Legal Issues

Interface of Law and Psychiatric Problems in the Elderly.

Caring for older adults with multiple myeloma during the COVID-19 Pandemic: Perspective from the International Forum for Optimizing Care of Older Adults with Myeloma

Introduction: Nurse managers (NM) face ongoing ethical issues when they work with older adults in long-term care settings (LTCS), including around end-of-life care. Legislation and healthcare ethics guide the provision of ethical care to older adults in a changing societal and global context. Research Aim: Our aim was to describe the ethical issues encountered by NMs. Methods: This qualitative study involved 23 NMs from seven randomly selected organisations who participated in semistructured focus group interviews in 2021. We analysed the data using inductive content analysis. Ethical Considerations: The subject of this study was sensitive and reflected the participants' individual views. They provided informed consent and their anonymity was guaranteed. Results: Ethical issues faced by NMs are related to residents' rights to self-determination, ethical decision-making about staff and procedures, providing ethical leadership despite having conflicting roles, and defending ethics in LTCS on a societal level. NMs struggled to spend sufficient time supporting their staff during everyday care. Conclusions: The ethical issues encountered by NMs are multidimensional and have both external and internal causes. NMs often deal with ethical issues on their own. Structuring their roles so that they can focus more on daily care could help NMs to provide more effective leadership and get more involved in their organisation's decision-making. Further research into the impact of NMs' backgrounds on their performance and responsibilities could provide new insight which would be useful in educating NMs and designing relevant organisational structures. Implications for Nursing Management: Our research can be applied to practice, policy, education and research. Practice: NMs' daily work should be organised in a way that enables them to work closely with residents and staff. Reducing their secondary tasks could increase the time available to manage staff and provide individual coaching for those with different independent abilities. Being present during daily care would make it easier to deal with ethical issues in a timely manner, which could reduce staff's moral distress and increase their well-being at work. Policy: Understanding the importance of the role of NMs could help policy makers in planning LTCS care. Involving NMs in decision-making in organisations and society could increase awareness about the relevant ethical issues and improve the care that residents receive and the well-being of staff and new members. For example, how many employees a single NM can manage could be defined in the same way as the number of staff per resident has been determined. Implementing ethics committees in LTCS could provide a mechanism for considering the views of NMs. Education: Ethical issues in the care of older adults should be included in the curriculum of those studying for the profession. Ethical issues change over time as the world around them changes. Addressing ethical issues should be a continuous theme in continuing education for relevant workers. Research: This qualitative study gave a voice to LTCS NMs in a society with a rapidly ageing population and labour shortages. Ethical issues faced by NMs were related to implementation of nursing and healthcare values in the daily care of residents. In the future, generalisable knowledge is needed about what is the ethical climate in LTCS workplaces, and what is the role of NMs' and care workers' ethical competencies and attitudes towards ageing when performing daily care in the LTCS. In addition, it is noteworthy that the ethical issues' NMs faced were related to policy decisions made in the surrounding society, and NMs felt they had no power or ability to influence on them. In the future, more knowledge is needed to understand how NMs in LTCS, but also in other areas of nursing, identify and consider their role in ethical issues related to health policy.

Ramifications of Diminished Capacity

Physical and cognitive decline in old age often put the autonomy of older adults at risk. A comorbid mental illness is likely to further compound this problem, increasing their dependency on those around them. A key issue encountered in the clinical care of older adults is respecting their autonomy, while also ensuring their overall well-being. This chapter describes important ethical and medicolegal concepts relevant to the care of older adults. The first section of the chapter examines the role of a geriatric psychiatrist across health-care systems and models of care. The next section describes the commonly encountered task of assessing the decision-making capacity of older adults across domains of health care, finances, independent living, driving, and sexual relations. This is followed by a discussion of medicolegal issues germane to the older adult, which includes the concepts of advance care planning, surrogate decision-making, as well as the assessment and diagnosis of elder abuse. We will then review issues that relate to the elderly prisoner, namely, their care in the criminal justice system, as well as the assessment of criminal responsibility and competence to stand trial. The last section of the chapter is a description of treatment setting regulations in geriatric psychiatry, specifically the care of older adults in nursing homes.

