This article will examine the elements of informed consent as they affect elders with Alzheimer's disease. The components of voluntariness, information, and competency will be reviewed. Case examples involving involuntary psychiatric treatment, institutionalization, and guardianship are examined as they relate to this vulnerable population. Important themes involve the presumption of competence, autonomy, beneficence, paternalism, and the power differential in the relationship between service provider and service recipient.
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References
1.
1. Morris W (ed.): The American heritage dictionary of the English language. Boston: Houghton Mifflin Company, 1980.
2.
2. Barker RL: The social work dictionary (3rd ed.). Washington, DC: National Association of Social Workers, 1995.
3.
3. Cohen-Mansfield J, Kerin P, Pawlson G, et al: Informed consent for research in a nursing home: Processes and issues. The Gerontologist. 1988; 28(3): 355-359.
4.
4. Petrila J, Otto RK: Law & mental health professionals Florida. Washington, DC: American Psychological Association, 1996.
5.
5. Berkowitz S: Informed consent, research, and the elderly. The Gerontologist. 1978; 18(3): 237-243.
6.
6. Taub HA: Informed consent, memory and age. The Gerontologist. 1980; 20(6): 686-690.
7.
7. Handler JF: Dependency and discretion. In Y. Hasenfeld (ed.). Human services as complex organizations. Newbury Park, California: Sage Publications. 1992: 276-297.
8.
8. Rabins PV, Mace NL: Some ethical issues in dementia care. Clinical Gerontologist. 1986; 5(3/4): 503-512.
9.
9. Roth LH, Miesel A, Lidz CW: Tests of competency to consent to treatment. American Journal of Psychiatry. 1977; 134(3): 279-284.
10.
10. Iris MA: Guardianship and the elderly: A multi-perspective view of the decision making process. The Gerontologist. 1988; 28(suppl.): 39-45.
11.
11. Kelly TB: Paternalism and the marginally competent: An ethical dilemma, No easy answers. Journal of Gerontological Social Work. 1994; 23(1/2): 67-84.
12.
12. Peters R, Schmidt WC, Miller KS: Guardianship of the elderly in Tallahassee, Florida. The Gerontologist. 1985; 25(5): 532-538.
13.
13. Scogin F, Perry J: Guardianship proceedings with older adults: The role of functional assessment and gerontologists. Law & Psychology Review. 1986; 10(Spr.): 123-128.
14.
14. Beauchamp TL, Childress JF: Principles of biomedical ethics (3rd ed.). New York: Oxford University Press, 1989: 71-71, 180-180.
15.
15. Coleman N, Dooley J: Making the guardianship system work. Generations. Supplement1990: 47-50.
16.
16. Fitting MD: Professional and ethical responsibilities for psychologists working with the elderly. The Counseling Psychologist. 1984; 12(3): 69-78.
17.
17. Hennessy CH: Autonomy and risk: The role of client wishes in community-based long-term care. The Gerontologist. 1989; 29(5): 633-639.
18.
18. Reamer FG: The concept of paternalism is social work. Social Service Review. 1983; (June): 254-271.
19.
19. Moody HR: Ethical dilemmas in nursing home placement. Generations. 1987; 11(4): 16-23.
20.
20. Cohen D, Eisdorfer C, Gorelick P, et al: Psychopathology associated with Alzheimer's disease and related disorders. Journal of Gerontology: Medical Sciences. 1993; 48(6), M255-M260.
21.
21. Feil N: The Validation Breakthrough. Baltimore: Health Professions Press, 1993.
22.
22. Reisberg B, Ferris SH, de Leon MJ, et al: The global deterioration scale for assessment of primary degenerative dementia. American Journal of Psychiatry. 1982; 139: 1136-1139.
23.
23. Rubin EH, Kinscherf BA: Psychopathology of very mild dementia of the Alzheimer's type. American Journal of Psychiatry. 1989; 146(8): 1017-1021.
