[The ethical charter for the elderly in the daily life of GHSIF care providers]. / La charte éthique du grand âge dans le quotidien des acteurs de soin du GHSIF.

The elaboration of a charter of ethics and support for the elderly, drawn up by Fabrice Gzil, places different notions of care at the center of the care of the elderly for those working in the field at the Groupe hospitalier sud Île-de-France (GHSIF). The 10 points presented are implemented on a daily basis. By highlighting these actions, the charter can be appropriated and brought to life in order to provide support adapted to the collective and individual needs of the elderly patients and residents.

Impact of a community health conversation upon advance care planning attitudes and preparation intentions.

Background: Advance care planning conversations and preparations do not occur as frequently as they should. Framing advance care planning as a health behavior and an opportunity for community engagement can help improve community-dwellers' intentions to have discussions and preparations regarding facing serious illness, death and dying.Methods: A multi-setting confidential pre/post paper survey assessing advance care planning discussions and preparation intentions was given to community-dwelling citizens residing in the New York metropolitan area. Survey items were adapted from a previous end of life survey to include questions on chronic illnesses, important conversations, comfort levels and concerns about end of life. The intervention was a 1-hour presentation on advance care planning (importance, laws, effective communication and audience questions)Results: Our study found significant interest in discussing advanced care planning across age groups. There were significant changes for participant intentions regarding: having conversations with loved ones, a health care proxy or similar document and none; as well as differences in participant intentions for discussions with caregiver, family, friends, primary physician and no-one.Conclusion: Educating individuals on the importance of advance care planning may be effective in changing community dwellers' intentions to start the conversation and put advanced care planning measures in place.Abbreviations: ACP: Advance Care Planning; CHAT: Conversations Health and Treatments; EoL: End of Life; HCP: Health Care Proxy; MOLST: Medical Orders for Life-Sustaining Treatments; PCP: Primary Care Physician.

Attitudes toward people with dementia among communication science and disorders students.

The purpose of this study was to: 1) explore attitudes among Communication Sciences and Disorders (CSD) students toward people with dementia, 2) investigate factors that might be associated with the expressed attitudes, and 3) suggest a means for promoting positive attitudes among CSD students. 94 CSD students completed a three-section online survey via Qualtrics. First, participants provided demographic information in three categories: person, courses, and experiences. Second, they completed a 25-item quiz on aging and dementia. Finally, each participant submitted responses to the Scale of Attitude toward People with Dementia. A stepwise regression analysis revealed two factors that best predicted positive attitudes of participants toward people with dementia. The first factor was having completed more courses on gerontology and/or dementia and the second factor was having found the courses beneficial for their future career as speech-language pathologists. The findings of this study imply that providing CSD students with more courses in gerontology and/or dementia may foster more positive attitudes toward people with dementia. These findings indicate that maximum benefit may be achieved by designing courses on gerontology and dementia that include professional practice-oriented activities and assessments.

[Legal questions in geriatric medicine-an overview]. / Rechtsfragen in der Altersmedizin ­ ein Überblick.

As a consequence of demographic developments, legal questions regarding medical treatment of the elderly are receiving increasing attention. In the first instance, elderly patients are of course just normal patients. However, they often require a special degree of medical care from physicians and nurses. From a legal perspective, this leads to a heightened level of due diligence from medical practitioners. Specific legal challenges come into play when dealing with patients who are unable to give consent, or who are subject to personal custody. Additionally, patient's provisions and health care proxies are playing an ever more important role. Thus, an overview of the different legal aspects has become absolutely necessary for medical practitioners.

Ethical issues related to the use of gerontechnology in older people care: A scoping review.

