Prevalence of enduring power of attorney and barriers towards it in community geriatric population in Counties Manukau Health.

AIM: Enduring power of attorney (EPA) is a simple and easy-to-set-up legal document which protects the wishes of the donor, as well as preventing significant psychological and social cost for the patient and their family when long-term residential care needs to be arranged due to the patient's increasing care requirements. It also reduces the significant cost in hospital beds days for the district health board involved while awaiting the Protection of Personal and Property Rights order. However, the prevalence of EPA is low in the geriatric population who arguably need it the most. This study aims to identify the barriers in obtaining an EPA in this population. METHODS: Using a cross-sectional design, 100 individuals seen in community geriatric clinics or home visits in Counties Manukau Health between June to September 2015 were surveyed. RESULTS: There was no significant difference in prevalence of EPA between those with cognitive impairment and those without (40.4% and 35% respectively with difference in proportion 5% (95% CI: -14% to 24%, p 0.61)). New Zealand Europeans were more likely than other ethnic groups to have EPA (63.5% vs 10.4%, with difference in proportion of 53% (95% CI: 37% to 69%, p<0.001)). Forty-three participants without EPA gave lack of information as their reason for not having obtained one. The majority of those without EPA (49 participants) felt that their doctor or lawyer would be the best person to convey such information to them, as opposed to mass media such as TV or internet. CONCLUSION: EPA has not been widely acknowledged as an important aspect of health and legal planning by the participants of this survey, predominantly due to the lack of knowledge in the general public and financial barriers. Increased efforts to educate and support uptake could have positive personal and social outcomes.

Review of capacity assessments and recommendations for examining capacity.

AIM: To audit the capacity assessments performed since December 2007 by Community Geriatric Services (CGS), Middlemore Hospital, and to develop a resource kit for training health professionals. METHOD: 1343 clinical letters were reviewed. Demographic data, reason for assessment and outcome of assessment were recorded. Data was analysed to reveal trends. RESULTS: There were 87 capacity assessments on 82 unique patients. The numbers of referrals for capacity assessments have increased since December 2007. 63% of patients were female, and the majority were European (75.6%). The mean age was 80.3 years. 66.7% of patients were referred by their general practitioner (GP). Dementia was the most common diagnosis. Fifty patients had more than one reason for referral. Thirty-seven were assessed for appointing an enduring power of attorney (EPOA), 44 for financial welfare, 73 for personal welfare, and two for testamentary capacity. Forty-five lacked capacity for all aspects assessed. Twenty-three did not have an EPOA and appointment of a guardian was recommended for 16 patients. CONCLUSION: The CGS is performing more capacity assessments over time. The majority of the patients are elderly and have dementia. There is a need to train specialist nurses and general practitioners to perform capacity assessments. A resource kit has been developed for this purpose.

Thrombosis on a Mechanical Aortic Valve whilst Anti-coagulated With Dabigatran.

There is currently limited evidence on the safety and efficacy of novel oral anticoagulants in patients with mechanical heart valves. This case report describes a patient with a St Jude aortic valve replacement who suffered valve thrombosis and an embolic stroke when anti-coagulated with the direct thrombin inhibitor dabigatran etexilate.