Search results for ‘Subject term:"older people"’ Sort:
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A choice too far
- Author:
- CRESSWELL Rick
- Journal article citation:
- Professional Social Work, March 2008, pp.10-11.
- Publisher:
- British Association of Social Workers
A social worker involved in assessing the capacity of patients to understand and make decisions, uses the example of an elderly women confronted with the prospect of losing her leg, and possibly her life, to highlight why, sometimes, there are no right and wrong answers to professional decision making.
Mental capacity to consent to treatment and admission decisions in older adult psychiatric inpatients
- Authors:
- MAXMIN K., et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 24(12), December 2009, pp.1367-1375.
- Publisher:
- Wiley
The mental capacity of older adult psychiatric inpatients to make informed treatment and admission decisions is investigated in this study. Ninety-nine consecutively admitted patients to 4 acute inpatient wards in inner and outer London were interviewed using the MacArthur Competence Assessment Tool for Treatment. The results showed that 52 (52.5%) of the participants had capacity for admission and 38 (38.4%) had capacity for treatment decisions, demonstrating that patients can have capacity to make decisions in one area but not in others. Capacity was associated with not having dementia and higher levels of insight and cognition, and was more likely with those admitted with dementia rather than psychosis. Three- quarters of the participants who lacked capacity to consent to admission were not legally detained under the Mental Capacity Act 2005. From April 2009, the Deprivation of Liberty Safeguards amendment to the Act was introduced in England and Wales to provide legal protection for patients without the mental capacity to consent to admission. This study demonstrates that this amendment is likely to apply to a significant proportion of older people. The study also showed that most people wanted doctors to make treatment and admission decisions, and very few wanted family to make decisions on their behalf.
Capturing the concealed: Interprofessional practice and older patients' participation in decision-making about discharge after acute hospitalization
- Authors:
- HUBY Guro, et al
- Journal article citation:
- Journal of Interprofessional Care, 21(1), January 2007, pp.55-67.
- Publisher:
- Taylor and Francis
The aim of this paper is to investigate ways in which the dynamics of interprofessional work shaped older patients' “participation” in decision-making about discharge from acute hospital care in a medical directorate of a District General Hospital in Scotland. Twenty-two purposively selected older patients and their key professional hospital carers in three different ward environments participated in the study. An ethnographic approach was adopted, involving semi-structured interviews with patients and staff combined with rigorous observation of the practical context for staff and patient interactions during the discharge planning process over a 5-month period. Patients' and staff's understanding of “decision-making” and their priorities for discharge were different, but patients' perspectives fragmented and became invisible. Care routines, which centred around assessments and the decisions that flowed from these tended to exclude both staff and patients from active decision-making. Research and practice on patient involvement in discharge decision-making needs to focus on the organizational context, which shapes patients', unpaid carers' and staff's interactions and the dynamics by which some views are privileged and others excluded. Procedurally driven care routines and their impact on patients', carers' and staff's opportunity to actively engage in decision-making should be re-considered from an empowerment perspective.
Striving to establish a care relationship-mission possible or impossible? Triad encounters between patients, relatives and nurses
- Authors:
- JOHNSSON Anette, et al
- Journal article citation:
- Health Expectations, 22(6), 2019, pp.1304-1313. Online only
- Publisher:
- Wiley
Background: When patients, relatives and nurses meet, they form a triad that can ensure a good care relationship. However, hospital environments are often stressful and limited time can negatively affect the care relationship, thus decreasing patient satisfaction. Objective: To explain the care relationship in triad encounters between patients, relatives and nurses at a department of medicine for older people. Design: A qualitative explorative study with an ethnographic approach guided by a sociocultural perspective. Method: Participatory observations and informal field conversations with patients, relatives and nurses were carried out from October 2015‐September 2016 and analysed together with field notes using ethnographic analysis. Result: The result identifies a process where patients, relatives and nurses use different strategies for navigating before, during and after a triad encounter. The process is based on the following categories: orienting in time and space, contributing to a care relationship and forming a new point of view. Conclusion: The result indicates that nurses, who are aware of the process and understand how to navigate between the different perspectives in triad encounters, can acknowledge both the patient's and relatives’ stories, thus facilitating their ability to understand the information provided, ensure a quality care relationship and strengthen the patient's position in the health‐care setting, therefore making the mission to establish a care relationship possible. (Edited publisher abstract)
Cost-effectiveness of donepezil and memantine in moderate to severe Alzheimer's disease (the DOMINO-AD trial)
- Authors:
- KNAPP Martin, et al
- Journal article citation:
- International Journal of Geriatric Psychiatry, 32(12), 2017, pp.1205-1216.
