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Marginal Competence, Risk Assessment, and Care Decisions: A Comparison of Values of Health Care Professionals and Older Adults

Published online by Cambridge University Press:  18 May 2010

Penny MacCourt  and
Holly Tuokko
Penny MacCourt*
Affiliation:
Centre on Aging, University of Victoria
Holly Tuokko
Affiliation:
Centre on Aging, University of Victoria
*
*Correspondence concerning this article should be addressed to / La correspondance concernant cet article doit être adressées à: Penny MacCourt, PhD Centre on Aging. University of Victoria Sedgewick Building A104 PO Box 1700 STN CSC Victoria, B.C. V8W 2Y2 (maccourt@uvic.ca)
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Abstract

Using a case scenario involving a marginally competent elderly woman living alone at risk, we assessed the care decisions made by older adults (n = 82) and health care professionals (HCPs, n = 87), and identified differences in the values underlying the care decisions. Overall, participants did not place a high value on independence when they appraised the risk to the client as high and safety as low. Under these conditions, elderly respondents tended to be more paternalistic in their decisions about care, while HCPs tended to be more beneficent. If the values of HCPs differ from those of elderly people, how likely is it that the care provided to marginally competent elderly people will be congruent with their wishes? The care provided by HCPs might be improved by incorporating knowledge of the values and perspectives of other older adults.

Résumé

Par l’utilisation d’un scénario impliquant une femme âgée vivant seule compétent marginalement à risque, nous avons évalué les decisions liées aux soins réalisés par les adultes plus âgés (n = 82) et les professionnels de la santé (professionnels de la santé, n = 87), et les différences identifiées dans les valeurs qui sous-tendent les décisions relatives aux soins. Dans l’ensemble, les participants n’ont pas placé une grande valeur à l’independance quand on a évalué les risques pour le client comme plus élevé et la sécurité comme aussi bas. Dans ces conditions, les répondants âgés tendaient à être plus paternaliste dans leurs décisions concernant les soins, tandis que les professionnels de la sante ont tendance à être plus salutaire. Si les valeurs des professionnels de la santé diffèrent de ceux des personnes âgées, quelle est la probabilité que les soins dispensés aux personnes âgées peu compétentes seront conformes à leurs désirs? Les soins donnés par les professionnels de la santé pourrait être ameliorés en y incorporant la connaissance des valeurs et des perspectives des autres adultes âgés.

Keywords

valeurscompétencedécisions liées aux soinsadultes âgésprofessionnels de la santévaluescompetencecare decisionsolder adultshealth care professionals
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 29 , Issue 2 , June 2010 , pp. 173 - 183
Copyright
Copyright © Canadian Association on Gerontology 2010

