Caring for the Older Patient
by Kathy Everitt
Thursday, January 18, 2018
The Institute for Healthcare Improvement (IHI) recently produced an interesting article regarding age- friendly health systems. According to the article, the population of people aged 65 and older is expected to nearly double during the next 40 years.
Is your practice ready for this influx of older patients? It’s important to create an age-friendly practice environment now so you have processes in place as your patient profile matures.
An age-friendly healthcare environment should begin with a comprehensive care assessment that is re-evaluated frequently, especially since two out of three older adults (age 65 and over) have multiple chronic conditions and many are on five or more medications.
Creating an age-friendly environment doesn’t stop with the assessment. It includes using the teach-back method to ensure that patients understand your treatment plan, your staff is culturally literate, and your practice uses shared decision making to recognize each patient’s care preferences. It also includes recognizing cognitive impairment and addressing the issue of mental capacity.
Healthcare decisions, including informed consent, are only valid if the patient has the mental capacity to comprehend and consent to treatment. Informed consent (depending on state law) can only be implied or presumed in an emergency situation.
When it comes to addressing mental health and cognitive issues, HIPAA can be a concern. If a patient has difficulty keeping appointments, doesn’t understand the treatment provided, seems disoriented to events and life activities, or other has other age-related issues, it is time to consider a surrogate decision maker.
When discussing a surrogate decision maker with the patient:
- Be proactive in your assessment as neurological status can change at any time.
- Make sure present the potential for a surrogate decision maker from the perspective--that it is in the patient’s best interest.
- Note in the patient’s response in the record, including if the patient cannot or does not wish to name a surrogate.
- Do not assume the family member attending appointments with the patient will be the individual assigned as the surrogate or responsible for healthcare decisions.
- Keep in mind that, in the absence of a surrogate, the healthcare professional has a duty to act in the patient’s best interest.
Advanced directives and durable power of attorney for healthcare decisions forms can help the healthcare professional with treatment decisions only when a patient is incapacitated.
When a surrogate is part of the care team, discussions with the surrogate should be documented in the patient’s records. The healthcare professional has an ethical obligation to inform the responsible party about treatment choices, costs, possible complications, expected outcomes and post treatment care when determining what is in the patient’s best interests.
This discussion must be provided in a manner the surrogate can understand so as to adequately make an informed treatment decision.
Please let us know if we can answer your questions about risk issues associated with caring for older patients.