End of life care - lecture 10

Question 1

Number of seniors living in poverty

Answer 1

5%

Question 2

What changed poverty among seniors?

Answer 2

introduction of canada pension plan and guaranteed income supplement

Question 3

What happened in 2008?

Answer 3

25% increase in the number of seniors living in poverty

why? life expectancy: money not lasting as long , recession

Question 4

To alleviate poverty?

Answer 4

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

Question 5

Main source of income for seniors?

Answer 5

OAS and CPP (2/3)

Question 6

Number of full time retirees that can afford to pay their basic expenses?

Answer 6

55%

Question 7

Earnings of seniors that can afford bills?

Answer 7

2/3 less than $20,000

Question 8

Types of elder abuse?

Answer 8

physical, sexual, financial, neglect, mental

Question 9

signs and symptoms?

Answer 9

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

Question 10

Principles of ethical decision making

Answer 10

fidelity, autonomy, beneficence, non maleficene, justice

Question 11

Fidelity

Answer 11

faithful devotion to duty

Question 12

Autonomy

Answer 12

the right of persons to choose for themselves what they think is best for them

Question 13

Benedicence

Answer 13

treatment must have some potential to help

Question 14

Non-maleficence

Answer 14

“do not harm” i.e. not performing painful tests to an elder patient that it will not survive

Question 15

Justice

Answer 15

equitable distribution of burdens and benefits among many individuals

Question 16

Geriatric care

Answer 16

information disclosure, informed consent, substitute decision making, withholding and withdrawing treatments, advance care planning, consent and capacity assessment

Question 17

assumption of capacity

Answer 17

assuming that a person is capable unless it is unreasonable to presume so

Question 18

what does it mean that capacity is decision specific not global?

Answer 18

may be capable of making a decision about one thing but not another

Question 19

Cognitive vs functional capacity

Answer 19

Cognitive: grasp, retain, rationally appraise information

Functional: physical ability to perform a task

Question 20

Indicators of capacity?

Answer 20

understand the information, appreciate the consequences of a decision. NO TO EITHER = INCAPABLE OF DECISION MAKING

Question 21

Consent

Answer 21

relate to treatment, be informed, given voluntarily, must not be misrepresentation or fraud

Question 22

SDM- substitute decision maker

Answer 22

must act in the best interest of the person, meet needs of person when they were capable

Question 23

Advance care directive

Answer 23

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

Question 24

persistent vegetative state

Answer 24

exhibiting motor reflexes but without the ability to regain cognitive behaviour, communicate, or interact purposefully with the environment

Question 25

Conflicts of interest as an RD

Answer 25

-educated to promote nourishment,

Question 26

Ethical Decision Making

Answer 26

1. recognize ethical issue
2. acknowledge your feelings
3. determine the facts
4. examine values
5. evaluate alternative actions from various ethical perspectives
6. make a decision and implement it
7. evaluate/ reflect on the decision later

Question 27

End of life care: judaism, islamic, hinduism

Answer 27

1. 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

Question 28

Palliative care

Answer 28

diagnosed with end of life care, still being actively treated

Question 29

end of life care

Answer 29

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