Determining the Capacity of Demented Nursing Home Residents to Name a Health Care Proxy

Acsw, Paulette Sansone PhD; Csw, Louise Schmitt PhD; Nichols, Jeffrey; Dsw, Michael Phillips; Belisle, Suzanne

doi:10.1300/j018v19n04_04

Cited by 16 publications

(12 citation statements)

References 19 publications

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“…An important limitation of this study is that residents' preferences for the nutrition interventions were not measured directly. However, resident preferences are best measured using a different methodological approach than that used in this study—in‐person interviews as opposed to questionnaires and simplified questions with a yes/no response format 26–29 . Future research should attempt to measure residents' nutrition intervention preferences with this approach and evaluate residents' responsiveness to the behavioral and environmental interventions identified as “most desirable” by family members in this study.…”

Section: Discussionmentioning

confidence: 99%

Family Members' Preferences for Nutrition Interventions to Improve Nursing Home Residents' Oral Food and Fluid Intake

Simmons

Lam

Rao

et al. 2003

J American Geriatrics Society

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Section: Discussionmentioning

confidence: 99%

Family Members' Preferences for Nutrition Interventions to Improve Nursing Home Residents' Oral Food and Fluid Intake

Simmons

Lam

Rao

et al. 2003

J American Geriatrics Society

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“…(8) Short Portable Mental Status Questionnaire [45]. The Short Portable Mental Status Questionnaire (SPMSQ) is a 10-item examination that has been found reliable and valid in distinguishing demented subjects from cognitively intact subjects.…”

Section: Methodsmentioning

confidence: 99%

The effects of a long-term care walking program on balance, falls and well-being

et al. 2012

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BackgroundThe effects of a regular and graduated walking program as a stand-alone intervention for individuals in long-term care are unclear. Exercise and fall prevention programs typically studied in long-term care settings tend to involve more than one exercise mode, such as a combination of balance, aerobic, strengthening, and flexibility exercises; and, measures do not always include mental health symptoms and behaviors, although these may be of even greater significance than physical outcomes.Methods/designWe are randomly assigning residents of long-term care facilities into one of three intervention groups: (1) Usual Care Group - individuals receive care as usual within their long-term care unit; (2) Interpersonal Interaction Group - individuals receive a comparable amount of one-on-one stationary interpersonal interaction time with study personnel administering the walking program; and, (3) Walking Program Group – individuals participate in a supervised, progressive walking program five days per week, for up to half an hour per day. Assessments completed at baseline, 2 and 4 months during intervention, and 2 and 4 months post-intervention include: gait parameters using the GAITRite® computerized system, grip strength, the Berg Balance Scale, the Senior Fitness Test, the Older Adult Resource Services Physical Activities of Daily Living, the Geriatric Depression Scale Short Form, the Cornell Scale for Depression in Dementia, the Revised Memory and Behavior Problems Checklist, the Short Portable Mental Status Questionnaire, the Coloured Analogue Scale, pain assessment scales, and the number and nature of falls. Sophisticated data analytic procedures taking into account both the longitudinal nature of the data and the potential for missing data points due to attrition, will be employed.DiscussionResidents in long-term care have a very high number of comorbidities including physical, mental health, and cognitive. The presence of dementia in particular makes standardized research protocols difficult to follow, and staff shortages, along with inconsistencies related to shift changes may impact on the accuracy of caregiver-rated assessment scales. Practical challenges to data collection validity and maintenance of inter-rater reliability due to the large number of research staff required to implement the interventions at multiple sites are also posed.Trial registrationClinicalTrials.gov NCT01277809

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“…Nursing home residents named consistent choices 80% (at the beginning and end of an interview) 33 to 55% (at 1-week intervals on three occasions) 35 of the time (i.e., inconsistent 20%–45% of the time). Like understanding of an HCP, the ability to name a consistent choice was associated with level of cognitive impairment.…”

Section: Empirical Studies Of Capacity To Appoint a Healthcare Surrogatementioning

confidence: 99%

“…The limited empirical study of capacity to appoint a healthcare surrogate suggests that just because a person can name a healthcare proxy once, this may not represent his or her only choice or a stable choice. 35 Although individuals can and sometimes do have a valid change of mind, findings of inconsistency at the beginning and end of an interview should sound a note of caution, particularly in the setting of potential malfeasance by the surrogate decision maker. Inconsistency could also reflect influence by a family member who has recently communicated with the patient.…”

Section: Ethical Perspectives: Consideration Of Risks and Benefitsmentioning

confidence: 99%

Evaluation of the Capacity to Appoint a Healthcare Proxy

Moye¹,

Sabatino²,

Brendel³

2013

The American Journal of Geriatric Psychiatry

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The appointment of a healthcare proxy is the most common way through which patients appoint a surrogate decision maker in anticipation of a future time in which they may lack the ability to make medical decisions themselves. In some situations, when a patient has not previously appointed a surrogate decision maker through an advance directive, the healthcare team may ask whether the patient, although lacking the capacity to make a healthcare decision, might still have the capacity to appoint a healthcare proxy. In this article the authors summarize the existing, albeit limited, legal and empirical basis for this capacity and propose a model for assessing capacity to appoint a healthcare proxy that incorporates clinical factors in the context of the risks and benefits specific to surrogate appointment under the law. In particular, it is important to weigh patients’ understanding and choice within the context of the risks and benefits of the medical and interpersonal factors. Questions to guide capacity assessment are provided for clinical use and refinement through future research.

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Determining the Capacity of Demented Nursing Home Residents to Name a Health Care Proxy

Cited by 16 publications

References 19 publications

Family Members' Preferences for Nutrition Interventions to Improve Nursing Home Residents' Oral Food and Fluid Intake

Family Members' Preferences for Nutrition Interventions to Improve Nursing Home Residents' Oral Food and Fluid Intake

The effects of a long-term care walking program on balance, falls and well-being

Evaluation of the Capacity to Appoint a Healthcare Proxy

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