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Making difficult decisions with older patients on medical wards

Khizar, Bushra; Harwood, Rowan H.


Bushra Khizar


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.


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
Keywords Cognitive impairment; decision making; end-of-life care; ethics; older people; professional
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