Subtle ethical dilemmas in geriatric management and clinical research

Rosin, Arnold J.; Dijk, Y van

doi:10.1136/jme.2004.008532

Cited by 21 publications

(18 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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%

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

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.

show abstract

Section: Resultsmentioning

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

“…In the bioethical debate, relatives’ needs are sometimes classed as conflicting and external interests (25): relatives may have been inhibited from mentioning them. Elsewhere, older people have expressed balanced and ethical stances about their own and their families’ needs (23, 27).…”

Section: Discussionmentioning

confidence: 99%

Discharge‐planning for long‐term care needs: the values and priorities of older people, their younger relatives and health professionals

Denson

Winefield

Beilby

2012

Scandinavian Caring Sciences

View full text Add to dashboard Cite

Discharge-planning decisions about long-term care (LTC) can be difficult and distressing for older people, families and discharge-planning health professionals. Retrospective research suggests that despite good intentions and a shared focus on the best interests of the older person, stakeholders may hold very different values about good outcomes and how to decide them. We aimed to compare the opinions and values of frail elders living at home, younger relatives and health professionals experienced in discharge-planning, prospectively: before, not after, a LTC decision. We interviewed three types of stakeholders (10 older people, 8 relatives and 18 health professionals) using a hypothetical vignette about a frail elder leaving hospital. In a mixed methods design, we quantitatively compared the discharge plans and decision-makers that stakeholders suggested, and qualitatively analysed the 36 interview transcripts for participants' articulation of underlying values during these discussions. Older participants often suggested safe restrictive options (residential care, proxy decision-making) for the hypothetical frail elder, while advocating autonomy for themselves. Younger people generally endorsed autonomous decision-making and less restrictive discharge options especially if the elder was mentally competent, but reported difficult ethical tensions between safety and autonomy. Individual personality and preferences, mental capacity, and the importance of personal care in supporting autonomy were central themes consistent with the Ecological Theory of Aging. Accordingly, discharge planners can usefully articulate the balance of safety and autonomy, conceptualizing home care as maintaining independence rather than accepting dependence. Ethical training should incorporate sophisticated models of practice specifying both psychological and physical safety as components of beneficence. Few elders adopt a consumer approach to LTC: health professionals can encourage mid-life adults to consider later care needs when planning for retirement.

show abstract

“…Thus, a person may be competent (in that a judge has not appointed a conservator or guardian) but not have reasonable decision-making capacity as determined by a licensed physician, psychiatrist, or psychologist. 67 In clinical medicine, these definitions are vital, especially in the elderly who are more affected by cognitive impairment. Impairment of capacity may be temporary, for example, as a result of delirium or depression.…”

Section: Pain Assessmentmentioning

confidence: 99%

Palliative Care for the Older Adult

Kapo

Morrison

Liao

2007

Journal of Palliative Medicine

View full text Add to dashboard Cite

The majority of deaths in the United States occur in the geriatric population. These older adults often develop multiple chronic medical problems and endure complicated medical courses with a variety of disease trajectories. Palliative care physicians need to be skilled in addressing the needs of these frail elders with life-limiting illness as they approach the end of life. Although geriatrics and palliative medicine share much in common, including an emphasis on optimizing quality of life and function, geriatric palliative care is distinct in its focus on the geriatric syndromes and on the provision of care in a variety of long-term care settings. Expertise in the diagnosis and management of the geriatric syndromes and in the complexities of long-term care settings is essential to providing high-quality palliative care to the elderly patient. This paper is a practical review of common geriatric syndromes, including dementia, delirium, urinary incontinence, and falls, with an emphasis on how they may be encountered in the palliative care setting. It also highlights important issues regarding the provision of palliative care in different long-term care settings.

show abstract

Subtle ethical dilemmas in geriatric management and clinical research

Cited by 21 publications

References 27 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

Discharge‐planning for long‐term care needs: the values and priorities of older people, their younger relatives and health professionals

Palliative Care for the Older Adult

Contact Info

Product

Resources

About