BACKGROUND: Demographic trends indicate growth of population aged 65 and older in Western countries. One of the greatest challenges is to provide high-quality care for all. Technological solutions designed for older people, gerontechnology, can somewhat balance the gap between resources and the increasing demand of healthcare services. However, there are also ethical issues in the use of gerontechnology that need to be pointed out. PURPOSE: To describe what ethical issues are related to the use of gerontechnology in the care of community-dwelling older people. METHODS: A scoping review was performed to identify and analyse studies concerning ethical issues when using gerontechnology in the home care of older people. The literature search was limited to studies published after 1990 and addressed to the electronic databases CINAHL, PubMed, Cochrane, Medic, IEEE Explore and Web of Science. The search was performed in July-August 2018. Data from empirical studies were analysed using thematic analysis. ETHICAL CONSIDERATIONS: This scoping review was conducted in accordance with good scientific practice. The work of other researchers was respected and cited appropriately. RESULTS: A total of 17 studies were identified. Two main themes were found. 'Balancing between the benefits of using gerontechnology and the basic rights of older people', consisted of the subthemes safety, privacy and autonomy. The other main theme, 'Gerontechnology as a risk of insecurity for older people', included the subthemes fear of losing human contact and concern and fear. Surveillance and monitoring technologies were mainly studied. CONCLUSION: These results suggest that there may be ethical issues related to the use of gerontechnology and they must therefore be taken into consideration when implementing technology in the care of community-dwelling older people.

Towards Ethically and Medically Sustainable Care for the Elderly: The Case of China.

An enormous challenge facing China is how to provide sustainable care for its rapidly-increasing elderly population. Its recent policy directives include three medical forms-the institution-cooperation-form, the institution-medical-form, and the family-physician-form-to integrate medical care into ordinary care for the elderly. This essay indicates that China will not be able to maintain sustainable elderly care unless it places emphasis on the family-physician-form that focuses on family physicians and the use of primary care services. The essay constructs arguments for this policy suggestion based on China's long-standing Confucian ethical resources of filial piety and family-based concerns for elderly care.

Negative prompts aimed at maintaining eating independence.

BACKGROUND: Psychological abuse of older people is difficult to recognise; specifically, nursing home residents have been documented to be at higher risk of psychological abuse during daily care, such as during feeding. Healthcare professionals adopt positive and negative verbal prompts to maintain residents' eating independence; however, negative prompts' purposes and implications have never been discussed to date. RESEARCH AIMS: To critically analyse negative verbal prompts given during mealtimes as forms of abuse of older individuals and violation of ethical principles. RESEARCH DESIGN: This is a secondary analysis of three cases of negative prompts that emerged in a large descriptive study based upon focus group methodology and involving 13 nursing homes and 54 healthcare professionals. PARTICIPANTS AND RESEARCH CONTEXT: This study included 3 out of 13 nursing homes caring for residents with moderate/severe functional dependence in self-feeding mainly due to dementia; in these nursing homes, we conducted three focus groups and 13 healthcare professionals participated. ETHICAL CONSIDERATIONS: This study was conducted in accordance with the Human Subject Research Ethics Committee guidelines after being approved by the Review Board of the Trust. FINDINGS: With the intent of maintaining self-feeding independence, negative verbal prompts have been reported as being used by nursing home teams. By critically analysing these negative prompts, it turned out they could trigger intimidation, depression and anxiety and thus could be considered as forms of abuse; moreover, negative prompts can threaten the ethical principles of (1) autonomy using a paternalist approach, (2) beneficence and non-maleficence as with the intent to act in the best interests of residents (to maintain self-feeding independence) they are harmed in their dignity and (3) justice, given that residents who received negative prompts are treated differently from those who received positive prompts. DISCUSSION: Eating should be a pleasant experience with a positive impact on physiological, psychological and social well-being. However, negative prompting can lead to abuse and violation of basic ethical principles, destroying the healthcare professional resident and relative relationships strongly dependent on trust. CONCLUSION: Negative verbal prompting must be avoided.

Medical Overtreatment: Friend or Foe?

