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2.
Med Health Care Philos ; 18(2): 229-36, 2015 May.
Article in English | MEDLINE | ID: mdl-25185872

ABSTRACT

The purpose of this study is to determine empirically the state of the art of the medical care, when healthcare personal is confronted with ethical dilemmas related with the care they give to the geriatric population. An observational, longitudinal, prospective and qualitative study was conducted by analyzing the correlation between healthcare personnel-patient relationship, and ethical judgments regarding dilemmas that arise in daily clinical practice with geriatric patients. Mexican healthcare personnel with current active practices were asked to write up an ethical dilemma that arose frequently or that had impacted their medical practice. From the narrative input, we were able to draw up a database with 421 dilemmas, and those corresponding to patients 60 years and older were selected (n = 54, 12.8 %). The axiological analysis of the narrative dilemmas of geriatric patients was made using dialectical empiricism. The axiological analysis values found most frequently were classified into three groups: the impact of healthcare, the roles of the physician, and refusal of therapy; the healthcare role of educator, caring for the patients' life and the risk of imminent death where the values found more often. The persistence and universality of certain dilemmas in geriatrics calls for awareness and requires a good training in the ethical discernment of these dilemmas. This would help to improve substantially the care and the life quality of this population.


Subject(s)
Attitude of Health Personnel , Ethics, Clinical , Geriatrics/ethics , Aged , Conflict, Psychological , Female , Humans , Interviews as Topic , Longitudinal Studies , Male , Mexico , Middle Aged , Morals , Patient Education as Topic , Population Dynamics , Professional Role , Prospective Studies , Qualitative Research , Treatment Refusal/ethics
3.
Rio de Janeiro; s.n; 2014. 167 p.
Thesis in Portuguese | LILACS | ID: lil-736671

ABSTRACT

O rápido envelhecimento populacional é a transformação demográfica mais marcante observada no mundo a partir da segunda metade do século XX. Neste cenário, vem aumentando rapidamente o número de pacientes idosos com demência – inclusive em grau avançado – necessitando de cuidados no centro de tratamento intensivo. Este estudo desenvolve a bioética de proteção como modelo de tomada de decisão moral na medicina clínica no centro de tratamento intensivo, em relação ao paciente idoso vulnerado. É um estudo teórico – conceitual e o método adotado foi baseado, essencialmente, em uma revisão bibliográfica. Os médicos intensivistas estão pouco familiarizados com os conhecimentos bioéticos necessários para lidar com a conflituosidade moral implícita na prática durante os cuidados da internação de pacientes geriátricos no fim da vida. Sendo assim, para determinadas populações de doentes a bioética principialista poderia ter o apoio da perspectiva da bioética de proteção na tomada de decisão moral Concluindo-se que bioética de proteção deve ser difundida através da educação, como disciplina do curso médico. E, em conjunto, difundir as diretrizes antecipadas para doentes crônicos ambulatoriais. Além de integrar os cuidados paliativos no centro de tratamento intensivo,garantindo ações paliativas aos vulnerados, como os idosos com demência avançada...


The fast population ageing is the most striking demographic change observed in the world from the second half of the 20th century on. In this scenario, the number of elderly patients has been increasing fast and many elderly suffering from dementia – including atadvanced stage – are in need of medical care in the intensive care unit. This study develops the bioethics of protection as a model of moral decision taking in the clinicmedicine in the intensive care unit, concerning vulnerable aging patient. It is a theoretical- conceptual study and method adopted was essentially based on a literature review. The intensivist doctors are little familiarized with the bioethics knowledge necessary to deal with the set of conflicts implicit in the triage practice for medical screening and duringthe medical care of the hospitalization in intensive care unit of severe geriatrics patients and at the end of their lives. Thus, for certain populations of sick people or ill individuals, particularly the vulnerable ones, the principialist bioethics might have the support of the perspective of the bioethics of protection in decision taking. The conclusion is that the bioethics of protection must be disclosed by means of education, as a subject of the medicine course. And, all together, disclose the previous guidelines for the chronically ill people in ambulatory field. Besides integrating the palliative care in the intensive careunit, assuring palliative actions to the vulnerable, such as the elderly with advanced dementia...


