the rest of the module. I will continue to use these notes while studying for the PRAXIS and as I continue on to my CFY, which will require me to know the swallowing evaluation steps and how to interpret the results.

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I have added this guide because it details each phase of the swallow and what cranial nerves are involved. This will be a very helpful guide for assessing patients during my externship and while studying for the COMPS and PRAXIS.

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I  added this diagram in module one as a refresher of the anatomy involved in the swallow mechanism. I continue to refer back to this photo while doing MBSimP and I will use this reference while I complete my medical externship.

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I have added the provided notes from chapter 7 as a supplement to module. I have referred back to these notes while studying for the COMPS and PRAXIS. These notes are very important because they outline EBP and how to effectively use it. I will continue to refer back to these notes when treating patients during my externship in the spring.

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I have added this diagram because it is important for us as SLPS to know the normal anatomy of a child because we work closely with that population. In order to know if there is a disorder in the anatomy we must know how it should look normally first. I will continue using this diagram to refer back to while working in the field.

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I added these helpful points from chapter 1 to help me remember the difference between penetration and aspiration and the different types of pneumonia. This was used while studying for quizzes and when completing my workbook. I will continue to use this while studying for the COMPS and PRAXIS and when working with patients in the hospital.

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I have added my notes and charts from the chapter that I think were difficult for me to understand in the chapter. I have used these notes as a reference while studying for quizzes and the COMPS. The information regarding the cranial nerves will continue to be used while I complete my externship

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This article explains the CAM method which is a quick way for professionals who are not trained to do psychiatrically assessments to quickly identify delirium. This is an important article because being able to identify delirium can help identify other underlying etiologies which can improve patient outcomes.

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Enhancing Communication in Hospice Settings

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Enhancing Communication in Hospice Settings

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I have added this article because it emphasizes the importance of understanding how to communicate with patients who are at the end of their life. It gives multiple strategies to use with different kinds of patients so we as medical professionals can give these patients the best care. We are often not taught these skills in school and the best way to understand how to have these conversations is through our clinical placements, so I will continue to refer back to this article if I encounter a patient that needs these strategies.

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I  have added this example of a bedside swallow because I  think it will be helpful as I  complete my medical externship. I   plan to refer back to it and other documents when completing evaluations and when writing evaluation reports.

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I added this document into my portfolio as a reference for how a laryngectomy affects the speech and swallow. I liked this document because it visually shows speech and swallowing before and after a laryngectomy which better helped me understand what happens when the procedure is done on a patient. I will continue to refer back to this visual while completing my externship and while creating treatment plans.

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I have added my end of life assignment because it outlines important topics regarding end of life care in America. I will use this assignment as a reference when discussing end of life care during my externship and during my CFY.

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I have added my notes from the chapter as a supplement to the chapter and module. I will continue to refer back to these notes while studying for the COMPS and PRAXIS.

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I  added this article because I  thought it outlined the importance of understanding non-oral feeding and the commonality of within the dementia patient population. In this case, the patient's daughter ,an SLP, recognized abnormal feeding patterns, and eventually discovered the reason behind her feeding difficulties which saved her life potentially. This article shows that our role with the geriatric population, especially those with dementia, is important and we should work to become more aware of signs that could make our patients quality of life better.

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These are my key points from the chapter and the module. I continue to refer back to them as I study for the final and for the PRAXIS.

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The IDDSI framework has been very helpful when completing MBSimP. I continued to refer back to this diagram while going through the components. It has also made it easier to understand the correlation between recommending different consistencies of liquids and foods. I will definitely continue to refer back to this scale as I complete my medical externship and CFY.

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I have added my personal notes and key points to the portfolio as a supplement to the modules material. I will continue to use these notes as a study for the final and the COMPS and PRAXIS.

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I have added this link because it helped me understand advanced directives while completing the end of life assignments. This website outlines the terms used in the medical setting when discussing end of life care, and why each term is used. I will continue to refer back to this link when working in the medical setting.

