Case Study: Dementia
John Beauford is a 77-year-old divorced male. He moved to Florida after his divorce and has no contact with his former wife. He has no children, and his only sister lives in a distant state. They talk weekly on the phone but have not seen each other in several years. He attends church and volunteers at a community organization. He has several acquaintances but no close friends. Recently he has become increasingly forgetful but passes it off as a sign of aging. He is staying home alone more and more frequently, and often cannot remember whether he ate. He missed several meetings at the community agency because he forgot. When someone from the agency called him about his absence, he became angry and defensive, stating nobody told him there was a meeting. While driving home from church one day on a route he had taken numerous times, he became disoriented and lost. Trying to find his way home, he drove for more than 2 hours, failed to notice a traffic light, and was involved in a motor vehicle collision. He is transported to the emergency department of the closest hospital. He is unable to answer questions about his health history and becomes belligerent when different staff members ask him the same questions. However, he does not have life-threatening injuries, only some minor contusions. The emergency department staff find his driver’s license and Medicare card in his wallet, but no health information is available. There are business cards from the community agency. There is no information about Mr. Beauford in the computer system of the medical center. The healthcare team needs more information about his health history, current medications, allergies, and emergency contact(s). A computerized tomography (CT) scan of the head shows no head injury that would explain his behavior. A psychiatrist and social worker are consulted.
Discussion Questions
- How can the healthcare team obtain necessary information without breaching confidentiality?
- What are some ways the healthcare team can use to attempt to establish a trusting relationship with Mr. Beauford?
- Use a formal ethical decision-making process to determine what should be done regarding Mr. Beauford’s case and eventual discharge.
- How can the healthcare team obtain necessary information without breaching confidentiality?
To obtain necessary information about Mr. Beauford’s health history, current medications, allergies, and emergency contact(s) without breaching confidentiality, the healthcare team can take the following steps:
a. Contact the community agency: Since Mr. Beauford has been volunteering at a community organization, it’s possible that they have some information about him. The healthcare team should contact the agency to inquire if they have any records or contact information for his emergency contacts.
b. Reach out to his sister: While respecting Mr. Beauford’s privacy, the healthcare team can ask him if he has a designated person who can provide them with the needed information in case of emergencies. If he is willing to share his sister’s contact information, they can get in touch with her to gather the necessary details.
c. Check for medical alert jewelry: The healthcare team can check if Mr. Beauford is wearing any medical alert jewelry that may provide essential health information, such as allergies or medical conditions.
d. Contact local authorities: If all else fails, and Mr. Beauford remains unable or unwilling to provide information, the healthcare team may need to involve local authorities or legal channels to access his medical records or contact his emergency contacts.
- What are some ways the healthcare team can use to attempt to establish a trusting relationship with Mr. Beauford?
Establishing a trusting relationship with Mr. Beauford is crucial for his care and cooperation. Here are some strategies the healthcare team can employ:
a. Empathy and active listening: Show empathy and actively listen to Mr. Beauford’s concerns and feelings. Validate his frustrations and fears about his situation.
b. Use a consistent and calm approach: Maintain a consistent and calm demeanor when interacting with him. Avoid confrontational or aggressive communication, as it may worsen his agitation.
c. Assign a dedicated caregiver: Designate a specific healthcare provider or nurse to build rapport with Mr. Beauford. Consistency in care providers can help him feel more comfortable.
d. Provide clear and simple explanations: Use plain language and provide clear explanations for procedures, tests, and treatment plans to minimize confusion and anxiety.
e. Involve a social worker or therapist: Enlist the help of a social worker or therapist who specializes in geriatric care to assess Mr. Beauford’s emotional and mental well-being and provide support.
f. Respect his autonomy: Whenever possible, involve Mr. Beauford in decision-making about his care and treatment options, respecting his autonomy and preferences.
g. Offer reassurance and support: Continuously reassure Mr. Beauford that the healthcare team is there to help and support him. Let him know that his well-being is their top priority.
h. Address safety concerns: Take steps to ensure his safety while respecting his independence. For instance, provide assistance with tasks that may pose a risk to him, such as driving.
- Use a formal ethical decision-making process to determine what should be done regarding Mr. Beauford’s case and eventual discharge.
A formal ethical decision-making process can guide the healthcare team in Mr. Beauford’s case:
a. Identify the ethical dilemma: The primary ethical dilemma in this case is the need to balance Mr. Beauford’s autonomy and privacy with his safety and well-being, given his cognitive decline.
b. Gather relevant information: Collect all available information about Mr. Beauford’s medical condition, cognitive status, and social support network.
c. Identify stakeholders: Determine who the key stakeholders are in this case, including Mr. Beauford, his sister, healthcare providers, and the community agency.
d. Review ethical principles: Consider ethical principles such as autonomy, beneficence, non-maleficence, and justice. Balancing these principles will guide decision-making.
e. Explore options: Evaluate different options, including involving legal authorities to access his medical history, involving his sister for decision-making, or seeking a court-appointed guardian if necessary.
f. Make a decision: Collaboratively decide on the best course of action that respects Mr. Beauford’s autonomy while ensuring his safety and care.
g. Implement the decision: Put the chosen plan into action, taking into account Mr. Beauford’s preferences and the involvement of his sister or legal authorities as needed.
h. Evaluate the outcome: Continuously assess and reassess Mr. Beauford’s condition and adjust the care plan accordingly. Ensure that his best interests and well-being remain the top priority throughout the process.
In the context of his eventual discharge, the healthcare team should consider his safety and ability to care for himself at home. If it is determined that he cannot safely live independently, alternative living arrangements or caregiver support should be explored while still respecting his autonomy as much as possible.