Considering Elderly Competence When Consenting to Treatment

Brooks, Christine L.

doi:10.1097/hnp.0b013e3182157c19

Cited by 2 publications

(3 citation statements)

References 9 publications

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“…Of the 80 articles, 16 were essay-type articles 16,20,23,27,30,33,37,42,64,65,67,68,71,72,81,91 ; 7 were surveys 18,19,46,47,73,75,85 ; and 57 were research articles consisting of case studies and case reports, follow-up studies, cross-sectional studies, case-control and cohort studies, randomized trials, and systematic reviews. 13–15,17,21,22,24–26,28,29,31,32,34–36,38–41,43–45,48–63,66,69,70,74,76–80,82–84,86–90,92 The studies reviewed were from a variety of international settings: United States (n = 33); United Kingdom (n = 7); France (n = 5); the Netherlands (n = 5); Spain (n = 3); and Canada, Sweden, Finland, Germany, Switzerland, Turkey, Hong Kong, Scotland, Norway, Italy, South Africa, Israel, Korea, Austria, and Nigeria.…”

Section: Resultsmentioning

confidence: 99%

“…13,15,32,38,87 The authors in most of these articles favored the MMSE and MacCAT over others. Investigators discussed concepts related to declining capacity and advance directives more thoroughly in the medical literature 20,23,39,42,61,67 than in the dental literature. Investigators identified decision making and preserving patient autonomy as substantial ethical concerns arising in cases of medical emergencies.…”

Section: Discussionmentioning

confidence: 99%

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Informed consent in dental care and research for the older adult population

Mukherjee¹,

Livinski²,

Millum³

et al. 2017

The Journal of the American Dental Association

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Background Ethics in health care and research is based on the fundamental principle of informed consent. However, informed consent in geriatric dentistry is not well documented. Poor health, cognitive decline, and the passive nature of many geriatric patients complicate this issue. Methods The authors completed this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The authors searched the MEDLINE PubMed, Web of Science, PsycINFO, and Cochrane Library databases. The authors included studies if they involved participants 65 years or older and discussed topics related to informed consent beyond obtaining consent for health care. The authors explored informed consent issues in dentistry and other biomedical care and research. Results The authors included 80 full-text articles on the basis of the inclusion criteria. Of these studies, 33 were conducted in the United States, 30 addressed consent issues in patients with cognitive impairment, 29 were conducted in patients with medical issues, and only 3 involved consent related to dental care or research. Conclusions Informed consent is a neglected topic in geriatric dental care and research. Substantial knowledge gaps exist between the understanding and implementation of consent procedures. Additional research in this area could help address contemporary consent issues typically encountered by dental practitioners and to increase active participation from the geriatric population in dental care and research. Practical Implications This review is the first attempt, to the authors’ knowledge, to identify informed consent issues comprehensively in geriatric dentistry. There is limited information in the informed consent literature covering key concepts applicable to geriatric dentistry. Addressing these gaps could assist dental health care professionals in managing complex ethical issues associated with geriatric dental patients.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Informed consent in dental care and research for the older adult population

Mukherjee¹,

Livinski²,

Millum³

et al. 2017

The Journal of the American Dental Association

View full text Add to dashboard Cite

show abstract

“…Improvements in healthcare have also resulted in increased life expectancy for those with intellectual disabilities [11], and those with acquired brain injuries such as stroke [12]–[14]. Decision-making for these individuals can present a number of practical, ethical and legal challenges [15]–[17]. It is particularly when questions of capacity arise with respect to the maintenance of life, or the end of life, as exemplified by decisions concerning artificial means for maintaining nutrition, that making healthcare choices may be the most difficult and contentious.…”

Section: Introductionmentioning

confidence: 99%

How are Treatment Decisions Made about Artificial Nutrition for Individuals at Risk of Lacking Capacity? A Systematic Literature Review

et al. 2013

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BackgroundWorldwide, the number of individuals lacking the mental capacity to participate in decisions about their own healthcare is increasing. Due to the ageing global population and advancing medical treatments, there are now many more people living longer with neurological disorders, such as dementia, acquired brain injuries, and intellectual disabilities. Many of these individuals have feeding difficulties and may require artificial nutrition. However, little is known about the decision-making process; the evidence base is uncertain and often ethically complex. Using the exemplar of artificial nutrition, the objective of this review is to examine how treatment decisions are made when patients are at risk of lacking capacity.Methods and FindingsWe undertook a systematic review according to PRISMA guidelines to determine who was involved in decisions, and what factors were considered. We searched PubMed, AMED, CINAHL, EMBASE, PsychINFO, and OpenSigle for quantitative and qualitative studies (1990–2011). Citation, reference, hand searches and expert consultation were also undertaken. Data extraction and quality assessment were undertaken independently and in duplicate. We utilised Thomas and Harden’s ‘Thematic Synthesis’ for analysis. Sixty-six studies met inclusion criteria, comprising data from 40 countries and 34,649 patients, carers and clinicians. Six themes emerged: clinical indications were similar across countries but were insufficient alone for determining outcomes; quality of life was the main decision-making factor but its meaning varied; prolonging life was the second most cited factor; patient’s wishes were influential but not determinative; families had some influence but were infrequently involved in final recommendations; clinicians often felt conflicted about their roles.ConclusionsWhen individuals lack mental capacity, decisions must be made on their behalf. Dynamic interactive factors, such as protecting right to life, not unnecessarily prolonging suffering, and individual preferences, need to be addressed and balanced. These findings provide an outline to aid clinical practice and develop decision-making guidelines.

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Considering Elderly Competence When Consenting to Treatment

Cited by 2 publications

References 9 publications

Informed consent in dental care and research for the older adult population

Informed consent in dental care and research for the older adult population

How are Treatment Decisions Made about Artificial Nutrition for Individuals at Risk of Lacking Capacity? A Systematic Literature Review

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