- Publisher:
- Wiley
Objective: Most investigations of pharmacotherapy for treating Alzheimer's disease focus on patients with mild-to-moderate symptoms, with little evidence to guide clinical decisions when symptoms become severe. The authors examined whether continuing donepezil, or commencing memantine, is cost-effective for community-dwelling, moderate-to-severe Alzheimer's disease patients. Methods: Cost-effectiveness analysis was based on a 52-week, multicentre, double-blind, placebo-controlled, factorial clinical trial. A total of 295 community-dwelling patients with moderate/severe Alzheimer's disease, already treated with donepezil, were randomised to: (i) continue donepezil; (ii) discontinue donepezil; (iii) discontinue donepezil and start memantine; or (iv) continue donepezil and start memantine. Results: Continuing donepezil for 52 weeks was more cost-effective than discontinuation, considering cognition, activities of daily living and health-related quality of life. Starting memantine was more cost-effective than donepezil discontinuation. Donepezil–memantine combined is not more cost-effective than donepezil alone. Conclusions: Robust evidence is now available to inform clinical decisions and commissioning strategies so as to improve patients' lives whilst making efficient use of available resources. Clinical guidelines for treating moderate/severe Alzheimer's disease, such as those issued by NICE in England and Wales, should be revisited. (Edited publisher abstract)
Treatment decision making and its discontents
- Authors:
- SINDING Chris, WIERNIKOWSKI Jennifer
- Journal article citation:
- Social Work in Health Care, 48(6), August 2009, pp.614-634.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
Patient participation in treatment decision making is held as a virtue in clinical contexts, and has much to recommend it. Yet important questions have been raised about the assumptions underlying models of patient participation. Debates have arisen about the significance of medically defined risks and outcomes of treatment; the adequacy and relevance across social groups of the concept of autonomy; and the emphasis on the professional-patient dyad. This article draws on findings in Ontario, Canada from interviews with 15 older women who had experienced a diagnosis of breast or gynaecological cancer, and 6 professionals who care for older women with cancer, to determine how health care decisions were made. The findings demonstrated that treatment choices depended on experiential knowledge, social roles and responsibilities, and the health policy context. It appeared that prevailing models of decision making may obscure patients’ more typical decision processes as well as the social determinants of those choices. The article ends with a call to conceptualise treatment decision making in more fully social terms, with implications for social work advocacy, research and practice.
Advance directives: limitations upon their applicability in elderly care
- Author:
- TRELOAR A.J.
- Journal article citation:
- International Journal of Geriatric Psychiatry, 14(12), December 1999, pp.1039-1043.
- Publisher:
- Wiley
Advance directives (ADs) are increasingly used and are seen as a way of directing care after the loss of mental capacity. There are, however, major potential problems associated with their use. They may require the withholding of treatment that will alleviate suffering, and have the potential to cause patients to lose abilities and live with unnecessary suffering or handicap. The requirements for a valid AD are discussed and a simple model for doctors to assess the validity of ADs is proposed.
Strike up the bands
- Authors:
- DENHAM Michael, NEWITT Angela, RYAN Cathy
- Journal article citation:
- Health Service Journal, 1.7.99, 1999, pp.26-28.
- Publisher:
- Emap Healthcare
Deciding who is eligible for long-term care and how it should be funded is a crucial issue for Health Authorities. Explains how one Health Authority has tackled it, using panels to assess patients against a banding system.
Health effects of the relocation of patients with dementia: a scoping review to inform medical and policy decision-making
- Authors:
- RYMAN Frida V M, et al
- Journal article citation:
- Gerontologist, 59(6), 2019, pp.e674-e682.
- Publisher:
- Oxford University Press
Background and Objectives: Research into the relocation (including international relocation) of people with dementia is increasingly important due to the ageing population and latest developments in the international politics (including globalisation and concerns over international migration). There is need for an overview of the health effects of relocation to facilitate and inform decision- and policy-making regarding these relocations. The aim of this literature review was to provide insight into the physical, psychological, and social consequences of varied types of relocations of older adults suffering from dementia. Research Design and Methods: A scoping literature review with a systematic search was performed in PubMed, Web of Science, PsychInfo, JSTOR, and ScienceDirect. The articles dealing with subject of relocation of older adults from 1994 to 2017 were included and analysed. Methodological quality assessment was performed for all articles. Results: Final list included 13 articles. The effects of relocation were discussed in terms of mortality and morbidity. In most studies, the health effects of the relocation of older adults suffering from dementia were negative. A decline in physical, mental, behavioural, and functional well-being was reported. The most recurring effect was a higher level of stress, which is more problematic for patients with dementia. In general, unless it is carefully planned, it is best to avoid changing lives of people with dementia and it is recommended to actively work to reduce their exposure to stress. Discussion and Implications: The outcomes of the study suggest definite evidence for the negative effects of relocation of the older adults. This research aims to be used as the support of the legal and medical decisions of relocation of patients with dementia. (Edited publisher abstract)
What factors influence mental health professionals when deciding whether or not to share a diagnosis of dementia with the person?
- Authors:
- KEIGHTLEY J., MITCHELL A.
- Journal article citation:
- Aging and Mental Health, 8(1), January 2004, pp.13-20.
- Publisher:
- Taylor and Francis
This study investigated what influences mental health professionals when deciding whether or not to tell someone with dementia their diagnosis. A qualitative methodology was employed and the data analysed using grounded theory. Currently people with dementia tend not to be told their diagnosis, despite evidence that sharing diagnostic information can improve psychological well-being and adjustment. Why professionals are reluctant to share diagnostic information with people with dementia is unclear, although the literature raises a number of possibilities. Seven professionals were interviewed (two clinical psychologists and five community psychiatric nurses). The main influence on their disclosure practice was uncertainty about whether the person with dementia would want to know the diagnosis, fuelled by a fear that to tell them if they did not want to know would cause harm. Professionals also expressed a strong sense of both hopelessness and helplessness when confronted with dementia. This was then projected onto the person with dementia, which in turn led to the professionals adopting an overly protective stance towards them. If professionals are to resolve their sense of uncertainty about what the person with dementia wants, in terms of diagnostic information, services need to develop ways in which the views of people with dementia can be heard and start to influence service provision and policy.