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References

Alzheimer, Society, (n.d.). Retrieved from:http://www.alzheimer.ca/english/care/ethics-alone.htm.Google Scholar
Arber, S., & Evandrou, M. (1993). Mapping and territory: Aging, independence and the life course. In Arber, S. & Evandrou, M. (Eds.), Ageing, independence and the life course (pp. 9–26). London: Jessica Kingsley.Google Scholar
Aronson, J. (1990). Old women’s experiences of needing care: Choice or compulsion. Canadian Journal on Aging, 9(3), 234–247.CrossRefGoogle Scholar
Bradley, J., Zia, M., & Hamilton, N. (1996). Patient preferences for control in medical decision making: A scenario-based approach. Family Medicine, 28, 496–501.Google ScholarPubMed
Clark, P. (1991). Ethical dimensions of quality of life in aging: Autonomy versus collectivism in the United States. The Gerontologist, 31, 631–639.CrossRefGoogle Scholar
Clark, P. (1997). Values in health care professional socialization: Implications for geriatric education in interdisciplinary teamwork. The Gerontologist, 37(4), 441–451.CrossRefGoogle ScholarPubMed
Clemens, E., & Hayes, H. (1997). Assessing and balancing elder risk, safety and autonomy: Decision-making practices of health care professionals. Home and Health Care Services Quarterly, 16(3), 3–21.CrossRefGoogle ScholarPubMed
Clemens, E., Wetle, T., Feltes, M., Crabtree, B., & Dubitzky, D. (1994). Contradictions in case management: Client-centred theory and directive practice with frail elderly. Journal of Aging and Health, 6(1), 70–88.CrossRefGoogle Scholar
Clouder, L. (2003). Becoming professional: Exploring the complexities of professional socialization. Health and Social Care, 2(4), 213–222.Google Scholar
Degenholtz, H., Kane, A., & Kivnick, Q. (1997). Care-related preferences and values of elderly community-based LTC consumer: Can case managers learn what’s important to clients? The Gerontologist, 37(6), 767–776.CrossRefGoogle ScholarPubMed
Egri, C.P., & Ralston, D.A. (2004). Generation cohorts and personal values: A comparison of China and the United States. Organization Science, 15(2), 210–220.CrossRefGoogle Scholar
Feinberg, L., & Whitlatch, C., (2001). Are persons with cognitive impairment able to state consistent choices? The Gerontologist, 41(3), 374–382.CrossRefGoogle ScholarPubMed
Fitzsimmons, D., George, S., Payne, S., & Johnson, C.D. (1999). Differences in perception of quality of life issues between health professionals and patients with pancreatic cancer. Psycho-Oncology, 8, 135–143.3.0.CO;2-Q>CrossRefGoogle ScholarPubMed
Healy, T. (1999). Community-dwelling cognitively impaired frail elders: An analysis of social workers’ decisions concerning support for autonomy. Social Work in Health Care, 30(2), 27–47.CrossRefGoogle ScholarPubMed
Horowitz, A., Silverstone, B., & Reinhardt, J. (1991). A conceptual and empirical exploration of personal autonomy issues within family caregiving relationships. The Gerontologist, 312(1), 23–31.CrossRefGoogle Scholar
Kane, R. (2000). Values and preferences. In Kane, R. & Kane, R. (Eds.), Assessing older persons: Measures, meaning, and personal applications (pp. 237–260). New York: Oxford University Press.Google Scholar
Kane, R., Bershadsky, B., & Bershadsky, J. (2006). Who recommends long-term care matters. The Gerontologist, 46, 474–482.CrossRefGoogle ScholarPubMed
Kane, R., Rockwood, T., Finch, M., & Philp, I. (1997). Consumer and professional ratings of the importance of functional status components. Health Care Financial Review, 19(2), 11–22.Google ScholarPubMed
Kapp, M. (1997). Who is responsible for this? Assigning rights and consequences in elder care. Journal of Aging & Social Policy, 9(2), 51–64.CrossRefGoogle ScholarPubMed
Katz, A., Conant, L., Inui, T., Baron, D., & Bor, D. (2000). Council of elders: Creating a multi-voiced dialogue in a community of care. Social Science & Medicine, 50(6), 851–860.CrossRefGoogle Scholar
Kaufman, S. (1994). Old age, disease, and the discourse on risk: Geriatric assessment in U.S. health care. Medical Anthropology Quarterly, 8, 76–93.CrossRefGoogle Scholar
Kaufman, S. (1995). Decision making, responsibility, and advocacy in geriatric medicine: Physician dilemma with elderly in the community. The Gerontologist, 35(4), 481–488.CrossRefGoogle ScholarPubMed
Kaufman, S., & Becker, G. (1996). Frailty, risk, and choice: Cultural discourses and the question of responsibility. In Smyer, M., Schaie, K. & Kapp, M. (Eds.), Older adults’ decision-making and the law (pp. 48–71). New York: Springer Publishing Company.Google Scholar
Keating, N., Fast, J., Connidis, I., Penning, M., & Keefe, J. (1997). Bridging policy in elder care. Canadian Journal on Aging, (Suppl.), 22–41.CrossRefGoogle Scholar
Kelly, L., Knox, J., & Gekoski, W. (1998). Women’s views of institutional versus community-based long-term care. Research on Aging, 20(2), 218–245.CrossRefGoogle Scholar
King, S., Collin, C., & Liken, M. (1995) Values and the use of community services. Qualitative Health Research, 5(3), 332–347.CrossRefGoogle Scholar
Kluge, E. (2005). Competence, capacity, and informed consent: Beyond the cognitive-competence model. Canadian Journal on Aging, 24(3), 295–304.CrossRefGoogle ScholarPubMed
Krothe, J. (1997). Giving voice to elderly people: Community-based long-term care. Public Health Nursing, 14(4), 217–226.CrossRefGoogle ScholarPubMed
Lawton, M., Moss, M., Hoffman, C., Grant, R., Have, T., & Kleban, M. (1999). Health, valuation of life, and the wish to live. The Gerontologist, 39(4), 406–416.CrossRefGoogle ScholarPubMed
Lindsay, C. (2000). Senior women. In Women in Canada (pp. 269–280). Ottawa, Canada: Statistics Canada.Google Scholar
Mack, R., Salmoni, A., Viverais-Dressler, G., Porter, E., & Garg, R. (1997). Perceived risks to independent living: The views of older, community-dwelling adults. The Gerontologist, 37(6), 729–736.CrossRefGoogle ScholarPubMed
McCullough, L., Wilson, N., Teasdale, T., Kolpakchi, A., & Skelly, J. (1993). Mapping personal, familial, and professional values in long-term care decisions. The Gerontologist, 33(3), 324–332.CrossRefGoogle ScholarPubMed
Miller, D., & Bolla, L. (1998). Patient values. A guide to medical decision making. Acute Hospice Care, 14(4), 813–829.Google ScholarPubMed
Moody, H. (1987). Ethical dilemmas in nursing home placement. Generations, Summer, 11(4), 16–23.Google Scholar
Otto, R., Dobie, R., Lawrence, V., & Sakai, C. (1997). Impact of a laryngectomy on quality of life: Perspective of the patient versus that of the health care provider. Annals of Otology, Rhinology and Laryngology, 106, 693–699.CrossRefGoogle ScholarPubMed
Ouslander, J., Tymchuk, A., & Rahbar, B. (1989). Health care decisions among elderly long-term care residents and their potential proxies. Archives of Internal Medicine, 149, 1367–1372.CrossRefGoogle ScholarPubMed
Porter, E. (1994). “Reducing my risks”: A phenomenon of older widows’ lived experience. Advances in Nursing Science, 17(20), 54–65.CrossRefGoogle ScholarPubMed
Raymond, L., & Wentworth, B. (1993). Autonomy and safety: The client’s perspective. Topics in Geriatric Rehabilitation, 9(1), 47–56.CrossRefGoogle Scholar
Reisberg, B., Ferris, S., de Leon, M., & Crook, T. (1982) The global deterioration scale for assessment of primary degenerative dementia. American Journal of Psychiatry, 139, 1136–1139.Google ScholarPubMed
Shidler, S. (1998). Participation of chronically ill older adults in their life prolonging treatment decisions: Rights and opportunity. Canadian Journal on Aging, 17(1), 1–23.CrossRefGoogle Scholar
Silberfeld, M. (1992). The use of ‘risk’ in decision-making. Canadian Journal on Aging, 11(2), 124–136.CrossRefGoogle Scholar
Silberfeld, M., & Fish, A. (1994). When the mind fails: A guide to dealing with incompetency. London: University of Toronto Press.Google Scholar
Tuokko, H., MacCourt, P., & Heath, Y. (1999). Home alone with dementia. Aging & Mental Health, 3(1), 21–27.CrossRefGoogle Scholar