Hostname: page-component-586b7cd67f-t8hqh Total loading time: 0 Render date: 2024-11-25T14:31:16.211Z Has data issue: false hasContentIssue false
  • English
  • Français

Obtaining Informed Consent from Continuing Care Residents: Issues and Recommendations

Published online by Cambridge University Press:  29 November 2010

Liza Stelmach ,
Candace Konnert  and
Keith Dobson
Liza Stelmach
Affiliation:
University of Calgary
Candace Konnert
Affiliation:
University of Calgary
Keith Dobson
Affiliation:
University of Calgary
Get access Rights & Permissions [Opens in a new window]

Abstract

As the number of older adults residing in continuing care facilities increases, mental health professionals will provide more services and conduct more research in this setting. Mental health professionals working with continuing care residents will find themselves regularly challenged by ethical issues, particularly obtaining informed consent. Characteristics of the continuing care setting and residents make obtaining informed consent especially challenging. Mental health professionals must overcome these challenges in order to fulfill the following three requirements of informed consent: (1) the client is competent, (2) the client is provided with sufficient information, and (3) the client has not been coerced and/or the consent is voluntary. This article will examine the issues surrounding the fulfillment of these requirements in a continuing care facility, and will provide suggestions and guidelines that mental health professionals can utilize during the informed consent process.

Résumé

Au fur et à mesure de l'augmentation du nombre d'ainé(e)s dans les établissements de soins de longue durée, les professionnel(le)s de la santé mentale fourniront plus de services et mèneront plus d'enquêtes dans ce milieu. Les professionnel(le)s de la santé mentale s'occupant de patients nécessitant des soins de longue durée se retrouveront régubèrement aux prises avec des questions de morale, surtout en matière de consentement éclairé. Les caractéristiques du milieu des soins de longue durée et de ses résidents rendent le consentement éclairé particulièrement délicat. Les professionnels de la santé mentale doivent relever les défis qui s'y relient pour respecter les critères suivants du consentement éclairé: (1) le client est compétent, (2) le client dispose de toute l'information nécessaire, et (3) le client n'a pas été contraint et/ou le consentement est volontaire. L'article examine la question de ces critères dans un milieu de soins de longue durée et propose des suggestions et des directives à utiliser par les professionnels de la santé mentale qui ont à obtenir un consentement éclairé.

Keywords

Informed ConsentContinuing Care ResidentsEthical Guidelines.Consentement éclairérésidents des soins continusdirectives de morale.
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 20 , Issue 3 , Automne/Fall 2001 , pp. 385 - 406
Copyright
Copyright © Canadian Association on Gerontology 2001

