Ethico-Legal Considerations for Older Adults PDF

ETHICO-LEGAL CONSIDERATIONS/ETHICAL PRINCIPLES & MEDICATIONS IN THE CARE OF OLDER ADULTS Prepered by: Caroline V. San Diego MAN,RN At the end of the course unit (CU), 1 learners will be able to:  Cognitive: 1.Gain awareness regarding the Senior Citizen Law in the Philippines. 2. List me...

ETHICO-LEGAL CONSIDERATIONS/ETHICAL PRINCIPLES & MEDICATIONS IN THE CARE OF OLDER ADULTS Prepered by: Caroline V. San Diego MAN,RN At the end of the course unit (CU), 1 learners will be able to:  Cognitive: 1.Gain awareness regarding the Senior Citizen Law in the Philippines. 2. List measure to promote safe drug use.. 3. Identify proper uses and risks using common drug used with elderly. ETHICS OF CARE 2  1. ADVOCACY  2. AUTONOMY  3. BENEFICENCE / NONMALEFICENCE  4. CONFIDENTIALITY  5. FIDELITY  6. FIDUCIARY RESPONSIBILITY  7. JUSTICE  8. QUALITY AND SANCTITY OF LIFE  9. RECIPPROCITY  10. VERACITY ISSUES TO BE CONSIDERED 3 Issues on Conflict of interest 1. Actual Conflict of Interest issues- between family members and caregivers represent the elderly or assist them in decision- making Issues on Conflict of Interest 4  These include conflicts:  Between spouses and the elder’s wishes and interest;  Between family members and the elder’s wishes and interest;  Between a guardian, conservator or other lawfully designated agent and the elder’s wishes and interests;  Between a caregiver’s business interests and the elder’s interests. Well-being and quality of life. Issues on Conflict of Interest 5 2. Perceived Conflicts of Interest – which include those which are not actual conflicts in the course of care but may later become conflicts when the elder patient’s interest diverge from those who provide the care. Issues on Confidentiality 6  in caring for an elderly patient, invariably, there is disclosure made by the family and relatives regarding information that may otherwise be personal and confidentiality to the patient alone. Issues on Decision- Making Capacity 7  Many times, the older patient’s decision- making capacity ( also referred to as “ competence”) may be required for certain decisions. Legal Risks in Gerontological Nursing  Malpractice  Confidentiality  Patient consent  Patient competency  Staff supervision  Medications  Restraints  Telephone orders  Do not resuscitate orders  Advance directives and issues related to death and dying  Elder abuse  Benefits and Previleges of 17 “Senior Citizen” RA 7432 – known as “an act to maximize the contribution of senior citizens to nation building, grant benefits and special privileges and for other purposes”. Republic Act No. 8425 – provides for the institutionalization and enhancement of the social reform agenda by creating the National Anti- Poverty commission (NAPC).  Benefits and Previleges of 18 “Senior Citizen” Republic act No. 344 or the Accessibility Law of 1982 – provides for the minimum requirements and standards to make buildings, facilities, and utilities for public use accessible to persons with disability, including older persons who are confined to wheelchair and those who have difficulty in walking or climbing stairs, among others.  Benefits and Previleges of 19 “Senior Citizen” Republic Act No. 9994. “Expanded Seniors Citizen Act of 2010”- an act granting additional benefits and privileges to senior citizens, further amending Republic Act No. 7432 and otherwise known as “an act to maximize the contribution of senior citizens to nation building, grant benefits and special privileges and for other purposes.  Benefits and Previleges of 20 “Senior Citizen” Republic Act No. 10155, “ The General Appropriations Act of 2012” – under Section 28 mandates that all government agencies and instrumentalities should allocate one percent of their total agency budget to programs and projects for older persons and persons with disability  Benefits and Previleges of 21 “Senior Citizen” Republic Act No. 10645, An Act Providing For the Mandatory Philhealth Coverage for All Senior Citizens”, Amending for the purpose, Republic act No. 7432, as amended by Republic Act No. 9994 by removing the qualification that a senior citizen has to be indigent before being covered by PhilHealth  Benefits and Previleges of 22 “Senior Citizen” Republic Act No. 10868, “Centenarians Act of 2016”, An Act Honoring and Granting Additional Benefits and Privileges to a FILIPINO CENTENARIANS. All Filipinos who have turned centenarian in the current fiscal year shall be awarded a plaque of recognition and a cash incentive by their respective city or municipal governments in appropriate ceremonies in addition to the LETTER of FELICITATION and centenarian gift of P 100,000.00.  Benefits and Previleges of 23 “Senior Citizen”  Presidential Proclamation No. 470, Series of 1994, declares the first week of OCTOCER of every year as “ Elderly Filipino Week.”  Presidential Proclamation No. 1048, Series of 1999,declaring a “Nationwide Observance in the Philippines of the International Year of Older Persons”.  