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

Abstract

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.

Consenso informato al trattamento medico: valutazione della capacità decisionale del paziente anziano

“…Many patients, however, may have no longer decision-making capacity because of learning disabilities, depression, brain injury and other forms of dementing illnesses affecting cognition [3] . Alzheimer disease [4] .…”

“…Every adult patient is legally assumed to be competent, however, in the clinical practice, failure to detect incompetence is quite common [3,4] . Where any doubt exists, the capacity of the patient to give medical consent should be assessed using specific tools appropriate to assess decision-making capacity.…”

Ethical issues in consenting older adults: academic researchers and community perspectives

“…For example, evidence‐based health services provided to older adults should be based on research conducted specifically on older adult populations. However, elderly based research is still inadequate and less illustrative compared to research involving younger populations . One of the important factors leading to underrepresentation of older adults in clinical, social and behavioural research is the difficulty associated with obtaining informed consents from older adult individuals .…”

“…However, elderly based research is still inadequate and less illustrative compared to research involving younger populations. [2,3] One of the important factors leading to underrepresentation of older adults in clinical, social and behavioural research is the difficulty associated with obtaining informed consents from older adult individuals. [2,4,5] In addition, obtaining informed consents from older adults is confined by many ethical and practical challenges, and therefore, it is much more than obtaining a signature.…”

A review of medicolegal considerations of endodontic practice for general dental practitioners

“…To understand the legal status of the clinical error and to prevent future litigations in the court of law, knowledge regarding the medicolegal aspects of particular clinical scenario with respect to the provision of law is required as a need of an hour. [ 1 2 3 ]…”