Participation of Chronically Ill Older Adults in Their Life-Prolonging Treatment Decisions: Rights and Opportunity

1998 ◽  
Vol 17 (1) ◽  
pp. 1-23 ◽  
Author(s):  
Sarah Shidler
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Decision Making ◽  
Clinical Practice ◽  
Older Adult ◽  
Chronically Ill ◽  
Treatment Decisions ◽  
The Individual ◽  
The Right ◽  
Legal Guidelines

ABSTRACTThe right of the individual to participate in her life-prolonging treatment decisions, either as a decision maker or by having her treatment wishes used as a decision-making criterion, is the result of an evolution in legal guidelines over the last two decades. Although necessary, these legal guidelines are however not sufficient to assure the individual's opportunity to participate. For the chronically ill older adult residing in a health care institution, the opportunity to participate in decisions concerning life-prolonging treatments implicitly depends on the effective communication among three key actors (the individual, her physician, and her proxy). The necessity of this communication has important implications for clinical practice and future empirical research.

“The Right to Make Choices”: The National Resource Center for Supported Decision-Making

Inclusion ◽  
2015 ◽  
Vol 3 (1) ◽  
pp. 24-33 ◽  
Author(s):  
Peter Blanck ◽  
Jonathan G. Martinis
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Decision Making ◽  
Daily Life ◽  
Self Determination ◽  
Life Choices ◽  
Resource Center ◽  
Independent Life ◽  
The Right ◽  
National Resource

Abstract Research shows that self-determination and the right to make life choices are key elements for a meaningful and independent life. Yet, older adults and people with disabilities are often placed in overly broad and restrictive guardianships, denying them their right to make daily life choices about where they live and who they interact with, their finances, and their health care. Supported decision-making (SDM)—where people use trusted friends, family members, and professionals to help them understand the situations and choices they face, so they may make their own decisions—is a means for increasing self-determination by encouraging and empowering people to make decisions about their lives to the maximum extent possible. This article examines the implications of overly broad guardianship and the potential for supported decision-making to address such circumstances. It introduces the National Resource Center for Supported Decision-Making as one means to advance the use of supported decision-making and increase self-determination.

scholarly journals The effectiveness of an educational project using older adult volunteers for training primary care nurse practitioners in geriatric assessment

2019 ◽  
Vol 10 (3) ◽  
pp. 51
Author(s):  
Jennifer M. Hackel ◽  
Teresa M. Eliot Roberts
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Health Care ◽  
Clinical Practice ◽  
Older Adult ◽  
Geriatric Assessment ◽  
Primary Care Providers ◽  
Care Nurse ◽  
Primary Care Nurse ◽  
Adult Volunteers

This article reports on the effectiveness of a pilot project, where older adult volunteers attending college campus programs were recruited to act as mock patients (MP) in a two-hour clinical simulation experience for primary care nurse practitioner (NP) students learning about geriatric assessment. Primary care providers, such as NPs, study variable content on geriatrics and see older adults in their primary care clinical practica yet report they desire more time in their training to practice geriatric assessment techniques, apply clinical practice recommendations, and discuss broader aspects of cases being managed by NPs within the interdisciplinary team. Utilization of live models acting as MPs with small groups of students acting as one provider is one way in which health care trainees can take more time to learn from each other as well as the models in the simulated clinical setting. The professor wrote a hypothetical case study based on clinical practice experience that either a male or female volunteer retiree could play as the MP. The case was a 75-year-old retiree with multiple other chronic conditions, on multiple medications, presenting with acute on chronic fatigue. Of the 48 students who participated, 47 returned surveys. Aggregate scores indicated an overall effectiveness of 88% across multiple aspects of geriatric primary care. Qualitative data indicated that the NP students would like more such cases in which they get more lead time with the case information to consider the myriad factors at play and have smaller groups of students per MP. The older adults who volunteered as MPs reported overwhelmingly that they found participating in the students’ education to be rewarding and a chance to offer input about improvement in the care of older adults in the current health system in our aging society. There was consistent feedback that the program should be continued and enhanced. The case content is offered in this article for use by other health care professionals who educate trainees in primary care.

scholarly journals Effects of Age, Mental Health, and Comorbidity on the Perceived Likelihood of Hiring a Healthcare Advocate

2016 ◽  
Vol 14 (3) ◽  
pp. 45-57 ◽  
Author(s):  
Symone A. McKinnon ◽  
Breanna M. Holloway ◽  
Maya S. Santoro ◽  
April C. May ◽  
Terry A. Cronan
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Older Adult ◽  
Health Care Professionals ◽  
Health Care Services ◽  
Chronically Ill ◽  
Cognitive Disorder ◽  
Medical Conditions ◽  
Care Services ◽  
System Method

