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A New Health Care Directive for Long-Term Care Elderly based on Personal Values of Life

Published online by Cambridge University Press:  29 November 2010

Najmi Nazerali ,
Bernadette Ska  and
Yvette Lajeunesse
Najmi Nazerali
Affiliation:
Centre hospitalier Côte-des-Neiges
Bernadette Ska
Affiliation:
Université de Montréal
Yvette Lajeunesse
Affiliation:
Centre hospitalier Côte-des-Neiges
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Abstract

Determining the appropriate intensity of investigation and treatment for individual elderly patients in long-term care settings can present a significant challenge to physicians, especially when patients are incompetent to decide for themselves. However, respecting established intervention levels may represent an even greater challenge, given the realities of coverage by on-call physicians. This paper describes a new Intervention Level Scale for competent as well as incompetent long-term care elderly, and its validation as a communication tool between attending and on-call physicians. Specifically studied were (a) concordance of interventions, (b) whether prior knowledge of an intervention level by an on-call physician was considered useful, (c) applicability of the scale in different institutions and (d) necessity of physician training for optimal use. The scale's uniqueness resides in the fact that it is based on personal values of life, rather than institutional resources, and it incorporates directives on family contact.

Résumé

Déterminer le niveau adéquat d'investigation et de traitement médical pour les patients en soins de longue durée constitue un défi, particulièrement quand les patients sont incapables de décider eux-mêmes. Appliquer ce niveau d'intervention présente un autre défi pour les médecins de garde. Une nouvelle échelle de niveaux d'intervention destinée à des patients aptes et inaptes, en soins de longue durée, est proposée ainsi que son évaluation comme moyen de communication entre médecins traitants et médecins de garde. Les aspects étudiés sont la concordance entre leurs interventions, l'utilité de la connaissance du niveau d'intervention préétabli, l'applicabilité de l'échelle dans des institutions différentes, et la nécessité d'un entraînement pour une utilisation optimale. L'originalité de l'échelle réside dans le fait qu'elle est basée sur des valeurs personnelles plutôt que sur les ressources de l'institution et qu'elle tient compte à la fois des désirs du patient et des directives de la famille.

Keywords

ElderlyLong-Term CareAdvance DirectiveHealth Care DirectiveIntervention Level ScaleEthics.Aîné(e)ssoins de longue duréedirective préalabledirective en matière de santééchelle de niveaux d'interventionmorale.
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 17 , Issue 1 , Printemps/Spring 1998 , pp. 24 - 39
Copyright
Copyright © Canadian Association on Gerontology 1998

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References

Addison, M.J.R. (1992). Managing serious worsening of condition: Decision-making for long-term care facilities. Canadian Family Physician, 38, 1878–1880.Google ScholarPubMed
American Heart Association. Emergency Cardiac Care Committee and Subcommittees. (1992). Guidelines for cardiopulmonary resuscitation and emergency cardiac care. Part VIII — Ethical considerations in resuscitation. Journal of the American Medical Association, 268, 2282–2288.Google Scholar
Besdine, R. (1983). Decisions to withhold treatment from nursing home residents. Journal of the American Geriatrics Society, 31, 602–606.CrossRefGoogle ScholarPubMed
Buchanan, A., & Brock, D. (1989). Deciding for others. The ethics of surrogate decision making. Cambridge, MA: Cambridge University Press.Google Scholar
Callahan, D. (1987). Setting limits. Medical goals in an aging society. New York, NY: Simon and Schuster.Google Scholar
Cassel, E.J. (1991). The nature of suffering and the goals of medicine. Oxford: Oxford University Press.CrossRefGoogle Scholar
Continuing Advisory Subcommittee on the Health Care of the Elderly and Long-Term Care of the Professional Advisory Committee to the Ministry of Health, Vancouver, Canada. (1989). Death and dying in long-term care facilities. Journal of Palliative Care, 5(4), 43–58.Google Scholar
Danis, M., Southerland, L.I., Garrett, J.M., Smith, J.L., Hielema, F., Pickard, C.G., Egner, D.M., & Patrick, D.L. (1991). A prospective study of advance directives for life-sustaining care. New England Journal of Medicine, 324(13), 882–888.CrossRefGoogle ScholarPubMed
Emanuel, L.L., & Emanuel, E.J. (1989). The medical directive. A new comprehensive advance care document. Journal of the American Medical Association, 261, 3288–3293.CrossRefGoogle ScholarPubMed
Emanuel, L.L., Barry, M.J., Stoeckle, J.D., Ettelson, L.M., & Emanuel, E.J. (1991). Advance directives for medical care — A case for greater use. New England Journal of Medicine, 324, 889–895.CrossRefGoogle ScholarPubMed
Gordon, M. (1995). Should we provide cardiopulmonary resuscitation to elderly patients in long-term care? Cardiology in the Elderly, 3, 53–57.Google Scholar
Gordon, M., & Cheung, M. (1993). Poor outcomes of on-site CPR in a multi-level geriatric facility: three and a half years experience at the Baycrest Center for Geriatric Care. Journal of the American Geriatrics Society, 41, 163–166.CrossRefGoogle Scholar
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(3), 249–256.CrossRefGoogle ScholarPubMed
Kane, R.A. (1994). Ethics and long-term care. Everyday considerations. Clinics in Geriatric Medicine, 10(3), 489–499.CrossRefGoogle ScholarPubMed
Kass, L. (1980). Ethical dilemmas in the care of the ill. What is the patient's good? Journal of the American Medical Association, 244, 1946–1949.CrossRefGoogle ScholarPubMed
Kohut, N., & Singer, P.A. (1993). Advance directives in family practice. Canadian Family Physician, 39, 1087–1093.Google ScholarPubMed
Levenson, S.A., List, N.D., & Zaw-Win, B. (1981). Ethical considerations on critical and terminal illness in the elderly. Journal of the American Geriatrics Society, 29, 563–567.CrossRefGoogle ScholarPubMed
Molloy, W., & Guyatt, G. (1991). A comprehensive health care directive in a home for the aged. Canadian Medical Association Journal, 145, 307–311.Google Scholar
Report of the Council on Scientific Affairs (1990). American Medical Association White Paper on elderly health. Archives of Internal Medicine, 150, 2459–2472.CrossRefGoogle Scholar
Urbany, M., Molloy, W., – Lever, J. (1992). Health care directives for the elderly. Canadian Family Physician, 38, 2357–2361.Google Scholar
Wanzer, S., Adelstein, S., & Cranford, R. (1984). The physician's responsibility toward hopelessly ill patients. New England Journal of Medicine, 310, 955–959.CrossRefGoogle ScholarPubMed
Woods, J.S. (1986). Nursing home care. Clinics in Geriatric Medicine, 2, 601–615.CrossRefGoogle Scholar