Ethical Concerns in Caring for Elderly Patients with Cognitive Limitations

Abstract

Mrs. A is a pleasant seventy-seven-year-old widow with an increasingly symptomatic right knee that has markedly limited her activities in the past year. Mrs. A's daughter, who lives in town, urged her to seek treatment. History, physical examination, and radiographs confirmed the diagnosis of end-stage knee arthritis. Dr. Z, the orthopaedic surgeon, presented total knee arthroplasty as a potential treatment option and provided detailed information on the surgery and recovery. Mrs. A indicated that if Dr. Z thinks that total knee arthroplasty is a good idea, she would agree to have the surgery. She lives alone and goes grocery shopping once a week, but her pain makes such endeavors frustrating for her. Her daughter visits regularly, takes her to medical appointments, and helps her with medications. Mrs. A has returned for a preoperative visit with Dr. Z, and her total knee arthroplasty has been tentatively scheduled for the following month. At this visit, Mrs. A notes that she wants to drive to the adjacent state to visit her son two weeks after the surgery and is glad she will have "a new knee" for that visit. When asked more questions about her understanding of the total knee arthroplasty and postoperative instructions, Mrs. A says Dr. Z can just talk to her daughter when she comes to pick her up from the appointment.

User participation is a family matter: A multiple case study of the experiences of older, hospitalised people and their relatives

“…Nevertheless, this contextual information seemingly did not lead to much participation from older people and their families in planning and decision‐making beyond the hospital context. In order to protect the interests of the patient in making decisions and achieve a full understanding of his/her perspective, Ho, Pinney, and Bozic () suggest that healthcare personnel address the patient's decisional context, the family (Ho et al., ). Ho () argues that the degree to which family participates in decision‐making in the hospital must match the family's level of participation in the patient's everyday life (Ho, ).…”

Sharing the helm: medical co‐management for the older surgical patient

“…Under-recognition of cognitive impairment could have implications for validity of informed consent and might limit a person's capacity to understand treatment options 42 and participate in shared decision-making. 43 Surgeons may grapple with the complexities and legal issues around informed consent in people with cognitive impairment, 44 a process that is fraught with hazard for the surgeon and can even be subject to retrospective criticism. Thus, surgeons may consider they are not well placed for this task and appreciate input from physician or geriatrician colleagues.…”

Leaving patients to their own devices? Smart technology, safety and therapeutic relationships

“…With smart devices, patients can ask more relevant and timely questions based on the recorded information, and physicians can confirm the accuracy of patients’ reports of their symptoms accordingly. Patients with busy lives or cognitive decline can particularly benefit, as they may recall their symptoms, activities, and other information incorrectly [ 26 ], especially when there is a significant time lapse between noticing the symptoms and consulting a physician [ 27 ]. At other times, patients’ physiological responses (e.g.…”