Respectful Care for Elders

1. Respectful Care for Elders Shirley KL LO Clinical Associate School of Nursing The Hong Kong Polytechnic University Bioethics Workshop 15 June 2012 S.Lo

2. Outline: Spectrum of Quality of care Inadequate care Respect Privacy & personhood Elder abuse Respectful care Bioethics Workshop 15 June 2012 S.Lo

3. Respectful Care • Respecting for autonomy • Respecting privacy and personhood • Upholding dignity Bioethics Workshop 15 June 2012 S.Lo

4. Respecting autonomy Respect for individuality is a core value in our society and is no less so when caring for the elderly. In fact, it may be even more needed because the elderly are usually not as able as the younger population to stand up for their rights and their decisions. Bioethics Workshop 15 June 2012 S.Lo

5. Respecting autonomy (2) • Eldercare providers owe the elderly the duty to respect his autonomy and to enable them to exercise autonomy in a meaningful way. • Autonomy is also involved in the elder being able to give his “informed consent” to treatments – exercising autonomy depends upon relevant information and implies a capacity to use that information. Bioethics Workshop 15 June 2012 S.Lo

6. Respecting autonomy (3) • Where the elder’s mental capacity to understand his options and make decisions is in question, true autonomy may not exist. • Then, autonomy may be exercised through a surrogate, the moral or legal agent – substituted decision – should be made in the best possible interests of the elder involved. Bioethics Workshop 15 June 2012 S.Lo

7. Scenario 1: A 70-year-old female is diagnosed with cancer, she refuses any invasive treatment. As her care provider, what course of action you may find most appropriate in her situation? Bioethics Workshop 15 June 2012 S.Lo

8. Ethical considerations: • Provided she has all her mental faculties and has been fully informed of the benefits and consequences of various treatments, she may refuse any treatments and elect to have alternative therapies of acupuncture and natural remedies. In this case, she is utilizing her rights of autonomy. • However, the elder’s autonomy reigns only after her caregivers have discharged their duty to fully communicate the information needed, including the risks and benefits, in a manner that allows her to both form and render her informed consent or decision. Bioethics Workshop 15 June 2012 S.Lo

9. Respect privacy and personhood • Privacy and independence – both are the strongest expression of personal identity. • Respecting privacy means not to invade or intrude upon an individual’s ‘personal space’ and not to pry. • Examples of such good aged care: • Call a patient/client by name, • Screen up for dressing , • Respect client’s choice regarding their choice as to when to get up from bed, when and what to eat, etc; and • Provide privacy during napkin change / toileting Bioethics Workshop 15 June 2012 S.Lo

10. Upholding dignity Increased dignity Mutual respect and trust Disrespect and humiliation Decreased dignity Bioethics Workshop 15 June 2012 S.Lo

11. Eight main factors that promote dignity in older people, all of which contribute to the person's sense of self respect. • Choice and control • Communication • Pain management • Personal hygiene • Eating and nutritional care • Practical assistance • Privacy • Social inclusion Magee, H., Parsons, S., & Askham, J. (2010) Bioethics Workshop 15 June 2012 S.Lo

12. Inadequate care • Unacceptable care provided to elderly people • Examples: • Unchanged soiled bed sheets • Leaving trays of food without helping elder to eat if (s)he is too frail to feed him/herself • Use excessive force to restrain • Ignoring call for assistance • Washing or dressing client without regard to his/her dignity Bioethics Workshop 15 June 2012 S.Lo

13. Elder abuse • Filial piety : do grown children owe their parents? • Ageism • Risks factors • Impacts of elder abuse on elders’ well-being • Protect elders from abuse Bioethics Workshop 15 June 2012 S.Lo

14. Definition of elder abuse[Or do we have one?] WHO (2002): defining elder abuse as “the intentional use of physical force or power, threatened or actual, against oneself, another person, or against a group or community that either results in or has a high likelihood of resulting in injury, death, psychological harm, mal-development or deprivation.” Bioethics Workshop 15 June 2012 S.Lo

15. Filial piety – ‘xiao’ • Confucius’ emphasis on “xiao”, as adult children’s taking respectful care for their aged parents, had a tremendous influence in shaping the Chinese understanding of the nature of morality. • Decline of such traditional values in Hong Kong (Chow, 2004) • Impacts from westernization, industrialization, and increase of nuclear families Bioethics Workshop 15 June 2012 S.Lo

16. Types of elder abuse Bioethics Workshop 15 June 2012 S.Lo

17. Types of elder abuse (2) Bioethics Workshop 15 June 2012 S.Lo

18. Ageism • First used in 1960s to describe negative attitudes towards older people and the way they are portrayed as a social problem and a burden on society simply because they are ‘old’. • Some common misconceptions and stereotype elders as: • ‘out of touch with reality’ • confused • frail • senile • vulnerable • powerless Bioethics Workshop 15 June 2012 S.Lo

19. Risk factors of elder abuse • Social isolation • Poor-quality long-term family relationship • Pattern of family violence • Carers’ personality • Dependence • Mental health problems • Poor run institution, under staff, poor training Bioethics Workshop 15 June 2012 S.Lo

20. Impacts on elders’ well-being • Increased mortality (Lachs et al., 1998) • More likely to report poor health conditions (Fisher and Regan, 2006) • Experience significantly more psychological distress, anxiety and demonstrated socially inappropriate behaviour (Yan and Tang, 2001) Bioethics Workshop 15 June 2012 S.Lo

21. Elder abuse in HK’s cultural and social contexts • Forces of social change impacting the traditional family structure in Hong Kong • Small public housing units – not encouraging multigenerational households, leaving elders alone • Elder’s expectation and care needs are not met • Challenges to the filial piety practices Bioethics Workshop 15 June 2012 S.Lo

22. Protect elders from elder abuse • Voices of older people • Culturally-sensitive interventions • Public awareness • General education • Uphold traditional respectful attitudes towards older people • Resources, policy-maker Bioethics Workshop 15 June 2012 S.Lo

23. Scenario 2 Mr. & Mrs. Li are 87 and 89 years old respectively. They are mentally competent, albeit a bit unsteady on feet. Their adult children hire a domestic helper and instruct her not to allow the elder parents out 24 hours a day. Bioethics Workshop 15 June 2012 S.Lo

24. Scenario 3 Ah Mo, 73-year-old, has diabetes and has becoming forgetful recently. To avoid her causing fire at home, her daughter send her to a Day Centre for Elderly People every morning on her way to work. The daughter then picks her up after work. After the Centre closes and before the daughter finishes work, Ah Mo needs to wait in a nearby park or to wander in a nearby shopping mall. Bioethics Workshop 15 June 2012 S.Lo

25. Scenario 4 Kwong, a son of a 76-year-old widow, who is physically independent. Kwong often has to work till 1-2 o’clock in the morning. When he returns home, he sometimes wakes her mom up to make him night meal. Bioethics Workshop 15 June 2012 S.Lo

26. THANK YOU!! Bioethics Workshop 15 June 2012 S.Lo