Making difficult decisions with older patients on medical wards

Khizar, Bushra; Harwood, Rowan H.

Abstract

Decision making with older people can be difficult because of medical complexity, uncertainty (about prognosis, treatment effectiveness and priorities), difficulties brought by cognitive and communication impairment and the multiple family and other stakeholders who may need to be involved. The usual approach, based on balancing benefits and burdens of a treatment, and then deciding on the basis of autonomy (or best interests for someone lacking mental capacity), within the constraints of resources and equity, remains valid, but is often inadequate. In addition, approaches relying on optimal communication and relationship building and professional virtues are important. Older people vary in their medical status, views and preferences more than younger people and these variations must be sought and accommodated, using a shared decision-making approach. This includes adapting to the increasing numbers of people from different cultures.

Citation

Khizar, B., & Harwood, R. H. (2017). Making difficult decisions with older patients on medical wards. Clinical Medicine, 17(4), 353-356. doi:10.7861/clinmedicine.17-4-353

• Journal Article Type: Article
• Acceptance Date: Aug 1, 2017
• Online Publication Date: Aug 1, 2017
• Publication Date: Aug 1, 2017
• Deposit Date: Feb 28, 2019
• Journal: Clinical Medicine
• Print ISSN: 1470-2118
• Electronic ISSN: 1473-4893
• Publisher: Royal College of Physicians
• Peer Reviewed: Peer Reviewed
• Volume: 17
• Issue: 4
• Pages: 353-356
• DOI: https://doi.org/10.7861/clinmedicine.17-4-353
• Keywords: Cognitive impairment; decision making; end-of-life care; ethics; older people; professional
• Public URL: https://nottingham-repository.worktribe.com/output/1476585
• Publisher URL: http://www.clinmed.rcpjournal.org/content/17/4/353