Background and Purpose: The projected increase in chronically ill older adults may overburden the healthcare system and compromise the receipt of quality and coordinated health care services. Healthcare advocates (HCAs) may help to alleviate the burden associated with seeking and receiving appropriate health care. We examined whether having dementia or depression, along with hypertension and arthritis, or having no comorbid medical conditions, and being an older adult, affected the perceived likelihood of hiring an HCA to navigate the health care system. Method: Participants (N = 1,134), age 18 or older, read a vignette and imagined themselves as an older adult with either a mood or cognitive disorder, and comorbid medical conditions or as otherwise being physically healthy. They were then asked to complete a questionnaire assessing their perceived likelihood of hiring an HCA. Results: Participants who imagined themselves as having dementia reported a greater likelihood of hiring an HCA than participants who imagined themselves as having depression (p < .001). Conclusion: It is imperative that health care professionals attend to the growing and ongoing needs of older adults living with chronic conditions, and HCAs could play an important role in meeting those needs.

scholarly journals Decision-making capacity in adults: its assessment in clinical practice

2001 ◽  
Vol 7 (4) ◽  
pp. 294-301 ◽  
Author(s):  
John Bellhouse ◽  
Anthony Holland ◽  
Isobel Clare ◽  
Michael Gunn
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Medical Treatment ◽  
Self Determination ◽  
Refusal Of Treatment ◽  
Decision Making Capacity ◽  
English Law ◽  
The Individual ◽  
The Right

In English Law, an adult has the right to make decisions affecting his or her own life, whether the reasons for that choice are rational, irrational, unknown or even non-existent. This right remains even if the outcome of the decision might be detrimental to the individual (Re T (Adult: Refusal of Treatment), 1992) or to a viable foetus (Re S (Adult: Refusal of Medical Treatment), 1992). However, such a right to self-determination is meaningful only if the individual is appropriately informed, has the ability (capacity) to make the decision and is free to decide without coercion (Grisso, 1986).

scholarly journals Starting an Older Adult Lecture for First Semester Nursing Students With a Truth or Myth Game

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 14-14
Author(s):  
Lynn Brown ◽  
Pao-feng Tsai
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Nursing Students ◽  
Older Adult ◽  
Care Needs ◽  
Final Exam ◽  
Negative Stereotypes ◽  
First Semester ◽  
Positive Attitudes ◽  
New Information

Abstract False ideas about the physical and psychosocial characteristics of older adults exist in America. It is especially important that nurses are not susceptible to myths and stereotypes as these myths can affect the quality of patient care. For example, some people stereotype older adults as forgetful, disabled, ill, and unable to understand new information. Misconceptions and negative stereotypes are also present in first year nursing students. It is vital that students assess their own attitudes about older adults to form positive attitudes and gain knowledge about aging and health care needs. To achieve this goal, the older adult lecture in a first semester theory and fundamental course begins with a PowerPoint slide presentation asking students to distinguish truths and myths. The truth or myth topics include a) developmental tasks; b) common physiological changes; c) a comparison of delirium, dementia, and depression; and d) addressing health concerns of older adults. Active discussion follows the activity. Seventy to ninety percent of students correctly answered nine of ten questions related to older adult content on the final exam. Considering the increasing number of older adults in the health care setting, nurse educators must dismantle negative stereotypes with creative teaching strategies.

scholarly journals Plain Language Summary: Opioid Prescribing for Analgesia After Common Otolaryngology Operations

2021 ◽  
Vol 164 (4) ◽  
pp. 704-711
Author(s):  
Samantha Anne ◽  
Sandra A. Finestone ◽  
Allison Paisley ◽  
Taskin M. Monjur
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Clinical Practice ◽  
Pain Management ◽  
Health Care Providers ◽  
Clinical Practice Guideline ◽  
Shared Decision ◽  
Care Providers ◽  
Plain Language ◽  
Opioid Prescribing

This plain language summary explains pain management and careful use of opioids after common otolaryngology operations. The summary applies to patients of any age who need treatment for pain within 30 days after having a common otolaryngologic operation (having to do with the ear, nose, or throat). It is based on the 2021 “Clinical Practice Guideline: Opioid Prescribing for Analgesia After Common Otolaryngology Operations.” This guideline uses available research to best advise health care providers, and it includes recommendations that are explained in this summary. Recommendations may not apply to every patient but can be used to facilitate shared decision making between patients and their health care providers.

scholarly journals Understanding the perspectives of older adults and elderly regarding vaccination; a snapshot in four European countries

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
A Timen ◽  
R Eilers ◽  
S Lockhart ◽  
R Gavioli ◽  
S Paul ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Decision Making ◽  
Infectious Diseases ◽  
Health Care Professionals ◽  
Elderly Care ◽  
European Countries ◽  
Decision Making Process ◽  
Ageing Population ◽  
Syncytial Virus