Caring Collaborative Beyond Our Borders

Many older adults struggle with lifelong addictions or become addicted to prescription drugs that they take for coping with physical or psychological pain. There has been little attention, however, focused on this problem in nursing homes, where powerful pain medications are administered routinely. The nursing home setting provides complex challenges for staff and administrators attempting to provide safe and high-quality care for older adults with substance use disorders. Nurses working in long-term care settings, hospitals, and the community need to be sensitive to the possibility of older adults being addicted to alcohol or drugs and identify strategies for addressing this problem. [Journal of Psychosocial Nursing and Mental Health Services, 55(1), 24-27.].

Within the United States, there is a deficit of Geriatricians providing care for older adults, and this deficit will only grow as the population continues to age, meaning all health care providers will be responsible for the care of older adults. A learner needs assessment is a systematic approach to examining what individuals or groups need to learn in relation to health care practice. A learner needs assessment is a core element of designing effective, targeted geriatric educational interventions. In 2022, a brief six question online survey was distributed to all health care providers within the South Central Veterans Affairs (VA) Health Care Network to determine the top geriatric education needs. Within the survey, provider demographics requested were primary discipline and primary work setting (inpatient/outpatient). Respondents were requested to choose at least 5 out of 50 topics provided that would be the most useful for future geriatric education. Responses were received from 143 health care providers with the majority of the responses being from social workers 59(41.3%) and nurses 45(31.5%). There were 103 health care providers from outpatient areas and 40 from inpatient areas. The top geriatric education topics requested were mental health (50.4%), Alzheimer’s disease/dementia (48.3%), legal issues (38.5%), chronic pain (35.0%), depression (32.2%), and management of chronic conditions (30.1%). Experts were recruited to provide geriatric education on the highest priority requested topics. Providing geriatric education improves care for older adults ensuring health care providers are prepared to care and advocate for this diverse and often vulnerable population.

BackgroundLiving with multiple chronic conditions (MCC), the coexistence of two or more chronic conditions, is becoming more prevalent as the population ages. Primary care and home care providers play key roles in caring for older adults with MCC such as facilitating complex care decisions, shared decision-making, and access to community health and support services. While there is some research on the perceptions and experiences of these providers in caring for this population, much of this literature is focused specifically on family physicians. Little is known about the experiences of other primary care and home care providers from multiple disciplines who care for this vulnerable group. The purpose of this study was to explore the experiences of primary and home care healthcare providers in supporting the care of older adults with MCC living in the community, and identify ways of improving care delivery and outcomes for this group.MethodsThe study used an interpretive descriptive design. A total of 42 healthcare providers from two provinces in Canada (Ontario and Alberta) participated in individual semi-structured, face-to-face 60-min interviews. Participants represented diverse disciplines from primary care and home care settings. Inductive thematic analysis was used for data analysis.ResultsThe experiences and recommendations of healthcare providers managing care for older adults with MCC were organized into six major themes: (1) managing complexity associated with MCC, (2) implementing person-centred care, (3), supporting caregivers, (4) using a team approach for holistic care delivery, (5) encountering challenges and rewards, and (6) recommending ways to address the challenges of the healthcare system. Healthcare providers identified the need for a more comprehensive, integrated system of care to improve the delivery of care and outcomes for older adults with MCC and their family caregivers.ConclusionsStudy findings suggest that community-based healthcare providers are using many relevant and appropriate strategies to support older adults living with the complexity of MCC, such as implementing person-centred care, supporting caregivers, working collaboratively with other providers, and addressing social determinants of health. However, they also identified the need for a more comprehensive, integrated system of care.

IntroductionFirst language care is critical for older immigrant adults with limited English proficiency, especially in long-term care settings where most residents require staff assistance and experience complex chronic conditions, resulting...

Guiding Principles for the Care of Older Adults with Multimorbidity: An Approach for Clinicians

Addressing the Need for New Models of Care for Older Adults Receiving Long-term Dialysis

After the End of Free Fall: Geriatricizing Primary Care

To evaluate the ethical, legal and forensic issues that is faced by the older adult population. Many older individuals will face a host of ethical, medical and legal issues associated with their care. Most prominent among these issues are the maintenance of autonomy while ensuring their safety and the safety of individuals who care for them. Decisions regarding end of life including the formulation of advance directives add to the complexity of care for these older adults. A significant portion of individuals in the criminal justice system are aging and many of these individuals have psychiatric disorders. Their care is compromised due to the lack of appropriate services within criminal justice system for providing care for these individuals. Ethical, legal and forensic issues among older are not uncommon and complicate the care of these vulnerable individuals.

Implementing a nurse leader fellowship model.