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A New Health Care Directive for Long-Term Care Elderly based on Personal Values of Life

Published online by Cambridge University Press:  29 November 2010

Najmi Nazerali ,
Bernadette Ska  and
Yvette Lajeunesse
Najmi Nazerali
Affiliation:
Centre hospitalier Côte-des-Neiges
Bernadette Ska
Affiliation:
Université de Montréal
Yvette Lajeunesse
Affiliation:
Centre hospitalier Côte-des-Neiges
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Abstract

Determining the appropriate intensity of investigation and treatment for individual elderly patients in long-term care settings can present a significant challenge to physicians, especially when patients are incompetent to decide for themselves. However, respecting established intervention levels may represent an even greater challenge, given the realities of coverage by on-call physicians. This paper describes a new Intervention Level Scale for competent as well as incompetent long-term care elderly, and its validation as a communication tool between attending and on-call physicians. Specifically studied were (a) concordance of interventions, (b) whether prior knowledge of an intervention level by an on-call physician was considered useful, (c) applicability of the scale in different institutions and (d) necessity of physician training for optimal use. The scale's uniqueness resides in the fact that it is based on personal values of life, rather than institutional resources, and it incorporates directives on family contact.

Résumé

Déterminer le niveau adéquat d'investigation et de traitement médical pour les patients en soins de longue durée constitue un défi, particulièrement quand les patients sont incapables de décider eux-mêmes. Appliquer ce niveau d'intervention présente un autre défi pour les médecins de garde. Une nouvelle échelle de niveaux d'intervention destinée à des patients aptes et inaptes, en soins de longue durée, est proposée ainsi que son évaluation comme moyen de communication entre médecins traitants et médecins de garde. Les aspects étudiés sont la concordance entre leurs interventions, l'utilité de la connaissance du niveau d'intervention préétabli, l'applicabilité de l'échelle dans des institutions différentes, et la nécessité d'un entraînement pour une utilisation optimale. L'originalité de l'échelle réside dans le fait qu'elle est basée sur des valeurs personnelles plutôt que sur les ressources de l'institution et qu'elle tient compte à la fois des désirs du patient et des directives de la famille.

Keywords

ElderlyLong-Term CareAdvance DirectiveHealth Care DirectiveIntervention Level ScaleEthics.Aîné(e)ssoins de longue duréedirective préalabledirective en matière de santééchelle de niveaux d'interventionmorale.
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 17 , Issue 1 , Printemps/Spring 1998 , pp. 24 - 39
Copyright
Copyright © Canadian Association on Gerontology 1998

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