"Overtreatment" is a neologism coined some 15 years ago to denote medical and surgical interventions that are unnecessary. It is a topical term for an old concept. However, it has rapidly become a shibboleth for those inclined toward finger-pointing and blaming in matters of health policy. As such, it is a "foe" that heats up rather than modulates debate. But if one examines the notion in the context of the contemporary patient-physician dialogue, it is anything but a foe. Overtreatment and its fellow travelers, overutilization and overprescription, face off with contrary notions when a patient contends with the challenge of evaluating any clinical option.

Supporting ethical use of electronic monitoring for people living with dementia: Social work's role in assessment, decision-making, and review.

Walking outdoors supports health and well-being, but some people living with dementia are at increased risk of getting lost and of harm while missing. Electronic monitoring can potentially play an important preventative role by enabling the person's location to be continuously monitored by caregivers. However, there are considerable ethical concerns arising from electronic monitoring. This paper explores these thematically, drawing attention to its implications for autonomy and liberty; privacy; dignity; the rights and needs of caregivers and families; beneficence and nonmaleficence. Following from this, key questions for consideration in social work assessment are identified. The ethical issues necessitate assessment of the person's unique circumstances and preferences and that of their caregivers, and careful ethical deliberation in decision-making. Social work can play an important role in facilitating inclusive assessment and decision-making, leading to consensus on intervening with electronic monitoring. The need for the ongoing review following implementation is discussed to track whether decisions need modification in light of the experience of usage. In conclusion, while legislative instruments and professional codes of ethics frame social work practice responses, there is need for a nuanced debate about ethical use of electronic monitoring and specific guidance to inform assessment, decision-making, and review.

Operationalising ethical challenges in dementia research-a systematic review of current evidence.

Background: the worldwide number of dementia cases is increasing, and this is a trend that is expected to continue as a growing proportion of the population ages. However, conducting research with persons suffering from dementia can be fraught due to fears surrounding research risks in vulnerable populations. This can make seeking approval for studies difficult. As research directly involving persons with dementia is key for the development of evidence-based best practice, the development of a coherent ethical strategy to perform such research feasibly and effectively is of paramount importance. Objective: this paper aims to review and synthesise ethical challenges in performing research with persons who have dementia. Methods: in undertaking a systematic review of the current research literature, we will identify the central issues and arguments characterising research that concerns the ethical dimensions of research participation in the dementia population. Data were analysed using both inductive and deductive content analysis. Ethical considerations in research involving persons with dementia primarily concern the representation of the interests of the person with dementia and protection of their vulnerabilities and rights. Results: a total of 2,894 results were returned from initial searches, following deduplication. In total, 2,458 were excluded at title review, and following abstract review 158 papers remained; 29 papers were included for analysis after full paper review and data extraction. Papers ranged between 1995 and 2013. Conclusion: this review has highlighted a lack of consensus in current research and guidelines addressing these concerns; a clear stance on ethical governance of studies is important for future research and best evidence-based practice in dementia.

Serving the Very Sick, Very Frail, and Very Old: Geriatrics, Palliative Care, and Clinical Ethics.

How can we provide the best care for growing numbers of very frail, very sick, or very old people? The disciplines of geriatrics, palliative care, and clinical ethics each have a good deal to offer to improve care for elders, yet each field is saddled with heavy historical baggage. Using a case as a springboard, we address specific strengths and shortcomings of each field, and what these disciplines can learn from each other. Geriatrics is currently largely focused on prevention of disability, cognitive impairment, and death; it should reorganize around a palliative approach to providing care for elders living with multiple chronic conditions, disability, and dementia. Palliative care, while paying some attention to the spectrum of advanced illness, concentrates primarily on cancer; it should expand its central purpose to include providing supportive care to elders with serious illness and their caregivers. Ethics committee members and consultants principally stress individual autonomy; they need to expand their approach and develop longitudinal relationships with patients and family members, routinely incorporating them in deliberations and the crafting of recommendations. However, improving these three disciplines will only go so far toward improving the care of very frail, very sick, or very old people. What is most needed is longitudinal care provided by interdisciplinary primary care teams steeped in the core principles of all three disciplines.

[Not Available]. / Il consenso informato in Terapia Occupazionale: proposta di una modulistica.

