Obtaining informed consent is the formal component of shared decision making by the physician and patient. Unfortunately, the documents developed by institutions to formally record the process of obtaining consent are often substituted for the process itself. Informed consent embodies certain conditions that must be satisfied; these include adequate information, freedom from coercion, and sufficient [...]
In some cases, disagreement arises over the choice of treatment. If the physician believes the patient is making a poor choice because of a lack of knowledge or information, the physician must inform the patient more fully. A competent patient can always abandon medical care, but a physician cannot abandon a patient. A competent patient’s [...]
Obtaining informed consent is the formal component of shared decision making by the physician and patient. Unfortunately, the documents developed by institutions to formally record the process of obtaining consent are often substituted for the process itself. Informed consent embodies certain conditions that must be satisfied; these include adequate information, freedom from coercion, and sufficient [...]
If a competent patient rejects treatment that the physician believes is in the patient’s interest, especially if the treatment would prolong life, the physician should explore the patient’s reasons and correct any misunderstandings. However, a physician should not impose treatment if the patient refuses it—even if the treatment could prolong life. Instead, the physician should [...]
USE OF HEALTH CARE SERVICES Older persons are more likely to use health care services than younger persons. While the elderly made up only 12% of the US population in 1990, they accounted for 34% of all hospital stays and 45% of all hospital days. For persons over age 65, the average length of stay [...]
Although social support includes help from neighbors and friends, family members usually provide most of the physical, emotional, social, and economic support. Family caregivers play a key role in delaying, if not preventing, institutionalization of the chronically ill older person. In fact, about 80% of home health care is provided as informal support by family [...]
Special housing for the elderly varies widely. Life-care communities (or continuing care retirement communities) are the most comprehensive, providing apartments for independent living and a range of services, including skilled nursing care. Most life-care communities have a single campus; some provide services at several sites. With congregate care, older persons live in individual apartments or [...]
Health care is provided to veterans without charge for service-connected disabilities and, on a complicated priority basis, for other conditions. The Veterans Administration operates 172 hospitals, 16 domiciliary facilities, and more than 100 nursing homes; it also contracts for care in community hospitals and nursing homes. The Veterans Administration has launched several innovative geriatric programs, [...]
