Cognitive Citizenship: Access to Hip Surgery for People with Dementia

Abstract

Dementia and chronic hip disease are both more prevalent with advancing age. Given this, the number of people with both dementia and hip disease is likely to increase in an ageing population such as the UK. This article raises questions about how people with dementia and chronic hip disease are conceptualized in the context of evidence-based medicine, and whether this conceptualization may limit unfairly their access to surgical services. The published clinical research discourse at the interface of hip disease and dementia is taken as an 'evidence-base', and is evaluated in terms of its suitability for informing professional decisions about viability for surgery. The analysis suggests that the outcomes criteria used to determine patient viability serve to discriminate unfairly against people with dementia. If such discrimination exists, it necessarily militates against the promotion of health-related citizenship rights of the cognitively impaired, creating an evidence-based culture that encourages a problematic model of cognitive citizenship.

Nursing home residents in emergency departments: a Foucauldian analysis

“…Although it is debatable if this process is the result of rationing or triaging of health care, it often results in patients waiting for extended periods before they can receive healthcare interventions and hospital admission (Rankin 2001). It is common for people from NHs to experience complications and exacerbations of their health conditions during these waiting periods (Graham, 2004; Rachlis 2004), which may require them to go to EDs for healthcare services. In these cases, the ED becomes the point of entry to the healthcare system.…”

“…It highlights how the power of one group (doctors) can subjugate the knowledge and power of another (NH staff – mainly nursing staff). Given that NHs are managed predominantly by nurses, and residents are generally amongst society's oldest and frailest (Kayser‐Jones (2002), it may reflect the prevailing hierarchy within health care that places physicians, their knowledge and skills, above those of other healthcare professionals, and views younger people as more deserving than older individuals (Graham, 2004; Lee et al. 2006).…”

Human rights, citizenship and dementia care nursing

“…Brannelly (2004, p. 13) argues that the fragmented and sometimes contradictory nature of policy and legislation for people with dementia does not easily facilitate professionals to ‘care well’– that is, to uphold and respect the rights of care recipients. Graham’s (2004) work on access to hip surgery for people with dementia reveals exclusionary practice based on ideas of ‘cognitive citizenship’– those with the most cognitive impairment are less likely to be referred for surgery; thus, they are excluded from equal rights to health care.…”

Dichotomising dementia: is there another way?

“…Indeed Gilleard and Higgs () suggest that nursing homes have become as terrifying as the workhouses once were. At their most cognitively impaired and thus most vulnerable, people with dementia are not regarded by the general public as ‘of our world’, nor considered to be bound by the same rules, nor are their human or citizenship rights respected to the same extent as those without dementia (Graham , Kelly and Innes ). In the context of the successful ageing paradigm, those with dementia who are most frail have failed the living well test.…”