Issues of Capacity and Decision-Making in the Context of Delirium

2015 ◽  
Vol 24 (4) ◽  
pp. 140-145
Author(s):  
Kevin R. Patterson
Keyword(s):  
Decision Making ◽  
Patient Autonomy ◽  
Care Setting ◽  
Cognitive Change ◽  
Treatment Team ◽  
Precipitating Factors ◽  
Term Care ◽  
Decision Making Capacity ◽  
Fundamental Consideration

Decision-making capacity is a fundamental consideration in working with patients in a clinical setting. One of the most common conditions affecting decision-making capacity in patients in the inpatient or long-term care setting is a form of acute, transient cognitive change known as delirium. A thorough understanding of delirium — how it can present, its predisposing and precipitating factors, and how it can be managed — will improve a speech-language pathologist's (SLPs) ability to make treatment recommendations, and to advise the treatment team on issues related to communication and patient autonomy.

scholarly journals The Decision-Making and Communication Capacities of Older Adults with Dementia: A Population-Based Study

2014 ◽  
Vol 8 (1) ◽  
pp. 17-24 ◽  
Author(s):  
Kazuko Mitoku ◽  
Setsu Shimanouchi
Keyword(s):  
Older Adults ◽  
Decision Making ◽  
Long Term Care ◽  
Population Based ◽  
Term Care ◽  
Daily Lives ◽  
People With Dementia ◽  
Decision Making Capacity ◽  
One Year

The present study assessed the decision-making and communication capacities of older adults with dementia who required assistance and care and measured the subsequent changes in these capacities. Of 845 older adults who received long-term care between April 2003 and December 2004, about half of them without dementia were excluded and the remaining 448 were finally included in the analyses. These individuals were completed follow-up for assessment for two years. The data were obtained from the Long-Term Care Insurance Certification Committee for Eligibility in Gujo City. A total of 73.7% of people with dementia were somewhat capable of making decisions (32.4% were reported as being “always capable”; 41.3% were reported as being “sometimes capable”). A total of 93.7% were somewhat capable of communicating with others (78.3% were reported as being “always capable”; 15.4% were reported as being “sometimes capable”). The results indicate that older adults with dementia can participate in their own care decisions, even if they require assistance and support in their daily lives. The present study shows, however, that baseline decision-making capacity declined to about half what they were after one year and to about one-third of what they were after two years, suggesting that earlier efforts are needed to ensure that the preferences of individuals with dementia are reflected in their care.

Legal Issues

2021 ◽  
pp. 85-110
Author(s):  
Thaddeus M. Pope
Keyword(s):  
Decision Making ◽  
Life Insurance ◽  
Assisted Suicide ◽  
Long Term Care ◽  
Legal Issues ◽  
Term Care ◽  
Insurance Policies ◽  
Decision Making Capacity ◽  
Significant Barrier

This chapter clarifies the legality of VSED for patients, families, and clinicians. Both clinicians and medical societies widely perceive VSED to be legal. While there continues to be variability, particularly in long-term care settings, legal uncertainty is generally not a significant barrier when the patient has decision-making capacity. Courts have repeatedly authorized VSED, and VSED falls squarely within broader, well-settled rights to refuse treatment and care. After establishing a patient’s right to VSED and a clinician’s correlative duty to honor that choice, the chapter explains why VSED probably does not constitute (1) the crime of assisted suicide, (2) the neglect of a vulnerable adult, or (3) a basis to invalidate life insurance policies. The chapter concludes by noting that while clinicians may have affirmative duties to discuss VSED, they also have rights to conscientiously object to participating.

Advance Care Planning by Proxy for Residents of Long-Term Care Facilities Who Lack Decision-Making Capacity

2002 ◽  
Vol 50 (4) ◽  
pp. 761-767 ◽  
Author(s):  
Ladislav Volicer ◽  
Michael D. Cantor ◽  
Arthur R. Derse ◽  
Denise Murray Edwards ◽  
Angela M. Prudhomme ◽  
...  
Keyword(s):  
Decision Making ◽  
Advance Care Planning ◽  
Long Term Care ◽  
Care Planning ◽  
Term Care ◽  
Decision Making Capacity ◽  
Care Facilities ◽  
Advance Care

Assessing the Need for Decision-Making Capacity Education in Hospitals and Long Term Care (LTC) Settings

2008 ◽  
Vol 34 (5) ◽  
pp. 359-371 ◽  
Author(s):  
Andrea K. Shreve-Neiger ◽  
Christi M. Houston ◽  
Kimberly A. Christensen ◽  
Frederick J. Kier
Keyword(s):  
Decision Making ◽  
Long Term Care ◽  
Term Care ◽  
Decision Making Capacity

scholarly journals Using a multidisciplinary approach to reveal decision-making capacity within acute care for an individual with aphasia

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110270
Author(s):  
Ruth Maxwell ◽  
Michelle O’Brien ◽  
Deirdre O’Donnell ◽  
Lauren Christophers ◽  
Thilo Kroll
Keyword(s):  
Decision Making ◽  
Multidisciplinary Team ◽  
Team Approach ◽  
Term Care ◽  
Multidisciplinary Team Approach ◽  
Decision Making Capacity ◽  
Health And Social Care ◽  
Functional Assessments ◽  
Health Nursing ◽  
Communication Approach

Formal assessments of cognition that rely on language may conceal the non-linguistic cognitive function of people with aphasia. This may have detrimental consequences for how people with aphasia are supported to reveal communicative and decision-making competence. This case report demonstrates a multidisciplinary team approach to supporting the health and social care decision-making of people with aphasia. The case is a 67-year-old woman with Wernicke’s type aphasia. As the issue of long-term care arose, the speech and language therapist used a supported communication approach with the patient who expressed her wish to go home. A multidisciplinary team functional assessment of capacity was undertaken which involved functional assessments and observations of everyday tasks by allied health, nursing, catering and medical staff. In this way, the patient’s decision-making capacity was revealed and she was discharged home. A collaborative multidisciplinary team approach using supported communication and functional capacity assessments may be essential for scaffolding the decision-making capacity of people with aphasia.

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