American Psychological Association
Table of Contents
Executive Summary
Authors
Why Practitioners Need Information
Demographic Realities
Myths About Older Adults
Realities of Aging
Psychological Problems
of Aging
Assessment of Older Adults
Psychological Intervention
Professional Concerns
Conclusion
Professional Resources
Bibliography |
Working with older adults may present special challenges to the psychologist.
This is because older adults receive care from overlapping and not always
well-integrated health systems. For some adults with chronic illness, both
family members and paid caregivers are involved. In some settings (e.g.,
nursing homes, adult homes, board and care facilities), older adults both
live and receive care in the same facility. With late life also comes increasing
risk of severe physical debilitation and death. Because of these factors,
there are particular ethical issues pertaining to confidentiality and end-of-life
decisionmaking for professionals working with older adults.
- APA's Ethical Principles of Psychologists and Code of Conduct provides
a framework for understanding central issues on the ethical treatment of
older and younger clients. With older adults, however, issues arise that
require careful evaluation and application of those principles.
- It is important to note that unless declared incompetent, the older
adult has a right to make decisions to initiate, withdraw, or terminate
treatment. They have the right to personal autonomy and to refuse medications,
surgery, and research participation.
- In community settings adults, children, spouses, and other caregivers
are frequently in contact with mental health professionals. To assure confidentiality,
written permission should be obtained from older persons to communicate
information regarding their status to relatives or to health care professionals.
- For older persons with dementia, or other forms of significant cognitive
impairment, confidentiality issues can become complex because questions
may arise about the cognitively impaired older person's ability to give
truly informed consent to release information. Competency is a legal judgment,
rules for which vary from state to state. However, if the older person
is legally judged incompetent, then the appointed guardian is responsible
for release of information. Some cognitively compromised persons have signed
a document that grants permission to another individual, usually a spouse
or adult child, to manage their affairs, in which case this is the person
responsible for consent. In some cases the as yet legally competent older
client may be willing to sign a consent form, yet the psychologist may
have serious doubt about their ability to understand what is being requested.
In this case, the psychologist must use best judgment guided by the principle
that what is done is in the client's best interest.
- In nursing homes and assisted care facilities, some older clients whom
the psychologist sees may be distressed over problems with the facility
or staff. Some staff may request information from the psychologist to clarify
the nature of the older client's concerns and seek solutions to problems.
Authorization to disclose information must be provided by the older client
or guardian. Even if permission is granted, the psychologist must communicate
only that information that is pertinent to the specific issue at hand.
- The Patient Self-Determination Act of 1990 requires Medicaid and Medicare
provider organizations to request at patient admission advanced directives
from the client regarding termination of care. Another form of directive
is the living will. The psychologist working with a severely ill older
person may be part of a decisionmaking process that also includes family
and medical personnel regarding end of life issues (e.g., whether or not
to make extraordinary efforts to prolong the patient's life). In these
circumstances, the psychologist's central task is to help patient and family
better understand issues and options and help them to make value laden
decisions without imposing the psychologist's own views.
 
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