Marginal Competence, Risk Assessment, and Care Decisions: A Comparison of Values of Health Care Professionals and Older Adults

Abstract

Using a case scenario involving a marginally competent elderly woman living alone at risk, we assessed the care decisions made by older adults (n = 82) and health care professionals (HCPs, n = 87), and identified differences in the values underlying the care decisions. Overall, participants did not place a high value on independence when they appraised the risk to the client as high and safety as low. Under these conditions, elderly respondents tended to be more paternalistic in their decisions about care, while HCPs tended to be more beneficient. If the values of HCPs differ from those of elderly people, how likely is it that the care provided to marginally competent elderly people will be congruent with their wishes? The care provided by HCPs might be improved by incorporating knowledge of the values and perspectives of other older adults.

Risk: ‘I know it when I see it’: how health and social practitioners defined and evaluated living at risk among community-dwelling older adults

“…For instance, from a social-cultural perspective, there is a suggestion that we have become a risk-preoccupied society, seeing events through the lens of risk (Heyman, 2010). From a personal perspective, deciding on what is risky behaviour, what is the likelihood of harm to occur, what is acceptable risk and what is the potential severity of the harm are all subjective and based on personal values, beliefs and knowledge base (Gunstone, 2003;MacCourt & Tuokko, 2010). The definition of risk in both contexts depends in part on issues of perceived accountability and blame (Alaszewski & Brown, 2012) and on how risk is specified and portrayed by, for example, individuals, public officials or the media (van Loon, 2014).…”

“…Older adult clients tend to relate to the biographical dimension of risk such as a loss of identity (Clarke, 2000) and make risk management decisions based on a sense of obligation (MacCourt & Tuokko, 2010), while family carers in contrast emphasise the present and focus on the interpersonal impacts of risk for the client (Bailey et al, 2013;Clarke, 2000). While clients perceive risk as being outside of themselves and their homes, for instance, from the threat of strangers gaining access to their home, family carers in contrast perceive risk as being within the older person and evaluated risk along an acceptable to non-acceptable continuum (Cott & Tierney, 2013).…”

“…As common as this concept is, it is used in different and often inconsistent ways in the literature. The literature on risk with community-dwelling older adults either does not define risk (Ceci & Purkis, 2009;McDermott, 2010;Reich, Eastwood, Tilling, & Hopper, 1998), refers to risk as being a perilous event/hazard (MacCourt & Tuokko, 2010;Taylor, 2006) or infers the consequences of the event as the risk (Gilbert, Adams, & Buckingham, 2011;Ryan, 1998;Tanner, 2003;Tierney et al, 2004). The majority of the literature on the risks relating to older people living in the community describes risk as events that have the potential to cause negative consequences, which Carson and Bain (2008) note is in line with the medical model of practice.…”

“…In order to support the older adult who experiences a decline in health affecting function and prefers to remain at home, health and social practitioners need to know how to evaluate risk when the client's safety is a concern. While current research provides information on how practitioners define, identify, perceive, assess and manage such risk, the breadth and inconsistencies in research findings make it difficult for practitioners to apply them in their everyday practice (Clarke, 2000;Gunstone, 2003;MacCourt & Tuokko, 2010;Moats, 2007;Purdy, 2010).…”

Evaluation of a workplace engagement project for people with younger onset dementia

“…This unscripted workplace activity unfolded naturally, so added to the challenge for participants and contributed to their satisfaction and pride in their accomplishments. However, for service providers, this type of situation is accompanied by a degree of risk, a tension between safety and supervision vs. risk and independence (MacCourt & Tuokko ). It concerns finding the balance between allowing the person with dementia to have the opportunity to take risks against the service provider's obligations of duty of care (Alzheimer's Australia ‐ NSW ).…”