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

American Psychological Association. (1998). Guidelines for the evaluation of dementia and age-related cognitive decline. American Psychologist, 53, 1298–1303.CrossRefGoogle Scholar
Areen, J. (1987). The legal status of consent obtained from families of adult patients to withhold or withdraw treatment. Journal of the American Medical Association, 258, 229.CrossRefGoogle ScholarPubMed
Baltes, M.M. (1994). Aging well and institutional living: A paradox? In Abeles, R.P., Gift, H.C., & Ory, M.G. (Eds.), Aging and quality of life (pp. 185–201). New York: Springer.Google Scholar
Baltes, M.M., & Reisenzein, R. (1986). The social world in long-term care institutions: Psychosocial control toward dependency? In Baltes, M.M. & Baltes, P.B. (Eds.), The psychology of control and aging (pp. 315–343). Hillsdale, NJ: Erlbaum.Google Scholar
Baltes, M.M., & Wahl, H.W. (1992). The dependency-support script in institutions: Generalization to community settings. Psychology and Aging, 7, 409–418.CrossRefGoogle ScholarPubMed
Barton, CD., Mallik, H.S., Orr, W.B., & Janofsky, J.S. (1996). Clinicians' judgement of capacity of nursing home patients to give informed consent. Psychiatric Services, 47, 956–960.Google ScholarPubMed
Beisecker, A.E. (1988). Aging and the desire for information and input in medical decisions: Patient consumerism in medical encounters. The Gerontologist, 28, 330–335.CrossRefGoogle ScholarPubMed
Berkowitz, S.B. (1978). Informed consent, research, and the elderly. The Gerontologist, 18, 237–243.CrossRefGoogle ScholarPubMed
Blazer, D. (1998). Emotional problems in later life. New York: Springer Publishing Company Inc.Google Scholar
Brod, M.S., & Feinbloom, R.I. (1990). Feasibility and efficacy of verbal consents. Research on Aging, 12, 364–372.CrossRefGoogle ScholarPubMed
Canadian Association of Social Workers. (1983). Canadian association of social workers code of ethics. Ottawa: Author.Google Scholar
Canadian Medical Association. (1996). Code of ethics. Ottawa: Author.Google Scholar
Canadian Nurses Association. (1997). Code of ethics for registered nurses. Ottawa: Author.Google Scholar
Canadian Psychological Association. (1991). The Canadian code of ethics for psychologists: Companion manual. Ottawa: Author.Google Scholar
Cassel, C.K. (1985). Research in nursing homes. Journal of the American Geriatric Society, 33, 795–799.CrossRefGoogle ScholarPubMed
Casten, R.J., Parmelee, P.A., Kleban, M.H., Lawton, M.P., & Katz, I.R. (1995). The relationships among anxiety, depression, and pain in a geriatric institutionalized sample. Pain, 61, 271–276.CrossRefGoogle Scholar
Cohen-Mansfield, J., Kerin, P., Pawlson, G., Lipson, S., & Holdridge, K. (1988). Informed consent for research in a nursing home: Processes and issues. The Gerontologist, 28, 355–358.CrossRefGoogle Scholar
Cohn, J., & Sugar, J.A. (1991). Determinants of quality of life in institutions: Perceptions of frail older residents, staff, and families. In Birren, J.E., Lubben, J.E., Rowe, J.C., & Deutchman, D.E. (Eds.), The concept and measurement of quality of life in frail elderly (pp. 28–49). San Diego: Academic Press.CrossRefGoogle Scholar
Corey, G., Corey, M.S., & Callanan, P. (1993). Issues and ethics in the helping professions (4th ed.). Pacific Grove, CA: Brooks/Cole Publishing Company.Google Scholar
Craik, F., & Lockhart, R. (1972). Levels of processing: A framework for memory research. Journal of Verbal Learning and Verbal Behavior, 11, 671–684.CrossRefGoogle Scholar
Danermark, B., & Ekstrom, M. (1990). Relocation effects on the elderly: A commented research review. Journal of Sociology and Social Welfare, 17, 25–49.CrossRefGoogle Scholar
Drane, J. (1984). Competency to give an informed consent: A model for making clinical assessments. Journal of the American Medical Association, 252, 925–927.CrossRefGoogle Scholar
Eisch, J.S., Colling, J., Ouslander, J., Hadley, B.J., & Campbell, E. (1991). Issues in implementing clinical research in nursing home settings. Journal of the New York State Nurses Association, 22, 18–21.Google ScholarPubMed