Subject(s)
Humans , Aged , Aged, 80 and over , Bioethics , Critical Care , Decision Making , Dementia , Palliative Care , Geriatrics/ethics , Health of the Elderly
4.
Rio de Janeiro; s.n; 2014. 167 p.
Thesis in Portuguese | LILACS | ID: lil-744969

ABSTRACT

O rápido envelhecimento populacional é a transformação demográfica mais marcante observada no mundo a partir da segunda metade do século XX. Neste cenário, vem aumentando rapidamente o número de pacientes idosos com demência – inclusive em grau avançado – necessitando de cuidados no centro de tratamento intensivo. Este estudo desenvolve a bioética de proteção como modelo de tomada de decisão moral na medicina clínica no centro de tratamento intensivo, em relação ao paciente idoso vulnerado. É um estudo teórico – conceitual e o método adotado foi baseado, essencialmente, em uma revisão bibliográfica. Os médicos intensivistas estão pouco familiarizados com os conhecimentos bioéticos necessários para lidar com a conflituosidade moral implícita na prática durante os cuidados da internação de pacientes geriátricos no fim da vida. Sendo assim, para determinadas populações de doentes a bioética principialista poderia ter o apoio da perspectiva da bioética de proteção na tomada de decisão moral Concluindo-se que bioética de proteção deve ser difundida através da educação, como disciplina do curso médico. E, em conjunto, difundir as diretrizes antecipadas para doentes crônicos ambulatoriais. Além de integrar os cuidados paliativos no centro de tratamento intensivo,garantindo ações paliativas aos vulnerados, como os idosos com demência avançada...


The fast population ageing is the most striking demographic change observed in the world from the second half of the 20th century on. In this scenario, the number of elderly patients has been increasing fast and many elderly suffering from dementia – including atadvanced stage – are in need of medical care in the intensive care unit. This study develops the bioethics of protection as a model of moral decision taking in the clinicmedicine in the intensive care unit, concerning vulnerable aging patient. It is a theoretical- conceptual study and method adopted was essentially based on a literature review. The intensivist doctors are little familiarized with the bioethics knowledge necessary to deal with the set of conflicts implicit in the triage practice for medical screening and duringthe medical care of the hospitalization in intensive care unit of severe geriatrics patients and at the end of their lives. Thus, for certain populations of sick people or ill individuals, particularly the vulnerable ones, the principialist bioethics might have the support of the perspective of the bioethics of protection in decision taking. The conclusion is that the bioethics of protection must be disclosed by means of education, as a subject of the medicine course. And, all together, disclose the previous guidelines for the chronically ill people in ambulatory field. Besides integrating the palliative care in the intensive careunit, assuring palliative actions to the vulnerable, such as the elderly with advanced dementia...


Subject(s)
Humans , Aged , Aged, 80 and over , Bioethics , Critical Care , Decision Making , Dementia , Palliative Care , Geriatrics/ethics , Health of the Elderly
5.
Poiésis (En línea) ; 22(Dic.): 1-10, 2011.
Article in Spanish | LILACS | ID: biblio-1117107

ABSTRACT

En este artículo se integran la revisión y clasificación descriptiva de las principales investigaciones encontradas en los últimos años, sobre los/as cuidadores/as de personas dependientes y con algún tipo de demencia, en dos revistas científicas españolas dedicadas al sector de la gerontología. Se ofrece una breve reseña de cada estudio hallado.


This article integrates the descriptive review and classification of the main research found in recent years, on caregivers of dependent people and with some type of dementia, in two Spanish scientific journals dedicated to the gerontology sector. A brief review of each study found is provided.


Subject(s)
Humans , Caregivers/psychology , Frail Elderly/psychology , Dementia/therapy , Geriatrics/ethics
6.
Rev. cuba. med. gen. integr ; 24(4)oct.-dic. 2008.
Article in Spanish | CUMED | ID: cum-39797

ABSTRACT

Se procedió a la revisión de fuentes bibliográficas relacionadas, no solo con el estado actual del envejecimiento en otras latitudes, sino también en Cuba, así como consideraciones bioético-sociales en pacientes de la tercera edad en estado terminal. Se enfatizó en el concepto de estado vegetativo persistente y muerte encefálica aplicado en nuestro país, al igual que los dilemas que existen desde el punto de vista ético entre unos y otros cuidados actualmente. Los cuidados paliativos al geronto-geriátrico, los dilemas y su aplicación a ancianos frágiles constituyen la motivación de este trabajo(AU)


The bibliographical sources related not only with the present state of aging in other latitudes, but also in Cuba, as well some bioethical and social considerations on elderly patients at the terminal stage of life were reiewed. Emphasis was made on the concept of persistent vegetative state and encephalic death applied in our country, and on the dilemas existing from the ethical point of view between one care and the other at present. The palliative care of the elderly, the dilemas and their application to fragile elderlies are the motivation of this work(AU)


