Question

Mrs. Angstrom is an 83-year-old patient who was admitted to the hospital after she fell outside her home and broke her hip. She has been living alone in her apartment since her husband died 4 years ago. Mrs. Angstrom has no long-term history of mental illness, but she has recently shown signs of cognitive impairment and dementia, according to her neighbor Jeanine Finch, 63, who called 911 after Mrs. Angstrom’s fall. “She wanders around outside sometimes and doesn’t always know how to get back home,” says Mrs. Finch. “My husband and I try keep an eye out for her, but we’ve been worried something like this might happen.”

Mrs. Angstrom will need to undergo surgery tomorrow morning. The nurse on shift, Greg, is new at the hospital and surprised when the supervising RN asks him to discuss advance directives with the patient, who denies having one. When Greg explains to Mrs. Angstrom that he needs to discuss some confidential matters with her, she asks that Mrs. Finch, who is in the room visiting, be allowed to stay. “I haven’t been remembering things lately,” she says, “so I’ll rest easier if Jeanine knows what’s going on.” Deciding that the patient’s permission is adequate to continue, Greg explains Mrs. Angstrom’s rights and options in regard to treatment decisions in the event that she is unable to make such decisions on her own. Mrs. Angstrom says that she has no living family members and that the only person she trusts is Jeanine. “Can I put her in charge of those decisions?” she asks.

“No,” Greg replies. “I’m sorry, but since Mrs. Finch is not a family member, she can’t be designated to act on your behalf. If you don’t have any family member to assign a durable power of attorney, I think you’ll need to sign a directive to your physician or agree to a guardianship. If you choose the guardianship, you can revoke the decision at any time, but the directive to a physician is binding until you legally have it changed.”

Has Greg provided accurate information concerning Mrs. Angstrom’s options for advance directives? If not, what’s wrong with what he said? What options would be more appropriate to suggest to her?

Mention at least 4 facts and 4 myth about aging, and explain one of then.

Answer 1

Greg has not provided accurate information regarding the options for advance directive .This is because the Power of Attorney can be given or assigned to any person (either family member or non family member )as a proxy by an individual (patient ) when he or she is in a sound mind or mentally capable .

Guardianship can be made after legal approach where the judiciary after completing analysis assigns a guardian who is responsible to take decision on behalf of the patient.

The options which can be more appropriate to suggest to her are the decision can be made after discussion with the provider regarding

• POLST :here the patient can fill in this form regarding what can be done on them when they are incapable of making decisions . The doctor has the rights to carry it in regards to the treatment .

The four facts and myths about aging are

Facts:

1. Decline in muscle mass
2. Sleep changes :As one ages the circadian cycle changes where the older adults falls asleep earlier and gets up earlier than usual. In certain cases they may have insomnia due to medical illness
3. They show an increased level of confidence and decision making out of their experiences
4. They adjusts to the losses as they age through various experiences and life events .

Myths:

1. Inability to learn or do new things or tasks
2. They will loss their cognitive function .If one ages they will have memory loss or dementia for sure.
3. More religious as they age
4. Not to do exercise