Farquhar-Mayes, A. (1995). Ethical considerations in the use of neuromuscular blockades. Critical Care Nursing, 18, 13–24.CrossRefGoogle ScholarPubMed
Fiesta, J. (1997). Legal implications in long-term care. New York: Delmar Publishers.Google Scholar
Fowler, M. (1984). Appointing an agent to make medical treatment choices. Columbia Law Review, 84, 985.CrossRefGoogle ScholarPubMed
Government of Alberta. (1985). Nursing Homes Act. Edmonton: Queen's Printer.Google Scholar
Government of Alberta. (1997). Personal Directives Act. Edmonton: Queen's Printer.Google Scholar
Grant, R., & Steel, E.K. (1990). Decision-making with psychiatrically impaired patients: A collaborative endeavor. Psychiatric Clinics of North America, 13, 149–156.CrossRefGoogle ScholarPubMed
Gurian, B.S., Baker, E.H., Jacobson, S., Lagerbom, B., & Watts, P. (1990). Informed consent for neuroleptics with elderly patients in two settings. Journal of the American Geriatrics Society, 38, 37–44.CrossRefGoogle ScholarPubMed
Hayley, D.C., Cassel, C.K., Snyder, L., & Rudberg, M.A. (1996). Ethical and legal issues in nursing home care. Archives of Internal Medicine, 156, 249–256.CrossRefGoogle ScholarPubMed
Health and Welfare Canada. (1990). Guidelines for establishing standards for services to elderly residents with mental heath problems in long-term care facilities. Ottawa: Health Services and Promotion Branch, Health and Welfare Canada.Google Scholar
Heller, T. (1982). The effect of involuntary residential relocation: A review. American. Journal of Community Psychology, 10, 471–492.CrossRefGoogle Scholar
High, D. (1988). All in the family: Extended autonomy and expectations in surrogate health care decision-making. The Gerontologist, 25(suppl.), 46–51.CrossRefGoogle Scholar
High, D.M., & Doole, M.M. (1995). Ethical and legal issues in conducting research involving elderly subjects. Behavioral Sciences and the Law, 13, 319–335.CrossRefGoogle ScholarPubMed
Hinrichsen, G.A. (1990). Mental health problems and the elderly. Santa Barbara, CA: ABC-CLIO.Google Scholar
Jaffe, M.S. (1996). The OBRA guidelines for quality improvement. Colorado: Skid-more-Roth Publishing.Google Scholar
Kahana, E., Kahana, B., & Riley, K. (1989). Person-centered transactions relevant to control and helplessness in institutional settings. In Fry, P.S., Psychological perspectives of helplessness and control in the elderly (pp. 121–153). North Holland: Elsevier Science Publishers.Google Scholar
Kapp, M.B. (1987). Preventing malpractice in long-term care: strategies for risk management. New York: Springer Publishing Company.Google Scholar
Kapp, M.B. (1988). Decision making by and for nursing home residents: A legal view. Clinics in Geriatric Medicine, 4, 667–679.CrossRefGoogle ScholarPubMed
Kapp, M.B. (1991). Health care decision-making by the elderly: I get by with a little help from my family. The Gerontologist, 5, 619–623.CrossRefGoogle Scholar
Krynski, M.D., Tymchuk, A.J., & Ouslander, J.G. (1994). How informed can consent be? New light on comprehension among elderly people making decisions about enteral tube feeding. The Gerontologist, 34, 36–43.CrossRefGoogle ScholarPubMed
Lichtenberg, P.A., Smith, M., Frazer, D., Mohnari, V., Rosowsky, E., Crose, R., Stillwell, N., Kramer, N., Hartman-Stein, P., Quails, S., Salamon, M., Duffy, M., Parr, J., & Gallagher-Thompson, D. (1998). Standards for psychological services in long-term care facilities. The Gerontologist, 38, 122–127.Google ScholarPubMed
Lidz, C.W., & Arnold, R.M. (1990). Institutional constraints on autonomy. Generations, 14(suppl.), 65–68.Google ScholarPubMed
Loverde, M.E., Prochazka, A.V., & Byyny, R.L. (1989). Research consent forms: Continued unreadability and increasing length. Journal of General Internal Medecine, 4, 410–412.CrossRefGoogle ScholarPubMed
Manitoba Law Reform Commission. (1999). Informal assessment of competence. Winnipeg: Author.Google Scholar
Medical Research Council of Canada (MRC), Natural Sciences and Engineering Research Council of Canada (NSERC), Social Sciences and Humanities Research Council of Canada (SSHRC). (1998). Tri-council policy statement: Ethical conduct for research involving humans. Ottawa: Author.Google Scholar