Subject(s)
Humans , Geriatrics/ethics , Aged/psychology , Self Concept
7.
Rev. cuba. med. gen. integr ; 24(4)oct.-dic. 2008.
Article in Spanish | LILACS | ID: lil-532180

ABSTRACT

Se procedió a la revisión de fuentes bibliográficas relacionadas, no solo con el estado actual del envejecimiento en otras latitudes, sino también en Cuba, así como consideraciones bioético-sociales en pacientes de la tercera edad en estado terminal. Se enfatizó en el concepto de estado vegetativo persistente y muerte encefálica aplicado en nuestro país, al igual que los dilemas que existen desde el punto de vista ético entre unos y otros cuidados actualmente. Los cuidados paliativos al geronto-geriátrico, los dilemas y su aplicación a ancianos frágiles constituyen la motivación de este trabajo.


The bibliographical sources related not only with the present state of aging in other latitudes, but also in Cuba, as well some bioethical and social considerations on elderly patients at the terminal stage of life were reiewed. Emphasis was made on the concept of persistent vegetative state and encephalic death applied in our country, and on the dilemas existing from the ethical point of view between one care and the other at present. The palliative care of the elderly, the dilemas and their application to fragile elderlies are the motivation of this work.


Subject(s)
Humans , Aged/psychology , Geriatrics/ethics , Self Concept
8.
Repert. med. cir ; 17(4): 217-221, 2008.
Article in English, Spanish | LILACS, COLNAL | ID: lil-523251

ABSTRACT

La vejez como situación cada vez más frecuente y compleja en nuestra época, ha sido objeto de múltiples estudios desde diferentes puntos de vista. Una mirada amplia nos muestra tres hechos clave queinciden en esta situación: el envejecimiento poblacional, el avance técnico-científico y la aparición de la bioética, que con su análisis metodológico propio logra ampliar la comprensión de los dilemas característicos de esta etapa de la vida, como son el replanteamiento de los objetivos de los tratamientos ofrecidos por el personal de salud, los cambios en la relación médico-paciente y la evaluación de la competencia mental para la toma de decisiones.


Old age as a more frequent and complex situation in our time has been the topic of many studies con-ducted from different standpoints. A comprehensive overview reveals three key factors which have implications for this matter: population aging, technical and scientific breakthroughs and the emergence of bioethics, which may broaden, through its own methodological analysis, the understanding of the typical dilemmas of this stage. These dilemmas may be: the redefinition of the purpose of treatments offered by healthcare professionals, changes in physician-patient relationship and assessment of mental competence for decision-making.


Subject(s)
Humans , Aged , Aged, 80 and over , Geriatrics/education , Geriatrics/ethics , Aged/ethics , Aging/ethics
10.
Rio de Janeiro; s.n; 2008. 179 p.
Thesis in Portuguese | LILACS | ID: lil-510711

ABSTRACT

O presente estudo é uma pesquisa qualitativa que emprega técnicas do trabalho de campo etnográfico, realizada nos serviços residenciais terapêuticos do Instituto Municipalde Assistência à Saúde Juliano Moreira, com o objetivo de estudar indivíduos idosos portadores de transtornos mentais crônicos que passaram pelo processo de desinstitucionalização. Procura conhecer de que forma estes idosos reconstroem suas relações com o novo território onde passam a circular e com o contexto social aonde vão seinserir, enquanto envelhecem e recriam a vida fora do asilo. De forma a atingi-lo, foram escolhidos, dentre os dispositivos que compõem o programa, 14 residências onde residem idosos. Os 30 indivíduos estudados representam 81 por cento do total de idosos e 36 por cento da clientela do programa, tendo sido observados em seu cotidiano dentro e fora das moradias, em suas relações entre si, com os membros da equipe e com o território, onde re-estabelecem suas redes sociais e recuperam sua capacidade de agir segundo a lógica da reciprocidade nas trocas com outras pessoas. Os dados foram coletados pela observação participante dentro efora das residências, assim como pelas entrevistas abertas, semi-estruturadas, as quais foram gravadas, transcritas e analisadas. Observou-se que os idosos apresentam ganhos em diversos aspectos de suas vidas com relação às trocas sociais e ao domínio sobre o território, mas ainda guardam resquíciosde seu período de institucionalização presentes nas suas rotinas diárias. Notou-se dentro das moradias, a existência de laços sociais baseados na reciprocidade e na ajuda mútua,possibilitando o cuidado e o apoio às necessidades dos idosos mais dependentes...


