End of life care - lecture 10 Flashcards
Number of seniors living in poverty
5%
What changed poverty among seniors?
introduction of canada pension plan and guaranteed income supplement
What happened in 2008?
25% increase in the number of seniors living in poverty
why? life expectancy: money not lasting as long , recession
To alleviate poverty?
CPP (60+), death benefits, benefits available from 60-64 but receive lesser amounts, old age security (450/month), GIS, OAS (GIS and OAS can be combined), spouse’s allowance, widowed spouse’s allowance
Main source of income for seniors?
OAS and CPP (2/3)
Number of full time retirees that can afford to pay their basic expenses?
55%
Earnings of seniors that can afford bills?
2/3 less than $20,000
Types of elder abuse?
physical, sexual, financial, neglect, mental
signs and symptoms?
depression, fear anxiety, passivity, unexplained physical injuries, dehydration or lack of food, poor hygiene, rashes, pressure ulcers, over sedation, money/ personal items missing without explanation
Principles of ethical decision making
fidelity, autonomy, beneficence, non maleficene, justice
Fidelity
faithful devotion to duty
Autonomy
the right of persons to choose for themselves what they think is best for them
Benedicence
treatment must have some potential to help
Non-maleficence
“do not harm” i.e. not performing painful tests to an elder patient that it will not survive
Justice
equitable distribution of burdens and benefits among many individuals
Geriatric care
information disclosure, informed consent, substitute decision making, withholding and withdrawing treatments, advance care planning, consent and capacity assessment
assumption of capacity
assuming that a person is capable unless it is unreasonable to presume so
what does it mean that capacity is decision specific not global?
may be capable of making a decision about one thing but not another
Cognitive vs functional capacity
Cognitive: grasp, retain, rationally appraise information
Functional: physical ability to perform a task
Indicators of capacity?
understand the information, appreciate the consequences of a decision. NO TO EITHER = INCAPABLE OF DECISION MAKING
Consent
relate to treatment, be informed, given voluntarily, must not be misrepresentation or fraud
SDM- substitute decision maker
must act in the best interest of the person, meet needs of person when they were capable
Advance care directive
process of communication among patients, their HCPs and their families regarding the kind of care that will be considered appropriate when the patient cannot make decisions
persistent vegetative state
exhibiting motor reflexes but without the ability to regain cognitive behaviour, communicate, or interact purposefully with the environment
Conflicts of interest as an RD
-educated to promote nourishment,
Ethical Decision Making
- recognize ethical issue
- acknowledge your feelings
- determine the facts
- examine values
- evaluate alternative actions from various ethical perspectives
- make a decision and implement it
- evaluate/ reflect on the decision later
End of life care: judaism, islamic, hinduism
- Do not assume anything ASK
Judaism: treatment to provide comfort allowed, even if risk of shortening life
Islamic: DNR, allah decides
Hinduism pain and suffering are part of acceptance and detachment
Palliative care
diagnosed with end of life care, still being actively treated
end of life care
comfort, support and care to people who are living with or dying from any progressive life threatening disease, treatment not longer an option, not long to live