Benefits and Previleges of 24 “Senior Citizen”  Executive Order No. 105, series of 2003, approved and directed the implementation of the program providing for group homes and foster homes for neglected, abandoned, abused, detached, and poor older persons and persons with disabilities.  The Philippine Plan of Action for senior Citizens (2011-2016). This plan aims to ensure giving priority to community-based approaches which are gender- responsive, with effective leadership and meaningful participation of senior citizens in decision-making processes, both in the context of family and community. PHARMACOLOGY AND OLDER ADULTS Older persons body is at greater risk for adverse drug events than younger persons. In body water ( as much as 15%) results to increase concentration of water-soluble drugs ( e. g. alcohol) in body fat more prolonged effects of fat- soluble drugs hepatic blood flow results in increased toxicity= Increased SGPT Increased PT, PTT serum albumin level altered binding capacity increased serum level of the free or unbound proportion of protein- bound drugs toxic level of highly bound drugs PREDICTORS OF MEDICATION RESPONSE  GENERAL STATE OF HEALTH  NUMBER AND TYPES OF OTHER MEDICATIONS TAKEN  LIVER (sgpt) , RENAL FUNCTION - Creatinine  PRESENCE OF COMORBIDITIES OR OTHER DIAGNOSED DISEASES MEDICATION ERROR Results from human knowledge based deficiencies and a lack of sophisticated systems to support and monitoring drug therapy. 2 IMPORTANT DISTINCTIONS IN MEDICATION ERROR LANGUAGE  ADVERSE DRUG REACTION ( ADR) any unintended response to a drug that occurs when drugs are used to diagnose, treat or prevent disease. ADR INCLUDES:  Difficulties in the activity of daily living.  Cognitive changes  Falls  Anorexia, nausea  Weight changes ADVERSE DRUG EVENT (ADE) any injury that results when medications are used, and this includes both ADR’s and medication errors that lead to an ADR. NOTE: the use of too many or wrong types of medications increases the risk of both an ADE and non-adherence!!!!! FACTORS THAT CONTRIBUTE TO INCREASED RISK OF ADE 1. PHARMACOKINETIC CHANGES : WHAT THE BODY DOES TO THE DRUG???  DRUG ABSORPTION  Do not usually contribute to drug response and have less impact on pharmacokinetics. altered distribution into the peripheral circulation and tissues  decrease in plasma albumin levels with age may result in decreased binding of drugs that are mainly bound to serum albumin  decrease in total body water, and intracellular water volumes may lead to an increased serum concentration of water soluble drugs such as lithium and alcohol DRUG DISTRIBUTION increase in body fat may increase in the distribution of fat- soluble medications ( e. g. benzodiazepines) into fatty tissue, resulting in prolonged half-lives and drug accumulation HEPATIC METABOLISM  age-related metabolism is not easily measured. Primarily, biotransformation occurs in liver, where enzymatic activity alters and detoxifies the drug to prepare it for excretion. RENAL EXCRETION  the most important pharmacokinetic parameter that changes with age  changes is extremely variable, majority of older adults have a decline kidney function, requiring a decrease dose or extension of interval for certain drugs  SERUM CREATININE may be used as indirect estimate of renal function.  CREATINE CLEARANCE is an estimate of GFR and decreases with age. 2. PHARMACODYNAMIC CHANGES WHAT THE DRUG DOES TO THE BODY?? Aging may result in different responses for older adults to the same drug concentrations at the site of action compared with younger adults. CHANGES IN PHARMACODYNAMICS IN OLDER PERSON MAY BE CAUSED BY:  Altered number of receptors or affinity.  Decreases in receptor binding.  Altered cellular response to the drug receptor- receptor interaction.  Organ pathologic condition.  Altered homeostatic mechanism. 3. DRUG-DRUG INTERACTION  an interaction between one drug and another can result from altered pharmacokinetics or pharmacodynamics.  it is largely thought that alterations in hepatic metabolism are specifically responsible for drug-drug interaction.  EX: Warfarin and aspirin- increased risk for bleeding. 4. DRUG-FOOD INTERACTION  the effect of a drug or food can be influenced by their combined actions.  EX: Theophylline and caffeine- increased risk for potential toxicity.  Levodopa and clonidine- decreased antiparkinsonian effect. 5. DRUG- DISEASE INTERACTIONS  certain states may be exacerbated by specific drug therapies, and these drugs may be contraindicated in patients with coexisting underlying disease.  EX: Aspirin, NSAID’s and Atrophic gastritis- GI hemorrhage POLYPHARMACY  Prescription, administration, or use of more medications that are clinically indicated in given patient.  MULTIPLE MEDICATIONS INCREASE THE CHANCE OF: 1. drug-drug interaction 2. ADE’s and ADR’s 3. Error of dosing PREVENTION OF POLYPHARMACY 1. Use of the same pharmacy to fill all prescriptions. 2. Notification to all prescribing clinicians of drug used. 3. Nurse obtaining a complete history of all drugs used.