This work is a qualitative research which employs techniques of ethnographic field work carried out at residential facilities of Instituto Municipal de Assistência à Saúde Juliano Moreira, focusing on elder subjects who have undergone psychiatric deinstitutionalization in search of how they rebuild their relationships in the territory and with their social context in which they live, while they get old and recreate life outside the mental asylum. In order to achieve it, 14 facilities where old people live were chosen among the other residential devices. The 30 elders represent 81% of the total of old people and 36% of the total amount of residents, having been observed in their daily activities inside and outside their houses in their relationships among themselves, other people and with the territory, where they reconstruct their social ties and recover their ability of acting according to the logic of reciprocity and gift. The data were collected by participant observation and open, half-structured interviews, which were recorded, transcribed and analyzed. Observations have shown that elders show improvements in several aspects of their lives but the internment period remains in their daily routines. There are social bonds based on reciprocity and mutual help providing care and social support, especially for the more dependent ones. The stimulus of gift and reciprocity plays a pivotal role on planning residential facilities for elders with mental disorders. Their social networks develop in theneighborhood, accomplishing their roommates and other deinstitutionalized individuals, although neighbors and friends with no connections to the psychiatric institution are increasing their participation. They visit the asylum and circulate well in their surroundings,demanding support from the staff to go to more distant places. Their relation with the territory is an ongoing process, based on each one’s ability...


Subject(s)
Humans , Male , Female , Aged , Deinstitutionalization/ethics , Deinstitutionalization/history , Deinstitutionalization/methods , Deinstitutionalization , Health of the Elderly , Mental Health , Assisted Living Facilities/ethics , Assisted Living Facilities/methods , Geriatrics/ethics , Geriatrics/history , Geriatrics/methods , Geriatrics/trends , Health Care Reform/ethics , Health Care Reform/methods , Health Care Reform/organization & administration , Health Care Reform/trends , Mental Disorders/diagnosis , Mental Disorders/prevention & control , Mental Disorders/therapy
11.
In. Netto, Matheus Papaléo. Tratado de Gerontologia. São Paulo, Atheneu, 2 ed; 2007. p.861-868.
Monography in Portuguese | LILACS | ID: lil-455150
12.
Buenos Aires; Ministerio de Desarrollo Social; 2003. 337 p. (102114).
Monography in Spanish | BINACIS | ID: bin-102114
13.
Buenos Aires; Ministerio de Desarrollo Social; 2003. 337 p.
Monography in Spanish | BINACIS | ID: biblio-1209605
14.
Acta bioeth ; 7(1): 9-25, 2001.
Article in Spanish | LILACS | ID: lil-391033

ABSTRACT

El envejecimiento y la atención geriátrica constituyen los dos aspectos (colectivo e individual) de una misma realidad cultural y social que deberían incitar a la medicina a una saludable transformación de su práctica,que la volviera más consciente de sus propios límites y finalidades. Que la volviera también más apta para convencer a la sociedad de admitir el envejecimiento; una sociedad dispuesta, con mucha facilidad, a desprendersey a encargar a la medicina de tareas sociales y políticas que no son de competencia médica. Esta es la idea central sostenida por este texto.


Subject(s)
Humans , Male , Female , Aged , Aging , Geriatrics/ethics
15.
Acta bioeth ; 7(1): 121-127, 2001.
Article in Spanish | LILACS | ID: lil-391039

ABSTRACT

Resolver sobre la utilización de recursos existentes y los dilemas morales que surgen en forma cotidiana en los cuidados en geriatría, se está convirtiendo en el patrón que dominará la atención de la salud en las próximas décadas. Si el cuidado de los ancianos en la comunidad se convierte en la norma, las dimensiones éticas de este tipo de cuidado van a requerir una atención muy especial que generará cuestionamientos sobre fragilidad, dependencia, autonomía, competencia y las complejas relaciones y controversias entre los ancianos y aquellos que ôlos sostienen y los cuidanõ. La toma de decisiones compartida requiere que la persona que cuida no sólo trate de entender y satisfacer las necesidades del otro, sino también de encontrar alternativas razonables, que le permitan al asistido elegir lo que él prefiera. Es en este proceso donde el conocimiento del cuidador y su experiencia profesional pueden aunarse con los valoressustanciados por el anciano. El desarrollo de un diálogo coherente y comprensible y las estrategias necesarias se imponen como tarea y deber para todos aquellos comprometidos con los criterios éticos de los cuidados en geriatría.


Subject(s)
Humans , Male , Female , Aged , Old Age Assistance/ethics , Geriatrics/ethics , Personal Autonomy
16.
Dordrecht; D. Reidel Publishing Company; 1987. 297 p. tab.
Monography in English | MINSALCHILE | ID: biblio-1543830
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