Ethics Of Elderly Care Flashcards
How have the government tried to combat ageism?
Introduced the ‘Equality Act’ (2010)
“Age is a ‘protected characteristic”
People are not allowed to discriminate,
harass or victimise another person because of their age
This is esp important bc aprox 22% of the world population will be 60+ by 2050
What are the key issues when treating elderly patients?
Older people MAY be:
- More deferential (respectful) to the Dr
- Have impaired or fluctuations capacity–> drs must support the patients as best as possible to make their own decision (e.g. if patient needs images to understand, then we must provide the image)
- More dependent on social and family support
- Have comorbidities (e.g. we consider risk and polypharmacy)
- Be discriminated against
Angela is 87 years old. She is in A+E following a fall. She is frail but is striving to maintain her independence as is quite feisty! You would like to admit her for a few days, partly to ensure she has somewhere safe to go home to. She, however, is adamant that she wants to go home, even though she lives alone and knows she will struggle to cope. She has the capacity to make this decision.
What should you do?
- IF she has capacity (which she does), then we SHOULD let her go home despite risk of falls at her home as this is her best interest and this is the law
- NOTE: what we HAVE to do will make us very uncomfortable
What is the ‘Mental Capacity Act 2005’?
Allows for the required/permitted validity to advanced directives (i.e. living will, power of attorney etc.)
The act provides for power of attorney on behalf of INCAPACITATED adults (i.e. dementia patient may not be able to have capacity to make own decisions)
How do you assess capacity within the terms of the MCA 2005?
No capacity if they are unable to:
* Understand + retain the info relevant to the decision
* Use or weigh that info as part of the decision making process
* Communicate his decision
* NOTE: if they do not have capacity, then under the mental health act (2005), they are permitted to advanced directives such as a power of attorney or validity of a living will
What is meant by capacity being a ‘dynamic concept’?
Capacity may change over time:
Patients may have capacity at some decisions/times, but not others
So shouldn’t put too much emphasis on previous assessments
Staff can influence whether or not a patient has capacity (e.g. environment, demeanour, manner etc.)
What are some factors that can affect a patient’s capacity?
- Pain
- Medication * Infection
- Fear
- Illness
- Injury
- Fatigue
What is the plan of action when we find that a patient lacks capacity for making a decision on their treatment?
- Do they have a valid lasting power of attorney (LPA)?
- Do they have a valid advance decision (AD)? (i.e. living will, do not attempt to resuscitate (DNR) etc.)
- If no LPA or AD, treat in patient’s best interest
- Is there anyone who can advocate (support) the patient?
- Document all assessments and rationale for conclusion/decisions
Can we FORCE treatment on a patient?
- Forced treatment is RARE (autonomy)
- However, the national assistance act 1947 allows for compulsion if pt has ‘grave chronic disease’ or is ‘aged, infirm and incapacitated’ and ‘living in insanitary conditions’
- The MCA 2005 also allows for exceptions to treatment refusal, usually in the case of informal patients.
FORCED treatment may inc moving an old person into a care home
What would you legally do when an older patient, requiring institutional care, resists admission?
- Consult the National Assistance Act 1948 – allows compulsory removal from the homes of people, based on pt BEST INTERESTS OR TO PREVENT HARM:
- Not mentally ill (but suffer from grave chronic disease)
- Old
- Infirm or physically incapacitated
- Living in insanitary conditions
- Not receiving care and attention
- Eviction cannot occur without notice by a doctor to a magistrate’s court
- Alternatively, the MHA 1983 can be used
in a person refusing to go to hospital
How do you assess an elderly patient’s QoL?
- It is effective to elicit a good social history to find out about PADLs and DADLs
- Do not assume that elderly patients do not enjoy their life, just because they have a mental health condition
What examples of Human Rights of care home patients can be breached?
- Leaving someone in soiled sheets
- Letting a patient become dehydrated
- Leaving trays of food/jugs of water when patient needs help to eat
- Using excessive force to restrain someone in care
- Breach of privacy – e.g. changing a patient in an open area
- A disregard for patient autonomy