UNLABELLED: The legislative developments that led to the Three-year Degree of the Health Professions poses any health professional in the position of having to comply with the ethical and legal duty to obtain valid informed consent from the patient prior to treatment. In the present work, attention was focused on the figure of the occupational therapist. MATERIALS AND METHODS: Informed consent forms have been developed according to the specific disease from which the patient undergoing occupational therapy is affected. The following categories of sick were identified: amputation, developmental age, orthopedy, spinal cord injury, neurology, psychiatry, geriatry and oncology. RESULTS AND CONCLUSION: The consent forms are particularly well suited to obtaining valid consent from the patient and, at the same time, allow the occupational therapist to obtain all the information he/she needs to carry out the treatment in safety. This results improved patient compliance to therapy by facilitating a better empathic relationship with the therapist.

Culture, compassion and clinical neglect: probity in the NHS after Mid Staffordshire.

Speaking of the public response to the deaths of children at the Bristol Royal Infirmary before 2001, the BMJ commented that the NHS would be 'all changed, changed utterly'. Today, two inquiries into the Mid Staffordshire Foundation Trust suggest nothing changed at all. Many patients died as a result of their care and the stories of indifference and neglect there are harrowing. Yet Bristol and Mid Staffordshire are not isolated reports. In 2011, the Health Services Ombudsman reported on the care of elderly and frail patients in the NHS and found a failure to recognise their humanity and individuality and to respond to them with sensitivity, compassion and professionalism. Likewise, the Care Quality Commission and Healthcare Commission received complaints from patients and relatives about the quality of nursing care. These included patients not being fed, patients left in soiled bedding, poor hygiene practices, and general disregard for privacy and dignity. Why is there such tolerance of poor clinical standards? We need a better understanding of the circumstances that can lead to these outcomes and how best to respond to them. We discuss the findings of these and other reports and consider whether attention should be devoted to managing individual behaviour, or focus on the systemic influences which predispose hospital staff to behave in this way. Lastly, we consider whether we should look further afield to cognitive psychology to better understand how clinicians and managers make decisions?

Novel ethical dilemmas arising in geriatric clinical practice.

The purpose of this study is to determine empirically the state of the art of the medical care, when healthcare personal is confronted with ethical dilemmas related with the care they give to the geriatric population. An observational, longitudinal, prospective and qualitative study was conducted by analyzing the correlation between healthcare personnel-patient relationship, and ethical judgments regarding dilemmas that arise in daily clinical practice with geriatric patients. Mexican healthcare personnel with current active practices were asked to write up an ethical dilemma that arose frequently or that had impacted their medical practice. From the narrative input, we were able to draw up a database with 421 dilemmas, and those corresponding to patients 60 years and older were selected (n = 54, 12.8 %). The axiological analysis of the narrative dilemmas of geriatric patients was made using dialectical empiricism. The axiological analysis values found most frequently were classified into three groups: the impact of healthcare, the roles of the physician, and refusal of therapy; the healthcare role of educator, caring for the patients' life and the risk of imminent death where the values found more often. The persistence and universality of certain dilemmas in geriatrics calls for awareness and requires a good training in the ethical discernment of these dilemmas. This would help to improve substantially the care and the life quality of this population.

Crossing boundaries: the design of an interdisciplinary training program to improve care for the frail elderly.

The Technology Evaluation in the Elderly Network (TVN) was funded in July 2012 under the Canadian Networks of Centres of Excellence program. This article highlights the development and preliminary evaluation of the TVN Interdisciplinary Training Program. This program is based on an experiential learning approach that crosses a multitude of disciplines including health sciences, law, social sciences, and ethical aspects of working with the frail elderly. Opportunities within the program include mentorship, interdisciplinary online collaborative projects, external placements, academic products, pre-grant submission, trainee-driven requirements, Network meetings, online modules/webinars, and most importantly active involvement with patients, families, and their support systems. The authors have 120 trainees from approximately 23 different disciplines including law, ethics, public policy, social work, and engineering engaged in the program. Based on our evaluation this program has been perceived as highly valuable by the participants and the community.

