Do Indigenous Australians age prematurely? The implications of life expectancy and health conditions of older Indigenous people for health and aged care policy.

OBJECTIVE: To assess whether Indigenous Australians age prematurely compared with other Australians, as implied by Australian Government aged care policy, which uses age 50 years and over for population-based planning for Indigenous people compared with 70 years for non-indigenous people. METHODS: Cross-sectional analysis of aged care assessment, hospital and health survey data comparing Indigenous and non-indigenous age-specific prevalence of health conditions. Analysis of life tables for Indigenous and non-indigenous populations comparing life expectancy at different ages. RESULTS: At age 63 for women and age 65 for men, Indigenous people had the same life expectancy as non-indigenous people at age 70. There is no consistent pattern of a 20-year lead in age-specific prevalence of age-associated conditions for Indigenous compared with other Australians. There is high prevalence from middle-age onwards of some conditions, particularly diabetes (type unspecified), but there is little or no lead for others. CONCLUSION: The idea that Indigenous people age prematurely is not well supported by this study of a series of discrete conditions. The current focus and type of services provided by the aged care sector may not be the best way to respond to the excessive burden of chronic disease and disability of middle-aged Indigenous people.

[The current situation regarding guarantees of legal rights to social welfare and nursing care in Japan: based on an analysis of adjudications spanning the period 1960 to 2005].

PURPOSE: To clarify whether people who need social care are legally guaranteed a "right to receive nursing-care services" as a living right in Japan. METHOD: Using the database "Judicial Information System on CD-ROM" and journals which cover judicial precedents, such as "Supreme Court Reports" and "Judicial Reports", we searched for adjudications from 1960 to 2005 with 'living rights' as key words. The complete content of these adjudications was ascertained by reference to the journals. We then assessed whether a "right to receive nursing-care services" was specifically discussed in each of the adjudications by determining how the courts interpreted Article 25 of the Constitution in the verdicts and whether or not there was specific discussion of legal rights in each case. RESULTS: Of 210 adjudications extracted from the database, 23 (11.0%) specifically discussed the right to some sort of social security. No specific reference was made in the remaining 187 decisions (89.0%), and plaintiffs' claims were rejected. Whereas the "right to nursing care" was specifically discussed in no decisions before 1992, it was discussed in 4 decisions (40.0%) from 1993 onwards, resulting in plaintiffs' demands being partly granted. The content of the decisions covered issues that included anxiety about future nursing care, the practice of nursing homes of placing several elderly people in one room, ill-defined standards and low pay for home nursing-care workers, provision of nursing-care services based on the assumption that nursing care would be provided by family members, and self-determination and independence of the severely handicapped. CONCLUSION: A "right to receive nursing-care services" has not been fully guaranteed in the legal sense. However, such a right, included as a living right, is a primary right with a constitutional basis. Although this right has been specifically discussed in only a minority of adjudications, there has been a recent tendency for more emphasis. Both elderly and handicapped persons, as well as caregivers, need to raise their consciousness about "right to receive nursing-care services" as a human right. It is necessary to assess the use of services and the quality of nursing care in understanding actual needs. The development and operation of a legal system which guarantees the rights of the elderly and handicapped is absolutely imperative.

Covert medication in older adults who lack decision-making capacity.

Any mentally competent adult has the right to give or refuse consent to treatment or nursing intervention. The ethical principle underpinning this free choice is respect for autonomy, and the nurse's professional duty to respect the decision of the patient is enshrined within the NMC's Code of Conduct (NMC, 2008). Capacity is paramount to consent and problems arise in practice when the patient is deemed to lack capacity. In this instance, the provisions of the code of practice of the Mental Capacity Act apply (2005). The aim of this article is to present the issues that arise when patients lack decision-making capacity, especially in relation to older adults with dementia who lack the capacity to consent to medication, as well as the covert administration of medication. In relation to consent and covert administration, the nurse is required to balance respect for the patient's autonomy with their desire to act beneficently and in a non-maleficent manner and emphasis will be given to these underlying ethical principles throughout the article.