Articles: aged.
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Conflicts of interest and other ethical dilemmas occur in Alzheimer disease (AD) patient care and research but often are underrecognized by physicians. One or more bioethical principles of autonomy, confidentiality, truth telling, beneficence, and justice, which apply to demented individuals as they do to other patients, may conflict in everyday clinical situations. For example, when demented patients wish to continue driving, autonomy (the patient's right to self-determination) conflicts with beneficence (the duty to promote the patient's welfare). ⋯ Full disclosure of financial interests increasingly is an accepted requirement in the conduct of biomedical research. In AD, less obvious potential conflicts of interest arise when physicians recruit their patients for antidementia drug trials sponsored by a pharmaceutical company (that provides the physician with research funding) or when investigators fail to acknowledge the patient's withdrawal of assent when attempting to complete a research protocol. The recognition of both financial and nonfinancial conflicts should lead to measures to reduce bias, which in turn will improve the integrity of research findings and promote patient welfare.
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In this article, general characteristics of suicide in the elderly are discussed. They have the highest suicide rate of any age group, are more determined to die, use "harder" methods, and seem less prone to communicate their suicidal intentions. ⋯ The particular factors affecting suicide in old age, such as retirement, relocation, social support, bereavement, depression, hopelessness, mental disorders, and alcohol abuse are described. Physical illness, especially attendant on depression and feelings of hopelessness, also plays an important role.
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We believe that a new agenda for the ethics of long-term nursing home care could be set by seeing nursing homes as communities of caring and interdependency. The goal should be not simply to eliminate or minimize dependency whenever possible, but to make a genuinely creative and nurturing use of the dependency that is an inevitable reality for most nursing home residents. Nursing homes are rarely places of curing, but they can and should be places of healing -- of making whole -- of enabling frail or chronically ill persons to use their dependency to grow as human beings... In general, nursing home regulation is a matter of striking a delicate balance between that degree of control necesary to ensure a basic standard of decent and humane care, and that degree of professional discretion needed to allow nursing homes to respond to their own particular problems of care as they make creative use of the dependency that is an essential fact of nursing home life.
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Review
The changing national policy system: complexity, Medicare, and implications for aging groups.
Changes in congressional processes, health agendas, and competitive positions of physician and hospital groups in the 1980s have produced important setbacks for such group interests within Medicare. Though united and successful in opposing Carter's 1977-79 hospital cost-containment proposals, these groups were subjected to severe new limits on hospital reimbursements under the 1982 budget reconciliation act. Thereafter, problems in protecting their interests continued or increased. ⋯ This projected narrow self-interest, thus decreasing the AMA's credibility. Further cost restrictions were imposed in 1985-86 budget acts. The problems of these organizations indicate that if aging groups are to protect their own stake in Medicare in the new political context, they must be particularly concerned with unity, credibility, and long-term perspectives.