Ethical and legal aspects of anaesthesia for the elderly.

The elderly have the ethical and legal equivalence of younger adults, yet are treated differently by society. Numerous recent reports have exposed poor inpatient care resulting in part from institutional ageism, which has moral and legal implications for healthcare providers. Morally, there is an argument for positive 'exceptionalism' in elderly peri-operative care, pursuing quality improvement through use of a dignity agenda. Legally, numerous changes in human rights, equality, consent, capacity, and end-of-life laws and professional guidance have consistently re-emphasised the need for greater communication between doctors, patients, their relatives and carers. This review describes current ethical thinking and legal precedent (in England and Wales), and directs readers to consider areas in which the law might change in the near future, particularly with regard to the end-of-life care of elderly surgical patients.

[The personality of the doctor as a corner stone in the temple of gerontology].

The fundamentals of gerontology are not fundamental science and not dialectical materialism, but, in our opinion, particularly respect for elders. The very same attitude toward the elderly in the society has changed to the best party not so long ago, when the material ability had appeared to adequately support the elderly and implement the monotheistic values, such as the value to God of every life. Thanks to the presence in St. Petersburg at 1889 year well-organized places for medical care of oldster professor S. P. Botkin was able to implement the world's first large-scale complex research of old age, surveyed more than two thousand old people. Today's liberal model of providing education without upbringing is fraught with the most terrible consequences. We must not forget a number of artifacts in medicine, when the doctor in different civilizations ignored the Hippocratic Oath. These are Josef Mengele and Karl Brandt, the physicians of "Unit 731", Leiba Shatunovskii, the doctors of the clinic "Medicus", and many others. These facts force to carefully scrutinize the current time. So in the British newspapers the information appear about the dead from hunger and thirst old people in expensive nursing homes. It seems necessary to go back to the moral roots of medicine. The pride of the Russian medicine is a life-physician Eugene S. Botkin, who ascended to Calvary with his crowned patient, Emperor Nicholas II, because he could not change his word of honor. Thus, in the Russian tradition, glorious Hippocratic writings oath strengthened by noble honor. Knight code of the Russian nobleman, described us as "4D" (in Russian): duty, virtue, goodness and leisure, is the best formula for education and self-improvement noble doctor. Thus, it is proposed to pay attention to the unity of education and upbringing in preparing the next generation of doctors, which should strengthen the guarantees of the preservation of high moral relations to the old people and gains of fundamental gerontology.

Substitute consent practices in the face of uncertainty: a survey of Canadian researchers in aging.

BACKGROUND: In Canada and elsewhere, research policies require researchers to secure consent from a legally authorized representative (LAR) for prospective participants unable to consent. Few jurisdictions, however, offer a clear legislative basis for LAR identification. We investigated Canadian researchers' practices regarding the involvement of decisionally incapacitated participants and tested whether reported practices were associated with (1) researchers' understanding of the law on third-party authorization of research and (2) their comfort with allowing a family member to consent on behalf of an incapacitated relative. METHODS: We surveyed researchers in aging from four Canadian provinces about their practices with prospective participants deemed incapable of consent, their understanding of relevant law, and comfort with family consent for research purposes. Understanding and comfort were measured with research vignettes that briefly described hypothetical studies in which an adult who lacks the capacity to consent was invited to participate. RESULTS: Many respondents reported soliciting consent from a family member (45.7% for low-risk studies and 10.7% for serious risks studies), even in jurisdictions where such authority is uncertain at law. Researchers' tendency to solicit family consent was associated with their comfort in doing so, but not with their understanding of the law on substitute consent for research. CONCLUSIONS: Findings underscore the need to clarify who may authorize an incapacitated adult's participation in research. Meanwhile, people should inform their relatives of their desire to participate or not in research in the event of incapacity, given researchers' tendency to turn to family for consent, even where not supported by law.