Obtaining informed consent in the teaching nursing home.

The authors observed attempts to obtain informed consent for clinical research at the Jewish Institute for Geriatric Care. One study entailed the use of venipuncture, urine collections, urethral catheterizations, and antibiotic therapy. The other required that venipunctures and lumbar punctures be performed on dementia patients. Patients and families were observed to be unwilling to consent to any procedure more invasive than venipuncture. Poor recall and other physical and psychologic factors impaired comprehension of the protocols, and some patients requested second opinions from trusted "others." Written consent could be refused despite verbal consent. Furthermore, incompetent patients could refuse to participate in protocols for which family members had given consent. The implications of these observations are discussed. Despite concerns, which are enumerated, it is concluded that informed consent can be obtained in the teaching nursing home.