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Advance care planning is not just about old age. At any age, a medical crisis could leave you too ill to make your own health care decisions. Even if you are not sick now, planning for health care in the future is an important step toward making sure you get the medical care you would want, if you are unable to speak for yourself and doctors and family members are making the decisions for you.

Many Americans face questions about medical treatment but may not be capable of making those decisions, for example, in an emergency or at the end of life. This article will explain the types of decisions that may need to be made in such cases and questions you can think about now so you're prepared later. It can help you think about who you would want to make decisions for you if you can't make them yourself. It will also discuss ways you can share your wishes with others. Knowing who you want to make decisions on your behalf and how you would decide might take some of the burden off family and friends.

What Is Advance Care Planning?

Advance care planning involves learning about the types of decisions that might need to be made, considering those decisions ahead of time, and then letting others know-both your family and your health care providers-about your preferences. These preferences are often put into an advance directive, a legal document that goes into effect only if you are incapacitated and unable to speak for yourself. This could be the result of disease or severe injury-no matter how old you are. It helps others know what type of medical care you want.

An advance directive also allows you to express your values and desires related to end-of-life care. You might think of it as a living document-one that you can adjust as your situation changes because of new information or a change in your health.

Research shows that advance directives can make a difference, and that people who document their preferences in this way are more likely to get the care they prefer at the end of life than people who do not.

Advance Care Planning Decisions

Sometimes decisions must be made about the use of emergency treatments to keep you alive. Doctors can use several artificial or mechanical ways to try to do this. Decisions that might come up at this time relate to:

CPR (cardiopulmonary resuscitation)

Ventilator use

Artificial nutrition (tube feeding) and artificial hydration (IV, or intravenous, fluids)

Comfort care

What is CPR? Cardiopulmonary resuscitation might restore your heartbeat if your heart stops or is in a life-threatening abnormal rhythm. It involves repeatedly pushing on the chest with force, while putting air into the lungs. This force has to be quite strong, and sometimes ribs are broken or a lung collapses. Electric shocks, known as defibrillation, and medicines might also be used as part of the process. The heart of a young, otherwise healthy person might resume beating normally after CPR. Often, CPR does not succeed in older adults who have multiple chronic illnesses or who are already frail.

Using a ventilator as emergency treatment. Ventilators are machines that help you breathe. A tube connected to the ventilator is put through the throat into the trachea (windpipe) so the machine can force air into the lungs. Putting the tube down the throat is called intubation. Because the tube is uncomfortable, medicines are often used to keep you sedated while on a ventilator. If you are expected to remain on a ventilator for a long time, a doctor may perform a tracheotomy or "trach" (rhymes with "make"). During this bedside surgery, the tube is inserted directly into the trachea through a hole in the neck. For long-term help with breathing, a trach is more comfortable, and sedation is not needed. People using such a breathing tube are not able to speak without special help because exhaled air does not go past their vocal cords.

Using artificial nutrition and hydration near the end of life. If you are not able to eat, you may be fed through a feeding tube that is threaded through the nose down to your stomach. If tube feeding is still needed for an extended period, a feeding tube may be surgically inserted directly into your stomach. Hand feeding (sometimes called assisted oral feeding) is an alternative to tube feeding. This approach may have fewer risks, especially for people with dementia.

If you are not able to drink, you may be provided with IV fluids. These are delivered through a thin plastic tube inserted into a vein.

Artificial nutrition and hydration can be helpful if you are recovering from an illness. However, studies have shown that artificial nutrition toward the end of life does not meaningfully prolong life. Artificial nutrition and hydration may also be harmful if the dying body cannot use the nutrition properly.

What is comfort care at the end of life? Comfort care is anything that can be done to soothe you and relieve suffering while staying in line with your wishes. Comfort care includes managing shortness of breath; limiting medical testing; providing spiritual and emotional counseling; and giving medication for pain, anxiety, nausea, or constipation.

