Academic literature on the topic 'Geriatricians Professional ethics'

Abstract Background The Assisted Decision Making (ADM) Act 2015 was introduced to support decision making and maximise a person’s capacity to make decisions but has not yet commenced. Within this context, medical professionals such as geriatricians must adjust from a best interest’s outlook to that of patient autonomy in response to the changing legislation. The aim of this study is to explore current geriatrician’s practice. In scrutinizing current practice, it will be evident as to what, if any, adaptations are required in order to practice in accordance with the new legislation. Methods Ten semi-structured interviews with individual consultant geriatricians were conducted, each lasting approximately 20 minutes on average in one hospital. Each interview was recorded and transcribed verbatim. The interview involved the geriatrician reading a vignette and answering questions as to how they would manage this situation. Following the vignette, the semi-structured interview proceeded covering topics including; patient decision making in the acute setting, deprivation of patient liberty in the acute setting, thoughts on the ADM (Capacity) Act 2015, and elements learned from experiences in other countries. A thematic analysis was conducted. Results Preliminary themes identified from the interviews include; (a) identification, accessibility and availability of medical and legal colleagues in assisting with difficult decision making, (b) need for clear frameworks, guidance and education in relation to laws applying to medical practice, (c) influence of environment, family, perceived risk and delirium on capacity assessment, (d) paternalism versus autonomy. This work is being conducted as part of a master’s in healthcare ethics and law. Conclusion Preliminary results highlight the need for collaborative communication between medics and the legal profession in order to achieve a structured and supportive framework to inform practice considering the new legislation.

Ageing, which is associated with a progressive decline and functional deterioration in multiple organ systems, is highly heterogeneous, both inter- and intraindividually. For this, tailored-made theranostics and optimum patient stratification become fundamental, when decision-making in elderly patients is considered. In particular, when cancer incidence and cancer-related mortality and morbidity are taken into account, elderly patient care is a public health concern. In this review, we focus on oncogeriatrics and highlight current opportunities and challenges with an emphasis on the unmet need of clinically relevant biomarkers in elderly cancer patients. We performed a literature search on PubMed and Scopus databases for articles published in English between 2000 and 2017 coupled to text mining and analysis. Considering the top insights, we derived from our literature analysis that information knowledge needs to turn into knowledge growth in oncogeriatrics towards clinically relevant biomarkers, cost-effective practices, updated educational schemes for health professionals (in particular, geriatricians and oncologists), and awareness of ethical issues. We conclude with an interdisciplinary call to omics, geriatricians, oncologists, informatics, and policy-makers communities that Big Data should be translated into decision-making in the clinic.

Abstract Assessment of decision-making capacity is essential to respect older adult dignity, particularly concerning major decision such as ageing in place. To date, it is the clinician's assessment, based on a global analysis of his clinical evaluation and neuropsychological tasks, which enables decision-making assessment. Given the difficulty it represents, and the ethical and societal issues raised, the research question concerns the contribution of neuro-imaging technologies as an aid to the evaluation of decision-making capacity. We included in our proof-of-concept study 4 healthy older patients and 2 older patients with dementia (mild stage) followed in a memory clinic. Each of the participants completed neuropsychological tests with a focus on executive functions, anosognosia and judgemental skills. Next, they performed a decision-making task, the Balloon Assessment Risk Task (BART) in functional MRI, and, finally, they participated in a semi-structured interview completed with interview of their caregiver. For both patients, their referring geriatrician was questioned a priori on his assessment of their decision-making capacity. The results showed a common activation pattern in functional MRI between the patient considered competent in decision-making and the healthy subjects, unlike the patient who was not clinically competent. The qualitative analysis highlighted major anosognosia in both pathological situations, but decision-making in everyday life situations differed between the 2 patients. This study shows the feasibility, on a sensitive topic, to explore the potential contribution of functional neuroimaging and semi-directed interviews as tools. It also demonstrates the value of conducting mixed research, combining neurosciences and social science to explore complex clinical issues.

Geriatric Forensic Psychiatry: Principles and Practice is one of the first texts to provide a comprehensive review of important topics in the intersection of geriatric psychiatry, medicine, clinical neuroscience, forensic psychiatry, and law. It will speak to a broad audience among varied fields, including clinical and forensic psychiatry and mental health professionals, geriatricians and internists, attorneys and courts, regulators, and other professionals working with the older population. Topics addressed in this text, applied to the geriatric population, include clinical forensic evaluation, regulations and laws, civil commitment, different forms of capacity, guardianship, patient rights, medical-legal issues related to treatment, long term care and telemedicine, risk management, patient safety and error reduction, elder driving, sociopathy and aggression, offenders and the adjudication process, criminal evaluations, corrections, ethics, culture, cognitive impairment, substance abuse, trauma, older professionals, high risk behavior, and forensic mental health training and research. Understanding the relationship between clinical issues, laws and regulations, and managing risk and improving safety, will help to serve the growing older population.