Ethical Issues in Elderly

- Roll no
77&78

18/04/2023
 IM 24.18: Describe impact of
demographic changes in aging of the
population

IM 24.19: Enumerate and describe

Competencies the social problems in elderly

including isolation, abuse, change in
family structure and their impact on
health

IM 24.21: Enumerate and describe

ethical issues in care of the elderly
DEMOGRAPHICS OF AGING AND ITS
IMPLICATIONS FOR GERIATRIC
CARE
● Most rapidly growing segment of the population in the United States and many
other developed countries is those older than 80
● According to the United Nations 2019 Aging Report, 1 in 6 people in the world
will be 65 years old or older by the year 2050.
● Gender composition of the aging population around the world is also expected
to change. Although females outlive males, an improvement in survival of the
oldest-old males could result in more balanced gender distribution in the
geriatric population in the future.
● As life span increases, efforts should continue to focus on pro- moting healthy
aging to reduce the burden of disability in health care systems all over the world.
 Indian Geriatric Population
● Population of the elderly in India has been increasing steadily since 1961 as it
touched 13.8 crore in 2021, growing faster due to decrease in death rate,
according to a study by NSO.

● There are nearly 138 million (13.8 crore) elderly persons in India in 2021
comprising 67 million males and 71 million females.

● During 2011 to 2021, the general population has increased by 12.4 per cent
while the elderly population has risen by 35.8 per cent, it showed.

● It has projected that while the general population in the country will rise by 8.4
per cent during 2021 to 2031, the population elderly in India will grow by 40.5
percent. https://www.businesstoday.in/lifestyle/health/story/indias-elderly-population-grows-to-138-cr-in-2021-over-lower-death-rates-nso-study-304209-
2021-08-15
 ● Isolation

Social Problems ● Abuse

in Elderly ● Changing family

structure
IMPACT
● The incidence of elder abuse and neglect and self-neglect are unknown
because they are often unrecognized.
● Abuse and neglect can result in physical injuries and related pain,
worsening of chronic medical conditions, dehydration and pressure
ulcers, emotional distress, and loss of income and savings.
EPIDEMIOLOGY
The incidence of elder abuse and neglect and self-neglect are unknown
because they are often unrecognized. The best data suggest that the
incidence over 12 months is at least 8–10%. Abuse and neglect can result in
physical injuries and related pain, worsening of chronic medical conditions,
dehydration and pressure ulcers, emotional distress, and loss of income and
savings.
ETHICAL ISSUES
1. Decision making capacity
2. Informed consent
3. Refusal of treatment
4. Advance directive - viewed as the cornerstone of advance care
planning, and can include both instructions about what kind of care
should be provided (living wills) and who makes the decisions (proxy
decision-making) in the event that the patient cannot.
Decision making capacity
● Implies the ability to understand the nature and consequences of different
options, make a choice among thode options, and communicate that
choice.
● Clinicians assess decision making capacity.
● It is required to give informed consent.
● May fluctuate over from transient changes in ability to comprehend and
communicate.
● Competency: legal determination by a judge as to mental ability and
capability and whether a person is legally fit and qualified to give
testimony.
Informed consent
Age related factors:

● Hearing and visual impairments

● Impaired communication: written and verbal
● Values and beliefs
● Fluctuating and diminished decision making capacity
Advanced Directive
● Advance directive are written statements of a persons wishes regarding
medical care.

● It is a formal, legally endorsed document that provides instruction for

care (living will) or names the proxy decision maker (durable power of
attorney)
Recent amendments
1. The Punjab and Haryana high court has
upheld the cancellation of property transfer
from a senior citizen to her son by a single
judge bench, observing that the children are
expected to look after their elderly parents
properly “which is not only a value-based
principle but a bounden duty as mandated by
law”.
1. Now, even daughter-in-law and son-in-law of
senior citizens would be responsible to take care of
them. Moving to amend the Maintenance and Welfare
of Parents and Senior Citizens Act, the government has
expanded the ambit of social security for the elderly by
making distant relatives responsible for their upkeep,
increased fine and imprisonment for abandoning
parents and done away with the financial cap of Rs
10,000 for maintenance of parents.

2. The ministry of social justice and empowerment has

finalised the Maintenance and Welfare of Parents and
Senior Citizens (Amendment) Bill 2018. The legislation
amends many clauses of the 2007 Act to ensure better
care and maintenance for the senior citizens.
DO NOT RESUSCITATE ORDERS (DNR)

● Dnr are legal and binding but must be justified as client request or be

medically indicated.

● When DNR order is made, the supporting documentation must include

clients current condition, prognosis, summary of decision making and

who was involved.

THANK YOU!