Learn more about hospice care and other health care decisions you may need to make at the end of life.

Getting Started with Advance Care Planning

Share this infographic to spread advance care planning tips to help get your affairs in order.

Start by thinking about what kind of treatment you do or do not want in a medical emergency. It might help to talk with your doctor about how your current health conditions might influence your health in the future. For example, what decisions would you or your family face if your high blood pressure leads to a stroke? You can ask your doctor to help you understand and think through your choices before you put them in writing. Discussing advance care planning decisions with your doctor is free through Medicare during your annual wellness visit. Private health insurance may also cover these discussions.

If you don't have any medical issues now, your family medical history might be a clue to help you think about the future. Talk with your doctor about decisions that might come up if you develop health problems similar to those of other family members.

In considering treatment decisions, your personal values are key. Is your main desire to have the most days of life? Or, would your focus be on quality of life, as you see it? What if an illness leaves you paralyzed or in a permanent coma and you need to be on a ventilator? Would you want that?

What makes life meaningful to you? If your heart stops or you have trouble breathing, would you want to undergo life-saving measures if it meant that, in the future, you could be well enough to spend time with your family? Would you be content if the emergency leaves you simply able to spend your days listening to books on tape or gazing out the window?

But, there are many other scenarios. Here are a few. What would you decide?

If a stroke leaves you unable to move and then your heart stops, would you want CPR? What if you were also mentally impaired by a stroke-does your decision change?

What if you are in pain at the end of life? Do you want medication to treat the pain, even if it will make you more drowsy and lethargic?

What if you are permanently unconscious and then develop pneumonia? Would you want antibiotics and to be placed on a ventilator?

For some people, staying alive as long as medically possible, or long enough to see an important event like a grandchild's wedding, is the most important thing. An advance directive can help to make that possible. Others have a clear idea about when they would no longer want to prolong their life. An advance directive can help with that, too.

Your decisions about how to handle any of these situations could be different at age 40 than at age 85. Or, they could be different if you have an incurable condition as opposed to being generally healthy. An advance directive allows you to provide instructions for these types of situations and then to change the instructions as you get older or if your viewpoint changes.

Many people are unprepared to deal with the legal and financial consequences of a serious illness such as Alzheimer's disease. Advance planning can help people with Alzheimer's and their families clarify their wishes and make well-informed decisions about health care and financial arrangements.

Learn more about legal and financial planning for people with Alzheimer's disease.

Making Your Advance Care Wishes Known

There are two main elements in an advance directive-a living will and a durable power of attorney for health care. There are also other documents that can supplement your advance directive. You can choose which documents to create, depending on how you want decisions to be made. These documents include:

Living will

Durable power of attorney for health care

Other advance care planning documents

Living will. A living will is a written document that helps you tell doctors how you want to be treated if you are dying or permanently unconscious and cannot make your own decisions about emergency treatment. In a living will, you can say which of the procedures described in the Decisions That Could Come Up section you would want, which ones you wouldn't want, and under which conditions each of your choices applies.

Durable power of attorney for health care. A durable power of attorney for health care is a legal document naming a health care proxy, someone to make medical decisions for you at times when you are unable to do so. Your proxy, also known as a representative, surrogate, or agent, should be familiar with your values and wishes. This means that he or she will be able to decide as you would when treatment decisions need to be made. A proxy can be chosen in addition to or instead of a living will. Having a health care proxy helps you plan for situations that cannot be foreseen, like a serious auto accident.

Some people are reluctant to put specific health decisions in writing. For them, naming a health care agent might be a good approach, especially if there is someone they feel comfortable talking with about their values and preferences. A named proxy can evaluate each situation or treatment option independently.

Other advance care planning documents. You might also want to prepare documents to express your wishes about a single medical issue or something not already covered in your advance directive. A living will usually covers only the specific life-sustaining treatments discussed earlier. You might want to give your health care proxy specific instructions about other issues, such as blood transfusion or kidney dialysis. This is especially important if your doctor suggests that, given your health condition, such treatments might be needed in the future.