24.
24. Rovner BW, Broadhead J.Spencer M, et al: Depression and Alzheimer's disease. American Journal of Psychiatry. 1989;146(3): 350-353.
25.
25. Gatz M, Smyer MA: The mental health system and older adults in the 1990's. American Psychologist. 1992; 47(6): 741-751.
26.
26. Kane R: Long-term care. In Encyclopedia of Social Work. Silver Springs, Maryland: National Association of Social Workers. 1987: 59-72.
27.
27. Kaplan HI, Sadock BJ: Synopsis of Psychiatry (6th ed.). Baltimore: Williams & Wilkins, 1991.
28.
28. Somers FP: Long-term care and federal policy. The American Journal of Occupational Therapy. 1991; 45(7): 628-635.
29.
29. Koren MJ, Guastadisegni P.Aronson MK: Reimbursement issues and the future direction of nursing home care for persons with dementia. In MK Aronson (ed.): Reshaping dementia care Practice and policy in long-term care. Thousand Oaks, California: Sage Publications, 1994: 145-160.
30.
30. Vinton L: An exploratory study of self-neglected elderly. Journal of Gerontological Social Work. 1992; 18(1/2): 55-68.
31.
31. Steele C, Rovner B, Chase GA, et al: Psychiatric symptoms and nursing home placement of patients with Alzheimer's disease. American Journal of Psychiatry. 1990; 147(8): 1049-1051.
32.
32. Kucharski LT, White RM, Schratz M: Age bias, referral for psychological assistance and the private physician. Journal of Gerontology. 1979; 34(3): 423-428.
33.
33. Ginther SD, Webber P, Fox PJ, et al: Professional allocations of counseling services to persons with Alzheimer's disease: An exploration. Social Work in Health Care. 1993; 19(2): 99-114.
34.
34. Gatz M, Pearson C: Ageism revised and the provision of psychological services. American Psychologist. 1988; 43(3): 184-188.
35.
35. Palmore E: Total chance of institutionalization among the aged. The Gerontologist. 1976; 16(6): 504-507.
36.
36. Kasi SV: Physical and mental health effects of involuntary relocation and institutionalization on the elderly—A review. American Journal of Public Health. 1972 (March): 377-384.
37.
37. Liu K, Manton KG: The characteristics and utilization pattern of an admission cohort of nursing home patients. The Gerontologist. 1983; 23(1): 92-98.
38.
38. Clark WG, Travis SS: Elderly admissions to a state psychiatric hospital: Cohort characteristics, after-care needs, and discharge destinations. Journal of Gerontological Social Work. 1994; 21(3/4): 101-115.
39.
39. Branch LG, Jette AM: A prospective study of long-term care institutionalization among the aged. American Journal of Public Health. 1982; 72(12): 1373-1379.
40.
40. Arras JD: (1988). The severely demented, minimally functional patient: An ethical analysis. Journal of the American Geriatrics Society. 1988; 36(10): 938-944.
41.
41. Parry J: Incompetency, guardianship and restoration. In: SJ Brakel, J Parry, BA Weiner (eds.). The Mentally Disabled and the Law. 3rd ed.Chicago: American Bar Foundation, 1985.
43. Watts DT, Cassel CK, Howell T: Dangerous behavior in a demented patient. Preserving autonomy in a patient with diminished competence. Journal of the American Geriatrics Society. 1989; 37(7): 658-662.
44.
44. Lawton M, Brody E: Assessment of older people: Self-maintaining and instrumental activities of daily living. The Gerontologist. 1969; 9:179-179.
45.
45. Loeb P: Validity of the community competence scale with the elderly. Unpublished doctoral dissertation. St. Louis University, 1983.
46.
46. Molloy DW, Clarnette RM, Braun EA, et al: Decision making in the incompetent elderly. “The daughter from California syndrome”. Journal of the American Geriatrics Society. 1991; 39(4): 396-399.