Abstract Prevention of infectious diseases in elderly by immunization is a prerequisite to ensuring healthy ageing. However, in order for the vaccine programs to be effective, these need to be provided by health care professionals who have up-to-date knowledge and high motivation. Furthermore, the knowledge and attitudes towards vaccination in the targeted age groups needs to be fully understood. When focusing on the information provision, it is important to know from whom or which institution older adults and elderly would like to receive and in which form. In January 2019, an international project called the VITAL (The Vaccines and InfecTious diseases in the Ageing population) project was started, within the framework of IMI (Innovative Medicines Initiatives). One of the goals of the VITAL project is to develop strategies to educate and train health care professionals (HCPs) and to promote awareness among stakeholders involved in elderly care management. We briefly focus on the results of studies undertaken in four European countries (Italy, France, The Netherlands and Hungary), which reveal the perspective of older adults and elderly regarding influenza, pneumococcal, herpes zoster vaccination and respiratory syncytial virus (RSV) as well as generic characteristics of the vaccines and diseases. We will show how attitudes towards vaccination are represented in our study population and which determinants influence the decision-making process of accepting vaccination. Furthermore, we shall elaborate on how the decision-making process towards vaccination takes place and which additional information is needed. In the second part of the session, we shall invite the audience to reflect on the findings and identify the factors they consider most important for setting up a training and education programme on vaccination.

scholarly journals Methodological Development of Mathematical Modeling Techniques in Health Care

2020 ◽  
Vol 9 (3) ◽  
pp. 3339-3342
Keyword(s):  
Mathematical Modeling ◽  
Health Care ◽  
Decision Making ◽  
Health Economics ◽  
Service Planning ◽  
Optimal Decision ◽  
Optimal Decision Making ◽  
The Individual ◽  
Specific Modeling ◽  
Health Care Application

The advancement of mathematical model has utilized for simulating the output of medical is a development area over medicine whereas the modeling can be mentioned with several activities namely simulation or decision analysis and predictive modeling. However, the traditional modeling technique utilized in planning of health service, assessment reports and its efficiency, financing about health care and assessment in budget impact, assessment in health economics, surveillance of infectious disease and other health care application. Therefore, the mathematical modelling is performed as a frequent and timely benefit in order to make rapid decision making while facing investigation with several issues like time elapsing, unusual and unethical particularly projected for future. This paper focused in applying the mathematical modeling to accomplish an optimal decision making in healthcare whereas this study discuss about the specific modeling concepts namely decision tree and fuzzified rule tables on evaluation of health economics and better service planning that my replicate the individual experience or patients cohorts.

Designing and Implementing a Comprehensive Telehealth Aural Rehabilitation Program for Adult Cochlear Implant Recipients

2021 ◽  
pp. 1-9
Author(s):  
Cornetta L. Mosley
Keyword(s):  
Older Adults ◽  
Health Care ◽  
Cochlear Implants ◽  
Older Adult ◽  
Health Care Professionals ◽  
Rehabilitation Program ◽  
Perceptual Training ◽  
Aural Rehabilitation ◽  
Additional Information ◽  
The University

Purpose A comprehensive aural rehabilitation (AR) program incorporates sensory management, perceptual training, counseling, and instruction. However, the process of designing and implementing such a program is inconsistent across clinical sites, and additional information regarding the use of teleaudiology to implement AR services is needed. The purpose of this clinical focus article is to describe the process of creating and implementing a comprehensive teleaudiology AR program for older adults who use cochlear implants (CIs) at the University of South Alabama (USA) Speech & Hearing Center. Conclusions A comprehensive teleaudiology AR program may be successfully designed and implemented for older adult populations. Information provided in this clinical focus article may serve as a guide or example for other trained health care professionals looking to create an in-person or telehealth AR program for older adults who use CIs. Supplemental Material https://doi.org/10.23641/asha.16755289

Better Knowledge for Better Health Services

2011 ◽  
pp. 233-255
Author(s):  
Stefano De Luca ◽  
Enrico Memo
Keyword(s):  
Data Mining ◽  
Health Care ◽  
Clinical Practice ◽  
Disease Management ◽  
Hidden Markov Models ◽  
Practice Guidelines ◽  
Markov Models ◽  
Hidden Markov ◽  
The Right ◽  
The Given

The expenses in Health Care are an important portion of the overall expenses of every country, so it is very important to determine if the given cares are the right ones. This work is about a methodology, Health Discoverer, and a consequent software, aimed to disease management and to the measure of appropriateness of cares, and in particular is about the data mining techniques used to verify Clinical Practice Guidelines (CPGs) compliance and the discovery of new, better guidelines. The work is based on Quality Records, episode parsing using Ontologies and Hidden Markov Models.

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