Medical issues that might arise at the end of life include:

DNR orders

Organ and tissue donation

POLST and MOLST forms

A DNR (do not resuscitate) order tells medical staff in a hospital or nursing facility that you do not want them to try to return your heart to a normal rhythm if it stops or is beating unsustainably using CPR or other life-support measures. Sometimes this document is referred to as a DNAR (do not attempt resuscitation) or an AND (allow natural death) order. Even though a living will might say CPR is not wanted, it is helpful to have a DNR order as part of your medical file if you go to a hospital. Posting a DNR next to your bed might avoid confusion in an emergency situation. Without a DNR order, medical staff will make every effort to restore your breathing and the normal rhythm of your heart.

A similar document, called a DNI (do not intubate) order, tells medical staff in a hospital or nursing facility that you do not want to be put on a breathing machine.

A non-hospital DNR order will alert emergency medical personnel to your wishes regarding measures to restore your heartbeat or breathing if you are not in the hospital.

Organ and tissue donation allow organs or body parts from a generally healthy person who has died to be transplanted into people who need them. Commonly, the heart, lungs, pancreas, kidneys, corneas, liver, and skin are donated. There is no age limit for organ and tissue donation. You can carry a donation card in your wallet. Some states allow you to add this decision to your driver's license. Some people also include organ donation in their advance care planning documents.

At the time of death, family members may be asked about organ donation. If those close to you, especially your proxy, know how you feel about organ donation, they will be ready to respond. There is no cost to the donor's family for this gift of life. If the person has requested a DNR order but wants to donate organs, he or she might have to indicate that the desire to donate supersedes the DNR. That is because it might be necessary to use machines to keep the heart beating until the medical staff is ready to remove the donated organs.

Learn more about organ and tissue donation.

Brain donation is different from other organ donation in that the brain is donated to scientific research. By studying the brains of people who have died - both those who had a brain disorder and those who were healthy during life - researchers learn more about how particular diseases affect the brain and how we might better treat and prevent them.

Learn more about brain donation.

POLST and MOLST forms provide guidance about your medical care preferences in the form of a doctor's orders. Typically you create a POLST (Physician Orders for Life-Sustaining Treatment) or MOLST (Medical Orders for Life-Sustaining Treatment) when you are near the end of life or critically ill and know the specific decisions that might need to be made on your behalf. These forms serve as a medical order in addition to your advance directive. They make it possible for you to provide guidance that health care professionals can act on immediately in an emergency.

A number of states use POLST and MOLST forms, which are filled out by your doctor or sometimes by a nurse practitioner or physician's assistant. The doctor fills out a POLST or MOLST after discussing your wishes with you and your family. Once signed by your doctor, this form has the same authority as any other medical order. Check with your state department of health to find out if these forms are available where you live.

Some people have pacemakers to help their hearts beat regularly. If you have one and are near death, it may not necessarily keep you alive. But, you might have an ICD (implantable cardioverter-defibrillator) placed under your skin to shock your heart back into regular beatings if the rhythm becomes irregular. If you decline other life-sustaining measures, the ICD may be turned off. You need to state in your advance directive what you want done if the doctor suggests it is time to turn it off.

How to Choose Your Health Care Proxy

If you decide to choose a proxy, think about people you know who share your views and values about life and medical decisions. Your proxy might be a family member, a friend, your lawyer, or someone in your social or spiritual community. It's a good idea to also name an alternate proxy. It is especially important to have a detailed living will if you choose not to name a proxy.

You can decide how much authority your proxy has over your medical care-whether he or she is entitled to make a wide range of decisions or only a few specific ones. Try not to include guidelines that make it impossible for the proxy to fulfill his or her duties. For example, it's probably not unusual for someone to say in conversation, "I don't want to go to a nursing home," but think carefully about whether you want a restriction like that in your advance directive. Sometimes, for financial or medical reasons, that may be the best choice for you.

