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ppd sem 4 > WEEK7: Ethics of elderly care > Flashcards

WEEK7: Ethics of elderly care Flashcards

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1
Q

What is wrong with talking about elderly care?

A
  • stereotyping

- not a separate group

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2
Q

What is ageism?

A
  • discriminating against age

- esp against old people

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3
Q

What is the equality act?

A
  • The Equality Act (2010) states that age is a ‘protected characteristic’.
  • People are not allowed to discriminate, harass or victimise another person because of their age.
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4
Q

The increase in global figures of elderly people can lead to what discussions?

A
  • resource allocation

= people 65+ disproportionately use the healthcare resources. Is this just?

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5
Q

Does palliative care vary?

A
  • yes depending on your postcode
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6
Q

What is different about elderly care?

A
  • same ethical duties apply to older people
  • Older people are usually more respectful to the HCPs.
  • Older patients are more dependent on social and family support, which is extenuated by an increasing life expectancy due to medical technology
  • problems with resources
  • government has passed the community care (delayed discharge) act
  • impaired or fluctuating capacity
  • have more complex health needs E.G. polypharmacy
  • May be discriminated against
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7
Q

What is the Community Care (delayed discharge) Act?

A
  • government has passed the community care (delayed discharge) act
  • fines local authorities for not assessing and transferring patients fast enough out of hospital
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8
Q

Why are elderly patients more respectful of doctors?

A
  • generation gap

- lawyers and doctors seen with lots of respect and high regard

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9
Q

What is impaired or fluctuating capacity?

A
  • e.g. dementia people
  • threshold
  • if someone has capacity and is above threshole= RESPECT THEIR DECISION
  • if someone is below threshold= DUTY TO SUPPORT THEM IN MAKING AUTONOMOUS CHOICE
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10
Q

What is EMI care?

A
  • EMI care (elderly, mentally infirm)

- abbreviation describing homes that are adapted to those living with dementia

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11
Q

What are some controversies surrounding elderly care?

A
  • discussions about if doctors treat elderly patients different to younger patients
    e. g:
  • Older patients cannot be discharged from hospital as fast as younger patients
  • this problem big= government now fining hospitals
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12
Q

What is capacity?

A
  • legal concept
  • NOT ethical concept
  • threshold value
  • need to be above threshold for autonomy to be accepted
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13
Q

What 2 important things should be maintained in elderly care?

A
  • Standard 1 : Rooting out age discrimination

- Standard 2: Person Centred Care : supports choice

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14
Q

What is the mental capacity act 2005?

A

The Mental Capacity Act 2005 is in force and affords statutory validity to advanced directives and provides for power of attorney on behalf of incapacitated adults

  • A person must be assumed to have capacity unless ESTABLISHED that they lack it
  • dont treat as not having capacity bc of an unwise decision
  • before taking action, think if there is another way you can go about something to reduce the risk of restricting the individuals rights
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15
Q

What is the criteria for capacity?

A
  • understand info
  • retain info
  • use or weigh info (to make the decision)
  • communicate his decision
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16
Q

How is capacity a dynamic concept?

A
  • capacity of patients can change over time
  • don’t base capacity on a previous experience/assessment
  • Doctors can do much to influence whether or not a patient is capacitous e.g. environment, demeanour, manner etc.
17
Q

Can someone with alzheimer’s have capacity?

A
  • sufficient for person to retain infor for short time and still have capacity to make decision
  • patient might have lots of notes and coping fine, but wont remember information after 30 mins
  • AS LONG AS PATIENT CAN RETAIN INFO FOR LONG ENOUGH TO MAKE DECISION, THEN CAPACITY IS THERE
18
Q

What if a patient has locked in syndrome (LIS)?

A
  • patient retains mental powers
  • patient can’t communicate or move
  • need to support patient:
    e. g. take patient into fMRI, questions them ‘‘if you want to say yes, think of playing tesnnis’’, if patient imagines tennis, you can see the associated brain activity and so you know the answer
  • but these things are expensive
19
Q

What happens when patient lacks capacity?

A
  • Is there a valid Lasting Power of Attorney (LPA)? – this is the first step
  • Is there a valid advance decision? (if no LPA)
  • If no LPA or AD, treat in patient’s best interests
  • Is there anyone who can advocate the patient?
  • Document all assessments and rationale for conclusion/decisions – these notes are also very important to protect us from liability
20
Q

What is the National Assistance Act 1947?

A
  • if someone has ‘grave chronic disease’
  • if someone ‘aged, infirm and incapacitated’
  • if someone ‘living in insanitary conditions’

= ALLOWS COMPULSION
- CAN INFLUENCE THEIR DECISION LOL

21
Q

What is ‘deprivation of liberty’ ?

A
  • allowed by MCA 2005
22
Q

What can dementia cause?

A
  • a cognitive deficit
  • behavioural/personality changes
  • temporary or permanent incapacity
23
Q

What is autonomy?

A
  • right to self-determination
  • if breached= affects trust on patient-doctor relationship
  • Paternalism is an out-dated and morally dubious model of practising healthcare
24
Q

What is paternalism?

A
  • patient blindly listens to the doctor

- act strictly but with benevolence

25
Q

What are problems with paternalism?

A
  • Autonomy only has meaning if it is informed
  • Autonomy may not be valued as highly by patients (esp. the elderly?) as by ethicists and doctors
  • Emotions, confusion, pain and distress can compromise decision-making so that it is not fully autonomous
  • Autonomous decision making can result in poor and preventable outcomes
26
Q

Under what act can paternalism be used?

A
  • National Assistance Act 1947

- Mental health act 1983

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