Ethical Considerations and Comprehensive Care for Elderly Patients with Alzheimer’s  Paper

Ethical Considerations and Comprehensive Care for Elderly Patients with Alzheimer’s  Paper

Ethical Considerations and Comprehensive Care for Elderly Patients with Alzheimer’s  Paper

Ethical Considerations and Comprehensive Care for Elderly Patients with Alzheimer’s Sample

Ella West, a 79-year-old woman presenting with confusion and memory loss, has been diagnosed with Alzheimer’s disease at a middle stage.

Ethical Challenges

1. Autonomy and Decision-Making

The diminishing cognitive abilities of individuals like Ella West pose significant challenges to the preservation of autonomy and decision-making capacity. As Alzheimer’s disease progresses, patients often face difficulties in comprehending and making informed choices about their medical care and personal affairs. Advance directives are legal documents that allow individuals to express their preferences for medical treatment in advance, particularly when they are no longer able to make decisions independently. For Ella, the creation and documentation of advance directives become crucial in providing guidance to healthcare providers and family members regarding her preferences for medical interventions, end-of-life care, and other relevant matters.

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Considering the progressive nature of Alzheimer’s disease, providers should encourage Ella to appoint a durable power of attorney for healthcare and financial decisions. However, ethical considerations must be taken into account when implementing advance directives and durable powers of attorney (Sun et al., 2021). The provider must engage in open and transparent discussions with Ella and her family, explaining the implications of these legal instruments and respecting Ella’s autonomy throughout the decision-making process. Moreover, periodic reviews and updates of these documents are essential to reflect any changes in Ella’s preferences or life circumstances.

2. Quality of Life

   Ensuring the quality of life for Ella West, who is grappling with Alzheimer’s disease, requires a delicate balance between maintaining well-being and addressing safety concerns. Ethical considerations arise prominently when managing behavioral disturbances, such as agitation, and deciding on interventions, particularly the use of antipsychotic medications. Preserving Ella’s quality of life involves acknowledging her individual preferences, values, and personal history. It requires healthcare providers to consider not only the medical aspects of her condition but also the psychosocial dimensions that contribute to her overall well-being.  

Alzheimer’s patients, especially in the middle stages of the disease, may exhibit behavioral disturbances that pose challenges for both the individual and those providing care. Addressing agitation, aggression, or psychosis becomes imperative, and antipsychotic medications are often considered as a potential intervention. However, the use of antipsychotic medications in elderly individuals with dementia raises ethical concerns due to potential side effects, including sedation, increased risk of falls, and cognitive decline. Moreover, regulatory bodies emphasize the need for caution, given the increased susceptibility of older adults to these side effects. The ethical dilemma lies in finding the right balance between addressing challenging behaviors and minimizing potential harm to the patient.

Healthcare providers must adhere to ethical principles such as beneficence and non-maleficence when deciding on interventions. In the case of Ella, a thorough assessment of the risks and benefits of antipsychotic medications is essential. Providers should explore alternative non-pharmacological interventions, such as behavioral therapies, environmental modifications, or engaging activities, before resorting to medication.

Open communication with Ella and her family is paramount in the decision-making process. Informed consent, including a comprehensive discussion of potential side effects and expected outcomes, ensures that Ella’s autonomy and preferences are respected (Sun et al., 2021).

3. Driving Privileges

 Revoking Ella’s driving privileges on medical grounds is ethically necessary for the safety of both Ella and the community. Communicating this decision sensitively to maintain her dignity and understanding family dynamics is vital.

4. Informed Consent

   The pharmacologic management of Alzheimer’s disease involves discussing risks and benefits with Ella’s family. Ethical considerations include obtaining informed consent for medications, such as cholinesterase inhibitors and NMDA-receptor antagonists while considering the patient’s stage of disease and behavioral features.

Resources for Ethical Care

Advance Care Planning

Encouraging discussions about advance directives and durable powers of attorney for healthcare and financial matters is a crucial component of Ella West’s comprehensive care plan. As Alzheimer’s disease progresses, Ella’s ability to make decisions may decline, making it imperative to ensure her wishes are documented and legally binding. By initiating these conversations, healthcare providers facilitate an open dialogue about Ella’s values, preferences, and end-of-life care, ensuring her autonomy is respected even as cognitive abilities diminish (Culberson et al., 2023).

Patient and Family Support

Assessing Ella’s family’s psychosocial and financial capabilities is essential to provide appropriate support. Alzheimer’s places a significant burden on caregivers, both emotionally and financially. Identifying community-based programs for enrichment activities not only enhances Ella’s quality of life but also creates a supportive environment for her family (Culberson et al., 2023). Acknowledging and addressing the challenges caregivers face is vital in maintaining their well-being and ensuring sustained quality care for Ella.

Communication

Maintaining open communication with Ella’s family is paramount in the comprehensive care plan. This involves addressing concerns, explaining the rationale behind decisions, and providing ongoing support. Careful consideration of the emotional challenges caregivers face is essential (Culberson et al., 2023). Healthcare providers should be sensitive to the impact of Alzheimer’s on both the patient and their family, fostering a collaborative and compassionate approach to care.

References

Culberson, J. W., Kopel, J., Sehar, U., & Reddy, P. H. (2023). Urgent needs of caregiving in ageing populations with Alzheimer’s disease and other chronic conditions: Support our loved ones. Ageing Research Reviews, 90(102001), 102001. https://doi.org/10.1016/j.arr.2023.102001

Sun, W., Matsuoka, T., & Narumoto, J. (2021). Decision-making support for people with Alzheimer’s disease: A narrative review. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.750803

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· Reflection: Address the following questions:

Caring for clients with memory loss can be challenging for caregivers and for providers. What ethical challenges might the provider face and what resources are available to ensure appropriate, ethically sound care for this client and her family?

DX: Alzheimer’s with agitation/// middle stage issues (money mgt, agitation, sundowning, crying in the evening)

Include the following components:

Write 150-300 words in a Microsoft Word document.

Demonstrate clinical judgment appropriate to the virtual patient scenario.

Cite at least one relevant scholarly source as defined by program expectations (scholarly of < 5 years.)

Communicate without errors in English grammar, spelling, syntax, and punctuation.