Of course, check with those you choose as your health care proxy and alternate before you name them officially. Make sure they are comfortable with this responsibility.

Making Your Health Care Directives Official

Once you have talked with your doctor and have an idea of the types of decisions that could come up in the future and whom you would like as a proxy, if you want one at all, the next step is to fill out the legal forms detailing your wishes. A lawyer can help but is not required. If you decide to use a lawyer, don't depend on him or her to help you understand different medical treatments. Start the planning process by talking with your doctor.

Many states have their own advance directive forms. Your local Area Agency on Aging can help you locate the right forms. You can find your area agency phone number by calling the Eldercare Locator toll-free at 1-800-677-1116 or by visiting https://eldercare.acl.gov.

Some states require your advance directive to be witnessed; a few require your signature to be notarized. A notary is a person licensed by the state to witness signatures. You might find a notary at your bank, post office, or local library, or call your insurance agent. Some notaries charge a fee.

Some states have registries that can store your advance directive for quick access by health care providers, your proxy, and anyone else to whom you have given permission. Private firms also will store your advance directive. There may be a fee for storing your form in a registry. If you store your advance directive in a registry and later make changes, you must replace the original with the updated version in the registry.

Some people spend a lot of time in more than one state-for example, visiting children and grandchildren. If that's your situation, consider preparing an advance directive using forms for each state-and keep a copy in each place, too.

What to Do After You Set Up Your Advance Directive

Give copies of your advance directive to your health care proxy and alternate proxy. Give your doctor a copy for your medical records. Tell close family members and friends where you keep a copy. If you have to go to the hospital, give staff there a copy to include in your records. Because you might change your advance directive in the future, it's a good idea to keep track of who receives a copy.

Review your advance care planning decisions from time to time-for example, every 10 years, if not more often. You might want to revise your preferences for care if your situation or your health changes. Or, you might want to make adjustments if you receive a serious diagnosis; if you get married, separated, or divorced; if your spouse dies; or if something happens to your proxy or alternate. If your preferences change, you will want to make sure your doctor, proxy, and family know about them.

It can be helpful to have conversations with the people close to you about how you want to be cared for in a medical emergency or at the end of life. These talks can help you think through the wishes you want to put in your advance directive.

It's especially helpful to talk about your thoughts, beliefs, and values with your health care proxy. This will help prepare him or her to make medical decisions that best reflect your values.

After you have completed your advance directive, talk about your decisions with your health care proxy, loved ones, and your doctor to explain what you have decided. This way, they are not surprised by your wishes if there is an emergency.

Another way to convey your wishes is to make a video of yourself talking about them. This lets you express your wishes in your own words. Videos do not replace an advance directive, but they can be helpful for your health care proxy and your loved ones.

Be Prepared

What happens if you have no advance directive or have made no plans and you become unable to speak for yourself? In such cases, the state where you live will assign someone to make medical decisions on your behalf. This will probably be your spouse, your parents if they are available, or your children if they are adults. If you have no family members, the state will choose someone to represent your best interests.
Always remember: an advance directive is only used if you are in danger of dying and need certain emergency or special measures to keep you alive, but you are not able to make those decisions on your own. An advance directive allows you to make your wishes about medical treatment known.
It is difficult to predict the future with certainty. You may never face a medical situation where you are unable to speak for yourself and make your wishes known. But having an advance directive may give you and those close to you some peace of mind.

You might want to make a card to carry in your wallet indicating that you have an advance directive and where it is kept. Here is an example of the wallet card offered by the American Hospital Association. You might want to print this to fill out and carry with you. A PDF can be found online (PDF, 40 KB).

Read about this topic in Spanish. Lea sobre este tema en español.

For More Information About Health Care Directives

This content is provided by the NIH National Institute on Aging (NIA). NIA scientists and other experts review this content to ensure it is accurate and up to date.

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