Miles, S.H., & Maletta, G. (1996). Clinical ethics. In Sadavoy, J., Lazarus, L.W., Jarvik, L.F., & Grossberg, G.T. (Eds.), Comprehensive review of geriatric psychiatry II (3rd ed., pp. 1051–1064). Washington DC: American Psychiatric Press.Google Scholar
Moye, J. (1996). Theoretical frameworks for competency in cognitively impaired elderly adults. Journal of Aging Studies, 10, 27–42.CrossRefGoogle Scholar
National Commission for the protection of human subjects of biomedical and behavioral research. (1979). The Belmont Report. Ethical principles and guidelines for the protection of human subjects of research. Washington DC: U.S. Government Printing Office.Google Scholar
Omnibus Budget Reconciliation Act (OBRA). PLWO-203 (1987). Subtitle C, Nursing Home Reform. Washington DC: U.S. Government Printing Office.Google Scholar
Ouslander, J.G., Tymchuk, A.J., & Rahbar, B. (1989). Health care decisions among the elderly long-term care residents and their proxies. Archives of Internal Medicine, 149, 1367–1372.CrossRefGoogle ScholarPubMed
Overman, W., & Stoudemire, A. (1988). Guidelines for legal and financial counseling of Alzheimer's disease patients and their families. American Journal of Psychiatry, 145, 1495–1500.Google ScholarPubMed
Parmalee, P.A., & Lawton, M.P. (1990). The design of special environments for the aged. In Birren, J.E. & Schaie, K.W. (Eds.), Handbook of the psychology of aging (3rd. ed., pp. 464–488). San Diego, CA: Academic Press.CrossRefGoogle Scholar
Reinardy, J.R. (1992). Decisional control in moving to a nursing home: Post admission adjustment and well-being. The Gerontologist, 32, 96–103.CrossRefGoogle Scholar
Sachs, G.A., Rhymes, J., & Cassel, C.K. (1993). Biomedical and behavioral research in nursing homes: Guidelines for ethical investigations. Journal of the American Geriatrics Society, 41, 111–111.CrossRefGoogle ScholarPubMed
Schieber, F. (1992). Aging and the senses. In Birren, J.E., Sloane, R.B., & Cohen, G.D. (Eds.), Handbook of mental health and aging (2nd ed., pp. 252–306). New York: Academic Press.Google Scholar
Smyer, M.A. (1989). Nursing homes as a setting for psychological practice: Public policy perspectives. American Psychologist, 44, 1307–1314.CrossRefGoogle Scholar
Spears, K., Drinka, P.J., & Voeks, S. (1993). Obtaining a durable power of attorney for health care from nursing home residents. The Journal of Family Practice, 36, 409–413.Google ScholarPubMed
Spiro, H.M. (1975). Constraint and consent: On being a patient and a subject. New England Journal of Medicine, 293, 1134–1135.CrossRefGoogle ScholarPubMed
Statistics Canada. (1994). National population health survey. Government of Canada: Queen's Printer.Google Scholar
Steinberg, A., Fitten, L.J., & Kachuck, N. (1986). Patient participation in treatment decision-making in the nursing home: The issues of competence. The Gerontologist, 26, 362–366.CrossRefGoogle ScholarPubMed
Strahan, G.W., & Burns, B.J. (1991). Mental illness in nursing homes: United States, 1985. Vital Health Statistics Series 13, no. 105. Data from the National Health Survey; no. 97 DHHS publication; no. (PHS) 89–758.Google Scholar
Sugar, J.A., & McDowd, J.M. (1992). Memory, learning, and attention. In Birren, J.E., Sloane, R.B., & Cohen, G.D. (Eds.), Handbook of mental health and aging (2nd ed., pp. 307–337). New York: Academic Press.CrossRefGoogle Scholar
Tymchuk, A.J., & Ouslander, J.G. (1990). Optimizing the informed consent process with elderly people. Educational Gerontology, 16, 245–257.CrossRefGoogle ScholarPubMed
Tymchuk, A.J., Ouslander, J.G, & Rader, N. (1986). Informing the elderly: A comparison of four methods. Journal of the American Geriatrics Society, 34, 818–822.Google ScholarPubMed
Wetle, T., Levkoff, S., Cwikel, J., & Rosen, A. (1988). Nursing home resident participation in medical decisions: Perceptions and preferences. The Gerontologist, 25(suppl.), 32–38.CrossRefGoogle Scholar
Zarit, S.H., Dolan, M.M., & Leitsch, S.A. (1998). Interventions in nursing homes and other alternative living settings. In Nordhus, I.H., Vanden Bos, G.R., Berg, S., & Fromholt, P. (Eds.), Clinicalgeropsychology (pp. 329–343). Washington, DC: American Psychological Association.Google Scholar